๐๐ฃ๐ (Diagnostic Peritoneal Lavage);
โขAt one time, DPL, described by Root in 1965,was the diagnostic test of choice for detecting bleeding within the abdominal cavity after trauma. However, the advent and widespread availability of computed tomography (CT), which carries near-comparable sensitivity and superior specificity, have limited the use of DPL to the diagnosis of intra-abdominal hemorrhage in unstable trauma patients.
โขCurrently, DPL is performed ๐น๐ฒ๐๐ ๐ณ๐ฟ๐ฒ๐พ๐๐ฒ๐ป๐๐น๐l than it once was, having been largely replaced by focused assessment with sonography for trauma (FAST) and CT. The American College of Surgeons (ACS) adopted FAST into the Advanced Trauma Life Support (ATLS) protocol, and the ninth edition of ATLS made DPL an optional skill station, owing to the widespread use of FAST. Still, each of these modalities has unique advantages & disadvantages.
โขDPL ๐ฟ๐ฒ๐๐ฎ๐ถ๐ป๐ its ๐๐๐ฒ๐ณ๐๐น๐น๐ป๐ฒ๐๐, especially in the โถ๏ธhemodynamically unstable trauma patient, โท๏ธwho has a negative or equivocal FAST examination, โธ๏ธCT scan not available or โน๏ธpt cannot be safely transferred from resuscitation bay for radiology deptt.
โข๐๐ฃ๐, Diagnostic peritoneal aspiration (๐ ๐ผ๐๐ ๐ฐ๐ผ๐บ๐บ๐ผ๐ป๐น๐ ๐ฝ๐ฟ๐ฎ๐ฐ๐๐ถ๐ฐ๐ฒ๐ฑ ๐ถ๐ป ๐ฟ๐ฒ๐๐๐๐ถ๐๐ฎ๐๐ถ๐ผ๐ป ๐ฏ๐ฎ๐ ๐ผ๐ณ ๐บ๐ ๐ถ๐ป๐๐๐ถ๐๐๐๐ถ๐ผ๐ป ๐ฒ๐๐ฒ๐ป ๐ฏ๐ฒ๐ณ๐ผ๐ฟ๐ฒ ๐๐๐ฆ๐ง ๐ถ๐ป ๐๐ป-๐๐๐ฎ๐ฏ๐น๐ฒ ๐ฃ๐ผ๐น๐-๐ง๐ฟ๐ฎ๐๐บ๐ฎ ๐ฝ๐) is a simpler, faster modification of DPL that appears to have very low rates of failure and complications in the setting of trauma.
โขA positive FAST examination (hemoperitoneum) is useful and reliable in the hemodynamically unstable blunt trauma patient. However, if the FAST examination is negative or equivocal, it should be followed by DPL. DPL is 100% accurate for intra-abdominal injury in hemodynamically unstable patients, whereas FAST is positive only 45% of the time. However, DPL also takes 10-15 minutes, and the patient must be stable for the test to be carried out.