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Splenic Injury
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Adult trauma surgeons thought non-operative management of splenic injuries was complete baloney, but pediatric surgeons were more open-minded to the practice change. — David Wesson, History Of Non Operative Management for Splenic Injury with Dr. Wesson · 8:47
History Of Non Operative Management for Splenic Injury with Dr. Wesson
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Non operative management for traumatic injuries of the spleen is nothing earth shattering today but that's thanks in part to the work of Dr. David Wesson nearly 4 decades ago. In this episode, we go back in time to when Dr. Wesson and the p
podcast15:17 · Jun 2022
In adults, 2 centimeters is the cutoff for mesenteric vessel pseudoaneurysms at which intervention is typically considered, but the threshold for pediatric patients is unclear. Solid Organ Injury Rapid Fire Session: Update Course 2015 · 9:24
Solid Organ Injury Rapid Fire Session: Update Course 2015
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During the 3rd Annual Stay Current in Pediatric Surgery Update Course in 2015,Dr. Kenneth Azarow, Surgeon-in-Chief for Doernbecher Children’s Hospital, presents on solid organ injury protocol treatment based on hemodynamic stability, and ps
video10:11 · Jan 2019
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, Trauma Abdominal Cerrado con el Dr. Raphael Parrado · 4:50
Trauma Abdominal Cerrado con el Dr. Raphael Parrado
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¿Te pasa que tienes que repasar algo sobre una patología pero necesitas que sea rapido?
En esta serie de podcast en resumen te traemos la solución ya que repasamos los temas mas comunes de la cirugía pediátrica con expertos del tema
podcast18:34 · Sep 2023
Expert statements from the recordings in this collection.
Trauma Abdominal Cerrado con el Dr. Raphael Parrado
Blunt abdominal trauma represents 5% of cases in pediatric trauma
Raphael Parrado0:09
The spleen is the most commonly injured organ in pediatric blunt abdominal trauma, accounting for 40% of cases
Raphael Parrado0:50
Other organs injured include pancreas, kidney, and intestines
Raphael Parrado1:20
Seatbelt sign on inspection is an important finding in pediatric blunt abdominal trauma, associated with pelvic fractures and intra-abdominal injuries
Raphael Parrado2:20
FAST ultrasound is the most commonly implemented imaging study to determine presence or absence of free fluid in the abdomen
Raphael Parrado3:20
Laboratory studies for blunt abdominal trauma include renal panel, hematocrit, amylase, and aminotransferase
Raphael Parrado4:00
Amylase greater than 200 or elevated aminotransferase indicates need for CT imaging
Raphael Parrado4:30
PECARN (Pediatric Emergency Care Applied Research Network) criteria for CT imaging include Glasgow Coma Scale, abdominal examination findings, seatbelt sign, and thoracic trauma
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 Parrado6:20
Non-operative management protocol includes crystalloid fluid limit, serial hemoglobin checks to determine transfusion need
Raphael Parrado7:30
Renal injuries with hematuria can be observed, with monitoring for worsening hematuria as indication for intervention
Raphael Parrado8:40
Grade 3, 4, and 5 solid organ injuries can be observed in many institutions if patient remains hemodynamically stable
Raphael Parrado9:20
Indications for operative intervention include peritonitis, free air, and hemodynamic instability
Raphael Parrado10:50
Transfusion threshold for operative consideration is 40 mL/kg of crystalloid or 40 mL/kg of packed red blood cells
Raphael Parrado11:20
Laparotomy incision extends from inferior border of pubis to xiphoid process
Raphael Parrado13:00
Most common injury grades requiring surgery are grades 4 and 5, though grade 3 may also require intervention
Raphael Parrado13:30
Initial surgical steps include packing anterior and posterior abdomen for hemorrhage control
Raphael Parrado14:00
Hemostatic techniques include use of non-permanent coagulation sutures and large figure-of-eight sutures
Raphael Parrado14:30
Anatomic resection is preferred when patient is hemodynamically stable; non-anatomic resection with stapler may be used for ongoing hemorrhage
Raphael Parrado15:00
Most common procedures performed are splenectomy and bowel resection
Raphael Parrado16:00
For arterial pulsatile bleeding versus diffuse venous bleeding, surgeon should pack and return for re-exploration at 24 hours
Raphael Parrado16:20
Damage control surgery with packing is appropriate when patient is hemodynamically unstable despite resuscitation
Raphael Parrado17:00
Transfusion-related complications include hemodynamic instability and pulmonary edema
Raphael Parrado17:30
Patients require monitoring in ICU to ensure adequate fluid removal without complete depletion
Raphael Parrado17:50
Important complications include peritonitis, infectious complications, and overwhelming post-splenectomy sepsis (OPSS), which can be fatal
Raphael Parrado18:10
Post-splenectomy vaccines are given at 2 weeks after surgery
Raphael Parrado18:40
Follow-up includes monitoring for hematoma or fluid collections
Raphael Parrado19:00
History Of Non Operative Management for Splenic Injury with Dr. Wesson
ATOMAC guidelines state that grade doesn't matter for splenic injury management; decision-making is based on clinical concern, and if hemodynamically normal and stable, admit to the floor with regular diet and out of bed as tolerated, then discharge after two stable hemoglobins.
Host summaryEm Gootee summarizes what Dr. David Wesson said — not the host's own clinical position2:05
In 1909, Dr. Coker wrote that if the spleen is injured it should be removed, and that was the only treatment.
David Wesson2:52
In 1909 there were no ICUs, no blood available, no way to maintain an IV, no monitored beds, no oxygen delivery, and no imaging, so surgeons only had clinical grounds to work with.
Host summaryEm Gootee summarizes what Dr. David Wesson said — not the host's own clinical position2:52