Emergency medicine clinics of North America
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The management of patients with penetrating abdominal trauma is outlined in Figure 1. Patients with hemodynamic instability, evisceration, significant gastrointestinal bleeding, peritoneal signs, gunshot wounds with peritoneal violation, and type 2 and 3 shotgun wounds should undergo emergency laparotomy. The initial ED management of these patients includes airway management, monitoring of cardiac rhythm and vital signs, history, physical examination, and placement of intravenous lines. ⋯ Patients with tangential gunshot wounds and possible type 2 shotgun injuries can undergo DPL. Table 8 lists the recommended thresholds for DPL. Patients with positive DPL should undergo exploration.(ABSTRACT TRUNCATED AT 400 WORDS)
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The patient in our case report presented with an acute abdomen but stable vital signs and ABCs. The differential diagnosis initially included most of the entities discussed in this chapter. The ECG ruled out an acute MI. ⋯ The CT scan confirms the presence of free air within the peritoneal cavity, and the patient is taken to surgery for an exploratory laparotomy. The final diagnosis is perforated peptic ulcer. With hindsight, the patient and wife recall a previous diagnosis of a possible ulcer in the past.
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Blunt abdominal trauma results in potentially life-threatening injuries that require organized rapid evaluation and treatment. Resuscitation of hemodynamically unstable patients should be completed in the operating room if retroperitoneal hemorrhage is not strongly suspected. ⋯ Repeated frequent physical examinations and serial laboratory tests are essential to exclude a missed injury. Deterioration of hemodynamic status or abdominal examination are indications for urgent laparotomy regardless of the initial diagnostic impressions.