Abdo and Pelvic Flashcards
Sign and symptoms of Diaphragmatic injuries
- Auscultation of bowel sounds in the chest
- Bowel or visceral herniation, obstruction, strangulation and possible rupture of the stomach and colon
- Tension pneumothorax
- Cardiac tamponade
- Diaphragmatic paralysis
Why are liver injuries so serious, its location, common causes and what occurs?
- Upper right Quadrant
- The liver is the largest organ in the abdomen and as so a rapid and significant amount of blood loss will occur. When the liver is injured blood and bile are caused to escape into the peritoneal cavity.
- The liver is often injured via the steering wheel and lap belt in MVA.
What are signs and symptoms of liver trauma?
- Pain in right upper quadrant
- Tenderness
- Rigidity
- Poor perfusion
What are common cause of spleen injuries and are patients generally presenting symptomatically or asymptomatic?
- Common cause of spleen injuries are due to RTA’s, falls, sporting injuries and are primarily caused by blunt trauma. These cause a significant and rapid blood loss.
- 40% of PT are asymptomatic.
What are signs and symptoms of a PT with a spleen injury?
- The PT may present with referred pain in the left shoulder tip as the splenic haematoma causes diaphragm irritation
- Poor perfusion
What traumatic injuries may affect the kidneys?
- The kidneys may be affected by contusions, haemorrhaging that my tamponade, lacerations, contusions and vascular injuries.
What is the main cause of Ureters injuries?
- The ureters may generally be injured by penetrating trauma.
List some signs and symptoms of a PT with kidney or ureters trauma.
- Haematuria (blood in urine) will be seen in 80% of cases
- Localised flank / abdominal pain
- Palpable posterior mass
- Tenderness in lower ribs, upper L spine and flank
- Pain in groin, should back and flank
Is the pancreas susceptible to injuries, what type of trauma might impact it?
- The pancreas is a solid organ that is rarely injured, however, if injured it may be due to penetrating trauma.
- Duodenum injury is also associated with pancreatic trauma.
How can a GI haemorrhage be confirmed?
- A GI haemorrhage can only be confirmed if there is obvious evidence of bleeding from the mouth of anus.
In what forms of trauma are you likely to see small and large intestine injuries in trauma setting?
- Penetrating trauma, RTA and shearing force injuries.
What signs and symptoms will a PT with small and large intestine injuries present with?
- Pain
- Peritoneal contamination
- Visible GI bleeding
What major vessels if lacerated require surgical repair?
- Aorta
- Inferior vena cava
- Renal arteries
- Mesenteric arteries
- Iliac arteries
What signs and symptoms and how can diagnosis be achieved of vessel lacerations?
- Pain and poor perfusion
- These patients can only be diagnosed via ultrasound and exploratory surgery
List the signs and symptoms of a traumatic aortic rupture.
- Severe tearing chest pain
- Cough
- Dyspnoea
- Dysphagia
- Back pain
- Hoarseness
- High upper body blood pressure
- Low lower body blood pressure
What may cause an abdominal vessel wall to become weakened?
- Trauma
- Atherosclerosis
- Vascular disease
- Infection
What are the four forms of Aneurysms?
- Scallular o True aneurysm - Fusiform o True aneurysm - False Aneurysm - Dissecting aneurysm
What are the signs symptoms and progression of a Ruptured aortic or thoracic aneurysm?
- They progress fast into a PEA arrest, you may see signs early on of PT complaining of severe tearing/ripping pain and present with poor perfusion.
What are the signs symptoms and progression of a Dissecting abdominal aortic aneurysm AAA?
- PT will have an acute onset of a severe tearing/ripping pain in the abdomen through to the back.
- The PT will present with poor perfusion, neurovascular compromise to lower limbs and have a pulsating abdominal mass.
What is the paramedic management of a PT having an Aneurysm?
- Prepare for cardiac arrest
- IV access, preferably x2 large bore – 14g or 16g
- Withhold fluid unless loss of cardiac output
o Hypotension is helping to avoid full rupture - 2 bags of normal saline ready for arrest ( will essentially be a traumatic arrest)
- Antiemetic’s
o Vomiting will increase intra-abdominal pressure.
What form of abdominal pain is felt on palpation?
- Parietal pain
What form of abdominal pain is felt on release of palpation?
- Visceral pain
What are the three types of lateral pelvis compression injuries?
- Type 1 o Compression of the sacrum - Type 2 o Fracture of the iliac - Type 3 o Normally when a hemi pelvis is crushed
List some details of lateral pelvic# compression
- 50% of pelvic fractures
- Common pedestrian injury
- Stable but often high forces
List some details of Anterior pelvic# compression
- Accounts for 25% of pelvic fractures
- Forces can be applied direct to pelvis or indirectly via the lower limbs
- Produces an open book fracture
- These are a lower energy force than lateral compression
List some details of Vertical shear pelvic #
- Account for 20% off pelvic#
- Usually occur from high falls or MVAs
List the 3 classifications of pelvic#
- Stable
o # does not disrupt the pelvic ring, only has one break point and minor haemorrhage. - Unstable
o # disrupts the pelvic ring, has two or more break points. # ma be within bones or separations between the fibrous joints between bones. - Open/closed
o Closed pelvic # is where the skin over the fracture site is not broken. Open pelvic # or compound fracture, skin over the # site is broken.
