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Chapter 13 Abdominal Trauma

Chapter 13 Abdominal Trauma. Abdominal Trauma. Courtesy of Roy Alson, MD. Overview. Basic abdominal anatomy How abdominal and chest injuries are related Blunt and penetrating injuries Complications associated with each Treatment for protruding viscera

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Chapter 13 Abdominal Trauma

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  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 -

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