NBME Step 2 CK Form 6 Laparotomy (NBME Answers)

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NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 2/Question#5 (reveal difficulty score)
A 37-year-old man is brought to the emergency ...
Laparotomy 🔍 / 📺 / 🌳 / 📖
tags: GI

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submitted by ∗step_prep7(71)

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Indications for urgent exploratory laparotomy (ex-lap) in setting of penetrating abdominal trauma includes (1) Hemodynamic instability (which this patient has) (2) Peritonitis (rebound, guarding) (3) Evisceration (externally exposed organs) (4) Blood from NG tube or on rectal exam
Note: If patient has no indications for immediate ex-lap, then next step would be local exploration of the wound and an extended FAST scan

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submitted by ∗tinylilron(57)

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The patient is relatively stable? Couldn't we do an abdominal CT scan before we do the laparotomy?

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drmohandes Already did CXR and saw air in abdomen. That is not a good sign, likely something perforated. Emergency surgery for this dude. +1

drmohandes Also he's not that stable (100 F, low BP, tachycardic, leukocytosis) with rigid abdomen, pain, acute distress, etc. +2

lubdub Agreed. I him-hawed about it, but figured the free air should tell us what to do. +1

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submitted by ∗step_prep7(71)

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Key idea: Peritonitis (rigidity, guarding) + Free air under diaphragm = Emergency laparotomy!!!!!

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submitted by ∗jlbae(159)

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Free air under diaphragm = pneumoperitoneum → emergency laparotomy is indicated

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