![]() ![]() This view is now changing, and stable patients with gunshot wounds with no signs of peritonitis who have been evaluated by a triple contrast CT scan may be observed if there is no evidence of intra-abdominal injury. After the ABCs are completed, most gunshot patients require an exploratory laparotomy. In most hospitals, penetrating trauma is handled by a trauma team. Other imaging tests may be done to assess for any associated head or skeletal injury. The diagnostic test of choice is a triple contrast CT scan in hemodynamically stable patients. CT scan is used in patients with wounds of the flank and back and can help assess solid organ injury. The use of DPL and FAST can be performed to assess the stable patient with a knife or gunshot wound, but both these modalities have a high rate of false negatives. Blood work is always done but is nonspecific. ![]() Many protocols exist for evaluating patients with a stab wound to the abdomen. Knife wounds are associated with a lower incidence of intra-abdominal injury, and hence, their work-up requires clinical judgment and experience. In general, gunshots to the abdomen are usually associated with hollow viscus injury and usually require exploration. The approach to patients with penetrating abdominal trauma depends on the type of instrument that caused the injury and hemodynamic status. Examination in awake patients may reveal signs of peritonitis such as guarding or rebound tenderness. The presentation of a patient with penetrating abdominal injury may reveal shock, hypotension, narrow pulse pressure, tachypnea, oliguria, and an apparent trajectory or open wound. ![]()
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