1. Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 36-1 Chapter 36 Abdominal and Genitourinary Trauma

2. 36-2 Objectives

3. Abdominal Trauma 36-3

4. Mechanism of Injury Blunt Forces Motor vehicle crashes Falls Assaults Penetrating Forces Guns Knives 36-4

5. Mechanism of Injury Considerations Type of trauma –Motor vehicle crash, fall injury, assault Object involved during impact –Bullet, knife, car, motorcycle, handlebars, tree Energy exchanged –Estimated speed of the vehicle at impact, size/caliber of gun, length of knife, distance of a fall Restraints / protective gear used 36-5

6. Abdominal Injuries 36-6

7. Location of Injuries 36-7

8. Abdominal Organs Hollow Organs Stomach Intestines Gallbladder Urinary bladder Uterus (female) Solid Organs Liver Spleen Pancreas Kidneys Adrenal glands Ovaries (female) 36-8

9. Types of Injuries Open injuries Closed injuries May involve multiple organs and major blood vessels 36-9

10. Closed Abdominal Injuries Common mechanisms of injury involving blunt trauma to the abdomen –Compression –Deceleration –Motor vehicle crash –Motorcycle collision –Pedestrian injury –Fall –Assault –Blast injury 36-10

11. Open Abdominal Injuries Low energy weapons –Knife, ice pick Medium energy weapons –Handguns and shotguns High-energy weapons –Military and hunting rifles 36-11

12. Liver Largest organ of the body Very vascular Injury can result in hemorrhage, leading to shock Suspect injury with: –Lower right rib fractures –Penetrating trauma to RUQ 36-12

13. Spleen Vascular organ Susceptible to injury Suspect injury with: –Lower left rib fractures –Penetrating trauma to LUQ Kehr’s sign –Suggests injury or rupture of the spleen or injury to the diaphragm 36-13

14. Pancreas Injury is uncommon –Can occur from both blunt and penetrating trauma Initial signs and symptoms –Upper abdominal pain –Flank tenderness Later signs and symptoms –Abdominal distention –Shock 36-14

15. Diaphragm Both blunt and penetrating trauma can cause injury to the diaphragm. Injury more commonly occurs on the left side 36-15

16. Stomach and Intestines Injury can result in leakage of organ contents into the peritoneum resulting in peritonitis and shock. Injuries to the large intestine are usually the result of gunshot wounds and stabbings. 36-16

17. Abdominal Vessels Injury to vascular structures in the abdomen can result in: –Significant hemorrhage –Peritoneal irritation –Abdominal distention –Shock 36-17

18. Genitourinary Trauma 36-18

19. Kidneys and Ureters Injury to the kidney –Usually caused by blunt trauma –Penetrating injury can result from gunshot or stab wounds Injury to a ureter is uncommon 36-19

20. Bladder and Urethra Empty bladder lies in the pelvis Full bladder rises above the umbilicus –Less protected –Increased likelihood of injury 36-20

21. External Male Genitalia 36-21

22. External Female Genitalia 36-22

23. Patient Assessment 36-23

24. Patient Assessment Ensure scene safety Assess the ABCs Manual stabilization of the patient’s head and neck if head or spinal injury suspected 36-24

25. Patient Assessment Remove the patient’s clothing Make sure that the patient is supine Assess the abdomen –DCAP-BTLS –Abdominal distention –Entrance and exit wounds 36-25

26. Patient Assessment If the patient is responsive, ask him to point to the area that hurts. –Assess the area that hurts last. Ask the patient to rate his pain on a 0 to 10 scale Determine if the abdomen feels soft or hard. Document your findings. 36-26

27. Patient Assessment Look for signs of impending shock that can include: –Restlessness –Anxiety –Decreasing level of responsiveness –Pallor –Tachycardia –Narrowing pulse pressure 36-27

28. Patient Assessment Male If the male patient with a genitourinary injury is responsive: –Explain to him that you will need to view the area and then obtain permission from him to proceed. –Be aware that he will most likely be anxious and may be embarrassed. –Offer emotional support, maintain the patient’s privacy, and protect his modesty. 36-28

29. Patient Assessment Female Looking at the external female genitalia is necessary if the patient complains of bleeding from the vaginal or rectal area. Before visualizing the area, tactfully explain that you will need to view the area and obtain permission from the patient to do so. If possible, it is advisable to have a female EMS professional in attendance during the assessment. 36-29

30. Patient Assessment Female Your assessment of the female genitalia is limited to looking at the area, while maintaining the patient’s privacy and protecting her modesty. You must never insert anything into the vagina or attempt to examine the internal female genitalia. –These actions are outside the Emergency Medical Technician’s scope of practice. 36-30

31. Emergency Care Put on appropriate PPE. Keep on-scene time to a minimum. If spinal injury is suspected, take spinal precautions. If a spinal injury is not suspected, place the patient in a position of comfort. Establish and maintain an open airway. –If the patient is unresponsive, insert an oral airway. Suction if needed. Give oxygen. 36-31

32. Emergency Care Expose the wound site. –Control external bleeding by applying direct pressure. If signs of shock are present or if internal bleeding is suspected, treat for shock. Do not remove penetrating objects; rather, stabilize in place with bulky dressings. Manage avulsed or amputated parts as other soft tissue injuries. 36-32

33. Emergency Care Do not touch protruding organs. –Evisceration management Protect patient’s modesty. Transport promptly. Reassess at least every 5 minutes en route. Record all patient care information, including the patient’s medical history and all emergency care given, on a PCR. 36-33

34. 24-34 Questions?