Diaphragmatic Trauma, Emergency Medicine

Jennifer Cullen Reviewed 06/2017
 


Basics

Description

  • Penetrating injury:

    • Violation of the diaphragm by penetrating object (most commonly stab and gunshot wounds)

    • May involve any portion of diaphragm

    • Smaller defect compared with blunt inju...

Diagnosis

In acute phase, there may be no abdominal visceral herniation: 
  • This injury may even be missed on initial laparotomy or laparoscopy.

Signs and Symptoms

  • Vary depending on whether phase is acute,...

Treatment

  • Herniation of abdominal contents into chest wall may mimic hemothorax or tension pneumothorax

  • Bowel sounds in chest may help distinguish

  • Be suspicious of diaphragmatic injury with lateral comp...

Follow-Up

Disposition

Admission Criteria

  • Patients with suspicion for diaphragmatic injury must be admitted to trauma surgery.

  • Patients should be admitted to the monitored or ICU setting.

Discharge Criteria

Pearls and Pitfalls

  • Overall mortality is 18–40% depending on mechanism.

  • Highly associated with concomitant severe injuries to spleen and liver, hemothorax, pneumothorax, and pelvic fractures.

  • Must have ...

Additional Reading

  • Al-Salem  AH. Traumatic diaphragmatic hernia in children. Pediatr Surg Int.  2012;28:687–691.

  • Blaivas  M, Brannam  L, Hawkins  M, et al. Bedside emergency ultrasonographic diagn...

Codes

ICD9

  • 862.0 Injury to diaphragm, without mention of open wound into cavity

  • 862.1 Injury to diaphragm, with open wound into cavity

ICD10

  • S27.802A Contusion of diaphragm, initial encounter

  • S27.803A Lace...

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