Splenic Trauma (Penetrating)


Background
  1. Definition
  2. Etiology
  3. A delayed threat to life
Pathophysiology
  1. Spleen receives 5% of cardiac output
  2. Wound basics
  3. Injury Grades
  4. Mortality

Diagnostics

  1. History
  2. Symptoms
  3. Physical exam
  4. Laboratory evaluation
  5. Diagnostic imaging
      • Positive if:
        • >10 cc gross blood, enteric contents
        • Bloody lavage effluent
        • >100,000 RBC/mm3 or >500 WBC/mm3
        • Amylase >175 IU/dl
        • DPL fluid exits through CT or Foley catheters
        • Bacteria, vegetable fibers or food present

Differential Diagnosis

  1. Penetrating hepatic injury
  2. Penetrating diaphragmatic injury
  3. Penetrating splenic injury
  4. Penetrating pancreatic injury
  5. Penetrating kidney injury
  6. Penetrating intestinal injury

Treatment

  1. ATLS as usual
  2. DO NOT remove impaling objects
  3. FAST scan / DPL
  4. NG tube / foley PRN
  5. Rapid surgical evaluation and intervention
  6. FREQUENTLY RE-ASSESS THE PATIENT
  7. Prophylactic antibiotics
  8. Tetanus prophylaxis

Disposition

  1. Admit all patients with known injury