Penetrating Diaphragmatic Trauma


Background
  1. Rare injuries
  2. Can occur with chest or abdomen penetrating trauma

Pathophysiology

  1. Usually result from GSW or stab wounds
  2. Anatomy
  3. Morbidity, mortality

Diagnostics

  1. Often masked by other injuries
  2. History / symptoms
  3. Physical exam
  4. Diagnostic testing
  5. Diagnostic imaging

Differential Diagnosis

  1. Hemothorax
  2. Pneumothorax
  3. Cardiac injury
  4. Pulmonary laceration
  5. Hepatic injury
  6. Splenic injury
  7. Vascular injury
  8. Intestinal injury
  9. Pancreatic injury
  10. Kidney injury
  11. Thoracic injury

Treatment

  1. ATLS as usual
  2. FAST exam to rule out intraperitoneal fluid and pericardial effusion
  3. NG/Foley
  4. BEWARE of chest tube placement
  5. Hemodynamically unstable
  6. If hemodynamically stable
  7. Emphasis on serial exams
  8. Consider need for antibiotics
  9. Tetanus prophylaxis
  10. Definitive management
  11. Complications

Disposition

  1. Admit patient
  2. Surgical repair for definitive treatment