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Abdominal trauma

Dutch -ErasmusMC - week 4.4.1

QuestionAnswer
Stomp buikletsel kan als gevolg hebben bechadiging v parenchymateuze organen, ruptuur in 1 v/d buikorganen en bloedingen
Bij opvang v trauma pas je LO om: tekenen v peritoneale prikkeling op te sporen
Bij opvang v trauma let je op vitale tekenen om shock vast te stellen
Bij opvang v trauma; laag ingeschoten X-thorax of staand X-BOZ om vrije lucht onder 't diafragma te diagnosticeren na 'n perforatie
Bij opvang v trauma; echografie om vrij vocht in de buikholte en retroperitoneal vast te stellen
Bij opvang v trauma; CT -om vrije vocht in de buikholte en retroperitoneaal vast te stellen - beter geschikt om kleine beschadiging aan organen op te sporen (bij voorkeur alleen hemodynamisch stabiele patienten, ivm met minder goed te kunnen bewaken)
bij opvang v trauma; CT met contrast Om perforaties v holle organen vast te stellen
Operatieve behandeling v stomp trauma bij hemodynamisch instabiele patient(ondanks infusie therapie en/of tekenen v peritoneale prikkeling
Wat is de meest gemiste diagnose bij stomp buik letsel bij kinderen ? letsel a/d pancreas
Beleid bij penetrerende trauma: -Schotverwondingen -Steekverwondingen - schotverw.: altijd exploratieve laparotomie - steekverw.:als patient hemodynamisch stabiel is en geen peritoneale prikkeling heeft; observatie
Hoe diagnosticeer je het snelts 'n diafragma ruptuur ? CT
Miltruptuur na stomp buik letsel - verdenking afh. v/d toedracht v/h ongeval -LO kan, maar hoef niet, peritoneal prikkeling te laten zien -behandeling milt proberen te "sparen"
miltruptuur behandeling hemodynam. stab. pat.; afwachten hemodynam. instab. pat.; laparotomie en zoveel mogelijk proberen milt te behouden
behandeling v leverruptuur na stom buik letsel hemod. stab.pat.; afwachten hemod.instab.pat.; laparotomie. Start met compressie v/d lever ("packing")
De urinewegen, met uitzondering v/e gedeelde v/d blaas ligt extraperitoneaal
2 soorten bloedingen vanuit de nieren inwendig; naar 't pyelum --> kan hematurie oorzaken uitwendig; perinefrisch hematoom --> kan leiden tot shock
diagnostiek v/e perinefrisch hematoom echo of CT
2 soorten hematurie - micro: bloeding hoog uit tractus - macro: letsel v/d blaas --> constrast onderzoek lage urinewegen (retrograde urethrocystografie)
Beleid trauma a/d urinewegen hemod.stab.+ geen blaas/urethra ruptuur: observatie hemod.instab. en geen andere bloedingsbronnen of blaas/urethra letsel: exploratie
Created by: SavageMD
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