Abdominal Trauma
description
Transcript of Abdominal Trauma
![Page 1: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/1.jpg)
1
Abdominal Trauma
Temple College
EMS Professions
![Page 2: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/2.jpg)
2
The Abdomen
Everything between diaphragm and pelvis
Injury, illness very difficult to assess because of large variety of structures
![Page 3: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/3.jpg)
3
Abdominal Anatomy
Abdomen divided into four quadrants by body mid-line, horizontal plane through umbilicus
Organs can be located by quadrant
![Page 4: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/4.jpg)
4
Abdominal Anatomy
Right Upper Quadrant– Liver– Gall Bladder – Right Kidney– Ascending Colon– Transverse Colon
![Page 5: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/5.jpg)
5
Abdominal Anatomy
Left Upper Quadrant– Spleen– Stomach– Pancreas– Left Kidney– Transverse Colon– Descending Colon
![Page 6: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/6.jpg)
6
Abdominal Anatomy
Right Lower Quadrant– Ascending Colon– Appendix– Right Ovary (female)– Right Fallopian Tube (female)
![Page 7: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/7.jpg)
7
Abdominal Anatomy
Left Lower Quadrant– Descending Colon– Sigmoid colon– Left Ovary (female)– Left Fallopian Tube (female)
![Page 8: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/8.jpg)
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
![Page 9: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/9.jpg)
9
Abdominal Cavity
Peritoneum = abdominal cavity lining Divides abdomen into two spaces
– Peritoneal cavity– Retroperitoneal space
![Page 10: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/10.jpg)
10
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
![Page 11: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/11.jpg)
11
Abdominal Anatomy
Organs can be classified as: – Hollow– Solid– Major vascular
![Page 12: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/12.jpg)
12
Solid Organs
Liver Spleen Kidney Pancreas
When solid organs are injured, they bleed heavily
and cause shock
![Page 13: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/13.jpg)
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
![Page 14: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/14.jpg)
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
![Page 15: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/15.jpg)
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
![Page 16: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/16.jpg)
16
Hollow Organs
Stomach Gall bladder Large, small intestines Ureters, urinary bladder
Rupture causes content spillage, inflammation of
peritoneum
![Page 17: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/17.jpg)
17
Hollow Organs
Stomach – Acid, enzymes– Immediate peritonitis– Pain, tenderness, guarding, rigidity
![Page 18: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/18.jpg)
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
![Page 19: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/19.jpg)
19
Major Vascular Structures
Aorta Inferior vena cava Major branches
Injury can cause severe blood loss ; exsanguination
(bleeding out)
![Page 20: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/20.jpg)
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
![Page 21: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/21.jpg)
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
![Page 22: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/22.jpg)
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
![Page 23: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/23.jpg)
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
![Page 24: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/24.jpg)
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)
![Page 25: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/25.jpg)
25
Abdominal Rigidity
NOT reliable Bleeding may not cause rigidity if free
hemoglobin absent Bleeding in retroperitoneal space may
not cause rigidity
![Page 26: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/26.jpg)
26
Abdominal Trauma Management
Less important to diagnose exact injury Treat clinical findings Management same regardless of
specific organ(s) injured
![Page 27: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/27.jpg)
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
![Page 28: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/28.jpg)
28
Impaled Object
Leave in place– Shorten if necessary for transport– Leave part of object exposed
![Page 29: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/29.jpg)
29
Evisceration
With large laceration abdominal contents may spill out
Do NOT try to replace
![Page 30: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/30.jpg)
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
![Page 31: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/31.jpg)
31
Genitourinary Trauma
![Page 32: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/32.jpg)
32
Urinary System
Kidney
UreterUrinary Bladder
Urethra
![Page 33: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/33.jpg)
33
Kidney Trauma
50% of all GU trauma
![Page 34: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/34.jpg)
34
Kidney Trauma
Penetrating– GSW– Stab wound
Rare, usually associated with trauma to other abdominal organs
![Page 35: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/35.jpg)
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
![Page 36: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/36.jpg)
36
Kidney Trauma
Signs and Symptoms– Gross Hematuria
• 80% of cases • Absence does NOT exclude renal injury
– Localized flank/abdominal pain– Palpable mass
![Page 37: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/37.jpg)
37
Kidney Trauma
Signs and Symptoms– Tenderness: Lower ribs, upper L-spine,
flank– Pain: groin, shoulder, back, flank
![Page 38: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/38.jpg)
38
Ureter Trauma
Less than 2% of GU trauma Usually secondary to penetrating
trauma Indicator
– Wound to lower back with urine escaping
![Page 39: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/39.jpg)
39
Urinary Bladder Trauma
Mechanisms– Blunt injury to lower abdomen– Seat belts– Pelvic fracture– Penetrating trauma to lower abdomen or
perineum (pelvic floor)
![Page 40: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/40.jpg)
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
![Page 41: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/41.jpg)
41
Intraperitoneal Bladder Rupture
Urgency to void Inability to void Shock Abdominal distension
![Page 42: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/42.jpg)
42
Urethral Trauma
Mechanisms – Sudden decelerations
(bladder shears off urethra)– Straddle injuries
![Page 43: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/43.jpg)
43
Urethral Trauma
Signs and Symptoms– Blood at external meatus– Perineal bruising (butterfly bruise)– Scrotal hematoma
![Page 44: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/44.jpg)
44
Reproductive System Trauma
Can occur to both external and internal reproductive systems– External
• More common• Pain, extensive bleeding
– Internal• Rarely injured
![Page 45: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/45.jpg)
45
Reproductive System Trauma
Treat like blunt or penetrating soft tissue injuries elsewhere on body
![Page 46: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/46.jpg)
46
Male Genitalia Trauma
Usually NOT life-threatening Very painful Great source of concern to patient
![Page 47: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/47.jpg)
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
![Page 48: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/48.jpg)
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
![Page 49: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/49.jpg)
49
Female Genitalia Trauma
Internal– Rarely injured
External– Can cause pain, extensive bleeding– Usually not life-threatening
Treat with compresses, pressure
![Page 50: Abdominal Trauma](https://reader031.fdocuments.in/reader031/viewer/2022020922/56814842550346895db5590b/html5/thumbnails/50.jpg)
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