Injuries to the Abdomen, Pelvis, and Genitalia

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Injuries to the Abdomen, Pelvis, and Genitalia
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Causes

• injuries to the abdomen, pelvis and genitalia are
  generally caused by accidents involving high
  kinetic energy and acceleration or deceleration
  forces

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Causes (continued)

• injury can occur from
• gunshots
• knife wounds
• motor vehicles
• snowmobiles
• falls
• skier or boarder collisions

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Open vs. Closed Injuries

• abdominal injuries can be either open or closed
• open injuries are caused by sharp or high
  velocity objects that create an opening between
  the peritoneal cavity and the outside of the body

• closed injuries are caused by compression trauma
  associated with deceleration forces and include
• contusions
• ruptures
• lacerations
• shear injuries

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Hollow and Solid Organs
The type of injury will depend on whether the
organ injured is solid or hollow.

• solid organs include
• liver
• spleen
• kidneys

• hollow organs include
• stomach
• intestines
• gallbladder
• bladder

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Hollow Organ Injuries

• when hollow organs rupture, their highly
  irritating and infectious contents spill into the
  peritoneal cavity, producing a painful
  inflammatory reaction called peritonitis

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Solid Organ Injuries

• damage to solid organs such as the liver can
  cause severe internal bleeding
• blood in the peritoneal cavity causes peritonitis

• when patients injure solid organs, the symptoms
  of shock may overshadow those from peritonitis

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Abdominal Injuries

• abdominal injuries can be obvious, such as an
  open wound, or subtle, such as a blow to the
  flank that initially causes little pain, but
  damages the liver or spleen

• suspect abdominal internal injury in any patient
  who has a penetrating abdominal wound or has
  suffered compression trauma to the abdomen

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Peritonitis

• Signs and Symptoms

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Signs and Symptoms

• pain and tenderness increase and spread from the
  injury site to the other parts of the abdomen,
  frequently the entire abdomen
• the abdomen becomes tender, distended, and rigid
• bowel sounds disappear

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Signs and Symptoms (continued)

• the patient becomes progressively sicker,
  develops fever, and usually vomits
• signs and symptoms of shock may appear
• respirations are shallow and rapid because it
  hurts to breathe deeply

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Signs and Symptoms (continued)

• abdominal pain is increased by moving,
  straightening the knees, or taking a deep breath
• the patient frequently prefers to lie quietly on
  his back or side with the knees flexed

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Injuries to the Pelvis and Genitourinary System
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Kidney Injuries

• an injury to the lower back may involve one or
  both kidneys
• signs include
• tenderness
• swelling
• ecchymosis
• blood in the urine

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Bladder Injuries

• pelvic fractures can lacerate the bladder or
  urethra
• always search for a pelvic fracture during
  assessment of the lower abdomen

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Male Genitalia Injuries

• these injuries are extremely painful
• the patient will have a high degree of anxiety
  and concern
• manage contusions by applying cold pack and
  stabilizing the injury with clothing

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Female Genitalia

• the female organs are protected by the pelvis
• the uterus of a pregnant woman is susceptible
  from compression trauma to the pelvis or abdomen
• soft tissue injury can cause anxiety and profuse
  bleeding

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Female Genitalia Injuries

• control any bleeding with direct pressure
• anchor dressings with a diaperlike arrangement
  made from triangular bandages
• never insert dressings or packs into the vagina

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Assessment

• Patients with an Abdominal or Pelvic Injury

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Assessment

• determine the mechanism of injury
• institute BSI
• ask the patient
• what happened?
• where do you hurt?
• the location of the pain and its character

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Assessment (continued)

• assess the abdomen, lower chest, pelvis, and back
  giving urgent care as necessary
• investigate a positive mechanism of injury or
  abnormal pulse by
• performing rapid body survey
• obtaining SAMPLE history

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• expose and assess the perineal area if you
  suspect a genitourinary injury
• anticipate vomiting
• inspect vomit
• conduct non-urgent survey
• conduct whole body survey

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• assess and record vital signs
• assess and record any changes in location or
  character of pain
• watch and record change in any symptoms
• inspect voided urine for visible blood

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• perform the ongoing survey
• do ongoing monitoring and recording of
• vital signs
• changes in location or character of pain,
  tenderness, abdominal distention and rigidity

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• assess for additional injuries if the level of
  shock is not explained by injuries found
• arrange for rapid transport unless the injury is
  trivial

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Emergency Care

• Patient with an Abdominal or Pelvic Injury

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Emergency Care

• keep the patient warm
• dont give anything by mouth
• control external bleeding with direct pressure
• maintain the airway

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Emergency Care (continued)

• bandage wounds
• protect eviscerated organs with a sterile, moist
  occlusive dressing
• stabilize an impaled object in place

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Emergency Care (continued)

• anticipate and treat shock
• give high flow oxygen
• immobilize the patient with a fractured pelvis on
  a long spineboard

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Emergency Care (continued)

• Arrange to transport the patient rapidly to the
  hospital