FAST, DPL and CT Scan in

Abdominal Trauma
 Why they are needed
When they should be used
How they should be used
Abdominal injury esspecially blunt
abdominal injury is the most subtle of all
injuries to the body, and is the most likely
to tax the diagnostic skills of the surgeon.
Delayed diagnosis (and consequently the
treatment) represents one of the most
common causes of preventable mortality,
and therefore constitutes a critical area of
trauma management
Blood in the peritoneal cavity is not
particulary irritating and intestinal leakage
may be minimal or contained initially.
In the presents of associated neurological
injuries or other painful distracting
injuries, the physical examination of the
abdomen becomes even less reliable.
Some surgeons advised an aggressive
operative approach in the doubtful cases to
lessen the mortality
In doubtful cases do not wait too long,
Before exploring for it is quite wrong,
To act upon the slogan wait and see,
When looking might provide the remedy.

(Zachery Cope)
Even to day some surgeons consider it to
be both proper and correct to err on the
side of an unnecessary operation rather
than to miss a possible life-threatening
condition amenable to surgery
We remain surprised at the reluctance of
surgeons to explore the abdomen of a
traumatized patient and at the same time
readily accept a negative exploration rate
of 20% to 30% for appendicitis as
representing good practice

Blaisdell F.W.
Turkey D.D
Such a policy, however, is undoubtedly
associated with unnecessary operations,
with possibilities of post operative
complications, a burden mostly shouldered
by the patient

The incidence of negative laparotomy can

be greater, as previous studies have
reported a wide variability of the
sensitivity of the physical exam, often not
much greater than 50% to 60%
On the other hand an effort to decrease the
number of the unnecessary interventions
by a less aggressive approach may lead to
some patients having an necessary
operation delayed (bad management
error).
Based on those facts, we should aim our
orientation toward saving maximum
number of lives with minimum morbidity,
and to achieved that goal we need some
objective diagnostic studies.
Objective diagnostic studies are those that
rely on well defined radiographic or
laboratory findings or discrete
observations, such as FAST, DPL and CT
Scan.

Aquestion arises concerning which

patients should be investigated and
which assessed purely clinically
Although most patients sustaining stab
wounds to the abdomen require some type
of objective evaluation, not all patients
suffering from blunt abdominal trauma
require objective studies.
Risk to the patient correlates directly with
energy imparted. High-speed automobile
impacts, fall from greater than 25 feet,
auto-pedestrian and industrial accidents
are high-energy transfer injuries.

Factors such as hematuria, axial spine

fractures, seetbelt sign, hypotension,
elevated arterial base deficit, pelvic and
chest wall fractures must be looked as
strong indicators for objective evaluation
of the abdomen
Indication for Objective Evaluation in
Blunt Abdominal Trauma.
How they should be used.

The pros and cons.

The specific diagnostic process and
methods used for abdominal trauma vary
from institution to institution depending on
expertise, equipment availability, patient
population, and to a certain degree,
physician preferences. There is, however,
a limited range of processes and methods
that provide optimal evaluation of blunt
and penetreting trauma and each surgeon
or institution should define this range
Suggested algorithm for the evaluation of blunt abdominal trauma.
 Hemodinamically Stable
(at Arrival / Rapid Response)

-MAP more than 80 mmHg

- Pulse rate less than 120 x/min
-Whole bloud transfusion not more
than 2 unit
- No clinically sign of shock
- Urine production more than 50 l/hour
Suggested algorithm for the evaluation of
penetrating abdominal trauma.
Penetrating abdominal trauma.
It is important to note that there are significant
injuries that may be missed by any or all of
these diagnostic techniques, for reasons of
inappropriate technique, inappropriate
application or used, operator dependency,
human error, delayed presentation, or simply
limitations of the method. Correlation with the
findings on physical examination, related
symptoms, and the early clinical trajectory
following injury, along with the use of
corroborative studies (including exploratory
laparotomy if necessary) are essential to avoid
the morbidity and mortallity associated with
delayed diagnosis
Thank You