Tag Archives: diagnosis

Bowel Sounds, Or Just Plain BS?

“Bowel sounds are normal”

How often do you see this on an H&P? Probably a lot more often than they are actually listened for, I would wager. But what do they really mean? Are they important to trauma professionals?

(Un)fortunately, there’s not a whole lot of research that’s looked at this mundane item. And pretty much all of it deals with surgical pathology (e.g. SBO) or the state of the postop abdomen. Over the years, papers have been published about the basics, and I will summarize them below:

  • Where to listen? Traditionally, auscultation is carried out in all four abdominal quadrants. However, sound transmission is such that listening centrally is usually sufficient.
  • Listen before palpation? Some papers suggest that palpation may stimulate peristalsis, so you should listen first.
  • How long should you listen? Reports vary from 30 seconds to 7 minutes (!)
  • Significance? This is the big question. We’re not expecting to find hyperactive or high pitched sounds suggestive of surgical pathology here. Really, we’re just looking for sounds or no sounds.

But does it make a difference whether we hear anything or not?

Bottom line: In trauma, we don’t care about BS! We’ve all had patients with minimal injury and no bowel sounds, as well as patients with severe abdominal injury and normal ones. We certainly don’t have time to spend several minutes listening for something that has no bearing on our clinical assessment of the patient. Skip this unnecessary part of the physical exam, and continue on with your real evaluation!

Reference: A critical review of auscultating bowel sounds. Br J Nursing 18(18):1125-1129, 2009.

Bowel Sounds, Or Just Plain BS?

“Bowel sounds are normal”

How often do you see this on an H&P? Probably a lot more often than they are actually listened for, I would wager. But what do they really mean? Are they important to trauma professionals?

(Un)fortunately, there’s not a whole lot of research that’s looked at this mundane item. And pretty much all of it deals with surgical pathology (e.g. SBO) or the state of the postop abdomen. Over the years, papers have been published about the basics, and I will summarize them below:

  • Where to listen? Traditionally, auscultation is carried out in all four abdominal quadrants. However, sound transmission is such that listening centrally is usually sufficient.
  • Listen before palpation? Some papers suggest that palpation may stimulate peristalsis, so you should listen first.
  • How long should you listen? Reports vary from 30 seconds to 7 minutes (!)
  • Significance? This is the big question. We’re not expecting to find hyperactive or high pitched sounds suggestive of surgical pathology here. Really, we’re just looking for sounds or no sounds.

But does it make a difference whether we hear anything or not?

Bottom line: In trauma, we don’t care about BS! We’ve all had patients with minimal injury and no bowel sounds, as well as patients with severe abdominal injury and normal ones. We certainly don’t have time to spend several minutes listening for something that has no bearing on our clinical assessment of the patient. Skip this unnecessary part of the physical exam, and continue on with your real evaluation!

Reference: A critical review of auscultating bowel sounds. Br J Nursing 18(18):1125-1129, 2009.

Diagnosing Facial Fractures With CT

Facial fractures are common after major blunt trauma. There are a number of diagnostic tests available for their diagnosis, including head CT, conventional facial imaging and facial CT.

Our preference has been to add a facial CT to the list of diagnostics in any patient with external evidence of facial trauma. Subjectively, it appeared that there were not many injuries being identified, and the vast majority did not require operative management. 

A review of the literature shows that head CT alone is sufficient for screening for significant facial fractures. A small retrospective series noted that the accuracy was 92%, with 90% sensitivity and 95% specificity. 

Bottom line: A head CT alone ordered for the usual indications is a very good screening test for facial fractures. If none are seen, it is unlikely that there are any fractures that require specific management. If fractures are seen, consultation with a facial surgeon is needed. However, unless the fractures involve critical areas (e.g. temporal bone near the middle ear) or are significantly displaced, the benefit of a facial CT scan is still very low since most will be treated without operation.

Reference: Computed tomography of the head as a screening examination for facial fractures. Marinaro et al. Am J Emerg Med 25, 616-619, 2007.