Safety Pearls and Pitfalls
- The presence of a physiologically normal patient does not exclude significant intra-abdominal injury.
- Intoxication, head injury or distracting injuries may make clinical assessment of the abdomen unreliable.
- An unconscious, anaesthetised or spinally-injured patient will not display signs of guarding.
- Flank injuries may produce retroperitoneal injury to the kidneys or bowel without any initial symptoms. Damage to this area should prompt a search for such injuries.
- Intraperitoneal blood will not produce signs of peritonitis.
- A high-risk mechanism of injury dictates that a patient should be admitted and re-examined over several hours.
- Always expose and inspect the entire patient. Just because you have found one stab wound doesn’t mean there’s not another one.
- Beware of penetrating buttock injuries
- If there is an implement still in situ, leave it alone.