1. ABDOMINAL TRAUMA RIFLES LIFESAVERS

2. Abdominal Trauma: The KEY to Saving Lives The abdomen is the “Black Box” The abdomen is the “Black Box” –I.e., it is impossible to know what specific injuries have occurred at initial evaluation The key to saving lives in abdominal trauma is NOT to make an accurate diagnosis, but rather to recognize that there is an abdominal injury The key to saving lives in abdominal trauma is NOT to make an accurate diagnosis, but rather to recognize that there is an abdominal injury

3. Examples of Abdominal Injuries Blunt Trauma Blunt Trauma –Aortic rupture –Splenic rupture –Liver rupture or laceration –Diaphragmatic tear –Pelvic fracture –Intestinal tear –Bladder rupture Penetrating Trauma Penetrating Trauma –Laceration of blood vessels –Splenic rupture –Liver rupture or laceration –Kidney laceration –Intestinal lacerations –Bladder rupture

4. Causes of Abdominal Injuries BLUNT TRAUMA – –Motor vehicle accidents – –Auto vs. pedestrian – –Falls – –Blast injuries PENETRATING TRAUMA –Gunshot wounds –Stab wounds –Shrapnel wounds –Impalements

5. Signs and Symptoms of Abdominal Injuries Blunt Trauma Blunt Trauma –Significant mechanism –Abdominal pain –Distension –Discoloration of abdomen or flank –Unexplained shock Penetrating trauma Penetrating trauma –Visible truncal injury including chest or abdomen –Abdominal pain –Bleeding –Impaled object –Evisceration –Shock

6. Blunt Abdominal Trauma Flank ecchymosis from internal bleeding

7. Blunt Abdominal Trauma Compressive or shearing forces may deform and rupture abdominal organs Compressive or shearing forces may deform and rupture abdominal organs Bruising across the lower abdomen is characteristic of a seat belt injury Bruising across the lower abdomen is characteristic of a seat belt injury Visible signs may not reflect severity of underlying injury Visible signs may not reflect severity of underlying injury The Seat Belt Sign

8. Penetrating Abdominal Trauma Visible wounds may not reflect severity of underlying injury Visible wounds may not reflect severity of underlying injury Significant internal bleeding likely Significant internal bleeding likely Bowel injury likely Bowel injury likely Patient may be in shock Patient may be in shock

9. Abdominal Injuries: CARE UNDER FIRE Casualty and RLS/medic return fire Casualty and RLS/medic return fire –““The best medicine on any battlefield is fire superiority” Apply tourniquet to severely bleeding extremities Apply tourniquet to severely bleeding extremities Wounded soldiers who are unable to fight should lay flat and motionless if no cover is available or move as quickly as possible to any nearby cover Wounded soldiers who are unable to fight should lay flat and motionless if no cover is available or move as quickly as possible to any nearby cover

10. Abdominal Injuries: TACTICAL FIELD CARE Remember the ABCs Remember the ABCs Position casualty on back with flexed knees Position casualty on back with flexed knees Expose the wound Expose the wound Stabilize any protruding objects Stabilize any protruding objects Cover protruding abdominal organs with moist gauze or cloth Cover protruding abdominal organs with moist gauze or cloth Prepare to evacuate to surgical assets Prepare to evacuate to surgical assets –9-line MEDEVAC

11. Evaluation and Examination Visually note wounds and abrasions Visually note wounds and abrasions Palpate abdomen for localized vs. diffuse tenderness Palpate abdomen for localized vs. diffuse tenderness Consider possible internal injuries Consider possible internal injuries Diffuse, severe tenderness is a sign of internal bleeding Diffuse, severe tenderness is a sign of internal bleeding

12. Don’t forget the back Turn the casualty over when you can do so safely Turn the casualty over when you can do so safely Visually inspect back Visually inspect back Palpate ribs, spine, sacrum for tenderness and irregularities Palpate ribs, spine, sacrum for tenderness and irregularities Dress the wound with an occlusive dressing Dress the wound with an occlusive dressing Don’t count on a “down-side sweep” to discover injuries this size Don’t count on a “down-side sweep” to discover injuries this size

13. Impalement Injury

14. Impalement Injuries DO NOT REMOVE OBJECT OR EXERT ANY FORCE UPON IT! DO NOT REMOVE OBJECT OR EXERT ANY FORCE UPON IT! –Severe bleeding may occur causing shock Check pulses distal to impaled object Check pulses distal to impaled object Immobilize the object Immobilize the object Apply bulky support bandages to hold in place Apply bulky support bandages to hold in place

15. Impalement Injuries: How to make a SAM Splint Make a box shape large enough to surround the object and dressings Make a box shape large enough to surround the object and dressings Cut V notches into box top Cut V notches into box top Place box over object and dressings and tape in place Place box over object and dressings and tape in place Tie cravats or ACE Wraps around torso for stability, using V notches in box to ensure stability Tie cravats or ACE Wraps around torso for stability, using V notches in box to ensure stability

16. Evisceration Extrusion of abdominal contents secondary to penetrating abdominal trauma

17. Management of Evisceration Injuries Use sterile side of dressing to place protruding organs near the wound (NOT into wound) Use sterile side of dressing to place protruding organs near the wound (NOT into wound) Cover organs and wound completely with sterile or clean moist dressing Cover organs and wound completely with sterile or clean moist dressing DO NOT APPLY PRESSURE TO WOUND or expose internal parts DO NOT APPLY PRESSURE TO WOUND or expose internal parts Tie dressing tails loosely around wound Tie dressing tails loosely around wound Prepare evacuation to surgical assets Prepare evacuation to surgical assets

18. QUESTIONS?