2Objectives Review anatomy of the abdominal cavity Discuss Abdominal TraumaDiscuss Genital Trauma
3Abdominal cavity Peritoneum – 2 layer sheath like membrane Visceral peritoneum – innermost liningParietal peritoneum – outer lining that adheres to the walls of the abdominal cavityPeritoneal cavity – the potential space between the visceral and parietal peritoneaRetroperitoneal cavity – Posterior space
7Abdominal InjuriesBlunt or penetrating trauma can cause abdominal injuriesMOI are similar to those of chest injuryBlunt trauma is especially lethal due to the large number of organs presentOpen abdominal injuries result from penetrating trauma such as gunshot, stabbing or other hard sharp objectsGunshot wounds, always examine for an exit woundOpen wounds are easier to see, but may be less dangerous than closed woundsAlways maintain suspicion of the existence of a closed abdominal injury
8Assessment based approach Scene size-upBSIScan scene for MOIAsk police/bystanders what happened, especially if gunshots were heardAttempt to determine the following, for vehicle collisions;Type of vehicleApproximate speedType of collision/point of impactWas patient driver, passenger, or pedestrianWhere was patient found, in what positionWas patient ejected?Impact marks on windshield, steering wheel, and dashboardWas patient wearing a seatbelt?
9Primary 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 stabilizationEnsure open airwayCheck for vomit, prepare for suctioningOxygen via 15 lpm, if adequate respirationsVentilation, if inadequateAssess circulation and look for signs of shock and abdominal injuryWeak or absent radial pulseAbnormally rapid heart rateMoist, pale, cool skinIf signs are present, patient is priority to immediate transport
10Secondary Assessment Consider complaints and MOI Expose the entire body and perform a rapid secondary assessment: head, neck, and chest firstApply cervical immobilization, if spinal injury suspectedInspect abdomen for open wounds, distensionInspect around the navel and flanks for discoloration and bruisingLook for bruising in lower abdomenInspect and provide emergency care for abdominal evisceration
11Secondary AssessmentPalpate abdomen, noting tenderness, masses or signs of painAssess extremities for injuries; check and compare pulsesAssess motor and sensory functionLog roll the patient and inspect back and lumbar region; log roll onto backboard if spinal injury is suspectedAssess baseline vitalsObtain history; if patient is unresponsive, ask bystanders
12Secondary AssessmentBe alert for the following signs and symptoms of abdominal injuryContusions, abrasions, lacerations, punctures, or other signs of blunt or penetrating traumaPain that continues to get worseTenderness on palpation to areas besides injury siteRigid abdominal musclesPatient has drawn up legs to his chest to reduce painDistended abdomenDiscoloration around the navel or the flank (late sign)Rapid, shallow breathingSigns of hemorrhagic shockDecreasing blood pressure, narrowing pulse pressure, increasing heart rate, increasing respiratory rateNausea/vomitingAbdominal crampingPain that radiates to either shoulderWeakness
13General emergency care – abdominal trauma Maintain open airway and appropriate spinal protectionOxygen therapyReassess breathing statusTreat for shock if symptoms apparentControl external bleedingSupine position with knees flexedStabilize an impaled objectApply PASG if appropriateTransport quickly
14Emergency care - Evisceration Expose the woundPosition patient supine with knees flexedPrepare clean, sterile dressingCover the moist dressing with an occlusive dressingAdminister high-flow, high-concentration oxygenTreat for shockReassess for effectivenessAssess for further deteriorationReassess vital signs
16Genital Trauma Injuries to male genitalia Lacerations, abrasions, avulsions, penetrations, amputations, contusionsUsually excruciatingly painful and causes great concern for the patientPenis is very vascularTreat as soft-tissue injury; apply direct pressure and cold compressWrap avulsed parts in sterile, moist dressing; place on ice; and transport with patientOxygen via 15 lpmAssess for signs of shock and transport
17Injuries to Female genitalia Include straddle injuries, sexual assault, blunt trauma, abortion attempts, lacerations after childbirth, and foreign bodies inserted into vaginaUsually produces excruciating pain and causes concern for the patientArea is highly vascularApply direct pressure to any bleeding; use moist compressNever pack or place dressings inside vaginaAssess for shockOxygen via 15 lpmTransport
18Rectal Injury Weightlifter in competition. (prolapse) How would you treat and package for transport?