Abdominal Trauma

ASSESSMENT OF ABDOMINAL INJURY 3. Rapid trauma assessment

Rapid and full trauma assessment Closely examine regions with high index of suspicion Expose and Examine for DCAP-BTLS If suspected pelvis injury do not test pelvis Palpate abdomin Evaluate for entrance and exit wounds

Increasing maternal blood volume protects mother from?

hypovolemia

Penetrating trauma to lateral abdomen likely to injury what?

large intestine

Pediatric patients and abdominal injuries; increased incidence of injury to:

liver kidney spleen

Trauma is the ___ ___ killer of pregnant females

number one

Specific organ pain referral: Pancreas

pain in back

Specific organ pain referral: Kidney

pain in flank to groin

Specific organ pain referral: Spleen

pain in left shoulder

Specific organ pain referral: Liver

pain in right shoulder

Abdominal injury is ____ concern during blast injury

secondary

what transmits blunt trauma to internal structures

skin and muscles

pregnancy; Increased circulatory blood volume by what %?

45% (greater volume but fewer RBC's)

Mechanism of injury: Penetrating trauma

Projectile, cavitation, pitch and yaw

PASG contraindications

Concurrent penetrating chest trauma Abdominal inflation contraindicated in pregnancy, use legs only

Blunt trauma causes (3)

Deceleration -Contents damaged by change in velocity Compression -Organs trapped between other structures Shear -Part of organ is able to move while other part is fixed (I.e. ligamentum teres)

Injury to Solid Organs (3)

Dense and less strongly held together Prone to contusion (bleeding, fracture) Unrestricted hemorrhage if organ capsule is ruptured

Superior boundary

Diaphragm

Injury to Mesentary and Bowel

Disrupt blood vessels supplying the bowel (lead to ischemia) Blood loss minimal Tear of mesentery may rupture bowel

• Initially ___ visible swelling and ___ occur over several hours

Erythema Ecchymosis

throwing up blood

hematemsis

Trauma where may penetrate abdomen? (4)

thorax buttock flanks back

Penetrating trauma may appear minimal externally in comparison

to internal trauma (muscles may mask the size of the external wound)

Compression of the ___ ___ in ___ trimester reduces venous return and blood pressure drops

vena cava 3rd

Injury to hollow organs (3)

May rupture with compression from blunt forces and penetrating trauma Spillage of contents into retroperitoneal, peritoneal and pelvic spaces Intestines have large amounts of bacterial

Why is the abdominal cavity so important?

Multiple vital organs Large volumes of blood can be lost before signs and symptoms manifest Transmitted injury (Swelling, ecchymosis)

ASSESSMENT OF ABDOMINAL INJURY 1. Scene size-up

Must evaluate MOI to assess seriousness of injury Identify strength and direction of forces Velocity of impact Focus observations and palpation on that site Develop a mental list of possible organs involved If auto crash Determine if seatbelts used properly Interiors signs of impact Steering wheel and dashboard deformity GSW Types and caliber of weapon

ASSESSMENT OF ABDOMINAL INJURY step 4

OPQRST Assessment

DUring pregnancy what % of blood loss necessary before sign of shock

30-35%

Penetrating abdominal trauma accounts for what % of maternal mortality?

38%

Pregnancy;cardiac output increased by what %?

40%

Pregnancy; GSW account for what % of penetrating trauma?

40-70%

Abdominal Aorta

Blood supply to abdomen located to the left of spinal cord

Abdominal Aorta

Blood to abdomen

Pregnancy; what kind of trauma is cause by improperly worn seat belts?

Blunt trauma

organs in Left Upper Quadrant

Spleen Stomach

inferior vena cava location?

adjacent to spinal column

Pediatric patients and abdominal injuries (3)

1. Children have poorly developed abdominal musculature and smaller diameter 2. May not show signs and symptoms of shock unto 50% of blood is lost 3. Rib cage more cartilaginous

GENERAL MANAGEMENT OF ABDOMINAL TRAUMA STEP 3

Fluid resuscitation Large bore IV with isotonic solution (Consider 2 bolus if HR does not slow) Fluid challenge 250 ml or 20 ml/kg Titrate to SBP of 90 mmHg

GENERAL MANAGEMENT OF ABDOMINAL TRAUMA STEP 2

General shock care

blood in urine

Hematuria

Diaphragmatic tears

Herniation of abdominal contents into thorax

pregnancy cause heart rate to?

Increase by 15-20 BPM

retroperitoneal structures (5)

Kidneys Pancreas Duodenum Urinary bladder Rectum

ASSESSMENT OF ABDOMINAL INJURY 2. Initial assessment

LOC Drug or alcohol involved ABCD

what organ is most commonly affected in abdominal trauma?

Liver

Organs in Upper Right Quadrant

Liver Gallbladder Head of pancreas Upper part of Kidney Small and Large intestines

Penetrating trauma result

Organ damage Uncontrolled hemorrhage Spillage of hollow organ content Irritation or inflammation of abdominal lining (peritonitis)

Inferior boundary

Pelvis

bacterial irritation of peritoneum

Peritonitis (can be caused by trauma,often dude to rupture of hollow organ) Blood does not induce peritonitis

Management of the pregnant patient (4)

Position in left lateral recumbent Oxygenation (high flow O2) Maintain IOS for intra-abdominal bleeding Consider IV

GENERAL MANAGEMENT OF ABDOMINAL TRAUMA STEP 1

Position patient Position of comfort, unless spinal injury Flex knees or left lateral recumbent

mesentery function

Provides bowel with circulation, innervation and attachment

Injury during pregnancy

Risk of uterine and fetal injury increases with the length of gestation Penetrating trauma may cause fetal and maternal blood mixing

ASSESSMENT OF ABDOMINAL INJURY step 5

SAMPLE history

PASG indications

SBP <90 Suspected intra-abdominal or retroperitoneal bleeding Unstable pelvis SBP<50 without contraindication Evisceration If SBP<60 Intra abdominal bleeding

Injury to pelvis (3)

Serious skeletal injury Life threatening hemorrhage Potential injury to pelvic organs

Considerations with pregnant patients (6)

Sign of shocks, pretreat , signs may not develops until 30% of blood volume is lost Supine hypotensive syndrome Premature contractions Vaginal hemorrhage Uterus development

Injury to peritoneum signs and symptoms

Slight tenderness at location of injury Rebound tenderness Guarding Rigid board like feel

ASSESSMENT OF ABDOMINAL INJURY 6. ongoing assessment

Trend vital signs (very 5 minutes for critical patients Evaluate for progressive peritonitis Evaluate for progressive hemorrhage BP and capillary refill Pulse and Pulse oximetry Mental status Skin condition Ineffective/excessive fluid rescucitation

Pelvic organs

Ureters Bladder Urethra Female Genitalia Prostate

Blunt force trauma complications during pregnancy

Uterine rupture Abruptio placentia Premature rupture of amniotic sac

Injury to vascular structures

abdominal aorta and vena cava (Prone to direct blunt or penetrating trauma/ May be injured by deceleration injuries)

Pregnancy; auto collisons are?

are leading cause of mortality

Iliac Arteries

bifurication of aorta at sacral level

Solid organs ___. hollow organs ___ ___ ___

bleed leak into cavity

blast injuries

blunt and penetrating MOIs Irregular shaped shrapnel and debris Pressure waves Compresses and relaxes air filled organs Contuse or rupture organs

what trauma produces least visible signs of injury?

blunt trauma

Bright red blood in stool

hemotochezia