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
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