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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Saturday, July 30, 2016

Penetrating Trauma

emDocs - July 29, 2016 - Authors: Chinn E and McGuire S
Edited by: Koyfman A and Long B
As ED doctors we play a critical role in trauma. Many of our patients who suffer injuries from penetrating trauma get admitted, ultimately receiving a “trauma tertiary survey” prior to discharge. This is a critical step in their care, and research shows that it transforms many “missed injures” into “delays in diagnosis”, meaning they are caught before they cause a problem.
In the acute setting the most important thing we can miss is a tension pneumothorax. Thankfully, ultrasound is accessible and with ultrasound education being integral in most residency training programs, it is only a matter of time until most ED doctors can rule it out nearly 100% of the time.
In the patient with a history of penetrating trauma we need to be aware of two injures that could have been missed: diaphragmatic tears and ureteral injuries. While CT scans can miss asymptomatic tears, they are quite good at diagnosing organs that have herniated through the diaphragm so if you are suspicious of it, order that CT scan. In any patient with abdominal or flank pain, fever, or urinary symptoms who has a history of penetrating trauma, consider ureteral injuries because you may need special imaging to diagnose it.
Finally, despite advances in imaging, hollow viscus injuries continue to be a diagnosis that can be missed in the absence of observation and serial abdominal exams. The utility of local wound exploration will likely be debated for some time, but there is growing evidence that it can be used to exclude hollow viscus injury if done appropriately while saving patients from unnecessary radiation and trips to the OR."