Presentation on theme: "Chapter 12 Abdominal Emergencies. Lesson Objectives List the abdominal organs by quadrants. Know how to assess and manage abdominal injuries, including."— Presentation transcript:
Chapter 12 Abdominal Emergencies
Lesson Objectives List the abdominal organs by quadrants. Know how to assess and manage abdominal injuries, including open and closed injuries and hernias. Know how to assess and manage abdominal illnesses, including pain, appendicitis, nausea and vomiting, diarrhea, constipation, bloody stools, and hemorrhoids. List the evacuation guidelines for abdominal problems.
Anatomy of the Abdomen
Abdominal Injuries (1 of 12) Closed: No break in skin Open: Penetration of the peritoneal cavity Both open and closed injuries can cause internal bleeding or leakage of intestinal contents that cause irritation and infection.
Abdominal Injuries (2 of 12) Closed injuries –Organs can be injured by a direct blow. –Solid organ injuries usually result in significant bleeding. –Hollow organ injuries are more likely to cause peritonitis.
Abdominal Injuries (3 of 12) Closed injuries –What to look for: Mechanism of injury Bruising or abrasions of the abdominal wall or lower chest Abdominal pain and tenderness
Abdominal Injuries (4 of 12) Closed injuries –What to look for: Possible spleen injury: Signs of shock, pain in right upper abdomen Possible kidney injury: Pain in the flank; blood in urine; signs of shock; enlarged, tight abdomen; increasing pain; fever; nausea and vomiting
Abdominal Injuries (5 of 12) Closed injuries –What to do: Have victim rest completely, allow only sips of water. Record observations frequently. Evacuate if signs of shock or peritonitis appear.
Abdominal Injuries (6 of 12) Open injuries –What to look for: Protruding bowel or fat External bleeding from a laceration of the abdominal wall Signs similar to closed injury
Abdominal Injuries (7 of 12) Open injuries –What to do: For penetrating injury with medical help close by, leave object in place. Might be necessary to remove object for evacuation. Consider shortening a long object. Treat as for closed injuries.
Abdominal Injuries (8 of 12) Open injuries –What to do: Protruding bowel that is not torn can be returned to the abdominal cavity if help is far away. If help is close, cover with a moist cloth. If bowel has torn, do not return to abdominal cavity.
Abdominal Injuries (9 of 12) Hernia –Loops of intestine protrude through a weak spot in the abdominal wall. –More common in men than in women. –Most common site is the groin. –Rarely require surgery. –Occasionally blood supply to the protruding loop of intestine is cut off requiring emergency medical care.
Abdominal Injuries (10 of 12) Hernia –What to look for: Unstrangulated hernia Bulging in the groin that is easier to see when the victim is straining and coughing Swelling, usually soft and painless Soreness Burning Feeling of pressure
Abdominal Injuries (11 of 12) Hernia –What to look for: Strangulated hernia Hernia that will not reduce Firm bulge with rapidly increasing pain and tenderness Pain spreading to the abdomen Possibly vomiting
Abdominal Injuries (12 of 12) Hernia –What to do: Attempt to reduce a possible strangulated hernia. Evacuate if there is increasing pain and you are unable to reduce the hernia.
Abdominal Illnesses (1 of 17) Pain –Often difficult to determine exact cause. –Decision to evacuate hinges on determining course of illness, difficulty in obtaining help, and the number of people in the group.
Abdominal Illnesses (2 of 17) Pain –What to look for: Signs of shock SAMPLE history Location of the pain Diarrhea and vomiting
Abdominal Illnesses (3 of 17) Pain –What to look for: Signs of dehydration Whether others in the party have the same problem Ingestion of potentially poisonous plants or unpurified water Diabetes or pregnancy Painful, rigid, swollen abdomen
Abdominal Illnesses (4 of 17) Pain –What to do: Perform initial check and assess vital signs Allow sipping of clear, non-caffeinated fluids. Provide an antacid. Apply heat. Be prepared for vomiting. Allow victim to assume most comfortable position.
Abdominal Illnesses (5 of 17) Appendicitis –What to look for: Intermittent pain in midabdomen that moves to the lower right abdomen. Pain increases over 6 to 24 hours, becomes constant. Tenderness over right lower abdomen.
Abdominal Illnesses (6 of 17) Appendicitis –What to look for (continued): Intermittent vomiting. Loss of appetite. Low-grade fever. Pain and tenderness throughout abdomen, indicating ruptured appendix.
Abdominal Illnesses (7 of 17) Appendicitis –What to do: Place victim in most comfortable reclining position. Let victim sip fluids. Evacuate.
Abdominal Illnesses (8 of 17) Nausea and vomiting: What to look for –Abdominal pain –Blood or brown, grainy material in vomit –Diarrhea –Chills and fever –Signs of dehydration –Others in group with similar symptoms –Recent head injury –Ingestion of wild plants/mushrooms or unpurified water
Abdominal Illnesses (9 of 17) Nausea and vomiting: What to do: –Provide clear fluids, clear soups, flat soda, juice –If victim can keep fluids down, offer carbohydrates, but no milk products. –Have victim rest. –Evacuate if vomiting persists more than 48 hours.
Abdominal Illnesses (10 of 17) Diarrhea: What to look for –Bloody mucus or pus in stool –Dehydration –Cramping abdominal pain –Lack of bowel control –Fever –Others in group with similar symptoms
Abdominal Illnesses (11 of 17) Diarrhea: What to do –Provide clear fluids and monitor urine output to assess for dehydration. –If victim can keep fluids down, gradually return to normal diet. –Provide pink bismuth, if available. –Provide loperamide HCL or diphenoxylate atropine if diarrhea persists, but not if there is fever or blood and pus in stools.
Abdominal Illnesses (12 of 17) Constipation –What to look for: Painful, hard bowel movements Infrequent bowel movements
Abdominal Illnesses (13 of 17) Constipation –What to do: Eat high-fiber foods. Maintain adequate fluid intake. Try to have a bowel movement. Use stool softeners. Avoid laxatives, alcohol, and constipation- causing foods.
Abdominal Illnesses (14 of 17) Bloody stools and hemorrhoids –What to look for: External hemorrhoid: Lump next to anus, bleeding with passage of stool, red blood and clots extruding from the lump or swelling Internal hemorrhoid: Soft swelling that may protrude from rectum during or after bowel movement; bleeding with passage of stool.
Abdominal Illnesses (15 of 17) Bloody stools and hemorrhoids –What to look for (continued): Fissure: Painful crack at margin of anus. Signs of serious bowel bleeding: Painless bowel movements with large quantities of blood; signs of shock.
Abdominal Illnesses (16 of 17) Bloody stools and hemorrhoids –What to do: For minor hemorrhoids and fissures Adjust diet to soften stool Warm baths to soothe and cleanse. Wear cotton underwear or loose clothing. Apply cold compresses, zinc oxide, or petroleum jelly
Abdominal Illnesses (17 of 17) Bloody stools and hemorrhoids –What to do: For minor hemorrhoids and fissures (cont’d) Apply hemorrhoid suppositories If cluster or swelling protrudes from rectum, have victim try to slip the tissue back inside by applying manual pressure. –What to do: For major bleeding Have victim walk, if possible. Evacuate.
Evacuation Guidelines for Abdominal Problems (1 of 2) Serious injury Persistent abdominal pain or pain with high fever Unable to drink or retain fluids for more than 24 hours Pregnant with abdominal pain Painful, rigid, swollen abdomen
Evacuation Guidelines for Abdominal Problems (2 of 2) Pain that increases with cough or movement Signs and symptoms of appendicitis Vomiting and diarrhea with severe pain, vomiting with severe headache, or diarrhea with fever and stools containing bloody mucus Signs of internal bleeding Signs of severe dehydration or shock