Safety Pearls and Pitfalls

The presence of a physiologically normal patient does not exclude significant intra-abdominal injury.
Intoxication, head injury or distracting injuries may make clinical assessment of the abdomen unreliable.
An unconscious, anaesthetised or spinally-injured patient will not display signs of guarding.
Flank injuries may produce retroperitoneal injury to the kidneys or bowel without any initial symptoms. Damage to this area should prompt a search for such injuries.
Intraperitoneal blood will not produce signs of peritonitis.
A high-risk mechanism of injury dictates that a patient should be admitted and re-examined over several hours.
Always expose and inspect the entire patient. Just because you have found one stab wound doesn’t mean there’s not another one.
Beware of penetrating buttock injuries
If there is an implement still in situ, leave it alone.