I want to pass along information that really changes what you do when a patient is in front of you. Now, we’re continuing our series on the ACEP guidelines. These policies give us tools on how to approach patients. The American College of Emergency Physicians sets the standard for extraordinary patient care. These standards are evidence-based and consensus-based. This is how we should practice as advanced practitioners.
We’re going to continue today with blunt abdominal trauma. My hope is that this review helps you use the ACEP guidelines for blunt abdominal trauma at a higher level.
ACEP Inclusion Criteria for Blunt Abdominal Trauma
The inclusion criteria are adults with blunt abdominal trauma. Excluded are pregnant females and pediatric patients.
Diagnosing Blunt Abdominal Trauma
The ACEP says the best screening test in the ED for an unstable patient with blunt abdominal trauma is the ultrasound. Is there any problem with that? There is for me because I’m not trained in ultrasound. And I work critical accident emergency medicine where I don’t have ultrasound as a modality. In this case, they’re recommending CT with IV contrast. Oral contrast did not show any additional diagnostic benefit.
If you have a high clinical suspicion of bowel injury, but a negative CAT scan, the patient needs further workup or further evaluation. With low-risk patients, you can maybe get away without a CAT scan, but there are a couple of things that have to be present. There needs to be a soft belly that’s not tender. They can’t be hypotensive. They have to be alert with a Glasgow Coma Scale of 15. They can’t have any costal margin tenderness. They have to have a normal chest x-ray. They can’t be anemic. The last thing you need to look for is hematuria. If they have blood in their urine, it’s a different story.
Can we avoid a scan? Yes, if their belly’s soft, their H and H is fine, they’re not hypotensive, they’re alert and oriented, and they have a normal chest x-ray with no blood in their urine. That demands you do a urinalysis.
How do you have a disposition of blunt abdominal trauma? If they’re sick, they need surgery. Can we discharge them? Yes, if they have a negative CAT scan with contrast and they’re clinically stable.