# Blunt Abdominal Trauma — GCMD Library living collection

Everything in the library about blunt abdominal trauma — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 84 cited statements

## Episodes
### Diagnosis & Workup
- [Indications for CT Scan for Blunt Abdominal Trauma: Update Course 2017](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407) — video · 34:38 · [machine version](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407.md)

### Surgical Management
- [Laparoscopic Distal Pancreatectomy for Traumatic Transection](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890) — video · 4:58 · [machine version](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890.md)

### In-Depth Reviews
- [Trauma Abdominal Cerrado con el Dr. Raphael Parrado](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222) — podcast · 18:34 · [machine version](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=0) Case presentations: sibling MVA patients with contrasting presentations (Ep 1)
- [4:16](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=256) Panel discussion on imaging protocols and FAST utility (Ep 1)
- [10:30](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=630) Multi-center study methodology and clinical prediction model (Ep 1)
- [15:35](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=935) Risk stratification and clinical application of prediction model (Ep 1)
- [22:53](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1373) FAST ultrasound performance analysis (Ep 1)
- [27:21](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1641) Key takeaways and future directions (Ep 1)
- [0:05](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=5) Introduction and Case Presentation (Ep 2)
- [1:30](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=90) Operative Technique: Access and Exposure (Ep 2)
- [3:00](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=180) Pancreatic Mobilization and Dissection (Ep 2)
- [4:00](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=240) Completion and Postoperative Course (Ep 2)
- [0:09](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=9) Epidemiology and Initial Assessment of Pediatric Blunt Abdominal Trauma (Ep 3)
- [3:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=180) Diagnostic Workup and PECARN Criteria for CT Imaging (Ep 3)
- [7:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=420) Non-Operative Management Protocols for Solid Organ Injuries (Ep 3)
- [10:50](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=650) Indications for Operative Intervention and Transfusion Thresholds (Ep 3)
- [15:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=900) Surgical Techniques and Damage Control Strategies (Ep 3)
- [17:30](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=1050) Post-Operative Management and Complications (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- 97% of pediatric blunt trauma patients presenting to trauma centers are hemodynamically stable (epidemiological) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=0)
- Seatbelt contusion indicates tremendous force and should be a red flag for underlying abdominal injury, particularly bowel injury which is difficult to assess on CT (clinical) [Ep 1 · 2:26](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=146)
- FAST ultrasound is not sensitive or specific for pediatric abdominal trauma and will not be useful until IV contrast for ultrasound becomes available (opinion) [Ep 1 · 4:16](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=256)
- Seatbelt sign over the anterior superior iliac spine in the correct anatomic position may be observed, but seatbelt sign in the wrong location (higher on abdomen) requires more aggressive evaluation (clinical) [Ep 1 · 8:02](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=482)
- Less than 12% of pediatric blunt trauma patients have an injury on abdominal CT (epidemiological) [Ep 1 · 10:30](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=630)
- 90% of pediatric trauma patients present to non-pediatric centers where pan-CT is standard practice (epidemiological) [Ep 1 · 11:40](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=700)
- The PECARN model was very sensitive for injuries requiring acute intervention but missed many clinically relevant solid organ injuries (clinical) [Ep 1 · 13:40](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=820)
- In the multi-center study, CT scan ordering rates ranged from 4% to 96% across four centers, indicating substantial opportunity for practice improvement (epidemiological) [Ep 1 · 14:20](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=860)
- Five variables predict intra-abdominal injury: AST >200, abnormal abdominal physical exam, abnormal chest X-ray, complaint of abdominal pain, and elevated amylase or lipase (clinical) [Ep 1 · 15:00](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=900)
- When all five predictor variables are negative, the risk of intra-abdominal injury is 0.6% and risk of injury requiring acute intervention is 0% (clinical) [Ep 1 · 15:35](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=935)
- At least one-third of pediatric blunt trauma patients with severe mechanisms do not need abdominal CT based on the five-variable prediction model (clinical) [Ep 1 · 16:22](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=982)
- The negative predictive value of the five-variable model is 100% for injury requiring intervention and 99.4% for all injuries (clinical) [Ep 1 · 17:00](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1020)
- Risk of injury increases with the number of abnormal predictor variables present (clinical) [Ep 1 · 15:51](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=951)
- A low-risk group (55% of population) can be identified with less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention (clinical) [Ep 1 · 17:30](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1050)
- Waiting one hour for lab results in stable patients with reliable exams is acceptable before deciding on abdominal CT (opinion) [Ep 1 · 18:05](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1085)
- Multi-slice CT scanners can identify subtle findings of small bowel or hollow viscus injury even without oral contrast (clinical) [Ep 1 · 19:40](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1180)
- Serial abdominal exams over time can help determine need for further evaluation even when CT findings are equivocal (clinical) [Ep 1 · 20:28](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1228)
- Laparoscopy is extremely helpful for evaluating moderate free fluid in males with no hard signs of small bowel perforation (clinical) [Ep 1 · 21:13](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1273)
- It is very rare to miss an injury during laparoscopic exploration in the current era (opinion) [Ep 1 · 21:49](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1309)
- There is huge variability across institutions in which labs are ordered for trauma evaluation (amylase vs lipase vs both) (epidemiological) [Ep 1 · 22:04](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1324)
- FAST ultrasound had 27.8% sensitivity for any intra-abdominal injury and 44% sensitivity for injury requiring intervention in the study cohort (clinical) [Ep 1 · 24:10](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1450)
- FAST ultrasound detected only 9 of 42 liver injuries (approximately 1 in 4) in the study (clinical) [Ep 1 · 24:50](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1490)
- FAST ultrasound detected 13 of 30 spleen injuries in the study (clinical) [Ep 1 · 25:20](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1520)
- Of 14 centers in the study, only one used negative FAST to reduce CT rates, and two centers actually performed more CTs after FAST (epidemiological) [Ep 1 · 26:20](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1580)
- FAST is not being used effectively to determine which patients can avoid CT (opinion) [Ep 1 · 26:50](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1610)
- Every patient who required intervention (transfusion, angiography, or operation) in the study had a CT scan first, so FAST did not change management (clinical) [Ep 1 · 26:50](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1610)
- The five-variable clinical prediction model provides guidance to the 90% of providers who don't routinely see pediatric trauma patients, indicating they don't need to scan every patient before transfer (opinion) [Ep 1 · 28:40](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1720)
- There may be a third category of abdominal injuries that clinicians don't need to know about, particularly low-grade solid organ injuries (opinion) [Ep 1 · 30:09](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1809)
- Grade 1 or grade 2 solid organ injuries are very unlikely to fail non-operative management (clinical) [Ep 1 · 31:16](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1876)
- The failure rate of non-operative management for solid organ injuries is 7% when defined as requiring laparotomy (epidemiological) [Ep 1 · 31:38](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1898)
- Of patients who fail non-operative management, 3.5% fail due to bowel or pancreas injury and 3.5% fail due to bleeding (epidemiological) [Ep 1 · 32:00](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1920)
- Patients with isolated spleen or isolated liver injuries are incredibly unlikely to fail non-operative management; risk increases substantially when both injuries are present (clinical) [Ep 1 · 32:25](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1945)
- Surgeons should perform FAST ultrasound themselves rather than relying on low-level residents, and 50 ultrasounds are required for qualification at some institutions (guideline) [Ep 1 · 33:40](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=2020)
- IV contrast for ultrasound is expected to be revolutionary and may replace CT for abdominal trauma evaluation (opinion) [Ep 1 · 34:10](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=2050)
- Blunt abdominal trauma represents 5% of cases in pediatric trauma — Raphael Parrado (epidemiological) [Ep 3 · 0:09](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=9)
- The spleen is the most commonly injured organ in pediatric blunt abdominal trauma, accounting for 40% of cases — Raphael Parrado (epidemiological) [Ep 3 · 0:50](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=50)
- Other organs injured include pancreas, kidney, and intestines — Raphael Parrado (clinical) [Ep 3 · 1:20](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=80)
- Seatbelt sign on inspection is an important finding in pediatric blunt abdominal trauma, associated with pelvic fractures and intra-abdominal injuries — Raphael Parrado (clinical) [Ep 3 · 2:20](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=140)
- FAST ultrasound is the most commonly implemented imaging study to determine presence or absence of free fluid in the abdomen — Raphael Parrado (clinical) [Ep 3 · 3:20](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=200)
- Laboratory studies for blunt abdominal trauma include renal panel, hematocrit, amylase, and aminotransferase — Raphael Parrado (clinical) [Ep 3 · 4:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=240)
- Amylase greater than 200 or elevated aminotransferase indicates need for CT imaging — Raphael Parrado (clinical) [Ep 3 · 4:30](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=270)
- PECARN (Pediatric Emergency Care Applied Research Network) criteria for CT imaging include Glasgow Coma Scale, abdominal examination findings, seatbelt sign, and thoracic trauma — Raphael Parrado (guideline) [Ep 3 · 4:50](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=290)
- For patients with minor injuries, observation in the emergency department or discharge home with follow-up may be appropriate in absence of other injuries — Raphael Parrado (clinical) [Ep 3 · 6:20](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=380)
- Non-operative management protocol includes crystalloid fluid limit, serial hemoglobin checks to determine transfusion need — Raphael Parrado (clinical) [Ep 3 · 7:30](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=450)
- Renal injuries with hematuria can be observed, with monitoring for worsening hematuria as indication for intervention — Raphael Parrado (clinical) [Ep 3 · 8:40](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=520)
- Grade 3, 4, and 5 solid organ injuries can be observed in many institutions if patient remains hemodynamically stable — Raphael Parrado (clinical) [Ep 3 · 9:20](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=560)
- Indications for operative intervention include peritonitis, free air, and hemodynamic instability — Raphael Parrado (clinical) [Ep 3 · 10:50](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=650)
- Transfusion threshold for operative consideration is 40 mL/kg of crystalloid or 40 mL/kg of packed red blood cells — Raphael Parrado (clinical) [Ep 3 · 11:20](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=680)
- Laparotomy incision extends from inferior border of pubis to xiphoid process — Raphael Parrado (clinical) [Ep 3 · 13:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=780)
- Most common injury grades requiring surgery are grades 4 and 5, though grade 3 may also require intervention — Raphael Parrado (clinical) [Ep 3 · 13:30](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=810)
- Initial surgical steps include packing anterior and posterior abdomen for hemorrhage control — Raphael Parrado (clinical) [Ep 3 · 14:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=840)
- Hemostatic techniques include use of non-permanent coagulation sutures and large figure-of-eight sutures — Raphael Parrado (clinical) [Ep 3 · 14:30](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=870)
- Anatomic resection is preferred when patient is hemodynamically stable; non-anatomic resection with stapler may be used for ongoing hemorrhage — Raphael Parrado (clinical) [Ep 3 · 15:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=900)
- Most common procedures performed are splenectomy and bowel resection — Raphael Parrado (clinical) [Ep 3 · 16:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=960)
- For arterial pulsatile bleeding versus diffuse venous bleeding, surgeon should pack and return for re-exploration at 24 hours — Raphael Parrado (clinical) [Ep 3 · 16:20](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=980)
- Damage control surgery with packing is appropriate when patient is hemodynamically unstable despite resuscitation — Raphael Parrado (clinical) [Ep 3 · 17:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=1020)
- Transfusion-related complications include hemodynamic instability and pulmonary edema — Raphael Parrado (clinical) [Ep 3 · 17:30](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=1050)
- Patients require monitoring in ICU to ensure adequate fluid removal without complete depletion — Raphael Parrado (clinical) [Ep 3 · 17:50](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=1070)
- Important complications include peritonitis, infectious complications, and overwhelming post-splenectomy sepsis (OPSS), which can be fatal — Raphael Parrado (clinical) [Ep 3 · 18:10](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=1090)
- Post-splenectomy vaccines are given at 2 weeks after surgery — Raphael Parrado (clinical) [Ep 3 · 18:40](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=1120)
- Follow-up includes monitoring for hematoma or fluid collections — Raphael Parrado (clinical) [Ep 3 · 19:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=1140)
- Resection versus non-operative management for traumatic pancreatic transection is still somewhat controversial. (opinion) [Ep 2 · 0:05](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=5)
- The pediatric surgery service strongly prefers an early distal pancreatectomy in cases of transection. (opinion) [Ep 2 · 0:15](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=15)
- Distal pancreatectomy for traumatic transection was typically done through a laparotomy. (clinical) [Ep 2 · 0:25](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=25)
- This video demonstrates the first laparoscopic distal pancreatectomy for trauma performed by this service. (clinical) [Ep 2 · 0:35](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=35)
- The patient was hemodynamically stable at presentation but had significant epigastric pain and tenderness. (clinical) [Ep 2 · 1:00](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=60)
- Pancreatic enzymes were elevated in this patient. (clinical) [Ep 2 · 1:10](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=70)
- CT scan showed a clear pancreatic transection at a point to the left of the spine. (clinical) [Ep 2 · 1:15](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=75)
- The patient underwent the operation approximately 10 hours after admission. (clinical) [Ep 2 · 1:25](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=85)
- A 3-trochar approach was used: a 12 millimeter trochar at the umbilicus for camera, stapler, and specimen extraction, and two 5 millimeter upper abdominal trochars for grasping and dissection. (clinical) [Ep 2 · 1:30](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=90)
- A large curved needle is brought through the abdominal wall, takes a large bite of stomach, and exits the abdominal wall again more medially, then tied outside to keep the stomach retracted anteriorly. (clinical) [Ep 2 · 2:10](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=130)
- The field at the site of pancreatic transection was remarkably clean. (clinical) [Ep 2 · 2:50](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=170)
- The pancreas was only holding by a thin superior bridge of tissue at the transection site. (clinical) [Ep 2 · 2:55](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=175)
- The transection was completed with the sealing device. (clinical) [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=180)
- A rec gauze was left at the site of transection to soak up any oozing that results during the remainder of the dissection. (clinical) [Ep 2 · 3:05](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=185)
- The LigaSure serves as an excellent dissecting device, minimizing instrument exchange. (opinion) [Ep 2 · 3:30](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=210)
- Each venous tributary to the pancreas was well skeletonized prior to ligation and division. (clinical) [Ep 2 · 3:50](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=230)
- The inferior pole of the spleen was ischemic, but this had no clinical consequences. (clinical) [Ep 2 · 4:05](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=245)
- The proximal pancreas was further mobilized for approximately 1 centimeter to allow for closure of the pancreatic duct using a vascular stapler. (clinical) [Ep 2 · 4:20](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=260)
- A Jackson Pratt drain was placed in the pancreatic bed, and fibrin sealant was injected over the staple line. (clinical) [Ep 2 · 4:30](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=270)
- The patient was fed on the 2nd postoperative day. (clinical) [Ep 2 · 4:40](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=280)
- The drain was removed on the 4th postoperative day. (clinical) [Ep 2 · 4:43](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=283)
- The patient was discharged home on the 5th postoperative day. (clinical) [Ep 2 · 4:46](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=286)
- Follow up at one year continued to show an excellent outcome. (clinical) [Ep 2 · 4:50](https://qa.library.globalcastmd.com/watch/laparoscopic-distal-pancreatectomy-for-traumatic-transection-1890?t=290)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- AST or ALT over 200 is used as a threshold for CT scanning in blunt abdominal trauma — The host summarizing the discussion [Ep 1 · 5:23](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=323)
- Adult trauma literature suggests pan-CT is safer, has fewer missed injuries, and is more cost-effective — The host summarizing the discussion [Ep 1 · 12:10](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=730)
- The PECARN study (2012) used only history and physical exam findings to predict injuries requiring acute intervention, defined as urgent surgery, angiography, transfusion, or 48-hour admission for IV fluids — The host summarizing the discussion [Ep 1 · 12:40](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=760)
- A missed bowel injury, if caught within 24 hours, usually causes no increased morbidity — The host summarizing the discussion [Ep 1 · 21:02](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1262)
- FAST may be helpful in hemodynamically unstable patients to identify hemoperitoneum and determine which body cavity is contributing to instability — The host summarizing the discussion [Ep 1 · 25:40](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1540)
- Shock index is useful for identifying patients who are NOT in shock but may not be as reliable for predicting who needs intervention — The host summarizing the discussion [Ep 1 · 29:12](https://qa.library.globalcastmd.com/watch/indications-for-ct-scan-for-blunt-abdominal-trauma-update-course-2017-407?t=1752)

---
Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://qa.library.globalcastmd.com/ai