Chapter 13 - Abd Trauma · 10/16/19 1 Abdominal Trauma Prehospital Trauma Life Support Intro ´Unrecognized ABD injury is one of the most common causes of preventable death in trauma

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Abdominal TraumaPrehospital Trauma Life Support

Intro

´ Unrecognized ABD injury is one of the most common causes of preventable death in trauma patients.

´ Usually die due to significant blood loss

´ Always rule out internal abdominal hemorrhage in all unexplained shocks

´ ABD is a poor historian so don’t exclude abd trauma if no acute symptoms in the abd.

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Anatomy

´ Abd contains all of the major organs of digestive, endocrine and urological systems.

´ Major vessels found in the abdcavity.

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External Genitalia

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Pathophysiology

´ Non Traumatic´ Anorexia

´ Vomiting´ Nausea´ Retching´ Constipation

´ Diarrhea´ ABD Pain´ GI Bleeding

´ Dysphagia ´ GERD´ Hiatal hernia´ Pyloric obstruction

´ Intestinal obstruction

´ Gastritis

´ Peptic Ulcer

´ Gastric Ulcer

´ Malabsorption syndromes

´ Inflammatory bowel disease

´ Ulcerative Colitis

´ Crohn Disease

´ Diverticular Disease

´ Appendicitis

´ Liver disease

´ Gallstones

´ Pancreatitis

´ Cancers

´ Traumatic´ Penetrating trauma

´ Blunt trauma

´ Impaled Objects

´ Evisceration

´ Obstetrical Trauma

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General Assessment´ Mechanism of Injury

´ Blunt? Penetrating?

´ History´ SAMPLE´ Collision Specific:

´ Type, position of patient, ejection?

´ Vehicle speed´ Extent of vehicle damage

´ Seat belts? ´ Penetrating

´ Type of weapon´ Number of penetrations

´ Distance from gun (if shooting)´ Blood on scene

Physical Examination

´ Inspection´ Examine for soft-tissue injuries, distension, symmetry, bruising, evisceration,

impaled objects, tire marks, etc.

´ Palpation´ Typically start right to left, or from area of less injury

´ Voluntary guarding: patients reaction to pain

´ Involuntary guarding: rigidity or spasm and remains without provocation

´ Rebound tenderness: pain when pressure released indicates peritonitis

´ Deep palpation to identify organs not necessary when trauma present

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´ Auscultation´ Not all that useful in a trauma

´ If you hear bowel sounds when auscultating the chest good indicator that the diaphragm is ruptured

´ Percussion´ Does indicate fluid but may not be crucial finding if already assessed by other

means

´ Defiantly can be useful if not sure

´ Tympanic or dull sounds may indicate liquid

´ Percussing kidney can indicate injury with pain

Systematic Approach

´ Inspect the abdomen´ Auscultate (if appropriate) (consider vascular auscultation)´ Palpate starting from the right quadrant to the left if no visible issues´ McBurney’s Point´ Murphy’s Sign´ Examine for Spleenic Enlargement´ Inspect genitalia ´ Palpate genitalia only if indicated ´ Palpate femoral pulses´ Percuss kidney landmarks

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Other assessment parameters

´ Don’t forget your basic principles ´ Scene size up

´ Primary

´ ABCDE

´ Secondary

´ Focused or complete

´ SAMPLE

´ Vitals

´ Ongoing Care

Field Ultrasounds

´ New technique in emergency care to find damage to tissues, vessels, free fluid, etc.

´ Need lots of expertise in reading u/s to be effective

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Impaled Objects

´ Standard management

´ Do not remove the object´ Stabilize the object and control bleeding from around the injury site

´ Do not palpate or percuss the organs as further damage can occur.

Evisceration

´ Organ penetrating through open wound

´ Treatment is to protect the protruding segment´ Never replace the organs

´ Apply a clean, sterile dressing saturated in NaCl

´ Continue to re-saturate the dressing as it dries

´ Wet dressings may also be covered by an occlusive dressing

´ Keep patient calm

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Internal Bleed

´ Stabilize vital signs

´ Consider IV ´ Careful consideration: IV increases blood volume, but can also

affect the ability to form a clot at the location of the bleed.

´ Trendelenburg position?´ Goal is to maintain systolic pressure >90 as long as no

indicator of TBI

Obstetrical

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Genitourinary Injuries

´ Blood in the urine or visible blood loss from the genitals is the usual sign

´ Pelvic fractures can cause lacerations to urinary bladder and walls of the vagina

´ Trauma can occur from many MOI

´ Most injuries are ‘external’

´ Bleeding controlled with direct pressure

´ Never insert dressings into the vagina, just external ´ Amputations managed like any other amputation