Abdominal Trauma Athens Technical College EMS Program 1
The Abdomen Everything between diaphragm and pelvis Injury, illness very difficult to assess because of large variety of structures 2
Abdominal Anatomy Abdomen divided into four quadrants by body mid-line, horizontal plane through umbilicus Organs can be located by quadrant 3
Abdominal Anatomy Right Upper Quadrant Liver Gall Bladder Right Kidney Ascending Colon Transverse Colon 4
Abdominal Anatomy Left Upper Quadrant Spleen Stomach Pancreas Left Kidney Transverse Colon Descending Colon 5
Abdominal Anatomy Right Lower Quadrant Ascending Colon Appendix Right Ovary (female) Right Fallopian Tube (female) 6
Abdominal Anatomy Left Lower Quadrant Descending Colon Sigmoid colon Left Ovary (female) Left Fallopian Tube (female) 7
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
Abdominal Cavity Peritoneum = abdominal cavity lining Divides abdomen into two spaces Peritoneal cavity Retroperitoneal space 9
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
Abdominal Anatomy Organs can be classified as: Hollow Solid Major vascular 11
Solid Organs Liver Spleen Kidney Pancreas When solid organs are injured, they bleed heavily and cause shock 12
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
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
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
Hollow Organs Stomach Gall bladder Large, small intestines Ureters, urinary bladder Rupture causes content spillage, inflammation of peritoneum 16
Hollow Organs Stomach Acid, enzymes Immediate peritonitis Pain, tenderness, guarding, rigidity 17
Hollow Organs Colon Spillage of bacteria May take 6 hrs to develop peritonitis Small Bowel Fewer bacteria May take 24-48 hours to develop peritonitis 18
Major Vascular Structures Aorta Inferior vena cava Major branches Injury can cause severe blood loss ; exsanguination (bleeding out) 19
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
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
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
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
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
Abdominal Rigidity NOT reliable Bleeding may not cause rigidity if free hemoglobin absent Bleeding in retroperitoneal space may not cause rigidity 25
Abdominal Trauma Management Less important to diagnose exact injury Treat clinical findings Management same regardless of specific organ(s) injured 26
Abdominal Trauma Management Airway C-Spine if mechanism indicates High flow O 2 Assist ventilations if needed Give nothing by mouth 27
Impaled Object Leave in place Shorten if necessary for transport Leave part of object exposed 28
Evisceration With large laceration abdominal contents may spill out Do NOT try to replace 29
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
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