Abdominal Trauma. Athens Technical College EMS Program

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1 Abdominal Trauma Athens Technical College EMS Program 1

2 The Abdomen Everything between diaphragm and pelvis Injury, illness very difficult to assess because of large variety of structures 2

3 Abdominal Anatomy Abdomen divided into four quadrants by body mid-line, horizontal plane through umbilicus Organs can be located by quadrant 3

4 Abdominal Anatomy Right Upper Quadrant Liver Gall Bladder Right Kidney Ascending Colon Transverse Colon 4

5 Abdominal Anatomy Left Upper Quadrant Spleen Stomach Pancreas Left Kidney Transverse Colon Descending Colon 5

6 Abdominal Anatomy Right Lower Quadrant Ascending Colon Appendix Right Ovary (female) Right Fallopian Tube (female) 6

7 Abdominal Anatomy Left Lower Quadrant Descending Colon Sigmoid colon Left Ovary (female) Left Fallopian Tube (female) 7

8 Abdominal Anatomy Periumbilical area Located around (peri) the navel (umbilicus) Small bowel lies in all quadrants in periumbilical area Suprapubic area Located just above pubic bone Urinary bladder, uterus lie in this area 8

9 Abdominal Cavity Peritoneum = abdominal cavity lining Divides abdomen into two spaces Peritoneal cavity Retroperitoneal space 9

10 Abdominal Anatomy Peritoneal Spleen Liver Stomach Gall bladder Bowel Retroperitoneal Pancreas Kidney Ureter Inferior vena cava Abdominal aorta Urinary bladder Reproductive organs Disease, injury of retroperitoneal organs often causes back pain 10

11 Abdominal Anatomy Organs can be classified as: Hollow Solid Major vascular 11

12 Solid Organs Liver Spleen Kidney Pancreas When solid organs are injured, they bleed heavily and cause shock 12

13 Solid Organs Liver Largest abdominal organ Most frequently injured Fractures of ribs 8-12 on right side Bleeding can be either: Slow, contained under capsule Free into peritoneal cavity 13

14 Solid Organs Spleen Frequently injured with trauma ribs 9-11 on left side Bleeds easily Capsule around spleen tends to slow development of shock Rapid shock onset when capsule ruptures 14

15 Solid Organs Pancreas Lies across lumbar spine Sudden deceleration produces straddle injury Very little hemorrhage Leakage of enzymes digests structures in retroperitoneal space, causes volume loss, shock 15

16 Hollow Organs Stomach Gall bladder Large, small intestines Ureters, urinary bladder Rupture causes content spillage, inflammation of peritoneum 16

17 Hollow Organs Stomach Acid, enzymes Immediate peritonitis Pain, tenderness, guarding, rigidity 17

18 Hollow Organs Colon Spillage of bacteria May take 6 hrs to develop peritonitis Small Bowel Fewer bacteria May take hours to develop peritonitis 18

19 Major Vascular Structures Aorta Inferior vena cava Major branches Injury can cause severe blood loss ; exsanguination (bleeding out) 19

20 Abdominal Trauma Blunt or penetrating trauma Most survive to reach hospital Most common factors leading to death Failure to adequately evaluate Delayed resuscitation Inadequate volume Inadequate diagnosis Delayed surgery 20

21 High Index of Suspicion Mechanism Trauma to lower chest, back, flank, buttocks, and perineum Hypovolemic shock with no readily identifiable cause Diffusely tender abdomen Pain in uninjured shoulder 21

22 Mechanism Look for signs of injury Bruises Tire marks Obvious open injuries Assume any abdominal injury is serious until proven otherwise! Injury above umbilicus also involves chest until proven otherwise 22

23 Unexplained Shock Assess vital signs; skin color, temperature; capillary refill Tachycardia; restlessness; cool, moist skin In trauma, signs of shock suggest abdominal injury if no other obvious causes present 23

24 Signs of Injured Abdomen Diffuse tenderness Pain Pain referred to shoulder = Organ under diaphragm involved (?spleen) Pain referred to back = Retroperitoneal organ involved (?kidney) 24

25 Abdominal Rigidity NOT reliable Bleeding may not cause rigidity if free hemoglobin absent Bleeding in retroperitoneal space may not cause rigidity 25

26 Abdominal Trauma Management Less important to diagnose exact injury Treat clinical findings Management same regardless of specific organ(s) injured 26

27 Abdominal Trauma Management Airway C-Spine if mechanism indicates High flow O 2 Assist ventilations if needed Give nothing by mouth 27

28 Impaled Object Leave in place Shorten if necessary for transport Leave part of object exposed 28

29 Evisceration With large laceration abdominal contents may spill out Do NOT try to replace 29

30 Evisceration Cover exposed organs with saline moistened multitrauma dressing Do NOT use 4 x 4s Cover first dressing with second DRY dressing or aluminum foil 30

31 31

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