For this week’s Wednesday Wrap-up, I want to discuss the issue of the pan-scan in blunt abdominal trauma. Dr. Morley gave a great review of the evidence in the literature. This topic is very controversial and you will hear many differing opinions not just between EM and trauma surgery but also within our specialty on this topic. I think it is important to remember that we have great decision rules to help guide us when it comes to whether or not to scan the head or cervical spine and we should use them. The tough choice comes when deciding to scan the chest/abdomen/pelvis. I really enjoyed the review of the use of chest ultrasound in blunt trauma and think it should definitely be the standard. Admittedly, I don’t use it as often as I should.
But, I wanted to discuss further under what circumstances you think an abdominal CT should be performed after blunt abdominal trauma. If a patient is alert, not intoxicated with a reliable exam that is benign and FAST negative, should they still receive a belly CT. Is the deciding factor mechanism? or a constellation of signs and symptoms and what are they? Is there a place for serial abdominal exams, serial FASTs, and observation? I would love to hear what others’ opinions are regarding this issue and what your practice is. I know when trauma surgery gets involved the patient is pretty much guaranteed a pan-scan. Please leave your thoughts below.
Thanks,
JK
Jay Khadpe MD
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