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Temple College EMS Professions

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Presentation on theme: "Temple College EMS Professions"— Presentation transcript:

1 Temple College EMS Professions
4/15/2017 Abdominal Trauma Temple College EMS Professions Temple College EMS Professions

2 The Abdomen Everything between diaphragm and pelvis
Injury, illness very difficult to assess because of large variety of structures

3 Abdominal Anatomy Abdomen divided into four quadrants by body mid-line, horizontal plane through umbilicus Organs can be located by quadrant

4 Abdominal Anatomy Right Upper Quadrant Liver Gall Bladder Right Kidney
Ascending Colon Transverse Colon

5 Abdominal Anatomy Left Upper Quadrant Spleen Stomach Pancreas
Left Kidney Transverse Colon Descending Colon

6 Abdominal Anatomy Right Lower Quadrant Ascending Colon Appendix
Right Ovary (female) Right Fallopian Tube (female)

7 Abdominal Anatomy Left Lower Quadrant Descending Colon Sigmoid colon
Left Ovary (female) Left Fallopian Tube (female)

8 Abdominal Anatomy Periumbilical area Suprapubic 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

9 Abdominal Cavity Peritoneum = abdominal cavity lining
Divides abdomen into two spaces Peritoneal cavity Retroperitoneal space

10 Disease, injury of retroperitoneal organs often causes back pain
Abdominal Anatomy Retroperitoneal Pancreas Kidney Ureter Inferior vena cava Abdominal aorta Urinary bladder Reproductive organs Peritoneal Spleen Liver Stomach Gall bladder Bowel Disease, injury of retroperitoneal organs often causes back pain

11 Abdominal Anatomy Organs can be classified as: Hollow Solid
Major vascular

12 When solid organs are injured, they bleed heavily and cause shock
Liver Spleen Kidney Pancreas When solid organs are injured, they bleed heavily and cause shock

13 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

14 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

15 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

16 Rupture causes content spillage, inflammation of peritoneum
Hollow Organs Stomach Gall bladder Large, small intestines Ureters, urinary bladder Rupture causes content spillage, inflammation of peritoneum

17 Hollow Organs Stomach Acid, enzymes Immediate peritonitis
Pain, tenderness, guarding, rigidity

18 Hollow Organs Colon Small Bowel Spillage of bacteria
May take 6 hrs to develop peritonitis Small Bowel Fewer bacteria May take hours to develop peritonitis

19 Major Vascular Structures
Aorta Inferior vena cava Major branches Injury can cause severe blood loss; exsanguination (bleeding out)

20 Abdominal Trauma Most survive to reach hospital
Most common factors leading to death Failure to adequately evaluate Delayed resuscitation Inadequate volume Inadequate diagnosis Delayed surgery

21 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

22 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

23 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

24 Signs of Injured Abdomen
Diffuse tenderness Pain Pain referred to shoulder = Organ under diaphragm involved (?spleen) Pain referred to back = Retroperitoneal organ involved (?kidney)

25 Abdominal Rigidity NOT reliable
Bleeding may not cause rigidity if free hemoglobin absent Bleeding in retroperitoneal space may not cause rigidity

26 Abdominal Trauma Management
Less important to diagnose exact injury Treat clinical findings Management same regardless of specific organ(s) injured

27 Abdominal Trauma Management
Airway C-Spine if mechanism indicates High flow O2 Assist ventilations if needed Give nothing by mouth MAST may be helpful in slowing intraabdominal bleeding with shock

28 Impaled Object Leave in place Shorten if necessary for transport
Leave part of object exposed

29 Evisceration With large laceration abdominal contents may spill out
Do NOT try to replace

30 Evisceration Cover exposed organs with saline moistened multi-trauma dressing Do NOT use 4 x 4s Cover first dressing with second DRY dressing or aluminum foil

31 Genitourinary Trauma

32 Urinary System Kidney Ureter Urinary Bladder Urethra

33 Kidney Trauma 50% of all GU trauma

34 Kidney Trauma Penetrating
GSW Stab wound Rare, usually associated with trauma to other abdominal organs

35 Kidney Trauma Blunt Direct blow to back, flank, upper abdomen
Suspect with fractures of 10th - 12th ribs or T12, L1, L2 Acceleration/Deceleration Shearing of renal artery/vein

36 Kidney Trauma Signs and Symptoms Gross Hematuria
80% of cases Absence does NOT exclude renal injury Localized flank/abdominal pain Palpable mass

37 Kidney Trauma Signs and Symptoms
Tenderness: Lower ribs, upper L-spine, flank Pain: groin, shoulder, back, flank

38 Ureter Trauma Less than 2% of GU trauma
Usually secondary to penetrating trauma Indicator Wound to lower back with urine escaping

39 Urinary Bladder Trauma
Mechanisms Blunt injury to lower abdomen Seat belts Pelvic fracture Penetrating trauma to lower abdomen or perineum (pelvic floor)

40 Extraperitoneal Bladder Rupture
Urine in umbilicus, anterior thighs, scrotum, inguinal canals, perineum Dysuria Hematuria Suprapubic tenderness Swelling, redness secondary to tissue damage from urine

41 Intraperitoneal Bladder Rupture
Urgency to void Inability to void Shock Abdominal distension

42 Urethral Trauma Mechanisms
Sudden decelerations (bladder shears off urethra) Straddle injuries

43 Urethral Trauma Signs and Symptoms Blood at external meatus
Perineal bruising (butterfly bruise) Scrotal hematoma

44 Reproductive System Trauma
Can occur to both external and internal reproductive systems External More common Pain, extensive bleeding Internal Rarely injured

45 Reproductive System Trauma
Treat like blunt or penetrating soft tissue injuries elsewhere on body

46 Male Genitalia Trauma Usually NOT life-threatening Very painful
Great source of concern to patient

47 Male Genitalia Trauma Avulsion of skin of penis, scrotum
Cover with a moist, sterile dressing Complete amputation of penis Treat as any amputated part

48 Male Genitalia Trauma Blunt trauma to penis, scrotum
Apply ice pack Urethral foreign bodies Do NOT remove Penis entrapped in zipper If 1 or 2 teeth involved, try to unzip If more involved, cut zipper out of trousers, transport

49 Female Genitalia Trauma
Internal Rarely injured External Can cause pain, extensive bleeding Usually not life-threatening Treat with compresses, pressure

50 Sexual Assault Avoid examining genitalia unless obvious bleeding present Ask patient to NOT wash, douche, urinate, defecate Ask patient NOT to change clothes Record history, but avoid extensive questioning about incident

51 PowerPoint Source Slides for this presentation from Temple College EMS:

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