Chapter 30: Abdominal and Genitourinary Injuries EMT 11th edition

What is the breathing like of a patient with an abdominal injury or injuries?

Rapid and shallow.

Peritonitis

inflammation of the peritoneum, typically caused by bacterial infection either via the blood or after rupture of an abdominal organ. Serious and may become life threatening

What can Closed abdominal injuries look like initially?

initially appear as abrasions.

The urinary meatus,

is the opening of the urethra. It is the point where urine exits the urethra in males and in females, and also where semen exits the urethra in males.

What happens if the seat belt lies to high?

it can squeeze abdominal organs or great vessels against the spine when the car decelerates or stops.

High-velocity injuries are caused by:

larger weapons, such as high-powered rifles and higher-powered handguns

Vascular

of, relating to, affecting, or consisting of a vessel or vessels, especially those that carry blood.

Vascularize

provide (a tissue or structure) with vessels, especially blood vessels; make vascular.

Signs of peritonitis

severe abdominal pain, tenderness, and muscular spasm.

If a hollow organ or loop of bowel is perforated and not treated quickly what can it lead to?

severe infection and septic shock may develop.

Medium-velocity injuries are caused by:

smaller caliber handguns and shotguns

The hollow organs of the abdomen:

stomach, intestines, ureters, and bladder.

Signs and symptoms of an open injury?

tachycardia.

In evisceration

the bowel protrudes from the peritoneum.

The solid organs of the abdomen include:

the liver, spleen, pancreas, and kidneys.

Melena

Black, tarry stools.

Seatbelts can save lives.. but what else can they do?

They occasionally cause blunt injuries of the abdominal organs.

What do the solid organs do?

They perform the chemical work of the body; Enzyme production, Blood cleansing, Energy production

Can determining the location of the pain or referred pain be difficult when the patient has voluntary or involuntary guarding?

YES

Closed abdominal injuries

Blunt trauma to abdomen without breaking the skin

What can cause hollow organ injuries?

Both blunt and penetrating trauma

How is the liver often injured in a trauma situation?

By a fractured lower right rib or a penetrating trauma

What happens if an organ ruptures or is lacerated and spills the contents into the abdominal cavity?

Can cause an intense inflammatory reaction and possible infection.

clasp-knife injury.

Caused by a poorly placed lap belt, which creates an injury pattern.

Why are Assessment of abdominal injuries is one of the more difficult assessments that you will perform?

Causes of injury may be apparent, but resulting tissue damage may not be so apparent. Patient may be overwhelmed with other more painful injuries. Some develop and worsen over time.

Blunt trauma causes what to an organ?

Causes the organ to "pop," releasing fluids and air.

Solid organs can also slowly ooze blood into the peritoneal cavity, what sensation does that create for the patient?

Causing pain to increase slowly over time.

Ensure that the patient has a blank and blank airway.

Clear and patent

Deceleration

Commonly occurs when a person or the vehicle that he or she is traveling in strikes a large, immovable mass such as a larger vehicle, a bridge abutment, or the ground

Third step of reassessment

Communication and documentation: Communicate your concerns to the hospital staff. Describe all injuries and treatment given.

Examples of blunt trauma to abdomen without breaking the skin

Compression: Typically caused by a poorly placed lap belt, which creates an injury pattern Can also be caused when a person is run or rolled over by vehicles or objects.

Guarding

Conscious or unintentional stiffening of the muscles of the surface of the abdomen to avoid further pain.

Guarding

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

What do you do with the clothing of an injured patient with an evisceration?

Cut clothing close to the wound.

What does penetrating injury cause?

Direct injury, such as lacerations and punctures.

What do you NOT do with an evisceration?

Do not push down on the patient's abdomen. Never pull on any clothing stuck to or in the wound channel.

What can loose bile and urine cause in the abdomin?

Eventually can lead to infection.

Later signs include of an open injury to the abdomin

Evidence of shock, such as decreased blood pressure and pale, cool, moist skin. Changes in patient's mental status. Abdomen may become distended from accumulation of blood and fluid.

Open abdominal injuries

Injuries in which a foreign object enters the abdomen and opens the peritoneal cavity to the outside

What is the leading cause of traumatic death?

Injuries to the abdomen that go unrecognized and are not repaired in surgery

If the diaphragm is penetrated or ruptured what can happen?

Loops of bowels may herniate into the thoracic cavity. Patients may exhibit dyspnea.

Since open wounds can be deceiving; you should what?

Maintain a high index of suspicion for unseen injuries, internal damage to organs, and potential life-threatening injuries.

Vital signs in secondary assessment..

Many abdominal emergencies can cause a rapid pulse and low blood pressure. Your records of the patient will help you identify changes in the patient's condition.

Secondary assessment, will you have time?

May not have time to perform this detailed, comprehensive exam in critically injured patients

What does cavitation cause?

Microscopic tears to the blood vessels and nerves

What do most of the hollow organs contain?

Most have food in them and are in the process of being digested, urine that is being passed to the bladder for release, or bile

What is different about the signs and symptoms of hollow organ injuries?

Often are delayed

What kind of assessment do you perform with an evisceration?

Only perform a visual assessment when there is any suspicion of this type of injury.

Penetrating injuries

Open abdominal injuries

Why is it important to understand the functions of the organs?

So you can assess an injury's seriousness.

Solid organs

Solid masses of tissue where much of the chemical work of the body takes place (eg: the liver, spleen, pancreas and kidneys).

What are some things you need to evaluate to determine condition and stage of shock?

Pulse, skin color, temperature, and condition

What can happen when cavitation occurs?

a large amount of bleeding can happen. +

Why is it important to transport abdominal injuries quickly?

A delay in medical evaluation and transport may result in an unnecessary and dangerous progression of shock and could potentially be life and death.

Signs of injury to the mesentery

Abdominal rigidity and periumbilical bruising.

What can A distended abdomen potentially prevent?

Adequate inhalation

With an injury to a hollow organ why do symptoms and signs sometimes are delayed?

An infection can develop, which can take hours or days.

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.

Closed abdominal injury

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

Why can hemorrages be severe when it occurs in solid organs?

Because of their rich blood supply,

Placing the seat belt for comfort on a pregnant woman can cause what, if injury or accident occurs?

Bladder injuries

Hematuria

Blood in the urine

What is the largest organ in the abdomin?

The liver

What other organs in the abdomin are very vascular?

. The spleen and pancreas.

Scene size up for an abdominal injury

1.scene safety 2.Call for additional resources early if needed. 3. Mechanism of injury/nature of illness a. Consider early spinal precautions. b. Consider all of the injuries the MOI could have produced.

What symptoms/signs should you ask the patient if he or she has experienced prior to your arrival?

Ask if the patient has experienced any nausea, vomiting, or diarrhea. Ask how many times and over what period? Ask about the appearance of any bowel movements and urinary output?Determine if there was any blood in the urine or black, tarry stools (melena).

Superficial abdominal injuries produce significant external bleeding? True or false

False

Solid organ injuries can be easy to identify from a physical exam because the patient is experiencing significant pain? True or False

False, Can be HARD to identify, Patient is NOT experiencing significant pain.

Abdominal distention or swelling between the xiphoid process and the groin is often the result of what?

Free fluid, blood, or organ contents spilling into the peritoneal cavity.

What can be mistaken for abdominal rigidity?

Guarding

What type of organs commonly spill into the abdomen with injury?

Hollow organs

What may not be apparent during physical examination?

Internal injury

Second step in reassessment

Interventions: Provide oxygen if there are signs of dyspnea or shock and maintain a patent airway. Attempt to control bleeding and treat for shock. Place patient in position of comfort and transport.

Is evisceration painful?

It can be extremely painful and visually shocking

The abdomen extends from the where to where ?

It goes from the diaphragm to the pelvis and contains the organs that make up the digestive, urinary, and genitourinary systems.

How many abdominal quadrants are there?

It is divided into four quadrants.

Tell me about the liver?

It is very vascular and can contribute to hypoperfusion if injured

Whats the proper placement of a seatbelt?

Lies below the anterior superior iliac spines of the pelvis and against the hip joints.

Movement of the body or the abdominal organs irritates the inflamed peritoneum, causing an increase or addition of what sensation?

Pain

Signs and symptoms of a closed injury

Pain can be deceiving. Often diffuse in nature May be referred to another body location. Liver and spleen injuries refer pain to the shoulder. Blood or fluid in the peritoneal cavity produces acute pain in the entire abdomin. Pain spreads as the blood or contaminant seeks out the voids in the peritoneal cavity.

What sensation does free air in the peritoneal cavity produce?

Pain.

What happens if the mesentery gets injured?

Patients can bleed significantly into the peritoneal cavity.

Where should you transport abdominal injury patient?

Patients should be evaluated at the highest level of trauma center available.

When a patient has an abdominal injury what position will the patient be in to alleviate pain?

Patients will lie still, usually with their knees drawn up.

What is the first step in the primary assessment? (other than scene safety)

Perform a rapid scan. 3. In trauma patients, life-threatening external hemorrhage must be addressed before airway or breathing concerns.

Details of a physical examinations in the secondary assessment?

Remove or loosen clothes to expose injured regions of the body. Inspect the patient for bleeding before removing the clothing to prevent damaging exposed tissues. Patient should be able to stay in position of comfort unless spinal injury is suspected. Examine the entire abdomen including all posterior, anterior, and lateral surfaces. Critical step for patients with an entrance wound Use DCAP-BTLS to help identify specific signs and symptoms of injury. Inspect and palpate the abdomen for the presence of deformities. Look for the presence of contusions and abrasions. Puncture wounds and other penetrating injuries cannot be overlooked. The intra-abdominal extent of these injuries may be life threatening. Note the signs of burns. Palpate for tenderness and attempt to localize to a specific quadrant of the abdomen. Treat lacerations with appropriate dressings. Swelling may involve the abdomen globally and indicate significant intra-abdominal injury.

First step in reassessment

Repeat the primary assessment and vital signs. Reassess the interventions and treatment you have provided.

If the kidneys are impacted or penetrated by trauma what can that cause?

Significant amounts of blood loss. Blood in the urine (hematuria) Blood visible on inspection of the urinary meatus indicates significant trauma to the genitourinary system.

What are some considerations when performing a rapid scan on an abdominal injury?

Some injuries will be obvious and graphic, but MOST will be very subtle and will go unnoticed. Remember that in some cases the injury may have occurred hours or days earlier.

What can leak highly toxic and acidic digestive liquids into the peritoneal cavity.

Stomach and intestines

Hollow organs

Structures through which materials pass, such as the stomach, small intestines, large intestines, ureters, and urinary bladder.

If the MOI suggests an isolated injury to the abdomen, focus your physical examination on what?

That specific location in the body.

What can an abdominal bleeding wound may hide?

That the object went farther and deeper into the peritoneal cavity and injured other organs and tissues.

Where is a common location for swelling and inflammation?

The RLQ

Peritoneal cavity

The abdominal cavity.

What is it important to clarify during history taking?

The chief complaint and MOI.

What can happen if an organ in the abdomen gets lacerated or ruptures?

The contents spill into the peritoneal cavity.

Where does intestinal blood supply come from?

The mesentery (fold of tissue that connects the small intestine to the abdominal wall).

Flank

The region below the rib cage and above the hip.

Where is a potential place the secondary assessment could take place?

The rig, ambulance.

Anytime a patient has an injury at or below the xiphoid process, it should be assumed that.....?

The thoracic and peritoneal cavities may have been violated.

What can help predict the amount of damage to tissue?

The velocity of the object

Why are the pancreas and spleen prone to heavy bleeding?

They are both vascular. When fractured, lacerated, or punctured they can bleed a lot.

Where does bile and urine that has leaked into the abdomin go?

They move into loose spaces and voids in the peritoneal cavity.

Solid organ injuries can bleed significantly and cause rapid blood loss? True or False

True a. Can be hard to identify from a physical exam because the patient is not experiencing significant pain. b. Solid organs can also slowly ooze blood into the peritoneal cavity, causing pain to increase slowly over time. 2. The liver is the largest organ in the abdomen. a. Very vascular and can contribute to hypoperfusion if injured b. Often injured by a fractured lower right rib or a penetrating trauma

Can signs of abdominal injury be bruising and discoloration?

YES

Should you notate the position the patient is lying in?

Yes

What is the first and most important aspect of scene size-up

Your safety, make sure it safe for you.

cavitation

a cavity forms as the pressure wave from the projectile is transferred to the tissues.

What does free air in the peritoneal cavity indicate?

a hollow organ or loop of bowel has perforated

What kinds of significant trauma to the abdomen can occur from?

blunt trauma, penetrating trauma, or both.

Low-velocity penetrations also have the capacity to

damage underlying organs.

What do high and medium velocity injuries have other than temporary wound channels?

exit and entrance wounds.

Urinary meatus:

external urethral orifice

In what organs are the contents potentially irritating and damaging if those organs ruptured? And what are those contents called?

gallbladder and the urinary bladder. Bile and Urine

Low-velocity injuries are caused by:

handheld or hand-powered objects, such as knives and other edged weapons

The (blank aka your answer) the velocity of the projectile, the larger the cavity it produces.

higher