abdominal of trauma. abdominal trauma the abdomen is the “black box” i.e., it is impossible to...
TRANSCRIPT
Abdominal Trauma The abdomen is the “Black Box”
I.e., it is impossible to know what specific injuries have occurred at initial evaluation
The key to saving lives in abdominal trauma is NOT to make an accurate diagnosis, but rather to recognize that there is an abdominal injury
Signs and Symptoms of Abdominal Injuries
Blunt Trauma Significant mechanism Abdominal pain Distension Discoloration of abdomen or
flank Unexplained shock Bent steering wheel Seat belt signs Peritoneal signs
Penetrating trauma Visible truncal injury
including chest or abdomen Abdominal pain Bleeding Impaled object Evisceration Shock
Peritoneal Signs Significant abdominal tenderness on palpation Involuntary guarding Percussion tenderness Diminished or absent bowel sounds
Causes of Abdominal Injuries BLUNT TRAUMA
Motor vehicle accidents
Auto vs. pedestrian Falls Blast injuries
PENETRATING TRAUMA Gunshot wounds Stab wounds Shrapnel wounds Impalements
Types of Injuries Blunt and penetrating abdominal injuries may be
associated with extensive damage to the viscera resulting in massive blood loss.
Blunt or penetrating abdominal injuries are related to the: Type of force applied Tissue density of structure injured (e.g., fluid-filled, gas-filled,
solid, or encapsulated) The liver and spleen are the most commonly injured
organs from blunt trauma. The liver, small bowel and stomach are the most
commonly injured organs from penetrating trauma.
Blunt Abdominal Trauma Compressive or shearing
forces may deform and rupture abdominal organs
Bruising across the lower abdomen is characteristic of a seat belt injury
Visible signs may not reflect severity of underlying injury The Seat Belt Sign
Penetrating Abdominal Trauma
Visible wounds may not reflect severity of underlying injury
Significant internal bleeding likely
Bowel injury likely Patient may be in
shock
Impalement Injuries Care DO NOT REMOVE
OBJECT OR EXERT ANY FORCE UPON IT! Severe bleeding may
occur causing shock Check pulses distal to
impaled object Immobilize the object Apply bulky support
bandages to hold in place
Management of Evisceration Injuries Use sterile side of dressing to place protruding
organs near the wound (NOT into wound) Cover organs and wound completely with sterile or
clean moist dressing DO NOT APPLY PRESSURE TO WOUND or
expose internal parts Tie dressing tails loosely around wound Prepare evacuation to surgical assets
Hepatic Injuries Because of its size and location, the liver is frequently
injured when force is applied to the abdomen. The friability of liver tissue, the extensive blood supply,
and the blood storage capacity cause hepatic injury to result in profuse hemorrhage.
SIGNS AND SYMPTOMS Upper right quadrant pain Abdominal wall muscle rigidity, spasm, or involuntary
guarding Rebound tenderness Hypoactive or absent bowel sounds Signs of hemorrhage and/or hypovolemic shock
Splenic Injuries Injury to the spleen is usually associated with blunt trauma, but
may also be associated with penetrating trauma. Fractures of the left 10th to 12th ribs are associated with
underlying damage to the spleen. The most serious splenic injury is a severely fractured spleen or
vascular tear, producing splenic ischemia and massive blood loss.
SIGNS AND SYMPTOMS Signs of hemorrhage or hypovolemic shock Pain in the left shoulder (Kehr's sign) Tenderness in the upper left quadrant Abdominal wall muscle rigidity, spasm, or involuntary guarding
Hollow Organ Injuries Forces causing trauma to hollow organs may result in
either blunt or penetrating injuries. The small bowel is the hollow organ most frequently
injured. Deceleration may lead to shearing, which causes avulsion or tearing of the small bowel.
Seat belts causing compression have resulted in rupture of the small bowel or colon.
SIGNS AND SYMPTOMS Peritoneal irritation Evisceration of the small bowel or stomach Diagnostic Peritoneal Lavage (DPL) may show presence of
bile, feces, or food fibers
Renal Injuries The most common injury to the kidney is a blunt
contusion, Suspect renal injury if there are fractures of the posterior ribs or lumbar vertebrae.
Renal parenchyma can be damaged by shearing and compression forces causing lacerations or contusion.
SIGNS AND SYMPTOMS Ecchymosis over the flank Flank or abdominal tenderness elicited during palpation Gross or microscopic hematuria—the absence of hematuria
does not rule out renal injury
Bladder and Urethral Injuries The majority of bladder injuries are blunt. If a distended bladder ruptures are perforated, urine is likely to
extravasate into the abdomen. Most ruptures of the bladder occur in association with pelvic
fractures. Urethral trauma is more common in males than females because
the male urethra is longer and less protected. SIGNS AND SYMPTOMS
Suprapubic pain Urge, but inability to urinate Hematuria (may be microscopic) Blood at the urethral meatus Blood in scrotum Rebound tenderness