Ch. 30: Abdominal and Genitourinary Injuries

11. Explain assessment of a patient who has experienced a genitourinary injury; include special considerations related to patient privacy and determining the MOI. (pp 1075-1077)

scene size up -look for blood on underwear primary assessment -control bleeding -ensure patent airway -consider inserting an airway if pt is unconscious -assess ventilations, pulse, skin, temp, and capillary refill time History taking -determine chief complaint -ask about associated complaints -SAMPLE and OPQRST -allergies -last intake -address events leading up to incident secondary assessment -expose only what's needed -provider should be same gender if possible -DCAP-BTLS -obtain vitals Reassessment -provide O2 and maintain patent airway -control bleeding and treat for shock -place pt in position of comfort and transport -communicate with hospital and document thoroughly

13. Explain special considerations related to a patient who has experienced a genitourinary injury caused by a sexual assault, including patient treatment, criminal implications, and evidence management. (p 1079)

-Do not examine the genitalia of a victim of sexual assault unless obvious bleeding requires you to apply a dressing. -Advise the patient not to wash, bathe, shower, douche (if female), urinate, or defecate until after a physician has examined him or her. -If oral penetration has occurred, advise the patient not to eat, drink, brush teeth, or use mouthwash until he or she has been examined. -wrap pt in a sterile burn sheet, if tolerated -place clothes and evidence in paper bags -provide privacy, support, and reassurance

8. Explain the emergency medical care of a patient who has sustained an open abdominal injury, including penetrating injuries and abdominal evisceration. (pp 1070-1072)

-assume there is unseen blood loss -follow steps for a blunt injury -inspect pt's back and sides for exit wounds -apply dry, sterile dressing to all open wounds -stabilize object if its still in place -never try to put an eviscerated organ back in place -Cover it with sterile dressings moistened with sterile saline solution and secure with a bandage and tape. -keep organs moist and warm -

7. Explain the emergency medical care of a patient who has sustained a closed abdominal injury, including blunt trauma caused by a seat belt or air bag. (pp 1069-1070)

-position pt for optimal comfort and apply high flow O2 if he or she has signs of hypoxia or shock -A patient who has sustained a blunt abdominal injury should be log rolled to a supine position onto a backboard. -monitor vital signs -signs of shock: pallor, cold swear, rapid thready pulse, or low blood pressure -pts with a diaphragmatic rupture may need pos. pressure vents

3. Demonstrate how to apply a dressing to an abdominal evisceration wound. (pp 1071-1072)

1. the open wound radiates heat and must be covered 2. cover wound with moistened, sterile dressing, depending on local protocol 3. secure the dressing with a bandage 4. secure bandage with tape

2. Describe some special considerations related to the care of pediatric patients and geriatric patients who have experienced abdominal trauma. (pp 1058-1059, 1065)

Falls are the most common mechanism of injury in geriatric patients. In addition to the typical orthopaedic injuries that a geriatric patient sustains in a fall, the abdominal organs that have lost some elasticity over time are exposed to forces that can damage them. Specifically, the aorta, liver, and spleen are at risk of injury from falls. If a geriatric patient's bones are brittle, they can fracture in a fall, creating dangerously sharp edges that can puncture internal organs.

5. Describe the different ways hollow and solids organs of the abdomen can be injured and include the common signs and symptoms exhibited by patients depending on the organ(s) involved. (pp 1062-1064)

Hollow: -Food, waste, and digestive liquids that are highly toxic and acidic can be spilled, which causes significant damage to the peritoneum -blunt trauma can cause hollow organs to "pop," releasing fluids or air -penetrating injuries can cause lacerations -bile and urine from the gallbladder and bladder are irritating to tissues. Can cause infection -perforation with free air is painful and can move around Solid: -injury to liver causes referred pain in right shoulder -if diaphragm because penetrated, the bowels can go into the cavity and displace lung tissue -kidneys can be crushed or displaced, causing great blood loss -hematuria could then result -

12. Explain the emergency medical care of a patient who has sustained a genitourinary injury to the kidneys, urinary bladder, external male genitalia, female genitalia, and rectum. (pp 1077-1079)

Kidneys -Treat shock and associated injuries in the appropriate manner. Provide rapid transport to the hospital, carefully monitoring the patient's vital signs en route. Urinary bladder -Suspect a possible injury of the urinary bladder if you see blood at the urethral opening or physical signs of trauma on the lower abdomen, pelvis, or perineum. -transport rapidly External male genitalia -Use sterile, moist compresses to cover areas that have been stripped of skin. -Apply direct pressure with dry, sterile gauze dressings to control bleeding. -If you encounter a patient with an avulsion (tearing away) of skin of the penis, wrap the penis in a soft, sterile dressing moistened with sterile saline solution, and rapidly transport the patient. -for a ruptured testicle, Apply an ice pack to the scrotal area while transporting the patient. Female genitalia -Treat lacerations, abrasions, and avulsions with moist, sterile compresses. Rectum Rectal bleeding can be caused by: Sexual assault Rectal foreign bodies Hemorrhoids Colitis Ulcers of the digestive track

4. Define open abdominal injuries; include the three common velocity levels that distinguish these injuries, provide examples of the MOI that would cause each, and common signs and symptoms exhibited by patients who have experienced this type of injury. (pp 1061-1062)

Open abdominal injuries are those in which a foreign object enters the abdomen and opens the peritoneal cavity to the outside; these are also known as penetrating injuries. Low-velocity injuries: Caused by hand-held or hand-powered objects such as knives and other edged weapons Medium-velocity penetrating wounds: Caused by smaller caliber handguns and shotguns High-velocity injuries: Caused by larger weapons such as high-powered rifles and the higher-powered handguns -high and medium velocity injuries can produce cavitation evisceration The displacement of organs outside of the body. signs and symptoms: -tachycardia. Heart is compensating for blood loss -late signs: shock, changes in mental status, trauma to abdomen/ more distended -blunt injuries have bruises

1. Describe the anatomy and physiology of the abdomen; include an explanation of abdominal quadrants and boundaries and the difference between hollow and solid organs. (pp 1057-1059)

Right upper quadrant (RUQ) -liver, gallbladder, duodenum of intestines, and a small portion of pancreas Left upper quadrant (LUQ) -stomach and spleen -pancreas has a small portion here posteriorly Left lower quadrant (LLQ) -both LI and SI. But mostly descending colon and left half of transverse colon Right lower quadrant (RLQ) -both LI and SI. But most notably the ascending colon and right half of transverse colon -appendix Hollow organs contain food being digested and urine. -if ruptured, contents spill into the peritoneal cavity and cause inflammation and pain-- peritonitis -signs of peritonitis include pain, tenderness, and muscular spasm. Nausea -the mesentery supplies the intestines with blood -rigidity is common in abdominal bleeding Solid organs -much of the chemical work of body takes place i.e. enzyme production, blood cleansing, and energy production -includes liver, spleen, pancreas, and kidneys -retroperitoneal space houses kidneys, ureters, urinary bladder, great vessels, abdominal aorta, and inferior vena cava

6. Explain assessment of a patient who has experienced an abdominal injury; include common indicators that help determine the MOI and whether it is a significant or insignificant MOI. (pp 1064-1069)

Scene size up -at least wear gloves and glasses -if its a penetrating wound, is the object smooth, serrated, smooth, or jagged? is it clean or dirty? how long is it? Primary assessment -AVPU -ask about chief complaint -treat via high flow O2 via non rebreathing mask for pts who are not alert and oriented -ensure patent airway -assess breathing -consider supplemental vents with BVM -for shock symptoms, provide O2, keep pt supine, and keep warm -rapid transport for any trauma pt with a significant MOI History Taking -clarify chief complaint and MOI -ask about previous injuries associated with chief complaint -SAMPLE -OPQRST -determine if there is internal bleeding by asking if bowel mvmts and urine have blood or melena (for stool) Secondary assessment -remove or loosen clothes to expose injured parts of body -pts without a spinal injury may sit with legs pulled up toward abdomen -pts with spinal injury should have padding under knees to relieve pressure off abdomen -Examine the entire abdomen, including all posterior, anterior, and lateral surfaces. -examine axillae for entrance wounds -Use DCAP-BTLS to help identify specific signs and symptoms of injury. -palpate abdomen. Start with light touch then gradually deeper to determine pain response -Start by palpating the quadrant farthest away from the quadrant that is exhibiting signs and symptoms of injury and pain. -Use pulse oximetry and noninvasive blood pressure devices when available. -for an isolated abdominal injury, focus on ly on the injured area -Avoid log rolling patients with an evisceration because this can cause more of the abdominal organs to protrude from the wound. Reassessment -redo things and check treatment efficacy -If there is an evisceration, place a sterile dressing moistened with normal saline over the wound, apply a bandage, and transport. -A patient who has a ruptured diaphragm may have an abdomen with a sunken anterior wall and difficulty breathing because of bowel contents in the chest cavity. Apply pos. pressure vents with BVM

10. Discuss the types of traumatic injuries sustained by the male and female genitourinary system, including the kidneys, urinary bladder, and internal and external genitalia. (pp 1073-1075)

The kidneys -injuries include: -An abrasion, laceration, or contusion in the flank -A penetrating wound in the flank (the region below the rib cage and above the hip) or the upper abdomen -Fractures on either side of the lower rib cage or of the lower thoracic or upper lumbar vertebrae -A hematoma in the flank region The urinary bladder -could rupture -sharp bone fragments can perforate the bladder The external male genitalia -soft tissue wounds -not life threatening -Pain from an injury to the testicles or another cause, such as infection or cancer, may be referred to the lower abdomen. The internal female genitalia -not typically injured -except for the pregnant woman. Uterus becomes vulnerable to penetrating and blunt injuries -uterus has rich blood supply -signs of shock will develop -make pt lie on left side so uterus will not lie on vena cava (for 3rd trimester babies) The external female genitalia -soft tissue injuries -assume all women of child bearing years are pregnant -apply a pad if needed

9. Describe the anatomy and physiology of the female and male genitourinary system; include the differences between the hollow and solid organs. (pp 1072-1073)

The male genitalia, except for the prostate gland and the seminal vesicles, lie outside the pelvic cavity. The female genitalia, except for the vulva, clitoris, and labia, are contained entirely within the pelvis.

3. Define closed abdominal injuries; provide examples of the mechanisms of injury (MOI) likely to cause this type of trauma, and common signs and symptoms exhibited by patients who have experienced this type of injury. (pp 1059-1060)

closed abdominal injuries An injury in which there is soft-tissue damage inside the body but the skin remains intact. MOIs include: Striking the handlebar of a bicycle or the steering wheel of a car Being struck by a wooden board or baseball bat Motorcycle crashes Falls Blast injuries Pedestrian injuries Compression Deceleration Signs and symptoms of a closed injury -in liver and spleen injuries or bleeding in the peritoneal space, pain is referred to the shoulder -abdominal aneurysm sign: pain that is described as tearing going from the abdomen posteriorly. -kidney or ureter damage sign: Pain that is following the angle from the lateral hip to the midline of the groin -inflamed or ruptured appendix sign: Pain primarily located in the right lower quadrant -gallbladder sign: pain found just under the margin of the ribs on the right side or between the shoulder blades -In guarding, the patient either consciously or unintentionally stiffens the muscles of the surface of the abdomen. -abdominal distention or swelling can occur in the abdomen as contents spill into the peritoneal space Other signs and symptoms include: Tenderness Bruising and discoloration rib fractures