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.
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