ABDOMINAL TRAUMA

INTRODUCTION

Optimal patient care requires that the EMT-I understand the significance of mechanism of injury, signs and symptoms, and field management of abdominal trauma. The following topics will be discussed during this lesson:

· Review of anatomy and physiology

· Types of injury

· Signs and symptoms of abdominal trauma

· Field management of abdominal trauma

· Field management of specific abdominal injuries

· Transport decisions for abdominal trauma patients

LESSON OBJECTIVES

At the end of this lesson the participants will be able to:

1. Identify the location of the following organs with reference to surface anatomy: stomach, liver, spleen, kidney, intestines and bladder.

2. Explain the pathophysiology of abdominal injuries.

3. State the significance of various mechanisms of injury in developing an index of suspicion for abdominal trauma.

4. Discuss signs and symptoms of blunt abdominal trauma.

5. Verbalize appropriate field management and transport decisions for the patient suspected of having abdominal trauma.

6. State the field management of abdominal organ evisceration.

7. State the field management of trauma to the external genitalia.

8. Discuss the field management of impaled objects.

SKILLS

Impaled Object Stabilization

KEY VOCABULARY

The following terms will be used during this class:

· MOI - Mechanism of injury

· Passenger Space Intrusion - part of the vehicle is forced into the space where the occupant should be.

KEY CONCEPTS

The following section provides information and space for taking notes on the key concepts discussed by the instructor.

TRAUMA STATISTICS

· When unrecognized, abdominal trauma is one of the major causes of death in trauma patients.

· Abdominal trauma is the second leading cause of (preventable) trauma deaths.

· Increased incidences of deaths are due to increased hemorrhage and delay in receiving surgical intervention.

REVIEW OF ABDOMINAL ANATOMY

Surface Anatomy

· Upper quadrants (2)

· Right and left

· Upper border – xiphoid

· Lower quadrants (2)

· Right and left

· Lower border – symphysis pubis

The point of intersection is the umbilicus.

Boundaries of the Abdomen

· Diaphragm

· Anterior abdominal wall

· Pelvic skeletal structure

· Vertebral column

· Muscles of the abdomen and flanks

Structures of the Abdomen

· Intrathoracic abdomen (located underneath the diaphragm and the lower ribs)

· Liver

· Gallbladder

· Spleen

· Stomach

True Abdomen

· Large intestines

· Small intestines

· Bladder

In females:

· Uterus

· Fallopian tubes

· Ovaries

Retroperitoneal Abdomen

(Lies behind the intrathoracic and true abdomen)

· Kidneys

· Uterus

· Pancreas

· Posterior duodenum

· Abdominal aorta

· Inferior vena cava

REVIEW OF PHYSIOLOGY

· Injury of abdominal structures causes death primarily as a result of hemorrhage

· Injury may be subtle

· High index of suspicion based on the mechanism of injury should alert prehospital personnel to the potential of intra-abdominal trauma

· Damage to solid and vascular organs can result in hemorrhage and shock

· Damage to hollow organs can result in spillage of contents, peritonitis and shock

· Hemorrhage in the true abdomen may lead to abdominal distension, however, extensive bleeding in the retroperitoneal space may go undetected

TYPES OF INJURY

Blunt Mechanisms (10-20% mortality rate)

· Compression forces

· Shearing forces

· Deceleration forces

· MVA collisions

· Front, rear, lateral or rotational impacts with or without restraints

· Seat belt injuries

· Steering wheel injuries

· Auto vs. pedestrian

Penetrating Mechanisms

· Gunshot wounds (5-15% mortality rate)

· Stab wounds (1-2% mortality rate)

Golden Rule: The path of injury caused by a penetrating object may not be readily apparent from the location of the wound.

SIGNS/SYMPTOMS OF ABDOMINAL TRAUMA

· Pain

· Any external signs of injury (i.e. abrasions, bruising, open wounds, bleeding)

· Signs and symptoms of shock

· Distended or rigid abdomen

· Pain on palpation

· Rebound tenderness

Golden Rule: The most reliable indicator of intra-abdominal hemorrhage is the presence of shock without an identifiable source.

FIELD MANAGEMENT OF ABDOMINAL TRAUMA

BLS procedures

· High flow oxygen

· Control external bleeding

· Treat for shock prn

· Nothing by mouth

· Monitor vital signs

· Assist with ALS procedures

· ALS procedures

· Advanced airway prn

· Monitor

· Venous access (large bore)

· Rapid transport to a trauma hospital when indicated

SPECIFIC INJURIES

Abdominal Evisceration

· Protrusion of abdominal organs from an opening in the abdomen

· Field management

· Do not attempt to reinsert

· Supine position

· Knees flexed

· Loose sterile saline dressings

· Rapid transport

Trauma to External Genitalia

· Mechanism of injury may be blunt or penetrating

· Field management

· Venous access (large bore)

· Control bleeding

· Apply moist sterile saline dressings over lacerations of avulsions

· Rapid transport

Impaled Object

· Multiple causes - may be intentional, accidental, or self-

inflicted

· Field management

· Venous access (large bone)

· Do not remove

· Stabilize with bulky dressing