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Abdominal and Genitourinary Trauma Chapter 35. Objectives  Review anatomy of the abdominal cavity  Discuss Abdominal Trauma  Discuss Genital Trauma.

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Presentation on theme: "Abdominal and Genitourinary Trauma Chapter 35. Objectives  Review anatomy of the abdominal cavity  Discuss Abdominal Trauma  Discuss Genital Trauma."— Presentation transcript:

1 Abdominal and Genitourinary Trauma Chapter 35

2 Objectives  Review anatomy of the abdominal cavity  Discuss Abdominal Trauma  Discuss Genital Trauma

3 Abdominal cavity  Peritoneum – 2 layer sheath like membrane  Visceral peritoneum – innermost lining  Parietal peritoneum – outer lining that adheres to the walls of the abdominal cavity  Peritoneal cavity – the potential space between the visceral and parietal peritonea  Retroperitoneal cavity – Posterior space

4 Hollow Organs  Stomach  Gall bladder  Urinary bladder  Ureters  Internal urethra  Fallopian tubes  Small intestines  Large intestines

5 Solid Organs  Liver  Spleen  Pancreas  Kidneys

6 Vascular and Additional Structures Vascular Structures  Abdominal aorta  Inferior Vena Cava Additional structures  Diaphragm  Abdominal wall

7 Abdominal Injuries  Blunt or penetrating trauma can cause abdominal injuries  MOI are similar to those of chest injury  Blunt trauma is especially lethal due to the large number of organs present  Open abdominal injuries result from penetrating trauma such as gunshot, stabbing or other hard sharp objects  Gunshot wounds, always examine for an exit wound  Open wounds are easier to see, but may be less dangerous than closed wounds  Always maintain suspicion of the existence of a closed abdominal injury

8 Assessment based approach Scene size-up  BSI  Scan scene for MOI  Ask police/bystanders what happened, especially if gunshots were heard  Attempt to determine the following, for vehicle collisions;  Type of vehicle  Approximate speed  Type of collision/point of impact  Was patient driver, passenger, or pedestrian  Where was patient found, in what position  Was patient ejected?  Impact marks on windshield, steering wheel, and dashboard  Was patient wearing a seatbelt?

9 Primary Assessment Form a general impression  Is patient lying still with knees flexed?  Is patient moaning and complaining of severe pain?  Spinal injury suspected, in-line stabilization  Ensure open airway  Check for vomit, prepare for suctioning  Oxygen via NRB @ 15 lpm, if adequate respirations  Ventilation, if inadequate  Assess circulation and look for signs of shock and abdominal injury  Weak or absent radial pulse  Abnormally rapid heart rate  Moist, pale, cool skin  If signs are present, patient is priority to immediate transport

10 Secondary Assessment  Consider complaints and MOI  Expose the entire body and perform a rapid secondary assessment: head, neck, and chest first  Apply cervical immobilization, if spinal injury suspected  Inspect abdomen for open wounds, distension  Inspect around the navel and flanks for discoloration and bruising  Look for bruising in lower abdomen  Inspect and provide emergency care for abdominal evisceration

11 Secondary Assessment  Palpate abdomen, noting tenderness, masses or signs of pain  Assess extremities for injuries; check and compare pulses  Assess motor and sensory function  Log roll the patient and inspect back and lumbar region; log roll onto backboard if spinal injury is suspected  Assess baseline vitals  Obtain history; if patient is unresponsive, ask bystanders

12 Secondary Assessment Be alert for the following signs and symptoms of abdominal injury  Contusions, abrasions, lacerations, punctures, or other signs of blunt or penetrating trauma  Pain that continues to get worse  Tenderness on palpation to areas besides injury site  Rigid abdominal muscles  Patient has drawn up legs to his chest to reduce pain  Distended abdomen  Discoloration around the navel or the flank (late sign)  Rapid, shallow breathing  Signs of hemorrhagic shock  Decreasing blood pressure, narrowing pulse pressure, increasing heart rate, increasing respiratory rate  Nausea/vomiting  Abdominal cramping  Pain that radiates to either shoulder  Weakness

13 General emergency care – abdominal trauma  Maintain open airway and appropriate spinal protection  Oxygen therapy  Reassess breathing status  Treat for shock if symptoms apparent  Control external bleeding  Supine position with knees flexed  Stabilize an impaled object  Apply PASG if appropriate  Transport quickly

14 Emergency care - Evisceration Expose the wound Position patient supine with knees flexed Prepare clean, sterile dressing Cover the moist dressing with an occlusive dressing Administer high-flow, high- concentration oxygen Treat for shock Reassess for effectiveness Assess for further deterioration Reassess vital signs


16 Genital Trauma Injuries to male genitalia  Lacerations, abrasions, avulsions, penetrations, amputations, contusions  Usually excruciatingly painful and causes great concern for the patient  Penis is very vascular  Treat as soft-tissue injury; apply direct pressure and cold compress  Wrap avulsed parts in sterile, moist dressing; place on ice; and transport with patient  Oxygen via NRB @ 15 lpm  Assess for signs of shock and transport

17 Injuries to Female genitalia Include straddle injuries, sexual assault, blunt trauma, abortion attempts, lacerations after childbirth, and foreign bodies inserted into vagina  Usually produces excruciating pain and causes concern for the patient  Area is highly vascular  Apply direct pressure to any bleeding; use moist compress  Never pack or place dressings inside vagina  Assess for shock  Oxygen via NRB @ 15 lpm  Transport

18 Rectal Injury Weightlifter in competition. (prolapse) How would you treat and package for transport?

19 Other Rectal Insults

20 Just a medical oddity……

21 Any questions???????????

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