The role of prehospital ultrasound in reducing time to definitive care in abdominal trauma patients with moderate to severe liver and spleen injuries

Injury ◽  
2021 ◽  
Author(s):  
Lorenzo Gamberini ◽  
Marco Tartaglione ◽  
Aimone Giugni ◽  
Laura Alban ◽  
Davide Allegri ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Trauma Patients ◽  
Severe Liver

scholarly journals Role of Diagnostic Laparoscopy in Penetrating Abdominal Trauma

2021 ◽  
Vol 15 (10) ◽  
pp. 3514-3516
Author(s):  
Fatima Abbasi ◽  
Muhammad Khurram Zia ◽  
Farhan Siddique ◽  
Ali Adnan ◽  
Hina Tahseen
Keyword(s):  
Abdominal Trauma ◽  
Diagnostic Laparoscopy ◽  
Bowel Perforation ◽  
Penetrating Trauma ◽  
Trauma Patients ◽  
Penetrating Abdominal Trauma ◽  
Missed Injury ◽  
Operative Findings ◽  
Intraabdominal Injury

Background and Objective: Trauma remains the major cause of mortality and disability among young people across the world with penetrating trauma being a very common cause. Traditionally, penetrating abdominal trauma was managed with exploration. But now with the advent of minimally access surgery and advancements in laparoscopic expertise, more patients can be managed with minimally invasive methods. This approach can save many unnecessary laparotomies and large midline incisions. The role of laparoscopy in blunt abdominal trauma is well established. The aim of this study was to evaluate the role of diagnostic laparoscopy in penetrating abdominal injuries. Methods: All the penetrating abdominal trauma patients presenting to the emergency department of Rawal Medical and Dental hospital from January 2019 till December 2020 for a period of 2years (a total of 102 patients) and who were hemodynamically stable, between the ages of 20 to 50 years of either gender were included in the study. All these patients had equivocal abdominal findings with no signs to suggest serious intraabdominal injury. These patients were prepared as standard for general anesthesia and diagnostic laparoscopy was performed. A predesigned performa was used for entering the patients’ details and operative findings. All patients gave written informed consent in urdu. Main outcome measures were the conversion rate, missed injuries leading to reexploration. Results: 85%of the patients were males with only 15% females. Mean age of the population was 38.7 years .Conversion to open was required in only 6.12 % of the cases .Laparoscopy alone was sufficient for all other patients. In about 36% of the patients no intraabdominal injury was found. In rest 58% patients the surgeons were able to repair the injuries laparoscopically.18 patients had minor liver injury,10 patients had minor hemoperitoneum<100 ml without any significant injury and 2 patients had single small bowel perforation which was repaired laparoscopically and cavity was irrigated. No patient had post operative complications of peritonitis due to missed injury or bleeding leading to re exploration. Conclusion: Laparoscopy is a very effective procedure to deal with penetrating abdominal trauma patients who are stable and with equivocal abdominal findings without increasing risk of missed injury with minimal rates of conversion to open laparotomy if patients are selected vigilantly. Keywords: Penetrating, Diagnostic Laparoscopy, Abdominal Trauma

Role Of Laparoscopy In Blunt Abdominal Trauma: A Comparative Prospective Cohort Study Between Laparoscopy And Laparotomy In Patients With Blunt Abdominal Trauma

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Tarek Ismail Ouf ◽  
Mohamed ElSayed ElShinawi ◽  
Ahmed Adel Abbas ◽  
Mostafa El Sayed Nagy
Keyword(s):  
Cohort Study ◽  
Respiratory Tract ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Respiratory Tract Infections ◽  
Operative Time ◽  
Trauma Patients ◽  
Exclusion Criteria ◽  
Tract Infections

Abstract Background Trauma is considered to be the main leading cause of death in young adults under 35 years old. Blunt mechanisms accounts for about 95% of injuries. Generally, laparotomy is considered to be the standard procedure used in the trauma cases. Recently, laparoscopic techniques have been increasingly introduced as an alternative to open surgery in trauma cases. This study aims to assess the efficacy of Laparoscopy in management of patients with Blunt abdominal trauma in order to avoid unnecessary laparotomies. Objective To investigate the effectiveness and role of laparoscopy in the management of blunt abdominal trauma patients. Patients and Methods Observational prospective cohort study. Ain Shams University Surgery Hospital. All isolated blunt abdominal trauma patients at Ain Shams University Surgery hospital from 1/3/2019 to 1/9/2019. Eligibility and exclusion criteria applied as following: Eligibility criteria All patients with blunt abdominal trauma presented to ASUH. Patients with class I &class II according to ATLS guidelines for hemorrhagic shock in trauma patients. Patients aged 18 years old or above. Exclusion criteria: Patients with class III &class IV according to ATLS guidelines for hemorrhagic shock in trauma patients. Pregnant patients. Patients with old trauma presented after 24 hours. Patients discharged on demand. Results Laparoscopy decreased the operative time in comparison with laparotomy, the mean operative time for patients underwent laparoscopy is 123.28 minutes while in patients underwent laparotomy is 150.48. Also, time to pass gas post operative after laparoscopy is 1-3 days compared to 2-4 days after laparotomy which is in favor of laparoscopy which is associated with rapid recovery of patients. Laparoscopy is associated with decreased post operative ICU stay (1-3) days in comparison with Laparotomy (2-5) days and decreased total hospital stay. The rate of complications after laparoscopy is much less than after laparotomy, 2 patients with respiratory tract infections after laparoscopy and no mortality while six patients with respiratory tract infections, 6 patients with wound infection, one patient with deep venous thrombosis and 2 patients died after laparotomy. Conclusion Laparoscopy is found to be a good alternative to laparoscopy, as it is considered to be reliable and safe as a diagnostic and treatment method in hemodynamically stable patients with blunt abdominal trauma, it can be used to reduce the laparotomy rate, and it is associated with lower morbidity and mortality.

THE ROLE OF ABDOMINAL UITNASONOGRAPHY IN ABDOMINAL TRAUMA PATIENTS

1987 ◽  
Vol 27 (7) ◽  
pp. 820 ◽  
Author(s):  
YUKIO ENDOH ◽  
KUNIO KOBAYASHI ◽  
TAKESHI KASAI ◽  
HIROMASA SUZUKI
Keyword(s):  
Abdominal Trauma ◽  
Trauma Patients

scholarly journals Effectiveness of laparoscopy in management of patients with penetrating and blunt abdominal trauma.

2021 ◽  
Vol 28 (08) ◽  
pp. 1090-1095
Author(s):  
Sajid Rashid ◽  
Keyword(s):  
Clinical Examination ◽  
Abdominal Trauma ◽  
Diagnostic Laparoscopy ◽  
P Value ◽  
Trauma Patients ◽  
Laparoscopy Group ◽  
Missed Injuries ◽  
Laparotomy Group ◽  
Laboratory Investigations

Objectives: To study the role of laparoscopy in reducing the incidence of non-therapeutic Laparotomies in abdominal trauma, and management of penetrating (PAT) and blunt (BAT) abdominal trauma. Study Design: Prospective Experimental study. Setting: Department of Surgery DHQ Hospital Rawalpindi. Period: January 2018 to June 2018. Material & Methods: All Patients (n=50) were admitted through emergency and were allocated to one of two groups Laparoscopy or Laparotomy group (25 in each) by lottery method according to the inclusion criteria of haemodynamically stable patients with systolic BP>90 mm of Hg. Patients in the Laparotomy group were managed according to the conventional protocol and decision of laparotomy was based on clinical examination, imaging and laboratory investigations. Where as in Laparoscopy group after clinical examination and chemical labortary. Reports diagnostic laparoscopy (screening tool) was done to identify injuries and decide whether patient needs laparotomy or not. Forward viewing 0 degree 10 mm laparoscope was used in all the cases following standard protocols for laparoscopy. Data analysis was done by SPSS 20. P-Value was set at 0.05. Results: Out of total 50 selected haemodynamically stable abdominal trauma patients (n=50) there were 77% males and 23% females. Average age of the patients was 37 years. Overall out of total of 50 patients 30 (60%) patients presented with PAT and 20 (40%) patients presented with BAT. Diagnostic laparoscopy was able to identify abdominal injuries in 96% (24 out of 25) patients. There were no missed injuries in both groups. Similarly there were no non-therapeutic laparotomies in Laparoscopy group where as in Laparotomy group 6 (24%) non-therapeutic laparotomies were done. Conclusion: Laparoscopy reduces the incidence of non-therapeutic laparotomies and missed injuries. It correctly identifies the injuries depending upon the experience of surgeon in selected stable trauma patients.

A COMPREHENSIVE STUDY ON THE ROLE OF LAPAROSCOPY IN ABDOMINAL TRAUMA

2021 ◽  
pp. 20-21
Author(s):  
Ankur Akela ◽  
Ravikant Ravikant ◽  
Runni Kumari
Keyword(s):  
Blunt Trauma ◽  
Abdominal Trauma ◽  
Diagnostic Laparoscopy ◽  
Penetrating Trauma ◽  
Therapeutic Interventions ◽  
Trauma Patients ◽  
Therapeutic Laparoscopy ◽  
Laparoscopic Intervention ◽  
Comprehensive Study

Explorative laparotomy has been the mainstay of management in patients with blunt abdominal trauma . The advantage of laparoscopy is that it can provide both diagnostic and therapeutic interventions for those hemodynamically stable abdominal trauma patients. Methods: 30 patients of blunt trauma abdomen were retrospectively studied for whom laparoscopic intervention was done. Results: In our study 30 patients with abdominal trauma were included of which 22 (76%) had penetrating trauma and 8 had blunt trauma (24%). Among penetrating trauma, seven patients (31.8%) underwent therapeutic laparoscopy whereas diagnostic laparoscopy was done for 10 patients (45.5%). Conclusions: Laparoscopy can be safely performed in haemodynamically stable patients of abdominal trauma for both diagnostic and therapeutic purposes and can help in avoiding the negative laparotomies.

scholarly journals Laparoscopy for blunt abdominal trauma: a challenging endeavor

2018 ◽  
Vol 108 (4) ◽  
pp. 273-279 ◽  
Author(s):  
M. Z. Koto ◽  
O. Y. Matsevych ◽  
F. Mosai ◽  
S. Patel ◽  
C. Aldous ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Injury Severity ◽  
Length Of Hospital Stay ◽  
Trauma Patients ◽  
Therapeutic Laparoscopy ◽  
The Mean ◽  
Trauma Score

Background and Aims: Laparoscopy in blunt abdominal trauma is challenging because of multiple associated injuries, higher trauma score values and higher morbidity and mortality, as compared with patients with penetrating abdominal trauma. The aim of this study was to investigate the role of laparoscopy in the management of blunt abdominal trauma patients and to highlight related challenges. Material and Methods: Over a 4-year period, patients managed laparoscopically for blunt abdominal trauma were retrospectively analyzed. Perioperative details, indications for laparoscopy and conversion, complications, and length of hospital stay were discussed. Results: A total of 35 stable patients underwent laparoscopy. The mean Injury Severity Score was 12 (4–38). Therapeutic laparoscopy was performed in 15 (56%) and diagnostic in 12 (44%) patients. Eight (23%) patients were converted to therapeutic laparotomy. Intraoperative bleeding, complex injuries, visualization problem, and equipment failure necessitated conversion. Three (30%) patients with negative computed tomography scan had therapeutic laparoscopy for mesenteric injuries. There were no missed injuries. The mean length of hospital stay was 11 days in both groups. Conclusion: Laparoscopy for stable patients is feasible and safe. Multiple injuries make laparoscopy more difficult, and advanced laparoscopic skills are required. The conversion rate is high; however, the non-therapeutic laparotomies were completely eliminated in this study.

scholarly journals The role of oxidative/nitrosative stress in pathogenesis of paracetamol-induced toxic hepatitis

2010 ◽  
Vol 63 (11-12) ◽  
pp. 827-832 ◽  
Author(s):  
Tatjana Radosavljevic ◽  
Dusan Mladenovic ◽  
Danijela Vucevic ◽  
Rada Jesic-Vukicevic
Keyword(s):  
Oxidative Stress ◽  
Nitric Oxide ◽  
Reactive Oxygen Species ◽  
Liver Injury ◽  
Kupffer Cells ◽  
Reactive Oxygen ◽  
Oxygen Species ◽  
Severe Liver ◽  
Hepatocellular Necrosis

Introduction. Paracetamol is an effective analgesic/antipyretic drug when used at therapeutic doses. However, the overdose of paracetamol can cause severe liver injury and liver necrosis. The mechanism of paracetamol-induced liver injury is still not completely understood. Reactive metabolite formation, depletion of glutathione and alkylation of proteins are the triggers of inhibition of mitochondrial respiration, adenosine triphosphate depletion and mitochondrial oxidant stress leading to hepatocellular necrosis. Role of oxidative stress in paracetamol-induced liver injury. The importance of oxidative stress in paracetamol hepatotoxicity is controversial. Paracetamol induced liver injury cause the formation of reactive oxygen species. The potent sources of reactive oxygen are mitochondria, neutrophils, Kupffer cells and the enzyme xatnine oxidase. Free radicals lead to lipid peroxidation, enzymatic inactivation and protein oxidation. Role of mitochondria in paracetamol-induced oxidative stress. The production of mitochondrial reactive oxygen species is increased, and the glutathione content is decreased in paracetamol overdose. Oxidative stress in mitochondria leads to mito?chondrial dysfunction with adenosine triphosphate depletion, increase mitochondrial permeability transition, deoxyribonu?cleic acid fragmentation which contribute to the development of hepatocellular necrosis in the liver after paracetamol overdose. Role of Kupffer cells in paracetamol-induced liver injury. Paracetamol activates Kupffer cells, which then release numerous cytokines and signalling molecules, including nitric oxide and superoxide. Kupffer cells are important in peroxynitrite formation. On the other hand, the activated Kupffer cells release anti-inflammatory cytokines. Role of neutrophils in paracetamol-induced liver injury. Paracetamol-induced liver injury leads to the accumulation of neutrophils, which release lysosomal enzymes and generate superoxide anion radicals through the enzyme nicotinamide adenine dinucleotide phosphate oxidase. Hydrogen peroxide, which is influenced by the neutrophil-derived enzyme myeloperoxidase, generates hypochlorus acid as a potent oxidant. Role of peroxynitrite in paracetamol-induced oxidative stress. Superoxide can react with nitric oxide to form peroxynitrite, as a potent oxidant. Nitrotyrosine is formed by the reaction of tyrosine with peroxynitrite in paracetamol hepatotoxicity. Conclusion. Overdose of paracetamol may produce severe liver injury with hepatocellular necrosis. The most important mechanisms of cell injury are metabolic activation of paracetamol, glutathione depletion, alkylation of proteins, especially mitochondrial proteins, and formation of reactive oxygen/nitrogen species.

scholarly journals Advances in the understanding of trauma-induced coagulopathy

Blood ◽  
2016 ◽  
Vol 128 (8) ◽  
pp. 1043-1049 ◽  
Author(s):  
Ronald Chang ◽  
Jessica C. Cardenas ◽  
Charles E. Wade ◽  
John B. Holcomb
Keyword(s):  
Animal Studies ◽  
Causes Of Death ◽  
Endothelial Activation ◽  
The United States ◽  
Trauma Patients ◽  
Platelet Dysfunction ◽  
Intracranial Injury ◽  
Trauma Induced Coagulopathy ◽  
Common Causes

Abstract Ten percent of deaths worldwide are due to trauma, and it is the third most common cause of death in the United States. Despite a profound upregulation in procoagulant mechanisms, one-quarter of trauma patients present with laboratory-based evidence of trauma-induced coagulopathy (TIC), which is associated with poorer outcomes including increased mortality. The most common causes of death after trauma are hemorrhage and traumatic brain injury (TBI). The management of TIC has significant implications in both because many hemorrhagic deaths could be preventable, and TIC is associated with progression of intracranial injury after TBI. This review covers the most recent evidence and advances in our understanding of TIC, including the role of platelet dysfunction, endothelial activation, and fibrinolysis. Trauma induces a plethora of biochemical and physiologic changes, and despite numerous studies reporting differences in coagulation parameters between trauma patients and uninjured controls, it is unclear whether some of these differences may be “normal” after trauma. Comparisons between trauma patients with differing outcomes and use of animal studies have shed some light on this issue, but much of the data continue to be correlative with causative links lacking. In particular, there are little data linking the laboratory-based abnormalities with true clinically evident coagulopathic bleeding. For these reasons, TIC continues to be a significant diagnostic and therapeutic challenge.

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