1. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 24 Abdominal and Pelvic Trauma

2. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 24.1 Identify and locate the major anatomical structures within the abdominopelvic cavity. 24.2 List the functions of the major anatomical structures within the abdominopelvic cavity. 24.3 List and describe at least six abdominopelvic injuries. continued

3. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 24.4 Describe and demonstrate how to assess a patient with abdominopelvic trauma. 24.5 Describe and demonstrate how to manage a patient with abdominopelvic trauma. 24.6 Describe and demonstrate how to manage an evisceration. continued

4. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 24.7 Describe and demonstrate how to manage an impaled object in the abdomen or pelvis. 24.8 Describe and demonstrate how to manage a pelvic fracture.

5. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Anatomy and Physiology Common Abdominal and Pelvic Injuries Assessment Management Chapter Summary

6. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation A teenage girl’s ski pole jams into her abdomen as she falls. She is clutching her abdomen and gasping for air when you arrive. Her mother is near the scene.

7. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Abdominal cavity extends from diaphragm to pelvic brim ◦ Organs are relatively unprotected Pelvic cavity is encased in the pelvic bones ◦ Organs are somewhat protected Some organs process blood Major blood vessels are present ◦ Bleeding can be life threatening continued

8. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Each of four quadrants holds specific organs: ◦ RUQ= liver; LUQ= spleen; RLQ and LLQ= intestines, bladder ◦ Medical emergencies may have non- localized pain ◦ Trauma injuries may be localized by pain and tenderness

9. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology

10. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Abdominal and Pelvic Injuries Abdominal wall contusion Blunt force tends to injure solid organs Penetrating trauma may injure solid or hollow organs Multiple organs may be involved Muscles/organs can tear or rupture Fractures of pelvic or hip Evisceration

11. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Solid Organ Injuries Liver, spleen, pancreas May have blunt or penetrating trauma Bleeding may be severe Hypovolemic shock and peritonitis may result

12. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Vascular Injuries and Diaphragm Tears, Ruptures Blood vessels, diaphragm, intestines, bladder May be from blunt injury, deceleration, penetrating injuries, or bone fragments Organs may migrate into thoracic cavity through diaphragm rupture Results may be severe bleeding, infection, peritonitis

13. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Impaled Objects and Evisceration Impaled Objects ◦ Impaled objects may cause life threatening injuries, or miss organs and vessels ◦ Bleeding and infection may result continued

14. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Impaled Objects and Evisceration continued Copyright Candace Horgan

15. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Impaled Objects and Evisceration Evisceration ◦ Evisceration exposes organs to outside environment ◦ Bleeding, heat loss, and infection may result

16. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Pelvic and Hip Fractures Pelvis ◦ Require large amount of force ◦ Multiple fractures are likely ◦ May damage internal structures, cause bleeding Hip ◦ May fracture or dislocate ◦ Review Chapter 20 for more details

17. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Hip Dislocations posterior dislocationanterior dislocation

18. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Straddle / Genital Injuries Blunt or sharp trauma Groin strikes an object, external structures are involved ◦ Often less problematic for females Bleeding, hematomas may result Pain and modesty are issues

19. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Pelvic Injury

20. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Standard assessment procedures – ABCDs, SAMPLE, and vitals Emphasis is on existence of injury Location of pain may lead to suspicion of organs involved Use OPQRST - note if pain goes from local to general or general to local Look for distention, discoloration, symmetry continued

21. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Palpate each quadrant, lower rib cage, and pelvis Genital exams require discretion Monitor for shock due to internal bleeding Serial vitals, follow-up exams are essential

22. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update Her mother permits you to evaluate her daughter. Her ABCDs are intact; there is no spine pain. During secondary assessment, she has severe pain in her stomach. Palpation reveals tenderness in the left upper quadrant. Her pulse is 124; respirations are 16. She says she has no problems, is not taking any medications, has no allergies to medications, and ate at breakfast three hours ago. She is breathing ok but states her “stomach really hurts.”

23. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Activate EMS for transport Position patient for comfort Protect C-spine as needed High flow oxygen Treat soft tissue injuries Do not remove impaled objects - stabilize continued

24. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Cover eviscerations with moist sterile dressings, keep patient warm Assist ventilations for diaphragm tear Full spinal immobilization for pelvic fracture ◦ Use pelvic binder ◦ Keep knees flexed continued

25. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Hip dislocations – position of comfort Femoral neck fractures, use spine board Treat for shock Monitor vitals and condition

26. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Copyright Candace Horgan

27. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition You administer oxygen to the patient. Because she has significant abdominal pain, you radio for ALS transport. You suspect shock. Further assessment reveals more abdominal tenderness. There is no abdominal distention. Her pulse is now 132, blood pressure is 98/50. Her injury was to her spleen.

28. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary The most obvious injury is not always the most serious one. The initial presentation may be relatively benign; shock may develop over time. Assessment of abdominal trauma includes examining all four quadrants and taking serial sets of vital signs. continued

29. National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Do not give a patient with abdominal trauma anything by mouth.