Trauma Guideline Manual - SUNY Upstate Medical University

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150____________ Trauma Guidelines ManualSUNY Upstate Trauma CenterPROCEDURE GUIDELINES: DIAGNOSTIC PERITONEAL LAVAGE (TAP)OBJECTIVES:1. Provide the indications for a diagnostic peritoneal lavage (TAP).GUIDELINES:1. Indications:a) When a FAST exam can not be performed for technical reasons and the followingconditions exist:i. A hemodynamically unstable patient with an altered level of consciousness orpara/tetraplegia with the possibility of abdominal trauma.ii.Suspected abdominal trauma, associated with hemodynamic instability, especiallyif abdominal tenderness is present.iii. Unexplained fall in the hematocrit or unstable patient.b) Rapid triage in a mass casualty situation with limited resources.2. Contraindications:a) Previous midline abdominal incision.b) Obvious need for laparotomy.3. Procedure Percutaneous Peritoneal tapa) NG and Foley catheter unless absolutely contraindicated in unstable patient.b) The area below the umbilicus is prepped and draped appropriately.c) The midline area below the umbilicus is infiltrated with 1% xylocaine with epinephrine.d) Use the triple lumen CVL kite) Make a small nick in the skin below the umbilicus with the provided scalpel.f) Place the angiocath catheter from the kit on the aspirating syringe.g) Advance the catheter into thru the midline fascia at a 90 o angle to the abdomen.h) Once you feel the pressure release aspirate. If you can aspirate gross blood it isPOSITIVE. Remove the angiocath and proceed to the Operating room for laparotomy.i) If the aspiration is negative, remove the syringe and needle leaving the angiocath inplace.j) Using the guidewire and seldinger technique gently advance the CVLcatheter into theabdominal cavity.k) Repeat aspiration: If still NEGATIVE: major intra-bdominal bleeding is unlikely.l) CAVEAT: NEGATIVE aspiration can be a false positive. If in doubt OPERATE..
Trauma Guideline Manual______________SUNY Upstate Trauma Center151PROCEDURE GUIDELINES: PERICARDIOCENTESISOBJECTIVES:1. Provide indications for the performance of a pericardiocentesis and suxiphoid pericardialwindow.DEFINITIONS:Needle pericardiocentesis: A procedure in which a needle is placed into the pericardial sac toremove blood that has resulted in a pericardial tamponade.Subxiphoid pericardial window: An emergency surgical procedure to diagnose pericardialtamponade and decompress blood from within the pericardium.GUIDELINES:1. Needle pericardiocentesis:a. Indications:i. Evidence of cardiac tamponade in the face of deteriorating vital signs:a) FAST pericaridial view positive with hypotensionb) Distended neck veins with blue facies.c) CVP (if measurable) >20 mmHg.d) Narrowed pulse pressure with other source of bleeding.e) No other explanation of hypotensionii. Consider when there is a penetrating injury to the chest between nipples.iii. This is not a primary diagnostic procedure (i.e., don’t do it when the vital signs arenormal).iv. Consider ultrasound as primary diagnostic modality for pericardial tamponade.b. Procedure:i. If positive:Notify the OR immediately and being making preparations to transfer tothe OR for median sternotomy.c. Complications:i. Aspiration of ventricular blood rather than pericardial blood.ii. Laceration of coronary artery or vein.iii. Laceration of myocardium.iv. Hematoma.v. Pneumothorax.vi. Infection.
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Trauma Guideline Manual - SUNY Upstate Medical University

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