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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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Male Genitalia Trauma
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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Male Genitalia Trauma
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