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Abdominal Trauma

Lesson

7

Prehospital Trauma Life Support

Copyright 2003, Elsevier Science (USA). All rights reserved.

PROVIDER COURSE

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Objectives

Relate how kinematics applies to theassessment of a patient with abdominal trauma

Identify the assessment and management of

blunt and penetrating abdominal trauma

Describe the differences in the assessment and

treatment of the pregnant patient with abdominal

trauma


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Abdominal Trauma

A leading cause ofpreventable traumadeath

Often goes unrecognized

Internal injury difficult to assess in thefield

Massive blood loss can lead to shock

and death


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Pathophysiology

Peritoneal cavity:

Solid organs (liver, spleen) hemorrhage

Hollow organs (small intestine, colon) filled

with enzymes and bacteria

Can hold large volume of blood


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Pathophysiology

Retroperitoneal cavity:

Solid organs (kidneys, pancreas)

Large blood vessels (aorta and vena cava)

Potential space that can hold massive

amount of blood


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Assessment

Kinematics provides index of suspicion

Observe for soft tissue wounds and distention

Palpate for tenderness

Auscultation of the abdomen is rarely useful

in the prehospital setting


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You are dispatched to a high-speed MVC. Your

patient is the 18-year-old unrestrained male driver

of the van.

On the basis of the kinematics, what

internal injuries do you suspect?


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Primary Survey

A - Gurgling with breathingB - Rapid and shallow

C - Minor bleeding from scalp laceration, radial

pulse rapid and weak, skin cool and diaphoretic

D - GCS score 8 (E-2, V-2, M-4)

E - Obvious left wrist deformity

Why is this patient in shock?


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The patient is a victim of two stab wounds tothe torso. One wound is along the left sixth

intercostal space and one is in the right lower

quadrant of the abdomen.

How could penetrating trauma to the lower

thorax involve the abdomen?


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Primary Survey

A - PatentB - Rapid and shallow; decreased BS on left side

C - No external hemorrhage, fast radial pulse, cool and

clammy skin

D - Anxious, GCS score 15E - No other injuries noted

How would you manage this patient?


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A 45-year-old female pedestrian has been

struck by a vehicle. She is anxious andcomplains of abdominal and pelvic pain.

In the field, can we identify the specific organs

injured?

Does this matter?


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Primary Survey

A - PatentB - Rapid; BS equal

C - No external hemorrhage; radial pulse absent; rapid

carotid pulse; skin pale

D - GCS score 13 (E-3, V-4, M-6)E - Crepitus of the pelvis noted on palpation

What are the potential causes of shock?


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Pelvic Fractures

How can pelvic fractures be recognized

and managed in the prehospital setting?


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Your patient sustained a close-range

shotgun blast to the abdomen. A

segment of bowel is eviscerated.

How are eviscerations managed?


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Impaled Objects

How are impaled objects managed in thefield?


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A 24-year-old female fell down a flight of

stairs. She is 36 weeks pregnant. She iscomplaining of severe back pain.

What physiologic changes occur duringpregnancy?

What are the common causes of injury in the

pregnant patient?


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Primary Survey

A - PatentB - Normal

C - Pulse rapid, skin warm and dry

D - Anxious

E - No obvious injury noted

Vitals: pulse, 114; VR, 20; BP, 92/56

Are these findings due to trauma or pregnancy?


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After immobilization to a long backboard,

reassessment shows her radial pulse to be140 and weak. Her BP is 80/60.

What could explain these findings?

How would you manage this patient?


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Summary

Maintain high index of suspicion - alwaysconsider kinematics

Consider PASG

Survival may depend on rapid transport to anappropriate facility where surgical intervention

is immediately available

Survival of the fetus depends on resuscitation

of the mother


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Copyright 2003 Elsevier Science (USA) All rights reserved

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Prehospital Trauma Life Support

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