Quote:
Originally Posted by Patriot007
Doc Dutch,
How does evaluation and treatment for peritonitis figure into your course of action? If the patient is hemodynamically stable and you are confident there are no significant bleeders is peritonitis the next big "killer" you should be worried/ evaluate for after ABC's? If so, how early can/ usually will it present in a low velocity penetrating wound such as a knife wound? Thanks for the education!
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Another good question:
Peritonitis in the face of pentrating trauma is ominous. Even if a patient is hemodynamically stable, a rigid abdomen needs prompt evaluation as the this usually means blood or enteric content and with abdominal penetration, watch out! So, I usually take them to the OR.
Honestly,one is never sure in the trauma bay that there are no "significant bleeders" as the patient may just be physiologically compensating, but if for the sake of argument, let us say that there is no significant bleeders, then peritonitis means bowel perforation and that is a killer if you delay or don't operate. Patients will eventually become septic and will die of multi-system organ failure which happened in WWI and prior as it was believed that to operate on the abdomen was foolish and heresy.
Knife wounds (low velocity) can obviously penetrate deeply and it is hard to know when the patient comes into the ED how deep the knife went. The wound could be superficial and just cut the skin and subcutaneous tissue and then it can go through and through from anterior to posterior and everything in between. Laparoscopy, DPL, CT scans, ultrasound, and local wound exploration are all modalities that can be used to evaluate the abdomen in general, but the bottom line is that penetrating trauma that goes through the fascia + peritonitis = surgical exploration.
Dutch