EMT Chapter 30: Injuries to the Abdomen and Genitalia

significance of a solid organ injury

can bleed significantly and cause rapid blood loss. this blood can ooze into the peritoneal cavity thus increasing chances of toxicity to develop

high-velocity injuries

caused by larger weapons such as high-powered rifles and handguns, militarized weapons.

medium-velocity injuries

caused by smaller caliber handguns and shotguns

what is a significance of a hallow organ injury

hollow organs hold various things, if the organ pops from blunt trauma, or gets sliced from penetrating, it can cause the contaminants to spread inside the body

bruising around the umbilicus can predict what

injury inside the abdomen/significant bleeding

organs of the right lower quadrant

intestines, cecum and ascending colon, appendix, ovary, ureter

treating a patient with possible kidney injury

kidney damage = potential significant blood loss. monitor for shock, monitor abc's, rapid transport, constant reassessments of the patient

pain that is following the angle from the lateral hip to the midline of the groin

kidneys or ureter damage

what is the largest organ in the abdomen

liver

organs of the right upper quadrant

liver, gallbladder, duodenum, intestines, pancreas, intestines

your primary concern with almost any unresponsive patient is to

maintain the airway

s/sx of a diaphragm injury

may feel anxious, have shortness of breath if placed supine (supine will spill contents into the thoracic cavity)

treating a patient with injury to female genitalia

moist, sterile compression, diaper-type bandaging to hold dressing in place.

treating a patient with a possible urinary bladder injury

monitor abc's, consider possible shock, reassess vitals en route

why does the body go into voluntary/involuntary guarding

natural response to abdominal pain, attempts to splint the area or prevent any unnecessary movement to avoid further pain

is the limbic system in the abdominal cavity

no - the limbic system involves nerves

placing a patient with an abdominal injury with and without a spinal injury

no spinal injury: place in a position of comfort with the legs pulled up toward the abdomen. with spinal injury: lay supine and carefully place padding under the knees to elevate tension depending on the severity of the injury

traumatic injuries to the abdomen are considered either

open or closed injuries, and can involve either hallow or solid organs

a penetrating wound that reaches the kidneys almost always involves

other organs

what is rebound tenderness

pain upon releasing the palpating hand pushing on the abdomen

general s/sx of closed abdominal injury

pain, distention, guarding, bruising, discoloration, swelling

how do you transport a person with a suspected kidney injury but no suspected spinal injury

position of comfort

where does a patient go to if they have a closed abdominal injury

rapid transport to the nearest and highest level of care available, primarily a trauma center with a surgeon.

kidneys are located where

retroperitoneal space

liver injury pain is referred to the

right shoulder

what are very common signs of bleeding in the abdomen

rigidity, ecchymosis, bruising around umbilicus

pain primarily in the right lower quadrant

ruptured appendix

first s/sx of peritonitis include

severe abdominal pain, tenderness, muscle spasms. nausea is a sign of late peritonitis

different parts of your intestions

small: duodenum, jejunum, ileum large: cecum, colon, rectum

solid organs

solid masses of tissue where much of the chemical work of the body takes place - liver, spleen, pancreas, kidneys.

energy production takes place in what type of organs

solid organs

referred pain to the left shoulder

spleen injury and/or bleeding in the retroperitoneal space

organs of the left upper quadrant

stomach, spleen, portion of colon, intestines

hallow organs

structures in which materials pass, such as the stomach, intestines, ureters, and urinary bladder.

A very common early sign of a significant abdominal injury is

tachycardia

signs of an open abdominal injury

tachycardia (compensating for blood loss), evidence of shock, hypotension, pale cool moist skin, ALOC, obvious trauma in abdomen, distention of abdomen.

symptoms of a dissecting abdominal aneurysm

tearing pain in the posterior abdomen

high and medium velocity injuries will often have what

temporary wound channels and exit wounds

peritoneal cavity

the abdominal cavity

the higher the velocity, the larger what is produced

the larger cavity is produced, larger amount of damage

peritoneum

the membrane lining of the abdominal cavity (parietal peritoneum) and covering the abdominal organs (visceral peritoneum)

air in the peritoneal cavity seeks to go where

the most superior space or void

what organ is often injured during MVA due to poor placement seatbelts or steering wheel impacts

the spleen

s/sx of peritonitis

when substances spill or leak into the peritoneal cavity, these include: severe abdominal pain, tenderness, and muscular spasm, diminishing bowel sounds, nausea, distended abdomen.

handling avulsion

wrap the area in a soft sterile dressing moistened with sterile saline solution, label it, plastic bag, cool container rapidly transport.

considerations for trauma in a pregnant patient

you are caring for two patients. the uterus will hold a lot of blood and a fetus as well.

hematuria

blood in the urine

low velocity injuries

caused by hand-held or hand-powered objects such as knives and other edged weapons

guarding

Contracting the stomach muscles to minimize the pain of abdominal movement; a sign of peritonitis.

open abdominal injury

An injury in which there is a break in the surface of the skin or mucous membrane, exposing deeper tissue to potential contamination.

melena

Black tarry stool

organs of the left lower quadrant

Part of descending colon, sigmoid colon, left ovary and tube, left ureter, left spermatic cord, intestines

evisceration

The displacement of organs outside of the body.

cavitation

The formation of cavities in an organ or tissue

flank

The region below the rib cage and above the hip.

considerations for injuries to the external male genetalia

although painful, rarely ever a life threat. treat other injuries first and provide prompt transport

closed abdominal injury

an injury in which there is soft-tissue damage inside the body but the skin remains intact

mesentery

any fold of tissue that attaches to an organ of the body wall

when should you suspect a kidney injury

any injury to the flank (the region below the rib cage and above the hip) or anything near the lower rib cage

retroperitoneal region

behind the peritoneum: includes great vessels, abdominal aorta, inferior vena cava, kidneys, ureters, urinary bladder, pancreas, colon.

your patient says their entire abdomen is in pain, what may be the issue

bleeding in the peritoneal space

suspect a possible injury of the urinary bladder with what findings

blood at the urethral opening, blood stains on the underwear, physical signs of trauma. bruising to the quadrant is not a significant finding.

signs of injury to the kidney include

bruises or lacerations on the overlying, skin, shock, and hematuria. increased urgency of urination is not a s/sx

treating a patient with injury to male genitalia

comfort, use sterile moist gauze, direct pressure, handle with care, slight compression.

give an example of a compression injury and a deceleration injury

compression: caused by a poorly placed lap belt or run over by an object. putting excess energy/force upon your body. deceleration: person strikes immovable object. rapid stop and shift of energy

how to deal with a patient with an evisceration

cover wound with moistened sterile dressing and occlusive dressing, cover with a plastic layer to preserve contents, secure with a bandage, then tape or tie down the entire wound

late s/sx of abdominal injury include

distention, change in mental status, and pale cool moist skin. increased blood pressure is not considered a late sign

assessment of a patient with a eviseration

do not press down on the abdomen, just visually inspect what is going on. carefully expose the patient, ensure the object doesn't move around.

treating a patient with injury to the rectum

expose as necessary, moist sterile compression with a diaper-type bandaging to hold in place. monitor for shock because this can have significant blood loss.

abdominal distention or swelling that occurs near the xiphoid process is often the result of

free fluids or organ contents spilling into the peritoneal cavity. it can also be a result of air from bowel infection.

your patient complains of pain that is found under the ribs on the right side along with pain between the shoulder blades

gallbladder injury/inflammation

injuries in what type of organ may have delayed s/sx

hollow organs