Step II DPL vs. FAST Scan vs. CT Scan vs. Laparotomy

[Pox in a box]

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I've come to the conclusion that I'm not sure when to order DPL (diagnostic peritoneal lavage). You do laparotomy if there is hemodynamic instability in abdominal trauma, you do a CT or FAST if the patient is stable, but when do you perform a DPL?

 

[quinsy]

I've come to the conclusion that I'm not sure when to order DPL (diagnostic peritoneal lavage). You do laparotomy if there is hemodynamic instability in abdominal trauma, you do a CT or FAST if the patient is stable, but when do you perform a DPL?

You do the DPL when you suspect there might be a tiny little bleed somewhere that wouldn't be picked up by the CT or ultrasound. The DPL would show even a tiny amount of blood. For example the guy has been in an MVA and the FAST was negative, but he has some peritoneal signs and hematocrit is decreasing little by little. I don't know if that's a crappy example or not, but I think this is the concept, correct me if I'm wrong.

 

[deleted109597]

You also do a DPL for those instances when you can't take them to CT, and don't have FAST available. DPL has gone by the wayside.

I must say, you are seriously asking some way out there questions when it comes to Step II.

 

[lattimer13]

according to our trauma surgeons it's FAST, CT and laparotomy...DPL no longer fits into the decision making.

never once did it come up on step 2 ck, nor do i remember it coming up during studying.

 

[Pox in a box]

according to our trauma surgeons it's FAST, CT and laparotomy...DPL no longer fits into the decision making.

never once did it come up on step 2 ck, nor do i remember it coming up during studying.

I have seen it on the NBME surgery shelf, in Surgery Recall, and USMLEWorld. Thanks for your help.

 

[Pox in a box]

You also do a DPL for those instances when you can't take them to CT, and don't have FAST available. DPL has gone by the wayside.

I must say, you are seriously asking some way out there questions when it comes to Step II.

Thanks buddy. Good explanation. I feel like learning by understanding is key to committing something to memory. That, and repetition.

 

[quinsy]

Thanks buddy. Good explanation. I feel like learning by understanding is key to committing something to memory. That, and repetition.

I agree, understanding is better. And even though I don't think DPL is often if ever used, it's all over the UW questions, so I thought it was prudent to know about it. If the USMLE only tested stuff that was common or important, it would be an easy test.