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Abdominal Trauma

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Chapter 13 Abdominal Trauma Penetrating injury often involves uncontrolled hemorrhage. Vigorous fluid administration may only worsen rate of hemorrhage. – PowerPoint PPT presentation

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Title: Abdominal Trauma


1
Chapter 13 Abdominal Trauma
2
Abdominal Trauma
Courtesy of Roy Alson, MD
3
Overview
  • Basic abdominal anatomy
  • How abdominal and chest injuries are related
  • Blunt and penetrating injuries
  • Complications associated with each
  • Treatment for protruding viscera
  • Relationship of exterior and underlying injuries
  • Possible intra-abdominal injuries
  • History, physical examination, mechanism of
    injury
  • Abdominal trauma ALS interventions

4
Abdominal Trauma
  • Difficult to evaluate
  • Attention to scene and mechanism of injury
  • Major cause of preventable death
  • Hemorrhage
  • Anticipate shock immediate or delayed
  • Require surgical intervention
  • Infection
  • Gross contamination prevention

5
Abdominal Regions
  • Thoracic abdomen
  • Retroperitoneal

True abdomen
6
Abdominal Region Injury
  • Thoracic region
  • Life-threatening hemorrhage liver, spleen
  • True abdomen
  • Infection, peritonitis, shock intestines
  • Severe hemorrhage with signs
  • Retroperitoneal abdomen
  • Severe hemorrhage hidden major vessels

7
Abdominal Trauma
  • Blunt
  • Most common mortality 1030
  • Penetrating
  • Gunshots mortality 515
  • Stabbings mortality 12
  • Concern
  • Intra-abdominal bleed with hemorrhagic shock
  • Sepsis and/or peritonitis

8
Abdominal Trauma
  • Scene Size-up

9
Blunt Abdominal
  • Mechanism
  • Direct compression of abdomen
  • Fracture of solid organs (spleen/liver)
  • Blowout of hollow organs (intestines)
  • Deceleration forces
  • Tearing of organs and blood vessels
  • Accompanying injuries
  • Head, chest, extremity 70 MVC victims

10
Blunt Abdominal
  • Liver and spleen injury most common
  • Evidence of injury
  • Often no or minimal external evidence
  • Significant blood volume concealed in regions
  • Seat-belt sign 25 intra-abdominal
  • Pain or tenderness
  • Often no pain or overshadowed by other pain

11
Penetrating Abdominal
  • Mechanism
  • Direct trauma to organ and vasculature
  • Projectile and fragments
  • Energy transmitted from mass and velocity
  • Caution
  • Vigorous fluid resuscitation may do more harm
  • PASG may do more harm

12
Penetrating Abdominal
  • Projectile pathway not always obvious
  • Abdominal injury is chest chest is abdominal
  • Gluteal area in 50 of significant injuries

13
Abdominal Assessment
  • ITLS Primary Survey Abdomen
  • Deformities
  • Contusions
  • Abrasions
  • Punctures
  • Evisceration
  • Distension
  • Tenderness
  • Tenseness

14
Signs and Symptoms
  • Splenic injury
  • Referred left posterior shoulder pain
  • Liver injury
  • Referred right posterior shoulder pain
  • Severe hemorrhage
  • Distention, tenderness, tenseness
  • Pelvic tenderness or bony crepitation

15
Stabilization
  • Signs usually do not appear early.

If present, injury is significant.
Assess and treat for shock.
16
Special Situations
  • Evisceration
  • Do not push viscera back into abdomen.
  • Gently cover with moistened gauze.
  • Apply nonadherent material to prevent drying.

17
Special Situations
  • Impaled object
  • Do not remove.
  • Uncontrollable hemorrhage
  • Gently stabilize object.
  • Avoid movement.

18
Summary
  • Intra-abdominal injury must be recognized and
    treated immediately.
  • Scene Size-up and detailed history
  • Rapid patient assessment
  • Early shock treatment
  • Minimize delays to maximize survival.

19
Discussion
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