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Abdominal Trauma

Abdominal Trauma

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Abdominal Trauma

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  1. Abdominal Trauma Athens Technical College EMS Program

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

  11. Abdominal Anatomy • Organs can be classified as: • Hollow • Solid • Majorvascular

  12. Solid Organs • 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. 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 • Spillage of bacteria • May take 6 hrs to develop peritonitis • Small Bowel • Fewer bacteria • May take 24-48 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 • NOTreliable • 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

  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 NOTtry 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