Em Tab Dom in a Ltr a Um A

8/9/2019 Em Tab Dom in a Ltr a Um A

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Abdominal Trauma

Temple College

EMS Professions


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The Abdomen

Everything between diaphragm and

pelvis

Injury, illness very difficult to assess

because of large variety of structures


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Abdominal Anatomy

Abdomen divided into four quadrants by

body mid-line, horizontal plane through

umbilicus

Organs can be located by quadrant


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Abdominal Anatomy Right Upper Quadrant

Liver

Gall Bladder

Right Kidney

Ascending Colon

Transverse Colon


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Abdominal Anatomy Left Upper Quadrant

Spleen

Stomach

Pancreas

Left Kidney

Transverse Colon Descending Colon


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Abdominal Anatomy

Right Lower Quadrant

Ascending Colon

Appendix

Right Ovary (female)

Right Fallopian Tube (female)


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Abdominal Anatomy

Left Lower Quadrant

Descending Colon

Sigmoid colon

Left Ovary (female)

Left Fallopian Tube (female)


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Abdominal Anatomy

Periumbilical area

Located around (peri) the navel (umbilicus)

Small bowel lies in all quadrants in

periumbilical area

Suprapubic area

Located just above pubic bone Urinary bladder, uterus lie in this area


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Abdominal Cavity

Peritoneum = abdominal cavity lining

Divides abdomen into two spaces Peritoneal cavity

Retroperitoneal space


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Abdominal Anatomy

Retroperitoneal

Pancreas

Kidney

Ureter

Inferior vena cava

Abdominal aorta

Urinary bladder

Reproductive organs

Peritoneal

Spleen

Liver

Stomach

Gall bladder

Bowel

Disease, injury of retroperitoneal organs

often causes back pain


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Abdominal Anatomy Organs can be classified as:

Hollow

Solid

Major vascular


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Solid Organs

Liver

Spleen

Kidney

Pancreas

When solid organs areinjured, they bleed heavily

and cause shock


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Solid Organs

Liver

Largest abdominal organ

Most frequently injured Fractures of ribs 8-12 on right side

Bleeding can be either:

Slow, contained under capsule

Free into peritoneal cavity


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S

olid Organs Spleen

Frequently injured with trauma ribs 9-11 on

left side Bleeds easily

Capsule around spleen tends to slow

development of shock

Rapid shock onset when capsule ruptures


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Solid Organs

Pancreas

Lies across lumbar spine

Sudden deceleration produces straddleinjury

Very little hemorrhage

Leakage of enzymes digests structures in

retroperitoneal space, causes volume loss,shock


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Hollow Organs

Stomach

Gall bladder

Large, small intestines Ureters, urinary bladder

Rupture causes contentspillage, inflammation of

peritoneum


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H

ollow Organs

Stomach

Acid, enzymes

Immediate peritonitis

Pain, tenderness, guarding, rigidity


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H

ollow Organs

Colon

Spillage of bacteria

May take 6 hrs to develop peritonitis

Small Bowel

Fewer bacteria

May take 24-48 hours to develop peritonitis


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M

ajor VascularS

tructures

Aorta

Inferior vena cava

Major branches

Injury can cause severeblood loss ; exsanguination

(bleeding out)


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Abdominal Trauma

Most survive to reach hospital

Most common factors leading to death

Failure to adequately evaluate

Delayed resuscitation

Inadequate volume

Inadequate diagnosis Delayed surgery


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H

ighI

ndex ofS

uspicion Mechanism

Trauma to lower chest, back, flank,

buttocks, and perineum

Hypovolemic shock with no readily

identifiable cause

Diffusely tender abdomen Pain in uninjured shoulder


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Mechanism

Look for signs of injury

Bruises

Tire marks

Obvious open injuries

Assume any abdominal injury is serious

until proven otherwise!

Injury above umbilicus also involveschest until proven otherwise


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Unexplained Shock

Assess vital signs; skin color,

temperature; capillary refill

Tachycardia; restlessness; cool, moist

skin

In trauma, signs of shock suggest

abdominal injury if no other obviouscauses present


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Signs ofInjured Abdomen

Diffuse tenderness

Pain

Pain referred to shoulder = Organ underdiaphragm involved (?spleen)

Pain referred to back = Retroperitoneal

organ involved (?kidney)


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Abdominal Rigidity

NOT reliable

Bleeding may not cause rigidity if free

hemoglobin absent

Bleeding in retroperitoneal space may

not cause rigidity


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Abdominal Trauma Management

Less important to diagnose exact injury

Treat clinical findings

Management same regardless of

specific organ(s) injured


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Abdominal Trauma Management

Airway

C-Spine if mechanism indicates

High flow O2

Assist ventilations if needed

Give nothing by mouth

MAST may be helpful in slowingintraabdominal bleeding with shock


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Impaled Object

Leave in place

Shorten if necessary for transport

Leave part of object exposed


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Evisceration

With large laceration abdominal

contents may spill out

Do NOT try to replace


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Evisceration

Cover exposed organs with saline

moistened multi-trauma dressing

DoN

OT use4

x4s

Cover first dressing with second DRY

dressing or aluminum foil


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Genitourinary Trauma


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Urinary System

Kidney

Ureter

Urinary Bladder

Urethra


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Kidney Trauma

50% of all GU trauma


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Kidney Trauma

Penetrating

GSW

Stab wound

Rare, usually associated with trauma to

other abdominal organs


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Kidney Trauma

Blunt

Direct blow to back, flank, upper abdomen

Suspect with fractures of 10th - 12th ribs or T12,

L1, L2

Acceleration/Deceleration

Shearing of renal artery/vein


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Kidney Trauma

Signs and Symptoms

Gross Hematuria

80% of cases Absence does NOT exclude renal injury

Localized flank/abdominal pain

Palpable mass


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Kidney Trauma

Signs and Symptoms

Tenderness: Lower ribs, upper L-spine,

flank

Pain: groin, shoulder, back, flank


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Ureter Trauma

Less than 2% of GU trauma

Usually secondary to penetrating

trauma

Indicator

Wound to lower back with urine escaping


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Urinary Bladder Trauma

Mechanisms

Blunt injury to lower abdomen

Seat belts Pelvic fracture

Penetrating trauma to lower abdomen or

perineum (pelvic floor)


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Extraperitoneal Bladder Rupture

Urine in umbilicus, anterior thighs, scrotum,

inguinal canals, perineum

Dysuria Hematuria

Suprapubic tenderness

Swelling, redness secondary to tissue

damage from urine


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Intraperitoneal Bladder Rupture

Urgency to void

Inability to void

Shock

Abdominal distension


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Urethral Trauma

Mechanisms

Sudden decelerations

(bladder shears off urethra) Straddle injuries


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Urethral Trauma

Signs and Symptoms

Blood at external meatus

Perineal bruising (butterfly bruise)

Scrotal hematoma


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Reproductive System Trauma

Can occur to both external and internal

reproductive systems

External

More common

Pain, extensive bleeding

Internal

R

arely injured


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Reproductive System Trauma

Treat like blunt or penetrating soft tissue

injuries elsewhere on body


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Male Genitalia Trauma

Usually NOT life-threatening

Very painful

Great source of concern to patient


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Avulsion of skin of penis, scrotum

Cover with a moist, sterile dressing

Complete amputation of penis Treat as any amputated part


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Blunt trauma to penis, scrotum

Apply ice pack

Urethral foreign bodies Do NOT remove

Penis entrapped in zipper

If 1 or2 teeth involved, try to unzip

If more involved, cut zipper out of trousers,

transport


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Female Genitalia Trauma

Internal

Rarely injured

External Can cause pain, extensive bleeding

Usually not life-threatening

Treat with compresses, pressure


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Sexual Assault

Avoid examining genitalia unless

obvious bleeding present

Ask patient to NOT wash, douche,urinate, defecate

Ask patient NOT to change clothes

Record history, but avoid extensive

questioning about incident

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