This document summarizes information on torso trauma, including thoracic and abdominal trauma. It discusses the types of blunt and penetrating torso injuries and emphasizes the importance of early resuscitation and examination in guiding appropriate investigations. Key investigations covered are chest X-ray, CT scan, ultrasound, and laparoscopy. Management depends on whether injuries are thoracic or abdominal, with most chest injuries managed conservatively and unstable abdominal trauma requiring damage control surgery to address bleeding and contamination.

1. TORSO TRAUMA
Dr Immad Ud Din
PGR Urology, BVH
Member of American college of Surgeon

2. Translation
• Blunt ‫ب‬
‫ی‬
‫نوک‬
/
‫لبه‬ ‫دارای‬
‫ضخیم‬
• Penetrating ‫کننده‬ ‫رسوخ‬/ ‫نافذ‬
• Haematoma ‫هماتوم‬
• Trauma ‫اسیب‬
/
‫ضربه‬
• Thorax ‫سینه‬ ‫قفسه‬
• Abdomen ‫بطن‬
• Resuscitation ‫احیا‬
/
‫اوری‬ ‫بهوش‬
• Examination ‫معاینه‬
• Auscultation ‫کردن‬ ‫گوش‬

3. TORSO TRAUMA
Thoracic Trauma Abdominal Trauma

5. Thoracic Trauma
They are often life threatening.
About 80% of patients with chest injury can be managed conservatively.
The key to good outcome is early physiological resuscitation followed by correct
diagnosis.
Examination:
A complete Chest examination including front and back of the patient is essential in
guiding investigations.
Respiratory rate, chest expansion, tracheal deviation, palpation, percussion,
Auscultation. All gives quality information about the status of patient and the possible
injuries.

6. • Investigations:
1.Chest X-ray
2.Ultrasound chest
3.CT-Scan
4.Chest Intubation

8. CHEST X-RAY

9. Chest Intubation
• It is both diagnostic and therapeutic procedure.
• Indicated in:
1. Pneumothorax
2. Hydrothorax
3. Pyothorax
4. Haemothorax

11. CT-Scan
• It has become the principal and most reliable test for major
injury.
• In blunt trauma, It allows the definition of fractures as well as,
haematomas, pneumathoraces and pulmonary contusions.
• In penetrating trauma, It shows the presence and track of
missile.

12. Management
• Most patients can be managed with appropriate resuscitation.
• If Sucking chest wound is present, this should be closed of
three sides, to form a one-way valve, and thereafter an
underwater chest drain should be inserted.
• In blunt injury, most bleeding occurs from the intercostal or
internal mammary vessels. It is rarely for these to require
surgery.
• Initial blood loss of >1500mL indicates class 3 shock, and any
ongoing bleeding must be dealt surgically. Same is the case
with an ongoing blood loss of more than 200mL/hr for 3
consecutive hours.

13. Abdominal Trauma
An abdominal trauma patient can be classified into one of the following:
1. Haemodynamically “Normal”
2. Haemodynamically “Stable”
3. Haemodynamically “Unstable”
History & Examination is very important and guides appropriate investigations.
Signs of peritonism, tenderness, rebound tenderness, eviseration of abdominal organs.

14. • Investigations:
I. Focused abdominal sonar for trauma
II. Diagnostic peritoneal lavage
III. Computed tomography
IV. Diagnostic laparoscopy

15. FAST Scan
• It is used to assess the torso for blood.
• Six areas:
1. The pericardium
2. Around the liver and spleen
3. Left and right pericolic gutters
4. The pelvis
It is accurate at determining >100ml of free
blood

16. DPL
• It is used to assess blood in the abdomen.
• It is positive if >10ml of blood is aspirated.
• It is largely replaced by FAST Scan

17. CT-Scan
• It is the “Gold standard” for the intra-abdominal diagnosis of
injury in the stable patient.
• It is sensitive for blood, individual organ injury and
retroperitoneal injury.
The following points are important when performing CT-scan:
i. It remains inappropriate for unstable patient.
ii. If duodenal injury is suspected, oral contrast is helpful.
iii. If rectal and distal colon injury is suspected, rectal contrast is
helpful.

18. Diagnostic Laparoscopy
• It is a valuable screening test in stable patients
with penetrating trauma to,
a. Detect or exclude peritoneal penetration
b. Diaphragmatic injury

19. LIVER INJURY
• Blunt trauma as a result of direct injury.
• Penetrating trauma is due to sharps and bullets.
CT-Scan is done in a stable patient
Management:
The four P’s
1. Push
2. Pringle
3. Plug
4. Pack

20. Damage Control Surgery
2 Goals:
i. Stop bleeding
ii. Control contamination
Deadly
Triad
Hypothermia
Coagulopathy
Acidosis