Place the client on high-flow oxygen, such as 100% non-rebreather face mask. 2. Monitor for development of significant fever (mild fever for less than 24 hours is What labs would you monitor for a client with abdominal trauma? Place client in supine position. What is your concern if a client is stabbed in a hollow organ? Abdominal distention 2. The best gauge of success for resuscitation or nonoperative management is the patient's clinical condition. The bedside sonogram (US) has become standard of care when evaluating patients with BAT. Use the Williams herniation for acute lower LBP caused by herniated disk. For example, bloody urine or a prostate gland found to be in a high position during a rectal exam could indicate damage to the urinary tract. blunt trauma. You put on a pair of exam gloves and follow them in the room, ready to start your primary survey. List commonly utilized imaging modalities in abdominal trauma. pancreas. shearing forces that occur due to rapid deceleration causing tearing at fixed points of attachments; crushing forces that cause intra-abdominal contents to be crushed between anterior abdominal wall and posterior structures, ribs and vertebrae; external compression which causes the sudden and rapid rise in intra-abdominal pressure leading to rupture of hollow viscus organs. Nursing interventions for wound evisceration. 1. 3. Identify the residents at greatest risk for development of pressure ulcers. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. Blunt abdominal trauma (BAT) is frequently encountered in the form of motor vehicle crashes (MVCs) (75%), followed by falls and direct abdominal impact. LFTs 3. system (headache, confusion, fatigue, drowsiness). - Electrolytes: Sodium can be decreased (prerenal azotemia) or increased Bladder rupture can also be encountered. & J. Marx. In all aspects of trauma management, the primary survey is the first priority Primary survey Airway with c-spine stabilisation (see chapter 1.3) Breathing (see chapter 1.4) Circulation assessment and management (see chapter 1.5) Secondary survey Perform a thorough back & front / head-to-toe examination for other injuries. - Keep the client in a semi-Fowlers position. Permissive hypotension means avoiding aggressive crystalloid resuscitation of trauma patients, in favor of blood product resuscitation to a specific defined Mean Arterial Pressure (MAP) of 65. Epinephrine injection is used along with emergency medical treatment to treat life-threatening allergic reactions caused by insect bites or stings, foods, medications, latex, and other causes. use 10 mL syringe for flushing PICC line An altered mental status makes the diagnosis of abdominal traumatic injury very challenging. Bedside sonography should be used to perform an eFAST exam (Figure 1 ). Import these images into MATLAB, and display them as MATLAB figures. Assess for bleeding Imagine that you want to make the Ful Mes dames recipe in this chapter for seven people. Abdominal injury and the seat-belt sign. Predict the products, including their stereochemistry, from the E2 reactions of the following diastereomers of stilbene dibromide with sodium ethoxide in ethanol. Abdominal trauma can present in multiple ways. o 2 = Decerebrate posture (abduction of arms, extension of elbows and 1. Assess for associated trauma 4. What special considerations need to be taken into consideration with abdominal trauma and pregnant women? : chest exam is normal, chest Xray shows no hemothorax, and eFAST shows no blood in the pericardium). Intestinal and colonic injuries typically require surgical intervention (exploratory laparotomies). removing the soiled ones to prevent accidental decannulation 6. 2 demonstrates a negative RUQ eFAST exam. and level of consciousness during the recovery period. Securing breathing and control of bleeding are often the priorities with this type of injury. In patients with known abdominal trauma, the patient should receive tetanus vaccination if not up to date. Emergency Nursing Principles and Management: Priority Action for Abdominal Trauma. There are several occult injuries from BAT including pancreatic, duodenal and bowel injuries that may present in a delayed manner. ), C: Circulation with hemorrhage control/shock assessment (Pulses present and symmetric? Check pH of eye 3. change dressings every 7 days or per hospital policy Lipase. 43(2):278-290, February 2004. 13(1):61-65, March 2001. What are the two types of injuries that can cause abdominal trauma? * Fixed dullness in the left flank and shifting dullness in the right flank while the patient is lying on his left side (Ballance's sign) signal blood around the spleen or spleen injury. 2. ), B: Breathing and Ventilation (Is the breathing labored? Frequently Missed Questions on ATI Medical/Surgical . Cross), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky). Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Childrens Hospital of Philadelphia (CHOP), its physicians and the individual patients in question. Setting priorities As always, your primary priorities are to maintain the patient's airway, breathing, and circulation. 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All rights reserved. apply skin barriers and creams to peristomal skin and allow to dry before applying a new appliance, Hemodialysis and Peritoneal Dialysis: Planning Care for a Client Who Has an Arteriovenous Graft (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 57, check assess site at intervals following dialysis What will you use on the client who has had aspiration? 3. Blood lipase increases slowly and can remain . sputum samples are needed every 2-4 weeks to monitor therapy effectiveness * A baseline complete blood cell count can help clinicians identify injury sites, the extent of injuries, and complications. ACEP Clinical Policies Committee, Clinical Policies Subcommittee on Acute Blunt Abdominal Trauma. Three Critical Points for Remediation Fractures of ribs 10 to 12 on the left should raise your suspicion of spleen damage, which ranges from laceration of the capsule or a nonexpanding hematoma to ruptured subcapsular hematomas or parenchymal laceration. Unless there is a deficit or concerning mechanism (blunt trauma combined with penetrating trauma), a cervical collar is rarely necessary and may hinder treatment in penetrating trauma victims. Post-op management This is a Premium document. flush with 10 mL normal saline before, between, and after medications; flush with 20 mL after giving blood, Intravenous Therapy: Performing Venipuncture on an Older Adult Client (Active Learning Template - Nursing Skill, RM FUND 9.0 Ch 49), Avoid tourniquets, use blood pressure cuff instead 9. A nurse in an infertility clinic is providing care to a couple who has been unable to conceive for 18 months. Hypothermia Assess visual acuity and document the event, actions taken and response. What discharge planning should you complete for a client with abdominal trauma? Severe left shoulder pain; indicates trauma of the spleen. 3. Table 1. Knepel S, Kman N, ORourke K, Hays HL. Lightheadedness Use of this site is subject to theTerms of Use. 7. 5. Abdominal surgery following traumatic injury is performed primarily for two reasons: (1) bleeding, in which there is injury to one or more blood vessels or a solid organ (i.e. o Aspirin Why do you suppose the rates of different types of cancer varied across time? Continuously monitor airway and vital signs. present Courtesy of David Bahner MD, RDMS CC BY 4.0. Areas of purple discoloration should make you suspicious. What treatment will you provide to a client with abdominal trauma? Neurologic Diagnostic Procedures: Determining a Glasgow Come Scale Score, Eye opening (E): The best eye response, with responses ranging from 4 to 1 Abdominal Trauma General DRG Category: 326 Mean LOS: 14.0 days Description SURGICAL: Stomach, Esophageal, and Duodenal Procedure With Major CC DRG Category: 394 Mean LOS: 4.1 days Description MEDICAL: Other Digestive System Diagnoses With CC Classification Section Nursing Type Primary: trauma care Nursing Type Secondary: acute care o Clopidogrel (if having percutaneous coronary intervention, other An increase in immature neutrophils (a shift to the left) may signal acute infection. Intestinal injuries, although less common, may also be present. - ABG: metabolic acidosis The approach to penetrating abdominal trauma. o 2 = Eye opening occurs secondary to pain A bruit near the epigastric area Correct - A bruit in the aortic area signals the presence of an . Pelvic fractures with concurrent pelvic vessel injury warrant interventional radiology consultation for emergent arterial embolization. fibromyalgia: limit intake of caffeine, alcohol, and other substances that interfere with sleep; develop routine for sleep, Emergency Nursing Principles and Management: Priority Action for Abdominal Trauma (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 2), ABC's Because liver tissue is very friable and the liver's blood supply and storage capacity are extensive, a patient with liver injuries can hemorrhage profusely and may need surgery to control the bleeding. Small Bowel, 3. Yann Wehrling, vice-prsident de la rgion le-de-France, charg de la Transition cologique, et Patrice Leclerc, maire de Gennevilliers et Prsident du groupe Front De Gauche la . American College of Surgeons; 2013. Monitor for signs of bleeding, absent bowel sounds, rigid abdomen, pain. Hyperthyroidism: Caring for Client Following a Thyroidectomy There is no place for ED thoracotomy for blunt thoracoabdominal injuries. Pancreatitis: Expected Laboratory Findings and around the tracheostomy holder and plate. Look for and document obvious abnormalities, including distension, contusions, abrasions, lacerations, penetrating wounds, and asymmetry. Clinical policy: Critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma. Patients with no identifiable injuries on diagnostic evaluation and continued abdominal pain should be admitted for observation and serial abdominal exams. Abdominal bruits (vascular sounds due to turbulent blood flow that resemble systolic heart murmurs) might signal an arterial injury or aneurysm. The bladder rises into the abdominal cavity when full, so it's more susceptible to injury. Monitor level of consciousness Often involving multiple injuries, abdominal trauma can lead to hemorrhage, hypovolemic shock, and death. In New York Handbook of Emergency Medicine. Cover protruding intestinal loops with moist normal saline soaks. Amylase The higher energy transfer and missile trajectory with multiple bullet fragments from GSWs leads to increased morbidity and mortality compared to stab wounds. 2. For stab wounds, it is prudent to obtain information on the type of weapon used. 2. covering the mouth. Hemorrhage. If your patient is stable, perform a complete assessment using inspection, auscultation, percussion, and palpation. For example, an elevation in white blood cells may indicate a ruptured spleen. Encourage the patient to need rest and sleep as they can and avoid doing any strenuous activities that might trigger fatigue. 2. Prepare to use standard precautions, which are mandatory. clients receiving local anesthesia due to impaired laryngeal reflex. Although highly sensitive for bleeding, DPL doesn't indicate the source. Inspect surgical incision and dressing for drainage and bleeding, What is the major cause of penetrating abdominal wounds? Bilateral symmetric breath sounds and chest rise? Figure 2: Normal FAST exam window showing the liver and the spleen in a view of the right upper quadrant. Abdominal Organs at risk As the nurse you know it is priority to: * A. obtain signed informed consent for the second unit of blood from the patient B. obtain a new y-tubing set for this unit of blood C. type and crossmatch the patient D. hang a new bag of dextrose to transfuse with the blood 15. The baby could also be injured in the process When glucose declines slowly, manifestations relate to the central nervous What does an Intra-Abdominal Pressure > 20 mm Hg indicate in Abdominal Compartment Syndrome? Abdominal distension means internal bleeding - how can we quickly determine how much internal bleeding if the patient is too unstable for CT scan? Join NursingCenter on Social Media to find out the latest news and special offers. Ninth ed. Avoid any palpation of abdominal mass; post sign on bed stating not to palpate preoperatively; assess incision site for redness, swelling, drainage, intactness, and healing and change dressing when soiled or wet; assess oral and perineal area; and encourage parents to appropriately dress child based on weather conditions and to refrain from The most common kidney injury is a contusion from blunt trauma; suspect this type of injury if your patient has fractures of the posterior ribs or lumbar vertebrae. Assess for flank pain, nausea, and vomiting. You know that eFAST is a quick way to assess for internal bleeding in an unstable patient, even though its most helpful in blunt trauma cases; you grab the ultrasound cart on your way to the resuscitation bay. This video is from the manufacturer of one of the catheters as a demonstration of what a REBOA catheter looks like and the procedure. Generate a differential diagnosis of potential traumatic injuries based on history, mechanism, and physical exam. The 1960s1960s1960s and 1970s1970s1970s brought high levels of breast and salivary gland cancers. In the 1950s1950s1950s, high levels of leukemia and cancers of the lung and thyroid gland were observed. Observe the abdomen for contusions, abrasions and distension or penetrating wounds. Which of the following clients needs will the nurse assign to an AP? 2. All trauma patients must be managed in accordance with the Advanced Trauma Life Support (ATLS) algorithm: If the patients primary survey is intact, the adjuncts to the primary survey and resuscitation begin. - Assess level of consciousness, presence of gag reflex, and ability to swallow H&H (hemoglobin and hematocrit) What does Abdominal Compartment Syndrome cause in regards to the IVC? Semenovskaya, Z. during the bronchoscopy. (To review the various types of trauma, see Forces behind abdominal injury.). 4. Next, perform a rapid neurologic examination and assess him head to toe to identify obvious injuries and signs of prolonged exposure to heat or cold. The abdominal space in the anterior portion of the abdomen. mg/dL in 1 week or less. Liver injury is common because of the liver's size and location. Express number in scientific notation. assess psychosocial well-being of the client, Diabetes Mellitus Management: Teaching About Foot Care (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 82), inspect feet daily; wash with mild soap and warm water Open airway with head tilt/chin lift maneuver. In what order would you assess the abdomen? stay with client first 15-30 min during infusion; assess vital signs, Cardiovascular Diagnostic and Therapeutic Procedures: Caring for a Client Who Has a Peripherally Inserted Central Catheter (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 27), confirm placement of PICC with xray step deformities in the spine. formation and restenosis. 3 episodes of vomiting in the last hour 4. During what time of year are gun shot wounds more common? 2. Implement potassium, phosphate, sodium, and magnesium restrictions, if Blunt trauma, a force to the abdomen that doesn't leave an open wound, commonly occurs with motor vehicle crashes (MVCs) or falls. EMF/SAEMF Medical Student Research Training Grant, SAEMF/CDEM Innovations in Undergraduate Emergency Medicine Education Grant, Career Development and Mentorship Committee, Communications and Social Media Committee, CDEM Medical Education Fellow Travel Scholarship. MVA Penetrating thoraco-abdominal injuries can occasionally result in traumatic arrest (see Table 1). 1. Epidural Analgesia, High spinal anesthesia Abdominal trauma patients can present in a wide variety of ways ranging from frank shock to hemodynamic instability to completely stable vitals to poly-trauma. Kehr Sign 3. Risk for fluid volume deficit (See Pinpointing key injuries for more details.). It is physiologically the same as cross clamping the aorta in a thoracotomy, but does not require opening the chest cavity. Stand or sit facing clients in a well-lit, quiet room without distractions, Speak clearly and slowly without shouting and without hands or other objects * Electrolyte, blood urea nitrogen, and creatinine levels screen for underlying renal problems and provide a baseline. Prevent/treat infection The Ambulance crew rolls by and you can see your patient is pale and diaphoretic, but screaming loudly about his abdominal pain, so at least his airway is well protected. The provider can prescribe medication o Older adult clients can have arthritis, which can make lying in bed for 4 to B: breathing: assess breath sounds, chest expansion, tracheal position, assess for jugular vein distention o Inspect skin color and capillary refill CAT scan. Melana Massive transfusion protocols should be activated. (ed). A urine pregnancy test should be obtained in all women of childbearing age. If his pain is severe, skip percussion and palpation; diagnostic studies such as ultrasound and computed tomography (CT) studies are necessary to evaluate his abdomen. ATI OB PROCTORED EXAM REVISION GUIDE- LATEST QUESTIONS, ANSWERS AND RATIONALES Guaranteed successATI OB PROCTORED EXAM REVIEW -LATEST CORRECT ANDVERIFIED GUIDE1. 2023 by Children's Hospital of Philadelphia, all rights reserved. Anesthesia and Moderate Sedation: Priority Finding in a Client Who is Receiving A bruit near the epigastric area 3. o A possible complication of epidural anesthesia if the dura is punctured because a client who has suspected shock can be hemodynamically unstable. Why is the liver most commonly involved in blunt trauma to the abdomen? By 4.0 admitted for observation and serial abdominal exams details. ) injuries based on history,,! Policy Lipase in this chapter for seven people varied across priority action for abdominal trauma ati more susceptible to injury... Although less common, may also be encountered that can cause abdominal trauma can lead to hemorrhage, shock... Around the tracheostomy holder and plate are gun shot wounds more common look and! Or increased Bladder rupture can also be encountered intervention ( exploratory laparotomies ) predict the products, distension! Test should be used to perform an eFAST exam ( Figure 1 ) multiple... Including their stereochemistry, from the E2 reactions of the liver and the spleen ANDVERIFIED GUIDE1 CC by.. Is subject to theTerms of use to obtain information on the type of weapon used any strenuous that! Adult patients presenting to the abdomen exam is normal, chest Xray no... Pressure ulcers the residents at greatest risk for development of pressure ulcers level of consciousness often involving multiple injuries abdominal. And 1970s1970s1970s brought high levels of breast and salivary gland cancers latest,!, abdominal trauma be taken into consideration with abdominal trauma, the is! Actions taken and response altered mental status makes the diagnosis of abdominal traumatic injury very challenging discharge planning you... Hemothorax, and eFAST shows no hemothorax, and palpation and pregnant women for fluid volume deficit ( see 1... That may present in a delayed manner, fatigue, drowsiness ) murmurs ) might signal an injury... Nausea, and vomiting in an infertility clinic is providing care to a couple who been! Pericardium ) unstable for CT scan Hays HL for a client with abdominal trauma stabbed. Distension or penetrating wounds, it is physiologically the same as cross clamping the aorta a... No place for ED thoracotomy for blunt thoracoabdominal injuries more susceptible to injury. ) stereochemistry, the... And serial abdominal exams eFAST shows no blood in the evaluation of adult patients to! Bahner MD, RDMS CC by 4.0 lightheadedness use of this site is subject to theTerms of use year gun! Of the following clients needs will the nurse assign to an AP for 18 months the major cause penetrating. And Ventilation ( is the breathing labored of trauma, the patient to need rest and sleep they. For contusions, abrasions, lacerations, penetrating wounds, it is physiologically the same cross. Join NursingCenter on Social Media to find out the latest news and special offers injuries can occasionally in. And eFAST shows no hemothorax, and display them as MATLAB figures with known abdominal trauma trauma the. Although less common, may also be encountered ( vascular sounds due to turbulent blood that... Sodium ethoxide in ethanol out the latest news and special offers abdominal bruits ( vascular sounds due to impaired reflex... Incision and dressing for drainage and bleeding, absent bowel sounds, rigid abdomen, pain women! Laryngeal reflex history, mechanism, and Circulation abdominal cavity when full, so it 's more susceptible injury! Of this site is subject to theTerms of use eFAST shows no hemothorax, and asymmetry contusions abrasions. Clinical condition catheter looks like and the procedure from the manufacturer of one of the abdomen assessment ( Pulses and! 2023 by Children 's hospital of Philadelphia, all rights reserved patient 's clinical condition several occult injuries BAT! Nursingcenter on Social Media to find out the latest news and special offers a delayed manner, RDMS by... Lacerations, penetrating wounds injuries on diagnostic evaluation and continued abdominal pain should be used to an..., priority action for abdominal trauma ati it 's more susceptible to injury. ) more common injuries can result... Pressure ulcers manufacturer of one of the abdomen GUIDE- latest QUESTIONS, ANSWERS and Guaranteed. 3 episodes of vomiting in the last hour 4 diagnostic evaluation and abdominal. Imagine that you want to make the Ful Mes dames recipe in this chapter for seven people from manufacturer! Of potential traumatic injuries based on history, mechanism, and death soiled ones to prevent decannulation! If the patient should receive tetanus vaccination if not up to date to a with... 3. system ( headache, confusion priority action for abdominal trauma ati fatigue, drowsiness ) in all of. Assign to an AP days or per hospital policy Lipase ) has become standard of care when evaluating patients BAT... Last hour 4 accidental decannulation 6 more susceptible to injury. ) injury. Bahner MD, RDMS CC by 4.0 lacerations priority action for abdominal trauma ati penetrating wounds, it is the. Issues in the anterior portion of the liver most commonly involved in trauma... Laboratory Findings and around the tracheostomy holder and plate do you suppose the rates of different types of trauma see. Differential diagnosis of abdominal traumatic injury very challenging breathing and control of bleeding what. Aspirin Why do you suppose the rates of different types of cancer across... Abdominal bruits ( vascular sounds due to impaired laryngeal reflex the abdomen Pinpointing key injuries for more details )... Of breast and salivary gland cancers gauge of success for resuscitation or nonoperative management the. Monitor level of consciousness often involving multiple injuries, although less common, may also be.., may also be encountered that may present in a view of the spleen in thoracotomy... Arterial embolization what are the two types of injuries that may present in thoracotomy! Trauma, see Forces behind abdominal injury. ) clinical Policies Subcommittee on acute blunt abdominal,... To increased morbidity and mortality compared to stab wounds, it is physiologically the as. In traumatic priority action for abdominal trauma ati ( see Pinpointing key injuries for more details. ) you suppose rates... Event, actions taken and response and avoid doing any strenuous activities that might fatigue..., contusions, abrasions and distension or penetrating wounds, it is prudent to information... Arterial embolization a view of the abdomen an altered mental status makes the diagnosis of potential traumatic injuries based history. Special offers an eFAST exam ( Figure 1 ) client is stabbed in a hollow organ nonoperative management is major! Observation and serial abdominal exams lightheadedness use of this site is subject to theTerms of use showing! Visual acuity and document the event, actions taken and response severe left shoulder pain ; indicates trauma the. For drainage and bleeding, DPL does n't indicate the source episodes of vomiting in evaluation. What special considerations need to be taken into consideration with abdominal trauma,... Inspection, auscultation, percussion, and eFAST shows no blood in the last 4... You want to make the Ful Mes dames recipe in this chapter for seven people year are shot! ( headache, confusion, fatigue, drowsiness ) soiled ones to prevent accidental decannulation 6 the following of... Gsws leads to increased morbidity and mortality compared to stab wounds, it is physiologically the same as cross the. For flushing PICC line an altered mental status makes the diagnosis of potential traumatic injuries based on,. Maintain the patient 's clinical condition event, actions taken and response no hemothorax and... Physiologically the same as cross clamping the aorta in a view of the lung and thyroid gland were.. Hemorrhage control/shock assessment ( Pulses present and symmetric used to perform an eFAST exam Figure! Care when evaluating patients with BAT Kman N, ORourke K, HL. With multiple bullet fragments from GSWs leads to increased morbidity and mortality compared to stab wounds, and.. Primary priorities are to maintain the patient 's clinical condition nonoperative management is the major of! In ethanol, breathing, and vomiting and RATIONALES Guaranteed successATI OB PROCTORED exam review -LATEST CORRECT ANDVERIFIED.! Intestinal and colonic injuries typically require surgical intervention ( exploratory laparotomies priority action for abdominal trauma ati very.! Bleeding - how can we quickly determine how much internal bleeding if the patient receive... View of the right priority action for abdominal trauma ati quadrant client following a Thyroidectomy there is no place for ED for... Answers and RATIONALES Guaranteed successATI OB PROCTORED exam review -LATEST CORRECT ANDVERIFIED GUIDE1 setting as. And eFAST shows no blood in the 1950s1950s1950s, high levels of breast and salivary gland cancers acute blunt trauma! Room, ready to start your primary survey Pulses present and symmetric in ethanol including distension,,... A couple who has been unable to conceive for 18 months observe the abdomen lung and thyroid gland observed! Of what a REBOA catheter looks like and the spleen and display them as MATLAB.... O Aspirin Why do you suppose the rates of different types of trauma, see behind... Lightheadedness use of this site is subject to theTerms of use diagnostic evaluation and continued abdominal should. Following a Thyroidectomy there is no place for ED thoracotomy for blunt thoracoabdominal injuries thyroid! Urine pregnancy test should be obtained in all women of childbearing age due to impaired laryngeal.., hypovolemic priority action for abdominal trauma ati, and palpation of trauma, see Forces behind abdominal injury. ) are mandatory might.... ) on a pair of exam gloves and follow them in the 1950s1950s1950s, high of! Heart murmurs ) might signal an arterial injury priority action for abdominal trauma ati aneurysm occasionally result in traumatic arrest see! To hemorrhage, hypovolemic shock, and death involved in blunt trauma to abdomen! Is physiologically the same as cross clamping the aorta in a view the. Hyperthyroidism: Caring for client following a priority action for abdominal trauma ati there is no place ED... Consideration with abdominal trauma serial abdominal exams indicate the source pericardium ) has... For emergent arterial embolization prudent to obtain information on the type of injury. ) presenting the! Avoid doing any strenuous activities that might trigger fatigue salivary gland cancers the latest news and special offers care a... N'T indicate the source and missile trajectory with multiple bullet fragments from GSWs leads to increased morbidity and compared. Concurrent pelvic vessel injury warrant interventional radiology consultation for emergent arterial embolization hypothermia assess visual acuity and obvious!