Diagnostic Peritoneal Lavage
                ============================

 - Accuracy 95%
 - indications in blunt trauma:
  + unreliable abdominal exam
   * abnormal mental status: drugs/alcohol, head trauma, children/retardation
   * spinal injury
   * distracting injury
   * language barrier
  + multiple trauma requiring general anaesthesia
  + unexplained drop in BP
 - absolute contraindications in blunt trauma:  none
 - relative contraindications in blunt trauma:  previous surgery, pregnancy,
   obesity, abdominal wall hematoma
 - technique:
  + get abdominal film first to rule out free air
  + 1/3 from umbilicus to pubic bone; above umbilicus if pregnant or pelvic
    fracture
  + aspirate 10 cc for blood OR lavage with 1 liter NS (15 cc/kg for peds)
  + results:
   * RBC cell count } 1000,000 is +; 20,000 to 100,000 equivocal; WBC not
     helpful; alk phos, amylase, bile, gram stain not useful
 - DPL can miss hollow viscus injury (though DPL better than CT), ruptured
   diaphragm, extraperitoneal injury; CT can miss hollow viscus injury,
   pancreatic injury, duodenal injury.  CT is better than DPL for peds.

[from 1993 Emergency Care Ski Conference]