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