ABDOMINAL TRAUMA Prepared by SamahIshtieh MSN. Mangement 17\3\2011
OBJECTIVES: • Identify the common mechanisms of injury associated with abdominal trauma. • Describe the pathophysiologic changes as a basis for signs and symptoms. • Identify selected abdominal injuries (S &S ).
OBJECTIVES • Discuss the NURSING of patients with abdominal trauma. • Identify appropriate nursing diagnosis. • Plan appropriate interventions for patients with abdominal trauma.
INTRODUCTION Abdominal injuries are common in patients who sustain major trauma. Unrecognized abdominal injuries are frequently the cause of preventable death. Approximately one-fifth of all traumatized pt requiring operative intervention have sustained trauma to the abdomen.
Abdominal trauma • Abdominal trauma is an injury to the abdomen. It may be blunt or penetrating and may involve damage to the abdominal organs.
TYPES OF INJURIES • Blunt abdominal traumais a leading cause of morbidity and mortality among all age groups. Blunt trauma: liver …spleen (most common). • Penetrating:liver, small bowel and stomach. Penetrating: present with single or multiple injuries
Penetrating abdominal trauma (PAT) is usually diagnosed based on clinical signs, blunt abdominal trauma is more likely to be missed because clinical signs are less obvious. • Penetrating trauma is further subdivided into stab wounds and bullet wounds, which have different treatments.
Multiple injuries, abdominal trauma can lead to hemorrhage, hypovolemic shock, and death. Yet even a serious, life-threatening abdominal injury may not cause obvious signs and symptoms, especially in cases of blunt trauma.
Key responses to decrease mortality and morbidity include :- aggressive resuscitation efforts, - adequate volume replacement,- early diagnosis of injuries, and- surgical intervention if warranted
Solid Organs Liver Spleen Kidneys Pancreas Hollow Organs Stomach Small bowel Large bowel Bladder ORGANS
Mechanisms of injury • The most common mechanism of blunt injury is MVC (motor vehicle crash). • Firearm , stabbings, are associated with Penetrating trauma. • Injuries result from acceleration, deceleration, or both forces. • Crushing forces compress the duodenum Or the pancreas against the vertebral column.
Mechanisms of injury • Forces applied to solid organ can rupture a surrounding capsule & injury the parenchyma as well. • Structures attached by ligaments or blood vessels may be stressed at their attachment points
Mechanisms of injury • Belts if improperly positioned cause deceleration injuries to the lower abdomen , • Frontal impact crashes with a bent steering wheel associated with spleen & liver injuries as well as head &chest trauma.
PATHOPHYSIOLOGY • Blood loss: (mesenteric attachments of the intestines ) semi fixed by ligaments, stressed, tears , bleeding. Liver & spleen ( rich blood supply) & capsulated , compression, rupture, hemorrhage. • Pain: rigidity, spasm, rebound tenderness Irritants(blood or gastric contents or enzymes)
Pancreatic & duodenal injury: diffuse abdominal, tenderness and pain radiating from epigastric to the back. • Splenic injury: referred shoulder pain (Kehr`s sign) . Because of: stress, blood in the abdominal cavity and direct bowel injury
Spleen injury is usually associated with blunt trauma. Fractures of ribs 10 to 12 on the left should raise your suspicion of spleen damage,which ranges from laceration of the capsule or a nonexpanding hematoma to ruptured subcapsular hematomas or parenchymal laceration.
Liver injury is common because of the liver’s size and location.Severity ranges from a controlledsubcapsular hematoma and lacerations of the parenchyma to hepatic avulsion or a severe injury of the hepatic veins. ((التمزيق الكبدي
Because liver tissue is very friable and the liver’s blood supply and storage capacity areextensive, a patient with liver injuries can hemorrhage profusely and may need surgery to control the bleeding.
The most common kidney injury is a contusion from blunt trauma; suspect this type of injury if your patient has fractures of the posterior ribs or lumbar vertebrae.
Other renal injuries include lacerationsor contusion of the renalparenchyma caused by shearingand compression forces; the deepera laceration, the more serious the bleeding.
Deceleration forces may damage the renal artery; collateral circulation in that area is limited, so any ischemia is serious and maytrigger acute tubular necrosis.
Hollow organ injuries, which can occur with blunt or penetrating trauma, most commonlyinvolve the small bowel. Decelerationwith shearing may tear the small bowel, generally in relatively fixed or looped areas
Blunt forces cause most bladder injuries. The bladder rises into the abdominal cavity when full, so it’s more susceptible to injury. If a distended bladder ruptures or is perforated, urine is likely to escape into the abdomen.
If the bladder isn’t full when ruptured, urine may leak into the surrounding pelvictissues, vulva, or scrotum.
Genitourinary tract - Perinephric hematomas should be entered only after vascular control has been obtained. Repair of many renal injuries (including partial nephrectomy) is now possible. When nephrectomy is required, it is reassuring to know that the contra lateral kidney is functioning.
Diaphragmatic injuries are notoriously difficult to diagnose. Small diaphragmatic injuries on the right side may heal without incident, and the liver protects against potential hernias. Small injuries on the left side may result in symptomatic diaphragmatic hernias. Acute diaphragmatic defects are best approached through the diaphragm.
Colon/Rectum - In contrast to military teaching, an increasing number of surgeons utilize primary repair for simple colon injuries without associated shock or significant fecal soilage. Even a small missed colon injury may be lethal
As always, your primary priorities are to maintain the patient’s airway, breathing, and circulation. Next, perform a rapid neurologic examination and assess him head to toeto identify obvious injuries and signs of prolonged exposure to heat or cold.
Ask the patient (or his family, emergency personnel, or bystanders) about his history—allergies, medications, preexisting medical conditions, when he last ate, and events immediately preceding or related to hisinjury.
If your patient sustained blunt trauma, as in a motor vehicle crash (MVC), keep his neck and spine immobilized until X-rays rule out a spinal injury. If his viscera are protruding,cover them with a sterile dressing moistened with 0.9% sodium chloride solution to prevent drying.
The following interventionsare routine for a patientwith abdominal trauma:
• Insert two large-bore intravenous(I.V.) lines to infuse 0.9% sodiumchloride or lactated Ringer’s solution,according to facility protocol.