Abdominal and Genitourinary Trauma Chapter 35

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

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

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

Solid Organs Liver Spleen Pancreas Kidneys

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

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

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?

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

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

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

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

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

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

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

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

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

Other Rectal Insults

Just a medical oddity……

Any questions???????????