# Blunt Abdominal Trauma — GCMD Library living collection Everything in the library about blunt abdominal trauma — built automatically from dossiers that name it. Updated: n/a · 7 episodes · 94 cited statements ## Episodes ### Diagnosis & Workup - [Indications for CT Scan for Blunt Abdominal Trauma: Update Course 2017](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407) — video · 34:38 · [machine version](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407.md) ### Acute Management - [Guías APSA actualizadas para el tratamiento de lesiones contusas del hígado y del bazo](https://library.globalcastmd.com/watch/gu-as-apsa-actualizadas-para-el-tratamiento-de-lesiones-contusas-del-h-gado-y-del-bazo-7735) — video · [machine version](https://library.globalcastmd.com/watch/gu-as-apsa-actualizadas-para-el-tratamiento-de-lesiones-contusas-del-h-gado-y-del-bazo-7735.md) ### Surgical Management - [Laparoscopic Distal Pancreatectomy for Traumatic Transection](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890) — video · 4:58 · [machine version](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890.md) ### Evidence & Research - [Trauma Talk Summary: Update Course 2017](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403) — video · [machine version](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403.md) - [Isolated low-grade solid organ injuries in children following blunt abdominal trauma](https://library.globalcastmd.com/watch/isolated-low-grade-solid-organ-injuries-in-children-following-blunt-abdominal-trauma-6671) — video · [machine version](https://library.globalcastmd.com/watch/isolated-low-grade-solid-organ-injuries-in-children-following-blunt-abdominal-trauma-6671.md) - [Lesiones de órgano sólido aisladas de bajo grado luego de un trauma abdominal cerrado…](https://library.globalcastmd.com/watch/lesiones-de-rgano-s-lido-aisladas-de-bajo-grado-luego-de-un-trauma-abdominal-cerrado-6672) — video · [machine version](https://library.globalcastmd.com/watch/lesiones-de-rgano-s-lido-aisladas-de-bajo-grado-luego-de-un-trauma-abdominal-cerrado-6672.md) ### In-Depth Reviews - [Abdominal Trauma with Dr. Richard Falcone](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614) — video · [machine version](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614.md) ## Chapters - [0:00](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=0) Case Presentations: Motor Vehicle Collision with Seat Belt Injuries (Ep 1) - [5:24](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=324) Institutional Practices and Laboratory Evaluation Strategies (Ep 1) - [10:31](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=631) Imaging Findings and Seat Belt Sign Interpretation (Ep 1) - [13:48](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=828) Multi-Center Study Design and Background on CT Overuse (Ep 1) - [19:37](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1177) Five-Variable Prediction Model Results (Ep 1) - [22:28](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1348) Clinical Implementation Challenges and Rapid-Fire Questions (Ep 1) - [0:00](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=0) Case presentations: sibling MVA patients with contrasting presentations (Ep 2) - [4:16](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=256) Panel discussion on imaging protocols and FAST utility (Ep 2) - [10:30](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=630) Multi-center study methodology and clinical prediction model (Ep 2) - [15:35](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=935) Risk stratification and clinical application of prediction model (Ep 2) - [22:53](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1373) FAST ultrasound performance analysis (Ep 2) - [27:21](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1641) Key takeaways and future directions (Ep 2) - [0:05](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=5) Case presentation and surgical approach rationale (Ep 3) - [1:30](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=90) Operative technique and pancreatic mobilization (Ep 3) - [3:00](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=180) Splenic vessel dissection and pancreatic resection (Ep 3) - [4:20](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=260) Postoperative course and outcomes (Ep 3) - [0:00](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=0) Introduction and rationale for selective CT imaging in pediatric blunt abdominal trauma (Ep 4) - [3:37](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=217) Clinical prediction rules and laboratory testing strategies (Ep 4) - [6:55](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=415) Alternative imaging modalities and ATOMIC guidelines for splenic injury (Ep 4) - [9:39](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=579) Renal trauma management (Ep 4) - [11:30](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=690) Pancreatic injury evaluation and the role of early ERCP (Ep 4) - [15:36](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=936) Closing remarks (Ep 4) - [0:00](https://library.globalcastmd.com/watch/isolated-low-grade-solid-organ-injuries-in-children-following-blunt-abdominal-trauma-6671?t=0) Discharge criteria for isolated low-grade solid organ injuries (Ep 5) - [0:00](https://library.globalcastmd.com/watch/lesiones-de-rgano-s-lido-aisladas-de-bajo-grado-luego-de-un-trauma-abdominal-cerrado-6672?t=0) Discharge criteria for low-grade isolated solid organ injuries after blunt abdominal trauma (Ep 6) - [0:00](https://library.globalcastmd.com/watch/gu-as-apsa-actualizadas-para-el-tratamiento-de-lesiones-contusas-del-h-gado-y-del-bazo-7735?t=0) Updated APSA guidelines for blunt hepatic and splenic trauma (Ep 7) ## Statements Every statement is attributed, typed, and timestamped; the link is the citation. - "97% of pediatric blunt trauma patients presenting to trauma centers are hemodynamically stable" (epidemiological) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=0) - "Seatbelt contusion indicates tremendous force and should be a red flag for underlying abdominal injury, particularly bowel injury which is difficult to assess on CT" (clinical) [Ep 2 · 2:26](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=146) - "FAST ultrasound is not sensitive or specific for pediatric abdominal trauma and will not be useful until IV contrast for ultrasound becomes available" (opinion) [Ep 2 · 4:16](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=256) - "AST or ALT over 200 is used as a threshold for CT scanning in blunt abdominal trauma" (host_summary) [Ep 2 · 5:23](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=323) - "Seatbelt sign over the anterior superior iliac spine in the correct anatomic position may be observed, but seatbelt sign in the wrong location (higher on abdomen) requires more aggressive evaluation" (clinical) [Ep 2 · 8:02](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=482) - "Less than 12% of pediatric blunt trauma patients have an injury on abdominal CT" (epidemiological) [Ep 2 · 10:30](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=630) - "90% of pediatric trauma patients present to non-pediatric centers where pan-CT is standard practice" (epidemiological) [Ep 2 · 11:40](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=700) - "Adult trauma literature suggests pan-CT is safer, has fewer missed injuries, and is more cost-effective" (host_summary) [Ep 2 · 12:10](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=730) - "The PECARN study (2012) used only history and physical exam findings to predict injuries requiring acute intervention, defined as urgent surgery, angiography, transfusion, or 48-hour admission for IV fluids" (host_summary) [Ep 2 · 12:40](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=760) - "The PECARN model was very sensitive for injuries requiring acute intervention but missed many clinically relevant solid organ injuries" (clinical) [Ep 2 · 13:40](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=820) - "In the multi-center study, CT scan ordering rates ranged from 4% to 96% across four centers, indicating substantial opportunity for practice improvement" (epidemiological) [Ep 2 · 14:20](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=860) - "Five variables predict intra-abdominal injury: AST >200, abnormal abdominal physical exam, abnormal chest X-ray, complaint of abdominal pain, and elevated amylase or lipase" (clinical) [Ep 2 · 15:00](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=900) - "When all five predictor variables are negative, the risk of intra-abdominal injury is 0.6% and risk of injury requiring acute intervention is 0%" (clinical) [Ep 2 · 15:35](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=935) - "At least one-third of pediatric blunt trauma patients with severe mechanisms do not need abdominal CT based on the five-variable prediction model" (clinical) [Ep 2 · 16:22](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=982) - "The negative predictive value of the five-variable model is 100% for injury requiring intervention and 99.4% for all injuries" (clinical) [Ep 2 · 17:00](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1020) - "Risk of injury increases with the number of abnormal predictor variables present" (clinical) [Ep 2 · 15:51](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=951) - "A low-risk group (55% of population) can be identified with less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention" (clinical) [Ep 2 · 17:30](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1050) - "Waiting one hour for lab results in stable patients with reliable exams is acceptable before deciding on abdominal CT" (opinion) [Ep 2 · 18:05](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1085) - "Multi-slice CT scanners can identify subtle findings of small bowel or hollow viscus injury even without oral contrast" (clinical) [Ep 2 · 19:40](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1180) - "Serial abdominal exams over time can help determine need for further evaluation even when CT findings are equivocal" (clinical) [Ep 2 · 20:28](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1228) - "A missed bowel injury, if caught within 24 hours, usually causes no increased morbidity" (host_summary) [Ep 2 · 21:02](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1262) - "Laparoscopy is extremely helpful for evaluating moderate free fluid in males with no hard signs of small bowel perforation" (clinical) [Ep 2 · 21:13](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1273) - "It is very rare to miss an injury during laparoscopic exploration in the current era" (opinion) [Ep 2 · 21:49](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1309) - "There is huge variability across institutions in which labs are ordered for trauma evaluation (amylase vs lipase vs both)" (epidemiological) [Ep 2 · 22:04](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1324) - "FAST ultrasound had 27.8% sensitivity for any intra-abdominal injury and 44% sensitivity for injury requiring intervention in the study cohort" (clinical) [Ep 2 · 24:10](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1450) - "FAST ultrasound detected only 9 of 42 liver injuries (approximately 1 in 4) in the study" (clinical) [Ep 2 · 24:50](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1490) - "FAST ultrasound detected 13 of 30 spleen injuries in the study" (clinical) [Ep 2 · 25:20](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1520) - "FAST may be helpful in hemodynamically unstable patients to identify hemoperitoneum and determine which body cavity is contributing to instability" (host_summary) [Ep 2 · 25:40](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1540) - "Of 14 centers in the study, only one used negative FAST to reduce CT rates, and two centers actually performed more CTs after FAST" (epidemiological) [Ep 2 · 26:20](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1580) - "FAST is not being used effectively to determine which patients can avoid CT" (opinion) [Ep 2 · 26:50](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1610) - "Every patient who required intervention (transfusion, angiography, or operation) in the study had a CT scan first, so FAST did not change management" (clinical) [Ep 2 · 26:50](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1610) - "The five-variable clinical prediction model provides guidance to the 90% of providers who don't routinely see pediatric trauma patients, indicating they don't need to scan every patient before transfer" (opinion) [Ep 2 · 28:40](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1720) - "Shock index is useful for identifying patients who are NOT in shock but may not be as reliable for predicting who needs intervention" (host_summary) [Ep 2 · 29:12](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1752) - "There may be a third category of abdominal injuries that clinicians don't need to know about, particularly low-grade solid organ injuries" (opinion) [Ep 2 · 30:09](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1809) - "Grade 1 or grade 2 solid organ injuries are very unlikely to fail non-operative management" (clinical) [Ep 2 · 31:16](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1876) - "The failure rate of non-operative management for solid organ injuries is 7% when defined as requiring laparotomy" (epidemiological) [Ep 2 · 31:38](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1898) - "Of patients who fail non-operative management, 3.5% fail due to bowel or pancreas injury and 3.5% fail due to bleeding" (epidemiological) [Ep 2 · 32:00](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1920) - "Patients with isolated spleen or isolated liver injuries are incredibly unlikely to fail non-operative management; risk increases substantially when both injuries are present" (clinical) [Ep 2 · 32:25](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1945) - "Surgeons should perform FAST ultrasound themselves rather than relying on low-level residents, and 50 ultrasounds are required for qualification at some institutions" (guideline) [Ep 2 · 33:40](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=2020) - "IV contrast for ultrasound is expected to be revolutionary and may replace CT for abdominal trauma evaluation" (opinion) [Ep 2 · 34:10](https://library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=2050) - "Resection versus non-operative management for traumatic pancreatic transection is still somewhat controversial." (opinion) [Ep 3 · 0:05](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=5) - "The pediatric surgery service strongly prefers an early distal pancreatectomy in cases of pancreatic transection." (opinion) [Ep 3 · 0:15](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=15) - "Distal pancreatectomy for traumatic transection was typically done through a laparotomy." (clinical) [Ep 3 · 0:25](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=25) - "This video demonstrates the first laparoscopic distal pancreatectomy for trauma at this institution." (clinical) [Ep 3 · 0:35](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=35) - "A 3-trocar approach was used: a 12 millimeter trocar at the umbilicus for camera, stapler, and specimen extraction, and two 5 millimeter upper abdominal trocars for grasping and dissection." (clinical) [Ep 3 · 1:30](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=90) - "The lesser sac is widely opened using the LigaSure to reveal the posterior wall of the stomach." (clinical) [Ep 3 · 1:50](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=110) - "A large curved needle is brought through the abdominal wall, takes a large bite of stomach and exits the abdominal wall again more medially, then tied outside to keep the stomach retracted anteriorly." (clinical) [Ep 3 · 2:00](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=120) - "Mobilization of the distal pancreas starts at its inferior margin." (clinical) [Ep 3 · 2:20](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=140) - "The pancreas was only holding by a thin superior bridge of tissue at the transection site." (clinical) [Ep 3 · 2:35](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=155) - "The transection was completed with the sealing device." (clinical) [Ep 3 · 2:45](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=165) - "A Ray-Tec gauze is left at the site of transection to soak up any oozing that results during the remainder of the dissection." (clinical) [Ep 3 · 2:50](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=170) - "The pancreas is elevated off the splenic vessels starting from the transection site and proceeding laterally." (clinical) [Ep 3 · 3:00](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=180) - "The LigaSure serves as an excellent dissecting device, minimizing instrument exchange." (opinion) [Ep 3 · 3:10](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=190) - "Each venous tributary to the pancreas is well skeletonized prior to ligation and division." (clinical) [Ep 3 · 3:30](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=210) - "The inferior pole of the spleen was ischemic, but this had no clinical consequences." (clinical) [Ep 3 · 3:50](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=230) - "The proximal pancreas is further mobilized for approximately 1 centimeter to allow for closure of the pancreatic duct using a vascular stapler." (clinical) [Ep 3 · 4:05](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=245) - "A Jackson-Pratt drain is placed in the pancreatic bed, and fibrin sealant is injected over the staple line." (clinical) [Ep 3 · 4:20](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=260) - "The patient was fed on the 2nd postoperative day." (clinical) [Ep 3 · 4:30](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=270) - "The drain was removed on the 4th postoperative day." (clinical) [Ep 3 · 4:35](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=275) - "The patient was discharged home on the 5th postoperative day." (clinical) [Ep 3 · 4:40](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=280) - "Follow-up at one year continued to show an excellent outcome." (clinical) [Ep 3 · 4:45](https://library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=285) - "The APSA Trauma Committee conducted a review to update guidelines on treatment of blunt abdominal trauma with liver or splenic injuries" — Cecilia Gigena (host_summary) [Ep 7 · 0:00](https://library.globalcastmd.com/watch/gu-as-apsa-actualizadas-para-el-tratamiento-de-lesiones-contusas-del-h-gado-y-del-bazo-7735?t=0) - "The updated guidelines divide treatment into four stages using the APSA acronym: A for Admission, P for Procedures, S for Set Free (discharge), and A for post-operative care" — Cecilia Gigena (host_summary) [Ep 7 · 0:00](https://library.globalcastmd.com/watch/gu-as-apsa-actualizadas-para-el-tratamiento-de-lesiones-contusas-del-h-gado-y-del-bazo-7735?t=0) - "The most important change is that all treatment is now based on the patient's clinical signs and symptoms rather than the injury grade of the spleen or liver" — Cecilia Gigena (host_summary) [Ep 7 · 0:00](https://library.globalcastmd.com/watch/gu-as-apsa-actualizadas-para-el-tratamiento-de-lesiones-contusas-del-h-gado-y-del-bazo-7735?t=0) - "Trauma is the leading cause of mortality in pediatric patients over 1 year old, and approximately 80% of pediatric trauma injuries are blunt." — Rod (host_summary) [Ep 4 · 0:00](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=0) - "Pediatric patients have more blunt abdominal injuries than adults because of smaller abdominal size with organs closer together, and flexible ribs that do not protect intra-abdominal organs as effectively as adult ribs." — Rod (host_summary) [Ep 4 · 1:46](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=106) - "Radiation exposure from CT scans carries risk for developing children because the exposure lasts their lifetime, with cumulative effects potentially not appearing for 50 years." — Rod (host_summary) [Ep 4 · 2:47](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=167) - "In one study of 125 patients scanned after blunt abdominal trauma, 78% were scanned but only 15% had an identifiable injury." — Rich Falcone (host_summary) [Ep 4 · 3:12](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=192) - "Six clinical factors (normal blood pressure for age, normal abdominal exam, AST less than 200, hematocrit greater than 30, and normal chest X-ray) have a 99% negative predictive value for intra-abdominal injury requiring CT scan." — Rod (clinical) [Ep 4 · 3:37](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=217) - "In a multi-institutional study including Cincinnati Children's Hospital, 34% of blunt abdominal trauma patients with no abdominal tenderness, no distension, normal X-ray, normal liver labs, and normal pancreatic enzymes had only 0.6% chance of abdominal injury, with 0% requiring intervention." — Rod (host_summary) [Ep 4 · 4:24](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=264) - "Cincinnati Children's Hospital removed trauma labs or belly labs from initial lab draws approximately 8 years ago because they were wasting money and causing multiple IV attempts in children." — Rod (clinical) [Ep 4 · 6:06](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=366) - "The only labs acutely needed for pediatric trauma are type and screen, CBC or gas, and coagulation studies for brain injury patients; belly labs should not be part of routine panel." — Rod (guideline) [Ep 4 · 6:06](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=366) - "Contrast-enhanced ultrasound can visualize splenic lacerations that are not visible on regular FAST ultrasound." — Rod (host_summary) [Ep 4 · 7:21](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=441) - "ATOMIC guidelines for splenic injury, published in 2015, allow discharge when hemoglobin is greater than 7, patient can ambulate and tolerate regular diet, and hemoglobin is stable after two checks, regardless of injury grade." — Rich Falcone (host_summary) [Ep 4 · 7:44](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=464) - "Dr. Falcone admitted a Grade 4 splenic injury to the floor rather than ICU based on clinical stability, despite institutional protocol concerns." — Rod (clinical) [Ep 4 · 8:52](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=532) - "Decisions about splenectomy or angioembolization should be based on vital signs and response to fluid resuscitation, not solely on imaging findings." — Rod (clinical) [Ep 4 · 9:13](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=553) - "A blush on imaging in a hemodynamically stable child with normal vital signs does not require emergent angiography; the finding informs future management if the patient decompensates but does not mandate immediate intervention." — Rod (clinical) [Ep 4 · 9:39](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=579) - "Non-operative management works for hemodynamically stable renal trauma and allows salvage of renal tissue." — Rod (clinical) [Ep 4 · 10:33](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=633) - "Grade 3-5 renal injuries warrant urology consultation due to risk of long-term hypertension and urinoma, but Grade 2 renal injury does not require urology involvement and is managed like Grade 2 splenic injury." — Rod (guideline) [Ep 4 · 10:33](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=633) - "AAST guidelines recommend observation for grade 1-2 pancreatic injuries and specific therapies for grade 4-5 injuries, but grade 3 injuries have ambiguous recommendations between observation and distal pancreatectomy." — Rich Falcone (host_summary) [Ep 4 · 11:30](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=690) - "Cincinnati Children's Hospital generally takes a non-operative approach to grade 3 pancreatic injuries because splenic parenchyma may fracture while the duct remains intact, appearing as complete transaction on CT but healing without intervention or developing a pseudocyst that resolves." — Rod (clinical) [Ep 4 · 12:22](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=742) - "A 20-institution study including Cincinnati Children's Hospital found that non-operative management of grade 3-5 pancreatic injuries produced good outcomes." — Rich Falcone (host_summary) [Ep 4 · 13:23](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=803) - "The decision to operate on pancreatic duct injury must be made early (within 3-4 days of injury); after that timepoint, non-operative management is preferred because operating becomes more difficult." — Rod (clinical) [Ep 4 · 13:50](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=830) - "Pancreatic injury patients should be discharged based on symptoms (eating, pain control) rather than laboratory values." — Rod (clinical) [Ep 4 · 13:50](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=830) - "Early ERCP (within first week) can help determine if pancreatic duct is completely disrupted versus partially injured, guiding operative versus non-operative decision-making, though there is risk of converting partial disruption to complete disruption during wire or stent placement." — Rod (clinical) [Ep 4 · 13:50](https://library.globalcastmd.com/watch/abdominal-trauma-with-dr-richard-falcone-5614?t=830) - "A retrospective study was conducted in South Carolina examining whether all isolated solid organ injuries after blunt abdominal trauma require hospital admission" — Cecilia Gigena (host_summary) [Ep 6 · 0:00](https://library.globalcastmd.com/watch/lesiones-de-rgano-s-lido-aisladas-de-bajo-grado-luego-de-un-trauma-abdominal-cerrado-6672?t=0) - "The study included 262 patients with isolated solid organ injuries" — Cecilia Gigena (host_summary) [Ep 6 · 0:00](https://library.globalcastmd.com/watch/lesiones-de-rgano-s-lido-aisladas-de-bajo-grado-luego-de-un-trauma-abdominal-cerrado-6672?t=0) - "148 patients had grade 1 and 2 solid organ injuries" — Cecilia Gigena (host_summary) [Ep 6 · 0:00](https://library.globalcastmd.com/watch/lesiones-de-rgano-s-lido-aisladas-de-bajo-grado-luego-de-un-trauma-abdominal-cerrado-6672?t=0) - "None of the 148 patients with grade 1-2 injuries required any acute intervention" — Cecilia Gigena (host_summary) [Ep 6 · 0:00](https://library.globalcastmd.com/watch/lesiones-de-rgano-s-lido-aisladas-de-bajo-grado-luego-de-un-trauma-abdominal-cerrado-6672?t=0) - "114 patients had grade 3 solid organ injuries" — Cecilia Gigena (host_summary) [Ep 6 · 0:00](https://library.globalcastmd.com/watch/lesiones-de-rgano-s-lido-aisladas-de-bajo-grado-luego-de-un-trauma-abdominal-cerrado-6672?t=0) - "Three of the 114 patients with grade 3 injuries required acute intervention" — Cecilia Gigena (host_summary) [Ep 6 · 0:00](https://library.globalcastmd.com/watch/lesiones-de-rgano-s-lido-aisladas-de-bajo-grado-luego-de-un-trauma-abdominal-cerrado-6672?t=0) - "Patients with isolated grade 1 and 2 solid organ injuries can be discharged from the emergency department" — Cecilia Gigena (host_summary) [Ep 6 · 0:00](https://library.globalcastmd.com/watch/lesiones-de-rgano-s-lido-aisladas-de-bajo-grado-luego-de-un-trauma-abdominal-cerrado-6672?t=0) - "A retrospective study was conducted in South Carolina examining isolated solid organ injuries after blunt abdominal trauma in children." — Cecilia Gigena (host_summary) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/isolated-low-grade-solid-organ-injuries-in-children-following-blunt-abdominal-trauma-6671?t=0) - "The study included 262 patients with isolated solid organ injuries, grades 1 to 3." — Cecilia Gigena (host_summary) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/isolated-low-grade-solid-organ-injuries-in-children-following-blunt-abdominal-trauma-6671?t=0) - "148 patients had solid organ injuries grades 1 or 2." — Cecilia Gigena (host_summary) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/isolated-low-grade-solid-organ-injuries-in-children-following-blunt-abdominal-trauma-6671?t=0) - "None of the 148 patients with grade 1 or 2 solid organ injuries required an acute intervention." — Cecilia Gigena (host_summary) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/isolated-low-grade-solid-organ-injuries-in-children-following-blunt-abdominal-trauma-6671?t=0) - "114 patients had grade 3 solid organ injuries." — Cecilia Gigena (host_summary) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/isolated-low-grade-solid-organ-injuries-in-children-following-blunt-abdominal-trauma-6671?t=0) - "Only 3 of 114 patients with grade 3 solid organ injuries required an acute intervention." — Cecilia Gigena (host_summary) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/isolated-low-grade-solid-organ-injuries-in-children-following-blunt-abdominal-trauma-6671?t=0) - "Isolated solid organ injuries after blunt abdominal trauma, grades 1 or 2, can be discharged from the emergency department." — Cecilia Gigena (host_summary) [Ep 5 · 0:00](https://library.globalcastmd.com/watch/isolated-low-grade-solid-organ-injuries-in-children-following-blunt-abdominal-trauma-6671?t=0) - "97% of pediatric blunt trauma patients presenting to trauma centers are hemodynamically stable" — Christian Streck (epidemiological) [Ep 1 · 0:23](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=23) - "A seat belt contusion indicates tremendous force generated against the patient and requires vigilance for underlying abdominal injury" (clinical) [Ep 1 · 3:35](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=215) - "Bowel injury is difficult to assess on CT scan even when solid organ injuries can be identified" — Christian Streck (clinical) [Ep 1 · 3:59](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=239) - "FAST ultrasound is not sensitive or specific enough for pediatric abdominal trauma evaluation" (clinical) [Ep 1 · 5:24](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=324) - "IV contrast for ultrasound may improve FAST utility in the future but is not currently helpful" (opinion) [Ep 1 · 5:55](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=355) - "Patients evaluated only by the emergency department (lowest tier activations) receive more labs and sometimes more imaging than higher-tier activations" (clinical) [Ep 1 · 6:52](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=412) - "The CHOP study established that if either AST or ALT is over 200, abdominal CT should be obtained" (host_summary) [Ep 1 · 7:12](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=432) - "A seat belt sign over the anterior superior iliac spine (correct position) may represent only soft tissue injury and can be observed, whereas a seat belt sign in the wrong position (higher on abdomen) is more concerning" (clinical) [Ep 1 · 10:31](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=631) - "The seat belt should be positioned over the bony pelvis; this is why booster seats are used in children" (clinical) [Ep 1 · 11:26](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=686) - "Less than 12% of pediatric patients scanned for blunt abdominal trauma have an intra-abdominal injury" — Christian Streck (epidemiological) [Ep 1 · 13:48](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=828) - "Fewer than 3% of pediatric blunt trauma patients with severe mechanisms have an injury requiring acute intervention" — Christian Streck (epidemiological) [Ep 1 · 13:48](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=828) - "90% of pediatric trauma patients present to non-pediatric centers where pan-CT is standard practice" — Christian Streck (epidemiological) [Ep 1 · 13:48](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=828) - "CT scan ordering rates for pediatric blunt abdominal trauma varied from 4% to 96% across 14 participating trauma centers" — Christian Streck (epidemiological) [Ep 1 · 13:48](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=828) - "Adult trauma literature suggests pan-CT is safer, has fewer missed injuries, and is more cost-effective" — Christian Streck (host_summary) [Ep 1 · 13:48](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=828) - "The 2012 PECARN prediction model using only history and physical exam was very sensitive for injuries requiring acute intervention but missed many clinically relevant solid organ injuries" — Christian Streck (clinical) [Ep 1 · 13:48](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=828) - "Five variables predict intra-abdominal injury: AST >200, abnormal abdominal physical exam, abnormal chest X-ray, abdominal pain, and elevated amylase or lipase" — Christian Streck (clinical) [Ep 1 · 19:37](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1177) - "When all five prediction variables are negative, the risk of intra-abdominal injury is 0.6% and risk of injury requiring acute intervention is 0%" — Christian Streck (clinical) [Ep 1 · 19:37](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1177) - "The five-variable model identifies 34% of pediatric blunt trauma patients who can safely avoid abdominal CT" — Christian Streck (clinical) [Ep 1 · 19:37](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1177) - "The negative predictive value of the five-variable model was 100% for injury requiring intervention and 99.4% for all injuries" — Christian Streck (clinical) [Ep 1 · 19:37](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1177) - "A modified low-risk group (55% of patients) with fewer than all five variables positive has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention" — Christian Streck (clinical) [Ep 1 · 19:37](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1177) - "Clinicians can wait up to one hour for laboratory results (AST, lipase) before deciding on abdominal CT in stable patients with reliable exams" — Christian Streck (clinical) [Ep 1 · 22:28](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1348) - "Oral contrast does not add diagnostic value for identifying small bowel or colonic injuries in pediatric blunt trauma" — Christian Streck (clinical) [Ep 1 · 24:20](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1460) - "Modern multi-slice CT scanners typically show subtle findings (even without free air) that raise concern for hollow viscus injury" — Christian Streck (clinical) [Ep 1 · 24:20](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1460) - "Serial abdominal examinations over 6-12 hours can help determine need for operative intervention even when CT findings are equivocal" (clinical) [Ep 1 · 25:16](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1516) - "Bowel injury, although significant, is not immediately life-threatening and can be safely observed for several hours before definitive management" (clinical) [Ep 1 · 25:42](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1542) - "An APSA study supports that missed bowel injury diagnosed within 24 hours does not increase morbidity" — Christian Streck (host_summary) [Ep 1 · 26:06](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1566) - "Laparoscopy is extremely helpful in 2017 for patients with moderate free fluid and no hard signs of small bowel perforation" — Christian Streck (clinical) [Ep 1 · 26:31](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1591) - "It is very rare to miss an injury during laparoscopic exploration of pediatric abdominal trauma" — Todd Ponsky (opinion) [Ep 1 · 26:31](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1591) - "Either amylase or lipase is acceptable for pancreatic injury screening; institutions vary in which enzyme they use" — Christian Streck (clinical) [Ep 1 · 27:37](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1657) - "There is huge variability across institutions in laboratory evaluation practices for pediatric blunt abdominal trauma" — Todd Ponsky (host_summary) [Ep 1 · 27:37](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1657) - "The five-variable prediction model has been validated in the publicly available PECARN dataset with significant negative predictive value" — Christian Streck (clinical) [Ep 1 · 28:33](https://library.globalcastmd.com/watch/trauma-talk-summary-update-course-2017-403?t=1713) ## Changelog - Sep 24: 7 items added automatically --- Educational content from recorded physician discussions — not medical advice. 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