Early decision making in abdominal trauma hinges on whether or not the patient needs a laparotomy, which can generally be decided clinically. If a decision against urgent surgery has been made then the surgeon must diagnose the injuries by other means. Ultrasound, CT scanning and laparoscopy each suit certain clinical scenarios and part of the clinician’s role is to choose the most appropriate investigation. Treatment involves initial resuscitation, then checking the response. Transient- and non-responders are likely to need urgent surgery for ongoing bleeding unless it is non-hypovolaemic shock, such as cardiac tamponade or spinal injury. Many specific injuries can be managed non-operatively but ongoing observation remains important to detect deterioration mandating a change in management plan. Unconscious patients, those with spinal injury, pregnant women and small children require extra vigilance although the underlying principles of trauma care still apply.
Chapter. 3050 words. Illustrated.
Subjects: Surgery ; Trauma and Orthopaedic Surgery
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