Patients with penetrating trauma to the flank should be resuscitated and evaluated according to standard resuscitative protocols. Initial resuscitative efforts should be directed towards the primary survey (see Chap.243). Information regarding the mechanism of injury, how much time has passed since the traumatic event, and the nature of the weapon should be obtained and recorded. In the case of a gunshot wound, the nature of the gun (shotgun, handgun, BB gun) and the range between the gun and the patient at time of the gun's discharge should be ascertained and noted in the emergency record. Following stabilization, an attempt should be made to find an exit wound, and a bullet path reconstructed. Baseline laboratory and radiologic data, including a hemogram, chest radiograph, urinalysis, and rectal exam with testing for occult blood, should be performed on all patients. In the presence of peritonitis, intravenous fluid and broad-spectrum antibiotics should be administered and urgent surgical consultation obtained. A suitable regime of antibiotics is ampicillin, gentamycin, and metronidazole initiated in the emergency department. Most patients are stable and will require additional diagnostic modalities.
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