THORACIC TRAUMA

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ABDOMINAL TRAUMA
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Case Chapter 13

• You respond to a reported industrial injury.
• Arrive on-scene to find this patient.

What are your treatment priorities?
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Overview

• Review anatomy.
• Review types of injuries
• Blunt
• Penetrating
• Evaluation of abdominal trauma.
• Management of abdominal trauma.

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Anatomy
Intrathoracic Abdomen
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Anatomy
True Abdomen
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Anatomy
Retroperitoneal
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Types of Injuries

• Blunt trauma
• Penetrating trauma

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Blunt Trauma
Pathophysiology

• High mortality
• Direct compression
• Solid organ fracture
• Hollow organ blowout
• Tearing from deceleration
• Little external evidence of injury

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Penetrating Trauma
Pathophysiology

• Stab wounds
• l-2 mortality
• Shock unlikely at scene
• Peritonitis over next few hours
• Gunshot wounds
• 5-15 mortality
• Injury to abdominal viscera

All penetrating abdominal wounds should be
evaluated at a hospital.
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Blunt Abdominal Trauma

• Fracture of solid organs
• Hemorrhage
• Rupture of hollow organs
• High risk of peritonitis
• Tearing of organs, blood vessels, and mesentery
  (attachments)
• Fractures of lower ribs associated with high
  incidence of liver or spleen injury

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Evaluation Scene Size-up

• Provides clues to
• Type of injury
• Path followed
• Forces involved
• Important factors
• Weapon or object involved
• Distance
• Force applied

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EvaluationBTLS Primary Survey

• Initial Assessment
• ABCs
• Rapid Trauma Survey
• Head, neck, chest
• Abdomen
• Look for wounds, bruises, distention.
• Feel for guarding, tenderness, rigidity.

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Signs Symptoms
Assessment

• Wounds
• Bruises
• Tenderness
• Rigidity
• Guarding
• Distention

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Signs Symptoms
Assessment

• Injury to upper abdomen
• Assume chest involvement.
• Use occlusive dressings on penetrations.
• Injury to chest below nipple line
• Assume abdominal involvement.

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Management

• Treat problems found in the BTLS Primary Survey.
• 100 oxygen.
• If abdominal tenderness, load-and-go.
• Dress wounds.
• Two large-bore IVs en route
• NS or RL to maintain BP of 90-100 systolic

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Management of Evisceration

• Cover protruding organs with moist sterile
  dressing and/or nonadherent material.
• Do not try to put organs back into the abdomen.
• Load-and-go.

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Management

• Airway with high-flow oxygen.
• Monitor vital signs.
• Dress wounds.
• IV access en route.
• Maintain systolic BP at 90-100 mmHg.
• Monitor cardiac status.
• Notify medical command.

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Management

• Moist sterile dressings recommended.
• Do not replace protruding organs.

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Summary

• Second leading cause of preventable death from
  trauma.
• Most deaths from delayed treatment.
• Be alert to mechanisms of injury.
• Maintain high index of suspicion.
• Abdominal pain impending shock.
• Penetrating wounds of the abdomen or tender
  abdomen mean load-and-go.

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Proper Assessment

• Scene survey.
• High index of suspicion.
• MOI provides clues
• Objects, distance, and forces involved
• Signs often develop late.
• Pain may signal impending shock.

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Proper Treatment

• Rapid assessment.
• Rapid transport.
• Perform interventions en route.
• Reassess patient frequently.

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Continually watch for
shock!
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Questions?