abdominal trauma and trauma in pregnancy
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7Abdominal
Trauma & Trauma
in Pregnancy
Lesson
Prehospital Trauma Life Support
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Developed by the
National Association ofEmergency Medical Technicians
In cooperation with
The Committee on Trauma,American College of Surgeons
This slide presentation is intended for use only
in approved PHTLS courses. 7-1B
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Abdominal Trauma
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Abdominal Trauma & Trauma
in Pregnancy
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Lesson 7 Abdominal Trauma Objectives
Associate blunt and penetrating abdominaltrauma with anatomy, physiology andpathophysiology.
Use mechanism of injury and index ofsuspicion when assessing, treating andprioritizing abdominal trauma.
Identify the appropriate assessment andmanagement of abdominal trauma, and thelimitations of each.
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Abdominal trauma often goesunrecognized.
Second leading cause of trauma death.
Extent of damage difficult to
determine. Massive blood loss can lead to shock
and death.
Abdominal Trauma
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Abdominal Assessment
Keys: Anatomy - to identify structures that may be
damaged. Mechanism.
Index of suspicion.
Tools: Observation for wounds, guarding, positioning. Palpation for rigidity, tenderness, and masses.
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Pitfall: Auscultation is a tool, but not
recommended in the prehospital setting.
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Penetrating Trauma
Your patient is the victim of multiplegunshot wounds to the abdomen.
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Pitfall: Injury significance missed due to
a lack of attention to kinematics.
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Anatomy
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How can you use anatomy toevaluate this patient?
Organ location.
Solid versus hollow.
Bleeding versus peritonitis. Associated chest injury.
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Frontal Impact
You are dispatched to a one-vehicle MVCwith one occupant. The scene is safe.
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Blunt Trauma
Your patient is the victim of an MVC. Her vanstruck a pole head on. Moderate damage to thevan. She was wearing a seatbelt, and it waspositioned over the soft part of her abdomen.
A- Airway clear. B- Breathing rapid and shallow.
C- Skin cool and diaphoretic, weak radials, rapidheart rate.
D- Confused and anxious.
E- Bruising to left clavicle area and abdomenabove the iliac crest. Abdomen is soft and
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Mechanism of Injury
Is the patient in this scenario critical ornon-critical?
What was the speed? What type of impact occurred?
What do you see inside the car?
What internal organs might be involved?
Are there signs and symptoms of shock?
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Index of Suspicion
Reliable indicators for index ofsuspicion:
Mechanism of injury. Unexplained indicators of shock.
Outward signs of trauma.
Level of shock greater than explainedby other injuries.
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Index of Suspicion Pitfalls
Blood in the abdomen may not alwayscause abdominal pain or tenderness.
In most cases, retroperitoneal injuries
are initially asymptomatic.
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Mechanism of Injury
Which of these should increase your indexof suspicion that this patient might beseriously injured?
A - Airway clear.
B - Breathing 18 & labored; lungs clear &equal.
C - Skin cool & dry; radial pulse 110. D - Anxious, intoxicated.
E - Bruising to right thorax and hip;abdomen soft, non-tender.
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Other Assessment Findings
You respond to a patient involved in afight. Hes been hit in the back and flank
with a heavy piece of pipe. He has no
complaints of abdominal pain. Scene is
safe. What injuries would you suspect?
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Injuries to the back may involveretroperitoneal structures like the kidneys,
aorta, and vena cava.
They often present with back pain ratherthan abdominal complaints and findings.
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Evisceration & Impaled Objects
You respond to a patient stabbed in theabdomen. A piece of bowel is eviscerated
and the knife is still impaled. How would
you manage this patient?
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Cover the bowel with moist sterile dressings.Why?
Stabilize the knife in place. Do not removeimpaled objects.
PASG contraindicated.
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Pelvic Fractures
You respond to a rollover MVC. The patientspelvis was crushed when the small tractor
he was driving rolled over.
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What is significant about this injury? Blood loss is usually significant and
occurs retroperitoneal.
Can the PASG be used to stabilizefractures and control bleeding?
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Rapid evaluation.
Shock therapy.
Pneumatic antishock garment.
Rapid transport to the appropriate
facility with surgical interventionimmediately available.
IV therapy en route.
Abdominal Trauma Management
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Abdominal Trauma & Trauma
in Pregnancy
Trauma in Pregnancy
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Lesson 7 Trauma in Pregnancy Objectives
Identify the implications of the anatomicaland physiological changes of pregnancyfor the trauma patient.
Identify the appropriate assessment,management and priorities for thepregnant patient.
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Increased heart rate of 15 - 20 bpm.
Decreased blood pressure.
Increased cardiac output.
Increased blood volume.
Normal Changes with Pregnancy
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Increased size of uterus.
Decreased peristalsis.
Loosening of ligaments.
Normal Pregnancy Changes
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A- Clear.
B- Breathing: 20 bpm, slightly laboredand shallow; lungs clear.
C- Pulse 114. Skin warm and dry. D- Anxious.
E- No obvious injury noted.
Vitals: BP 92/56.
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Findings
Are these changes due to trauma or pregnancy?
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Resuscitation of the babydepends on aggressive
resuscitation of the mother.
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Trauma in Pregnancy
You are dispatched to the scene of a 23 y/ofemale who is 32 weeks pregnant. She waspushed down a flight of stairs, and is foundlying on her back.
A- Airway clear. B- Breathing 18 per minute, slightly labored. Clear
breath sounds.
C - Very weak radial pulse of 120. No external
hemorrhage. D - Responsive to verbal stimuli.
E - Contusion to right temporal region of head.
Vitals: BP 86/54. Secondary survey negative exceptfor head contusion.
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Discussion
How would you manage this patient?
What condition mimics a head injury?
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Abdominal Trauma Summary
The cornerstone of assessing and
managing the pregnant and non-
pregnant abdominal trauma patient is
maintaining a high index of suspicion.
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