Gunshot wound

[SCCBCCAK]

For the purpose of step 2/ surgical shelf, gunshot wound to the abdomen if hemodynamically stable, do you go straight to ex lap or get a CT first?
If the question stem already mentioned that CT was obtained, and patient is stable, I think you still go to ex lap anyway

---

Members don't see this ad.

 

[CherryRedDracul]

If hemodynamically stable, CT first because it can delineate which organs are injured and assist with preoperative planning. If the patient is crashing, there's no time to beat around the bush and you go towards ex-lap and other resuscitative efforts.

There can still be a role for nonoperative management, particularly for low velocity and low-caliber gunshot wounds to the right upper quadrant/liver. That I know is cover in Pestana's notes (which I highly, highly recommend for the surgery shelf). There is also a gray area where some surgeons would try nonoperative management in a closely monitored setting and others would err on the side of caution and proceed with ex-lap anyway. Controversial and contentious points about management, however, won't show up on the shelf or the Steps.

 

[TomC727]

For the purpose of step 2/ surgical shelf, gunshot wound to the abdomen if hemodynamically stable, do you go straight to ex lap or get a CT first?
If the question stem already mentioned that CT was obtained, and patient is stable, I think you still go to ex lap anyway

You should start with and X-ray first with markers on the hole(s) to locate the bullet(s). CT scans are reserved for stable patients with no abdominal pain with trajectories that likely don’t enter the abdomen or RUQ trajectories where only liver may be injured.

For a shelf exam, the safe answer is to operate. Sending an abdominal GSW to CT is an aggressive move unless trauma is your specialty.

 

[TypeADissection]

I can't remember the last time we took a chest/abdominal GSW to CT. If anything we do an eFAST, CXR, get him lined up and zip him open.

 

[smoke4joy]

My answer is CT first, of course.