Emergency medicine clinics of North America
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The management of the patient with blunt abdominal trauma remains in continuous flux. The emergency physician cannot place undue reliance on physical examination, and plain radiography of the abdomen rarely adds to patient care. Laboratory tests, particularly elevated liver function tests or a large base deficit, may increase our suspicion for intraabdominal trauma. ⋯ However, the more critically injured a patient is, the greater the danger of delays introduced by CT. In these patients, greater emphasis should be placed on immediate DPL or direct transport to the operating room. The challenge in the 1990s will be to refine the diagnosis of intraabdominal trauma to allow for swift recognition of those injuries that require surgical intervention.
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Extensive knowledge of pelvic fractures is a must for emergency physicians. The emergency physician must be able to distinguish the minor fracture from one that is more severe, one that may have associated injuries, and one that is quite possibly life threatening.
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The public health problem of injury has an enormous impact on individuals and society, both as a health and economic issue. Prior to the last decade, little attention has been paid to the costs generated by injury, much of which is preventable. By looking at aggregate economic costs for different injuries and population groups, the physician can understand where the problems occur that need to be addressed to curb this staggering burden on society.
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Injured children require an organized, properly equipped, team approach to management. The emergency physician must be aware of the anatomic and physiologic differences that predispose the child to certain injuries. ⋯ Continued research and the ongoing epidemiologic studies from the National Pediatric Trauma Registry will improve our understanding and management of the injured child. It is essential for each of us to become a strong injury prevention advocate in our own community.
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Penetrating trauma of the abdomen no longer warrants automatic laparotomy. Reasonably accurate clinical predictors of the need for operation should first be employed. ⋯ Nevertheless marked morbidity or mortality caused by failure to conduct laparotomy in a timely manner can be a dreaded consequence. When clinical and diagnostic studies are unable to resolve the presence or severity of injury, laparotomy is often more prudent than expectant observation.