{"id":59313,"date":"2024-03-04T14:56:00","date_gmt":"2024-03-04T17:56:00","guid":{"rendered":"https:\/\/med.estrategia.com\/portal\/?p=59313"},"modified":"2024-03-04T16:35:51","modified_gmt":"2024-03-04T19:35:51","slug":"caso-clinico-de-trauma-abdominal-avaliacao-fluxograma-e-mais","status":"publish","type":"post","link":"https:\/\/med.estrategia.com\/portal\/conteudos-gratis\/casos-clinicos\/caso-clinico-de-trauma-abdominal-avaliacao-fluxograma-e-mais\/","title":{"rendered":"Caso cl\u00ednico de Trauma Abdominal: avalia\u00e7\u00e3o, fluxograma e mais!\u00a0"},"content":{"rendered":"<p><strong>Ol&aacute;, meu Doutor e minha Doutora!<\/strong> As les&otilde;es abdominais n&atilde;o diagnosticadas continuam sendo uma causa de morte evit&aacute;vel ap&oacute;s um trauma. O desconhecimento ou atraso na identifica&ccedil;&atilde;o dessas les&otilde;es pode resultar em complica&ccedil;&otilde;es graves e at&eacute; mesmo fatais. Acompanhe comigo o seguinte caso cl&iacute;nico e algumas dicas para te auxiliar na prova e, na pr&aacute;tica, em um atendimento de trauma abdominal.&nbsp;<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_79_2 counter-hierarchy ez-toc-counter ez-toc-transparent ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\"><p class=\"ez-toc-title\" style=\"cursor:inherit\">Navegue pelo conte\u00fado<\/p>\n<\/div><nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/med.estrategia.com\/portal\/conteudos-gratis\/casos-clinicos\/caso-clinico-de-trauma-abdominal-avaliacao-fluxograma-e-mais\/#Apresentacao-do-Caso-Clinico\" >Apresenta&ccedil;&atilde;o do Caso Cl&iacute;nico<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/med.estrategia.com\/portal\/conteudos-gratis\/casos-clinicos\/caso-clinico-de-trauma-abdominal-avaliacao-fluxograma-e-mais\/#Hipoteses-diagnosticas\" >Hip&oacute;teses diagn&oacute;sticas<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/med.estrategia.com\/portal\/conteudos-gratis\/casos-clinicos\/caso-clinico-de-trauma-abdominal-avaliacao-fluxograma-e-mais\/#Exames-fisicos\" >Exames f&iacute;sicos<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/med.estrategia.com\/portal\/conteudos-gratis\/casos-clinicos\/caso-clinico-de-trauma-abdominal-avaliacao-fluxograma-e-mais\/#Diagnostico-e-Tratamento\" >Diagn&oacute;stico e Tratamento<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/med.estrategia.com\/portal\/conteudos-gratis\/casos-clinicos\/caso-clinico-de-trauma-abdominal-avaliacao-fluxograma-e-mais\/#Definicao-de-Trauma-Abdominal\" >Defini&ccedil;&atilde;o de Trauma Abdominal&nbsp;&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/med.estrategia.com\/portal\/conteudos-gratis\/casos-clinicos\/caso-clinico-de-trauma-abdominal-avaliacao-fluxograma-e-mais\/#Orgaos-Mais-Acometidos-no-Trauma-Abdominal\" >&Oacute;rg&atilde;os Mais Acometidos&nbsp;no Trauma Abdominal<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/med.estrategia.com\/portal\/conteudos-gratis\/casos-clinicos\/caso-clinico-de-trauma-abdominal-avaliacao-fluxograma-e-mais\/#Exames-Diagnosticos-no-Trauma-Abdominal\" >Exames Diagn&oacute;sticos no Trauma Abdominal&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/med.estrategia.com\/portal\/conteudos-gratis\/casos-clinicos\/caso-clinico-de-trauma-abdominal-avaliacao-fluxograma-e-mais\/#Fluxograma-de-Avaliacao-do-Trauma-Abdominal\" >Fluxograma de Avalia&ccedil;&atilde;o do Trauma Abdominal&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/med.estrategia.com\/portal\/conteudos-gratis\/casos-clinicos\/caso-clinico-de-trauma-abdominal-avaliacao-fluxograma-e-mais\/#Questoes-para-orientar-o-caso-clinico-de-Trauma-Abdominal\" >Quest&otilde;es para orientar o caso cl&iacute;nico de Trauma Abdominal<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/med.estrategia.com\/portal\/conteudos-gratis\/casos-clinicos\/caso-clinico-de-trauma-abdominal-avaliacao-fluxograma-e-mais\/#Respostas\" >Respostas<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/med.estrategia.com\/portal\/conteudos-gratis\/casos-clinicos\/caso-clinico-de-trauma-abdominal-avaliacao-fluxograma-e-mais\/#Questao-de-prova-sobre-Trauma-Abdominal\" >Quest&atilde;o de prova sobre Trauma Abdominal<\/a><\/li><\/ul><\/nav><\/div>\n<h2 class=\"wp-block-heading\" id=\"h-apresentacao-do-caso-clinico\"><span class=\"ez-toc-section\" id=\"Apresentacao-do-Caso-Clinico\"><\/span><strong>Apresenta&ccedil;&atilde;o do Caso Cl&iacute;nico<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2><p>Carlos Santos, um homem de 28 anos, foi admitido &agrave;s pressas &agrave; emerg&ecirc;ncia ap&oacute;s ser esfaqueado durante uma tentativa de assalto. Ele apresenta sinais de dor intensa no abdome, sangramento vis&iacute;vel e dificuldade respirat&oacute;ria.<\/p><h3 class=\"wp-block-heading\" id=\"h-identificacao-do-paciente\">Identifica&ccedil;&atilde;o do paciente<\/h3><p><strong>Nome<\/strong>: Carlos Santos&nbsp;<\/p><p><strong>Idade<\/strong>: 28 anos&nbsp;<\/p><p><strong>Localidade<\/strong>: Rio de Janeiro&ndash;RJ&nbsp;<\/p><p><strong>Profiss&atilde;o<\/strong>: Uber<\/p><p><strong>Estado Civil<\/strong>: Solteiro&nbsp;<\/p><h3 class=\"wp-block-heading\" id=\"h-queixa-principal-qp\">Queixa principal (QP)<\/h3><p>Dor abdominal intensa, sangramento vis&iacute;vel e dificuldade respirat&oacute;ria ap&oacute;s les&atilde;o por arma branca.&nbsp;<\/p><h3 class=\"wp-block-heading\" id=\"h-historico-da-molestia-atual-hma-nbsp\">Hist&oacute;rico da mol&eacute;stia atual (HMA)&nbsp;<\/h3><p>Carlos sofreu uma tentativa de assalto quando foi esfaqueado na regi&atilde;o abdominal. Ele come&ccedil;ou imediatamente a sentir dor intensa e notou sangramento significativo.<\/p><h3 class=\"wp-block-heading\" id=\"h-historia-familiar-hf-nbsp\">Hist&oacute;ria familiar (HF)&nbsp;<\/h3><p>N&atilde;o h&aacute; hist&oacute;rico significativo na hist&oacute;ria familiar.<\/p><h3 class=\"wp-block-heading\" id=\"h-historia-social-hs\">Hist&oacute;ria social (HS)<\/h3><p>Carlos trabalha como Uber, n&atilde;o tem hist&oacute;rico significativo de alergias ou condi&ccedil;&otilde;es m&eacute;dicas preexistentes. Seu hist&oacute;rico social inclui relatos de eventos traum&aacute;ticos recentes.<\/p><h2 class=\"wp-block-heading\" id=\"h-hipoteses-diagnosticas\"><span class=\"ez-toc-section\" id=\"Hipoteses-diagnosticas\"><\/span>Hip&oacute;teses diagn&oacute;sticas<span class=\"ez-toc-section-end\"><\/span><\/h2><p>Considerando o quadro cl&iacute;nico de Carlos, as hip&oacute;teses diagn&oacute;sticas podem incluir:&nbsp;<\/p><ul class=\"wp-block-list\">\n<li>Perfura&ccedil;&atilde;o de &oacute;rg&atilde;os abdominais (intestino, est&ocirc;mago, etc.).&nbsp;<\/li>\n\n\n\n<li>Les&otilde;es em vasos sangu&iacute;neos abdominais.&nbsp;<\/li>\n\n\n\n<li>Poss&iacute;veis complica&ccedil;&otilde;es como hemorragia interna.<\/li>\n<\/ul><h2 class=\"wp-block-heading\" id=\"h-exames-fisicos\"><span class=\"ez-toc-section\" id=\"Exames-fisicos\"><\/span>Exames f&iacute;sicos<span class=\"ez-toc-section-end\"><\/span><\/h2><h3 class=\"wp-block-heading\" id=\"h-sinais-vitais-nbsp\">Sinais Vitais&nbsp;<\/h3><figure class=\"wp-block-table is-style-regular\"><table class=\"has-black-color has-white-background-color has-text-color has-background has-link-color\"><tbody><tr><td><strong>Par&acirc;metro<\/strong><\/td><td><strong>Resultado<\/strong><\/td><\/tr><tr><td><strong>Press&atilde;o Arterial<\/strong><\/td><td>90\/60 mmHg<\/td><\/tr><tr><td><strong>Frequ&ecirc;ncia Card&iacute;aca<\/strong><\/td><td>130 bpm<\/td><\/tr><tr><td><strong>Frequ&ecirc;ncia Respirat&oacute;ria<\/strong><\/td><td>28 rpm<\/td><\/tr><tr><td><strong>Temperatura Corporal<\/strong><\/td><td>36,8&#8239;&deg;C<\/td><\/tr><tr><td><strong>Satura&ccedil;&atilde;o de Oxig&ecirc;nio<\/strong><\/td><td>94%<\/td><\/tr><\/tbody><\/table><\/figure><p><strong>A: <\/strong>Via a&eacute;rea p&eacute;rvia, colocado colar cervical;&nbsp;<\/p><p><strong>B: <\/strong>Murm&uacute;rio vesicular fisiol&oacute;gico sem ru&iacute;dos advent&iacute;cios, FR 28irpm, SatO2 94%;&nbsp;<\/p><p><strong>C: <\/strong>Bulhas r&iacute;tmicas e normofon&eacute;ticas, FC 130bpm, PA 90\/60mmHg, hipocorado ++\/4+;&nbsp;<\/p><p><strong>D: <\/strong>Escala de coma de Glasgow =15, pupilas isoc&oacute;ricas e fotorreagentes;&nbsp;<\/p><p><strong>E: <\/strong>Abdome doloroso &agrave; palpa&ccedil;&atilde;o com ferimento penetrante de 3 cm em hipog&aacute;strio. Aus&ecirc;ncia de outras les&otilde;es.<\/p><div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img decoding=\"async\" width=\"283\" height=\"359\" src=\"https:\/\/med.estrategia.com\/portal\/wp-content\/uploads\/2024\/03\/Capturar-1.jpg\" alt=\"\" class=\"wp-image-59316\"><\/figure><\/div><h3 class=\"wp-block-heading\">Exames Complementares<\/h3><p>FAST realizado na sala de emerg&ecirc;ncia positivo em janela hepatorrenal.&nbsp;<\/p><h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Diagnostico-e-Tratamento\"><\/span>Diagn&oacute;stico e Tratamento<span class=\"ez-toc-section-end\"><\/span><\/h2><p>Com base nos dados fornecidos, incluindo a hist&oacute;ria cl&iacute;nica, exame f&iacute;sico e avalia&ccedil;&atilde;o dos exames, Carlos Santos apresenta trauma abdominal aberto com instabilidade hemodin&acirc;mica. Ele &eacute; encaminhado para laparotomia de emerg&ecirc;ncia para reparo dos &oacute;rg&atilde;os afetados e controle do sangramento, al&eacute;m de reposi&ccedil;&atilde;o de hemocomponentes.&nbsp;<\/p><h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Definicao-de-Trauma-Abdominal\"><\/span>Defini&ccedil;&atilde;o de Trauma Abdominal&nbsp;&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2><p>O trauma abdominal refere-se a les&otilde;es de origem traum&aacute;tica resultantes de for&ccedil;as externas diretas ou indiretas que afetam a regi&atilde;o do abdome. Essas les&otilde;es podem envolver &oacute;rg&atilde;os internos, vasos sangu&iacute;neos, m&uacute;sculos, ossos e tecidos circundantes. O trauma abdominal pode resultar de uma variedade de eventos, como acidentes automobil&iacute;sticos, quedas, ferimentos por arma de fogo ou arma branca, entre outros.&nbsp;<\/p><p>Podemos dividir o trauma abdominal em duas partes: trauma abdominal fechado ou contuso e trauma abdominal aberto ou penetrante.&nbsp;<\/p><h2 class=\"wp-block-heading\" id=\"h-orgaos-mais-acometidos-nbsp-no-trauma-abdominal\"><span class=\"ez-toc-section\" id=\"Orgaos-Mais-Acometidos-no-Trauma-Abdominal\"><\/span>&Oacute;rg&atilde;os Mais Acometidos&nbsp;no Trauma Abdominal<span class=\"ez-toc-section-end\"><\/span><\/h2><p><strong>Trauma abdominal fechado<\/strong>: os &oacute;rg&atilde;os mais acometidos s&atilde;o o ba&ccedil;o (40 a 55%), seguido pelo f&iacute;gado (35% a 45%), e o intestino delgado (5 a 10%).&nbsp;<\/p><p><strong>Trauma abdominal aberto por arma de fogo<\/strong>: intestino delgado (50%), c&oacute;lon (40%), f&iacute;gado (30%) e estruturas vasculares abdominais (25%).<\/p><p><strong>Trauma abdominal aberto por arma branca<\/strong>: f&iacute;gado (40%), intestino delgado (30%), diafragma (20%) e c&oacute;lon (15%).<\/p><h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Exames-Diagnosticos-no-Trauma-Abdominal\"><\/span>Exames Diagn&oacute;sticos no Trauma Abdominal&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2><p><strong>FAST<\/strong>: O FAST &eacute; um dos dois exames diagn&oacute;sticos mais r&aacute;pidos utilizados para identificar hemorragia. O Ultrassom deve ser obtido do saco pericardial (1), do espa&ccedil;o hepatorrenal (2), do espa&ccedil;o esplenorrenal (3) e da pelve (4) ou fundo de saco de Douglas.<\/p><div class=\"wp-block-image\">\n<figure class=\"aligncenter\"><img decoding=\"async\" width=\"374\" height=\"350\" src=\"https:\/\/med.estrategia.com\/portal\/wp-content\/uploads\/2024\/03\/image.jpg\" alt=\"\" class=\"wp-image-59332\"><figcaption class=\"wp-element-caption\">Janelas FAST. ATLS<\/figcaption><\/figure><\/div><p><strong>Lavagem Peritoneal Diagn&oacute;stica<\/strong>: a LPD &eacute; o outro exame r&aacute;pido para identificar hemorragia. &Eacute; mais invasiva e necessita de experi&ecirc;ncia cir&uacute;rgica.&nbsp;&nbsp;<\/p><div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full is-resized\"><img decoding=\"async\" width=\"456\" height=\"508\" src=\"https:\/\/med.estrategia.com\/portal\/wp-content\/uploads\/2024\/03\/Capturar-2.jpg\" alt=\"\" class=\"wp-image-59334\" style=\"aspect-ratio:1;width:526px;height:auto\"><figcaption class=\"wp-element-caption\">LPD<\/figcaption><\/figure><\/div><p><strong>Tomografia computadorizada<\/strong>: a TC &eacute; o melhor exame diagn&oacute;stico, com maior sensibilidade e especificidade, devendo ser realizado de prefer&ecirc;ncia com contraste endovenoso. O exame pode evidenciar se h&aacute; sangramento ativo, avaliar les&otilde;es retroperitoneais inacess&iacute;veis ao FAST e ao LPD, e definir o tratamento conservador de algumas les&otilde;es de v&iacute;sceras maci&ccedil;as.<\/p><h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Fluxograma-de-Avaliacao-do-Trauma-Abdominal\"><\/span>Fluxograma de Avalia&ccedil;&atilde;o do Trauma Abdominal&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2><p>Acompanhe o fluxograma com as principais indica&ccedil;&otilde;es dos exames diagn&oacute;sticos:&nbsp;<\/p><figure class=\"wp-block-table alignwide is-style-regular\"><table class=\"has-black-color has-white-background-color has-text-color has-background has-link-color\"><tbody><tr><td class=\"has-text-align-center\" data-align=\"center\" rowspan=\"4\"><strong>Penetrante<\/strong><\/td><td class=\"has-text-align-center\" data-align=\"center\" colspan=\"2\">Arma de Fogo&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">Laparotomia<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\" rowspan=\"3\">Arma Branca<\/td><td class=\"has-text-align-center\" data-align=\"center\">Instabilidade Hemodin&acirc;mica<\/td><td class=\"has-text-align-center\" data-align=\"center\">Laparotomia<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\" rowspan=\"2\">Estabilidade Hemodin&acirc;mica<\/td><td class=\"has-text-align-center\" data-align=\"center\">Sem les&atilde;o peritoneal: Sutura, vacina antitet&acirc;nica e alta&nbsp;<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Com les&atilde;o peritoneal: observar por 24h<\/td><\/tr><\/tbody><\/table><\/figure><figure class=\"wp-block-table alignwide is-style-regular\"><table class=\"has-black-color has-white-background-color has-text-color has-background has-link-color\"><tbody><tr><td class=\"has-text-align-center\" data-align=\"center\" rowspan=\"4\"><br><strong>Fechado&nbsp;<\/strong><\/td><td class=\"has-text-align-center\" data-align=\"center\" rowspan=\"2\">Instabilidade Hemodin&acirc;mica<\/td><td class=\"has-text-align-center\" data-align=\"center\">Somente abd&ocirc;men: laparotomia<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Politrauma: FAST ou LPD<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\" rowspan=\"2\">Estabilidade Hemodin&acirc;mica<\/td><td class=\"has-text-align-center\" data-align=\"center\" rowspan=\"2\">TC<\/td><\/tr><\/tbody><\/table><\/figure><figure class=\"wp-block-table alignwide is-style-regular\"><table class=\"has-black-color has-white-background-color has-text-color has-background has-link-color\"><tbody><tr><td class=\"has-text-align-center\" data-align=\"center\" rowspan=\"5\"><strong>Indica&ccedil;&otilde;es de Laparotomia Imediata No Trauma Abdominal Aberto<\/strong>&nbsp;<\/td><td class=\"has-text-align-center\" data-align=\"center\">Ferimento por arma de fogo na regi&atilde;o abdominal anterior (trajeto transperitoneal)&nbsp;<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Instabilidade hemodin&acirc;mica<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Eviscera&ccedil;&atilde;o<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Irrita&ccedil;&atilde;o peritoneal<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Sangramento gastrointestinal (observado na sonda nasog&aacute;strica ou retal) ou do trato geniturin&aacute;rio<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\" rowspan=\"6\"><strong>Indica&ccedil;&otilde;es de Laparotomia Imediata No Trauma Abdominal Fechado<\/strong><\/td><td class=\"has-text-align-center\" data-align=\"center\">Trauma abdominal com dor e irrita&ccedil;&atilde;o abdominal;<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Paciente inst&aacute;vel com FAST ou LPD positivos<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Pneumoperit&ocirc;nio, retropneumoperit&ocirc;nio<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Evid&ecirc;ncia de ruptura diafragm&aacute;tica<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">Sangramento gastrointestinal persistente e significativo observado na drenagem nasog&aacute;strica ou v&ocirc;mito (hemat&ecirc;mese) ou sangramento retal;<\/td><\/tr><tr><td class=\"has-text-align-center\" data-align=\"center\">TC de abdome revelando les&atilde;o do trato gastrointestinal, les&atilde;o vesical intraperitoneal, les&atilde;o de ped&iacute;culo renal e les&atilde;o parenquimatosa grave.<\/td><\/tr><\/tbody><\/table><\/figure><figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<div class=\"cs-embed cs-embed-responsive\"><iframe title=\"Trauma Abdominal e P&eacute;lvico - Aula de Cirurgia do Curso Intensivo Resid&ecirc;ncia M&eacute;dica\" width=\"1200\" height=\"675\" src=\"https:\/\/www.youtube.com\/embed\/H0CtK0_7Cuw?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" allowfullscreen><\/iframe><\/div>\n<\/div><\/figure><h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Questoes-para-orientar-o-caso-clinico-de-Trauma-Abdominal\"><\/span>Quest&otilde;es para orientar o caso cl&iacute;nico de Trauma Abdominal<span class=\"ez-toc-section-end\"><\/span><\/h2><ol class=\"wp-block-list\">\n<li>Qual a prioridade na avalia&ccedil;&atilde;o inicial de um paciente com trauma abdominal?&nbsp;<\/li>\n<\/ol><ol class=\"wp-block-list\" start=\"2\">\n<li>Quais os &oacute;rg&atilde;os mais afetados no trauma abdominal aberto por arma branca?&nbsp;<\/li>\n<\/ol><ol class=\"wp-block-list\" start=\"3\">\n<li>Quais as janelas avaliadas no FAST?&nbsp;<\/li>\n<\/ol><ol class=\"wp-block-list\" start=\"4\">\n<li>Quais as indica&ccedil;&otilde;es de laparotomia imediata no trauma abdominal aberto?&nbsp;<\/li>\n<\/ol><ol class=\"wp-block-list\" start=\"5\">\n<li>Qual a conduta diante de um trauma penetrante por arma branca e instabilidade hemodin&acirc;mica?<\/li>\n<\/ol><h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Respostas\"><\/span>Respostas<span class=\"ez-toc-section-end\"><\/span><\/h2><ol class=\"wp-block-list\">\n<li>Avaliar a necessidade de tratamento cir&uacute;rgico imediato, ou seja, uma laparotomia exploradora.&nbsp;<\/li>\n<\/ol><ol class=\"wp-block-list\" start=\"2\">\n<li>F&iacute;gado (40%), intestino delgado (30%), diafragma (20%) e c&oacute;lon (15%).<\/li>\n<\/ol><ol class=\"wp-block-list\" start=\"3\">\n<li>Saco pericardial (1), espa&ccedil;o hepatorrenal (2), espa&ccedil;o esplenorrenal (3) e pelve ou fundo de saco de Douglas (4).<\/li>\n<\/ol><ol class=\"wp-block-list\" start=\"4\">\n<li>Ferimento por arma de fogo na regi&atilde;o abdominal anterior (trajeto transperitoneal), instabilidade hemodin&acirc;mica, eviscera&ccedil;&atilde;o, irrita&ccedil;&atilde;o peritoneal e sangramento gastrointestinal (observado na sonda nasog&aacute;strica ou retal) ou do trato geniturin&aacute;rio.<\/li>\n<\/ol><ol class=\"wp-block-list\" start=\"5\">\n<li>Laparotomia exploradora.<\/li>\n<\/ol><h2 class=\"wp-block-heading\" id=\"h-questao-de-prova-sobre-trauma-abdominal\"><span class=\"ez-toc-section\" id=\"Questao-de-prova-sobre-Trauma-Abdominal\"><\/span>Quest&atilde;o de prova sobre Trauma Abdominal<span class=\"ez-toc-section-end\"><\/span><\/h2><p><em>SP &ndash; SECRETARIA MUNICIPAL DA SA&Uacute;DE DE S&Atilde;O PAULO &ndash; SMS 2024 4000211099 Um paciente de 30 anos de idade foi admitido na sala de emerg&ecirc;ncia ap&oacute;s colis&atilde;o do pr&oacute;prio carro contra um poste. Ele queixava-se de dor abdominal intensa e estava consciente ao longo de todo o atendimento. Ao exame f&iacute;sico, verificaram-se distens&atilde;o abdominal, equimoses na regi&atilde;o abdominal superior e dor &agrave; palpa&ccedil;&atilde;o profunda no quadrante superior direito. Os sinais vitais revelaram FC = 110 bpm, FR = 22 irpm, PA = 90 mmHg X 60 mmHg e temperatura = 37 &deg;C. Foram realizados exames de imagem, e a radiografia de abdome em dec&uacute;bito dorsal mostrou g&aacute;s livre no espa&ccedil;o subfr&ecirc;nico direito. O FAST demonstrou l&iacute;quido livre na cavidade peritoneal. Com base nesse caso cl&iacute;nico e nos exames realizados, assinale a alternativa que indica a conduta mais apropriada.&nbsp;<\/em><\/p><p><em>A. Observar o paciente e repetir os exames de imagem em 24 horas.&nbsp;<\/em><\/p><p><em>B. Realizar uma laparotomia explorat&oacute;ria imediatamente.&nbsp;<\/em><\/p><p><em>C. Realizar uma tomografia computadorizada abdominal com contraste oral e venoso.&nbsp;<\/em><\/p><p><em>D. Prescrever analg&eacute;sicos e esperar pela melhora dos sintomas.<\/em><\/p><p><em>E. Iniciar antibi&oacute;ticos de amplo espectro para prevenir infec&ccedil;&atilde;o.<\/em><\/p><h3 class=\"wp-block-heading\">Coment&aacute;rio:&nbsp;<\/h3><p>Estamos diante de um paciente v&iacute;tima de acidente automobil&iacute;stico com trauma abdominal fechado. Admitido com importante dor abdominal, taquicardia, hipotens&atilde;o arterial. FAST positivo e radiografia evidenciando g&aacute;s livre no espa&ccedil;o subfr&ecirc;nico direito, ou seja, pneumoperit&ocirc;nio, indica&ccedil;&atilde;o absoluta de laparotomia exploradora. <strong>Portanto, alternativa B<\/strong>.<\/p><h3 class=\"wp-block-heading\">Refer&ecirc;ncias:<\/h3><ol class=\"wp-block-list\">\n<li>American College of Surgeons Committee on Trauma. <strong>Advanced Trauma Life Support (ATLS)<\/strong> Student Course Manual, 10th ed, American College of Surgeons, Chicago 2018.<\/li>\n<\/ol><\/p>\n","protected":false},"excerpt":{"rendered":"Ol&aacute;, meu Doutor e minha Doutora! As les&otilde;es abdominais n&atilde;o diagnosticadas continuam sendo uma causa de morte evit&aacute;vel&hellip;\n","protected":false},"author":46,"featured_media":59314,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"wl_entities_gutenberg":"","footnotes":""},"categories":[303],"tags":[768,785],"wl_entity_type":[199],"class_list":{"0":"post-59313","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-casos-clinicos","8":"tag-caso-clinico","9":"tag-trauma-abdominal","10":"wl_entity_type-article"},"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v26.6 (Yoast SEO v26.6) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Caso cl\u00ednico de Trauma Abdominal: avalia\u00e7\u00e3o, fluxograma e mais!\u00a0<\/title>\n<meta name=\"description\" content=\"Carlos Santos, um homem de 28 anos, foi admitido \u00e0s pressas \u00e0 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