abdominal trauma new.ppt

By Tony Suharsono tony/en-b 2007

tony/en-b 2007

Introduction 13 -15 of traumatic death are a direct result of injury to abdominal structure, making this the third leading cause of trauma related mortality (trauma nursing core course)In UK the incidence of life threatening abdominal and genitourinary trauma is low, just over 1% of all trauma admissions to hospital Injury to the abdomen can be a difficult condition to evaluate even in the hospital . In the field it is usually more so

tony/en-b 2007

tony/en-b 2007

Anatomy of abdomen Abdomen is traditionally divided into three region :The thoracic abdomenThe true abdomen The retroperitoneal abdomen

tony/en-b 2007

tony/en-b 2007

Thoracic abdomenLocated underneath the thin sheet muscle, the diaphragm, and is enclosing by the lower ribs It contains the liver, gall bladder, spleen, stomach and transverse colon. Injury to the liver and spleen can result in life-threatening hemorrhage tony/en-b 2007

tony/en-b 2007

True Abdomen It contains intestines and the bladder Damage to the intestines can result in infection, peritonitis and shock tony/en-b 2007

tony/en-b 2007

The retroperitoneal AbdomenIt lies behind the thoracic and true portion of the abdomen This area include kidneys, ureters, pancreas, posterior duodenum, ascending and descending colon , abdominal aorta, the inferior vena cavaInjuries here difficult to evaluate tony/en-b 2007

tony/en-b 2007

Types of injuries Blunt trauma, (have relative high rate mortality rates of 10-30%, fracture solid organ, blow out of hollow organ and tearing of organ and their blood vessel )Penetrating trauma (Stab wound and gunshot wound, gunshot caused greater incidence of injury to abdominal viscera from the higher energy imparted to the intra abdominal organ

in the prehospital phase , with both blunt and penetrating trauma , you must be concerned about intra abdominal bleeding with hemorrhagic shocktony/en-b 2007

tony/en-b 2007

General considerations although penetrating injuries may be restricted to the abdomen, blunt abdominal trauma is rarely in isolated eventtony/en-b 2007

tony/en-b 2007

Assessment abdominal trauma patientPrimary survey : rapid visual evaluation and palpation DCAPBLSEvisceration Distention TendernessGentle palpate iliac crest (tenderness and crepitus associated with fracture)

tony/en-b 2007

tony/en-b 2007

Sign and symptoms patient with abdominal injuries Contusions, abrasion, laceration, punctures, or other signs of blunt or penetrating injuriesPain that may initially be mild, than worseningTenderness on palpation to areas other than the site of injury Rigid abdominal musclePatient lies with his legs drawn up to the chest in an attempt to reduce pain Distended abdomen tony/en-b 2007

tony/en-b 2007

Sign and symptoms patient with abdominal injuriesDiscoloration around the umbilical or to the flank Rapid shallow breathing Signs of shock Nausea and vomiting Abdominal cramping may be present Pain may radiate to either shoulder Weakness tony/en-b 2007

tony/en-b 2007

Management abdominal traumaImmediate determination of specific structure that have been injured is not essential : the most important management decision is whether the patient requires immediate surgery. With this mind, care is focused on basic stabilization, frequent reassessment, and diagnostic testing. Airway Assessment Ensure the patient has a patent airway Intervention Clear the airway and use adjuncts as indicated tony/en-b 2007

tony/en-b 2007

Management abdominal traumaBreathing AssessmentEvaluate the respiratory rate, depth, effectiveness, and work of breath. Consider the possibility of concurrent thoracic injury Intervention Administer supplemental oxygen via a non rebreather mask or tracheal tubeAssisst ventilations as needed with a bag valve mask or mechanical ventilation

tony/en-b 2007

tony/en-b 2007

Management abdominal traumaCirculation Assessment Assess circulatory status: pulses, skin status, and blood pressure. Patient with abdominal injuries can lose tremendous amounts of bloodIntervention Insert two (or more) large bore (14-16 G) intravenous catheterInfuse warmed, isotonic crystalloid solutionTransfuse blood component as needed Administer fluid based on clinical status and test result (a Judicial approach to volume replacement is recommended)Consider central line placement in unstable patient for infusion of large fluid volume and central venous pressure monitoring

tony/en-b 2007

tony/en-b 2007

Management abdominal traumaMiscellaneous AssessmentIdentify the mechanism of injury and prehospital event Determine medical history Inspect the anterior and posterior abdomen to identify all wounds Check for major injuries to other body sites Intervention Place an orogastric or nasogastric tube for stomac decompression Insert inwelling urinary catheter and monitor outputCover open abdominal wound with sterile saline dressing, do not allow exposed to dry Facilitate diagnostic studies and surgical intervention tony/en-b 2007

tony/en-b 2007

tony/en-b 2007

tony/en-b 2007

Summary Scene size up for mechanism and pertinent history from the patient Rapid patient assessment Rapid transport to appropriate hospital Other intervention as neededtony/en-b 2007

tony/en-b 2007

Suggested reading Brady Basic trauma life supportEmergency care, textbook for paramedic, second edition Sheehys Manual of emergency care Prehospital emergency care tony/en-b 2007

tony/en-b 2007

tony/en-b 2007

tony/en-b 2007