宠物医院腹部创伤的急诊（英文版）.ppt

Management of Acute Abdominal Trauma Ronald S. Walton, DVM MSDiplomate ACVIM and ACVECC Colorado Springs, Colorado USA OutlineIntroductionDiagnosisTreatmentConclusion IntroductionIncidence in cats is unknown IntroductionMany causes to acute abdominal injurySome are easy to diagnose and some can be very challengingPrincipal causesBlunt trauma (automobile or fall), penetrating injury (gunshot wound or bite wound) are most common types presented DiagnosisPhysical examination findingsDiagnostic studiesExperience with trauma cases Theses help to determine which patient can be managed conservatively and which must be rapidly taken to surgical therapy DiagnosisBlunt abdominal trauma cases are challenging diagnostic problems because the clinical manifestations may be delayed for hours or even days in some cases. DiagnosisPhysical examination is the most informativeIncreasing abdominal size is an important clue for intra-abdominal hemorrhagePalpate the abdomen for rigidity and painMany blunt injuries can cause internal bleeding and laceration of the liver and spleen ExaminationSevere Ventral Bruising ExaminationPenetrating Wound ExaminationPale mucous membranesWeak pulseProfound hypovolemic shock Patient TriageOften must begin stabilization therapy prior to complete diagnosis or during diagnostic procedures depending on severity of the conditionIV FluidsOxygenBlood Transfusion Diagnostic 4 Quadrant Abdominocentesis Fluid obtained is tested for : HCT, Total solids, Cytology Blood Urea Nitrogen Lipase, Amylase, and Bilirubin Diagnostic 4 Quadrants HCT Blood Urea NitrogenRupture of the Urinary system Kidney, Ureter, Bladder BilirubinFluid almost black in color Cytology Radiology RadiologyContrast media leakage RadiologyAbdominal fluid = loss of detail UltrasoundFree fluid easy to detect. Creates a space between organs ManagementAbdominal compression bandage TreatmentRapid volume expansionIntravenous fluid (crysta