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    General Surgery Grand Rounds: DR N Singh

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    entistde
    A 27-year-old female presented with two stab wounds - one to the left chest and one above the right costal margin. On examination, she had abdominal tenderness and guarding. Investigations showed no pneumothorax or haemothorax on chest x-ray. She was prepared for an exploratory laparotomy which found 500cc of blood in the abdomen from a small liver laceration and a haematoma near the diaphragm. No other internal injuries were discovered. Her postoperative course was uneventful.

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    General Surgery Grand Rounds: DR N Singh

    Uploaded by

    entistde
    114 views11 pages
    A 27-year-old female presented with two stab wounds - one to the left chest and one above the right costal margin. On examination, she had abdominal tenderness and guarding. Investigations showed no pneumothorax or haemothorax on chest x-ray. She was prepared for an exploratory laparotomy which found 500cc of blood in the abdomen from a small liver laceration and a haematoma near the diaphragm. No other internal injuries were discovered. Her postoperative course was uneventful.

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    surgery medicine

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    General Surgery

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    A 27-year-old female presented with two stab wounds - one to the left chest and one above the right costal margin. On examination, she had abdominal tenderness and guarding. Investigations showed no pneumothorax or haemothorax on chest x-ray. She was prepared for an exploratory laparotomy which found 500cc of blood in the abdomen from a small liver laceration and a haematoma near the diaphragm. No other internal injuries were discovered. Her postoperative course was uneventful.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    114 views11 pages

    General Surgery Grand Rounds: DR N Singh

    Uploaded by

    entistde
    A 27-year-old female presented with two stab wounds - one to the left chest and one above the right costal margin. On examination, she had abdominal tenderness and guarding. Investigations showed no pneumothorax or haemothorax on chest x-ray. She was prepared for an exploratory laparotomy which found 500cc of blood in the abdomen from a small liver laceration and a haematoma near the diaphragm. No other internal injuries were discovered. Her postoperative course was uneventful.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 11

    General Surgery Grand Rounds

    Dr N Singh

    History
    27 F No Known Chronic Illnesses Presents with Two Stab Wounds Blood soaked shirt Nil Syncope or Symptomatic Anemia Chest pain at injury , SOB , Haemoptysis Hematemesis, Vomit , Abd pain , Distension

    Examination
    Young female in painful distress Mucous Membranes pink and moist Anicteric, Acyanotic Vitals BP143/72, T 96.5, PR 72, RR 20 SP02 98%

    Examination
    Injuries
    1cm stab wound, Lt hemithorax, 1st intercostal space, 1cm lateral to MCL 1cm stab wound just above right costal margin, 2cm from the midline

    Chest AEEB, Nil Added Sounds

    Examination
    CVS:
    Pulses N, normal heart sounds Distended Neck Veins Grade III/IV systolic Murmur

    Abd: Soft, Flat, generalized tenderness, guarding, rebound tenderness, rigidity, BS normal, DRE normal CNS: Nil Deficit

    Assessment
    Multiple Stab Wounds
    Likely intra-abdominal injury R/O Cardiopulmonary injury R/O Diaphragmatic injury Haemodynamically Stable

    Investigations Already Done


    CBC: Hb 12.3, PCV .36, WBC 7.4, Plt 242 HCG: Neg CXR: Nil Pneumothorax, haemothorax, or pneumoperitoneum. Normal cardiac silhouette

    Plan
    Resuscitate NPO, NGT, UCATH Prepare for Exploratory Laparotomy, Subxiphoid Window, +/- Thoracostomy tube, +/- Thoracotomy Antibiotics FAST

    FAST
    Nil Pericardial Effusion Free Pelvic Fluid Morrisons Pouch not visualized

    OP Notes
    Findings
    500cc haemoperitoneum <1cm laceration to Segment 4a of Liver
    No active bleed No injuries to under surface

    Small haematoma to noted just adjacent to superior border of D1 Normal Stomach, pancreas, deudenum, small and large bowel and GB Nil retroperitoneal haematoma Straw Coloured fluid from Pericardial Sac

    Post OP
    Patients Course has been uneventful thus far Patient to have Arterial Doppler as an outpatient

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