Abdominal and Genitourinary Trauma

Chapter 35

Objectives

Review anatomy of the abdominal cavity

Discuss Abdominal Trauma Discuss Genital Trauma

Abdominal cavity Peritoneum – 2 layer

sheath like membrane Visceral peritoneum –

innermost lining Parietal peritoneum –

outer lining that adheres to the walls of the abdominal cavity

Peritoneal cavity – the potential space between the visceral and parietal peritonea

Retroperitoneal cavity – Posterior space

Hollow Organs

Stomach Gall bladder Urinary bladder Ureters Internal urethra Fallopian tubes Small intestines Large intestines

Solid Organs

Liver Spleen Pancreas Kidneys

Vascular and Additional Structures

Vascular Structures Abdominal aorta Inferior Vena Cava

Additional structures Diaphragm Abdominal wall

Abdominal Injuries Blunt or penetrating trauma

can cause abdominal injuries MOI are similar to those of

chest injury Blunt trauma is especially

lethal due to the large number of organs present

Open abdominal injuries result from penetrating trauma such as gunshot, stabbing or other hard sharp objects

Gunshot wounds, always examine for an exit wound

Open wounds are easier to see, but may be less dangerous than closed wounds

Always maintain suspicion of the existence of a closed abdominal injury

Assessment based approachScene size-up BSI Scan scene for MOI Ask police/bystanders what happened, especially if

gunshots were heard Attempt to determine the following, for vehicle

collisions; Type of vehicle Approximate speed Type of collision/point of impact Was patient driver, passenger, or pedestrian Where was patient found, in what position Was patient ejected? Impact marks on windshield, steering wheel, and

dashboard Was patient wearing a seatbelt?

Primary AssessmentForm a general impression Is patient lying still with knees

flexed? Is patient moaning and

complaining of severe pain? Spinal injury suspected, in-line

stabilization Ensure open airway

Check for vomit, prepare for suctioning

Oxygen via NRB @ 15 lpm, if adequate respirations

Ventilation, if inadequate Assess circulation and look for

signs of shock and abdominal injury Weak or absent radial pulse Abnormally rapid heart rate Moist, pale, cool skin

If signs are present, patient is priority to immediate transport

Secondary Assessment Consider complaints and MOI Expose the entire body and perform a rapid

secondary assessment: head, neck, and chest first

Apply cervical immobilization, if spinal injury suspected

Inspect abdomen for open wounds, distension

Inspect around the navel and flanks for discoloration and bruising

Look for bruising in lower abdomen Inspect and provide emergency care for

abdominal evisceration

Secondary Assessment Palpate abdomen, noting tenderness,

masses or signs of pain Assess extremities for injuries; check

and compare pulses Assess motor and sensory function Log roll the patient and inspect back

and lumbar region; log roll onto backboard if spinal injury is suspected

Assess baseline vitals Obtain history; if patient is

unresponsive, ask bystanders

Secondary AssessmentBe alert for the following signs and symptoms of

abdominal injury Contusions, abrasions, lacerations, punctures, or other

signs of blunt or penetrating trauma Pain that continues to get worse Tenderness on palpation to areas besides injury site Rigid abdominal muscles Patient has drawn up legs to his chest to reduce pain Distended abdomen Discoloration around the navel or the flank (late sign) Rapid, shallow breathing Signs of hemorrhagic shock

Decreasing blood pressure, narrowing pulse pressure, increasing heart rate, increasing respiratory rate

Nausea/vomiting Abdominal cramping Pain that radiates to either shoulder Weakness

General emergency care – abdominal trauma

Maintain open airway and appropriate spinal protection

Oxygen therapy Reassess breathing status Treat for shock if symptoms apparent Control external bleeding Supine position with knees flexed Stabilize an impaled object Apply PASG if appropriate Transport quickly

Emergency care - Evisceration

• Expose the wound• Position patient supine with knees flexed• Prepare clean, sterile dressing• Cover the moist dressing with an occlusive dressing• Administer high-flow, high-concentration oxygen•Treat for shock• Reassess for effectiveness• Assess for further deterioration• Reassess vital signs

Genital TraumaInjuries to male genitalia Lacerations, abrasions,

avulsions, penetrations, amputations, contusions

Usually excruciatingly painful and causes great concern for the patient

Penis is very vascular Treat as soft-tissue injury;

apply direct pressure and cold compress

Wrap avulsed parts in sterile, moist dressing; place on ice; and transport with patient

Oxygen via NRB @ 15 lpm

Assess for signs of shock and transport

Injuries to Female genitaliaInclude straddle injuries,

sexual assault, blunt trauma, abortion attempts, lacerations after childbirth, and foreign bodies inserted into vagina

Usually produces excruciating pain and causes concern for the patient

Area is highly vascular Apply direct pressure to

any bleeding; use moist compress

Never pack or place dressings inside vagina

Assess for shock Oxygen via NRB @ 15

lpm Transport

Rectal InjuryWeightlifter in competition.

(prolapse)

How would you treat and package for transport?

Other Rectal Insults

Just a medical oddity……

Any questions???????????