Abdo and Pelvic

Question 1

Sign and symptoms of Diaphragmatic injuries

Answer 1

• 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

Question 2

Why are liver injuries so serious, its location, common causes and what occurs?

Answer 2

• 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.

Question 3

What are signs and symptoms of liver trauma?

Answer 3

• Pain in right upper quadrant
• Tenderness
• Rigidity
• Poor perfusion

Question 4

What are common cause of spleen injuries and are patients generally presenting symptomatically or asymptomatic?

Answer 4

• 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.

Question 5

What are signs and symptoms of a PT with a spleen injury?

Answer 5

• The PT may present with referred pain in the left shoulder tip as the splenic haematoma causes diaphragm irritation
• Poor perfusion

Question 6

What traumatic injuries may affect the kidneys?

Answer 6

• The kidneys may be affected by contusions, haemorrhaging that my tamponade, lacerations, contusions and vascular injuries.

Question 7

What is the main cause of Ureters injuries?

Answer 7

• The ureters may generally be injured by penetrating trauma.

Question 8

List some signs and symptoms of a PT with kidney or ureters trauma.

Answer 8

• 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

Question 9

Is the pancreas susceptible to injuries, what type of trauma might impact it?

Answer 9

• 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.

Question 10

How can a GI haemorrhage be confirmed?

Answer 10

• A GI haemorrhage can only be confirmed if there is obvious evidence of bleeding from the mouth of anus.

Question 11

In what forms of trauma are you likely to see small and large intestine injuries in trauma setting?

Answer 11

• Penetrating trauma, RTA and shearing force injuries.

Question 12

What signs and symptoms will a PT with small and large intestine injuries present with?

Answer 12

• Pain
• Peritoneal contamination
• Visible GI bleeding

Question 13

What major vessels if lacerated require surgical repair?

Answer 13

• Aorta
• Inferior vena cava
• Renal arteries
• Mesenteric arteries
• Iliac arteries

Question 14

What signs and symptoms and how can diagnosis be achieved of vessel lacerations?

Answer 14

• Pain and poor perfusion

- These patients can only be diagnosed via ultrasound and exploratory surgery

Question 15

List the signs and symptoms of a traumatic aortic rupture.

Answer 15

• Severe tearing chest pain
• Cough
• Dyspnoea
• Dysphagia
• Back pain
• Hoarseness
• High upper body blood pressure
• Low lower body blood pressure

Question 16

What may cause an abdominal vessel wall to become weakened?

Answer 16

• Trauma
• Atherosclerosis
• Vascular disease
• Infection

Question 17

What are the four forms of Aneurysms?

Answer 17

-	Scallular
o	True aneurysm
-	Fusiform
o	True aneurysm
-	False Aneurysm
-	Dissecting aneurysm

Question 18

What are the signs symptoms and progression of a Ruptured aortic or thoracic aneurysm?

Answer 18

• 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.

Question 19

What are the signs symptoms and progression of a Dissecting abdominal aortic aneurysm AAA?

Answer 19

• 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.

Question 20

What is the paramedic management of a PT having an Aneurysm?

Answer 20

• 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.

Question 21

What form of abdominal pain is felt on palpation?

Answer 21

• Parietal pain

Question 22

What form of abdominal pain is felt on release of palpation?

Answer 22

• Visceral pain

Question 23

What are the three types of lateral pelvis compression injuries?

Answer 23

-	Type 1
o	Compression of the sacrum
-	Type 2
o	Fracture of the iliac 
-	Type 3
o	Normally when a hemi pelvis is crushed

Question 24

List some details of lateral pelvic# compression

Answer 24

• 50% of pelvic fractures
• Common pedestrian injury
• Stable but often high forces

Question 25

List some details of Anterior pelvic# compression

Answer 25

• 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

Question 26

List some details of Vertical shear pelvic #

Answer 26

• Account for 20% off pelvic#

- Usually occur from high falls or MVAs

Question 27

List the 3 classifications of pelvic#

Answer 27

• 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.