Download
slide1 n.
Skip this Video
Loading SlideShow in 5 Seconds..
Chapter 13 Abdominal Trauma PowerPoint Presentation
Download Presentation
Chapter 13 Abdominal Trauma

Chapter 13 Abdominal Trauma

352 Vues Download Presentation
Télécharger la présentation

Chapter 13 Abdominal Trauma

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. Chapter 13 Abdominal Trauma

  2. Abdominal Trauma Courtesy of Roy Alson, MD

  3. Overview Basic abdominal anatomy • How abdominal and chest injuries are related Blunt and penetrating injuries • Complications associated with each • Treatment for protruding viscera • Relationship of exterior and underlying injuries Possible intra-abdominal injuries • History, physical examination, mechanism of injury Abdominal trauma ALS interventions Abdominal Trauma -

  4. Abdominal Trauma Difficult to evaluate • Attention to scene and mechanism of injury Major cause of preventable death • Hemorrhage • Anticipate shock: immediate or delayed • Require surgical intervention • Infection • Gross contamination prevention Abdominal Trauma -

  5. Abdominal Regions Thoracic abdomen Retroperitoneal True abdomen Abdominal Trauma -

  6. Abdominal Region Injury Thoracic region • Life-threatening hemorrhage: liver, spleen True abdomen • Infection, peritonitis, shock: intestines • Severe hemorrhage with signs Retroperitoneal abdomen • Severe hemorrhage hidden: major vessels Abdominal Trauma -

  7. Abdominal Trauma Blunt • Most common: mortality 10–30% Penetrating • Gunshots: mortality 5–15% • Stabbings: mortality 1–2% Concern: • Intra-abdominal bleed with hemorrhagic shock • Sepsis and/or peritonitis Abdominal Trauma -

  8. Abdominal Trauma Scene Size-up Abdominal Trauma -

  9. Blunt Abdominal Mechanism • Direct compression of abdomen • Fracture of solid organs (spleen/liver) • Blowout of hollow organs (intestines) • Deceleration forces • Tearing of organs and blood vessels Accompanying injuries • Head, chest, extremity: 70% MVC victims Abdominal Trauma -

  10. Blunt Abdominal Liver and spleen injury most common Evidence of injury • Often no or minimal external evidence • Significant blood volume concealed in regions • Seat-belt sign: 25% intra-abdominal Pain or tenderness • Often no pain or overshadowed by other pain Abdominal Trauma -

  11. Penetrating Abdominal Mechanism • Direct trauma to organ and vasculature • Projectile and fragments • Energy transmitted from mass and velocity Caution: • Vigorous fluid resuscitation may do more harm • PASG may do more harm Abdominal Trauma -

  12. Penetrating Abdominal Projectile pathway not always obvious • Abdominal injury is chest; chest is abdominal • Gluteal area in 50% of significant injuries Abdominal Trauma -

  13. Abdominal Assessment ITLS Primary Survey: Abdomen • Deformities • Contusions • Abrasions • Punctures • Evisceration • Distension • Tenderness • Tenseness Abdominal Trauma -

  14. Signs and Symptoms Splenic injury • Referred left posterior shoulder pain Liver injury • Referred right posterior shoulder pain Severe hemorrhage • Distention, tenderness, tenseness • Pelvic tenderness or bony crepitation Abdominal Trauma -

  15. Stabilization Signs usually do not appear early. If present, injury is significant. Assess and treat for shock. Abdominal Trauma -

  16. Special Situations Evisceration • Do not push viscera back into abdomen. • Gently cover with moistened gauze. • Apply nonadherent material to prevent drying. Abdominal Trauma -

  17. Special Situations Impaled object • Do not remove. • Uncontrollable hemorrhage • Gently stabilize object. • Avoid movement. Abdominal Trauma -

  18. Summary Intra-abdominal injury must be recognized and treated immediately. • Scene Size-up and detailed history • Rapid patient assessment • Early shock treatment Minimize delays to maximize survival. Abdominal Trauma -

  19. Discussion Abdominal Trauma -