Abdominal and Pelic Injury Flashcards
Name some examples of blunt force trauma.
Falls from height.
Blast.
Crush.
RTC.
What should you expect from higher energy mechanisms?
High risk of internal injury.
What factors should you look at with an RTC?
Type of vehicle (New vehicles transfer less energy to casualty)
Did air bags deploy?
Nature of impact. (B post intrusion or side impact increases risk of pelvic/abdo injury)
What are some example of penetrating trauma?
Gunshot wound
Stabbing
Fragmentation
What can be difficult to gauge by looking at a small pentrating wound?
The severity on the inside.
What can be easily missed if a primary servey is not completed thoroughly?
Small wounds.
If practicable what should happen to a patient?
They should be exposed completely.
What is the most important factor when assessing for Abdo and Pelvic wounds? And what can it be combined with to further strengthen this?
History and mechanism. Combined with signs and symptoms.
What is a sign?
Something a practitioner can detect.
Wound you can see, pulse rate you can feel
What are symptoms?
Things a patient will report. (Pain)
What signs and symptoms may be seen in Abdo or Pelvic injury?
Bruising and abrasion.
Wounds including back, loin, lower chest.
Direct and referred pain.
Tenderness, rigidity, guarding.
Unexplained hypovolimia. (Fast breathing, fast heart rate, pale).
Blood at urethral orifice.
Swollen or bruised scrotum.
What is direct and indirect pain.
Direct- Pain over the area of wound.
Indirect- Pain in an area away from wound.
What is the umberlicus.
The belly button.
Name the 9 regions of the abdominal and the 4 quadrants
TR- Right Hypochondic Region. TM- Epigastric Region. TL- Left Hypochondic Region. MR- Right Lumbar Region MM- Umbilical Region ML- Left Lumbar Region BR- Right Iliac Region BM- Hypogastric Region BL- Left Iliac Region
Right Upper Quadrant
Left Upper Quadrant
Right Lower Quadrant
Left Lower Quadrant
What could signifiacant bruising over the left side of the lower chest and abdomin indicate?
Damage to spleen.
Why is the spleen clinically important in blunt trauma?
It is relatively vanrable organ with an excellent blood supply
What are the structures of the abdomin and where can they be found?
Liver- Right Upper Quadrant Spleen- left Upper Quadrant Mesenteric Arteries- Epigastric Head of the Pancreas- Epigastric Biliary Tract- Epigastric Ligament of Triats- Right Upper Quadrant
What might different changes to urine colour indicate?
Red (Hematuria) - Damage to genitourinary tract. I.e. Kidney Uritars, Blader, Urethra. Dark brown (Myoglobiuria)- Myoglobin in blood.
What causes Myoglobinuria.
Rabdomyolysis. (Rapid muscle breakdown.)
Can be caused by muscle damage from trauma, burns, compartment syndrome, heat stroke.
What can high amounts of myoglobin cause?
An acute kidney injury.
What should be done prehospitally for myoglobinuria?
Stop activity and start intravenous fluids.
What is the management for suspected Abdominal or Pelvic injury?
- Rapid identification
- Minimal patient handling
- Managed to BATLs protocols.
- TXA
- Analgesia
- Continually reassessed
- Imperative evacuation
Why must is evacuation so important for Abdo and Pelvic casualties?
Cannot be definitively treated on the ground.
May require further investigation and surgery.
Why is good prehospital care important for Abdo and Pelvic patients?
Greatly decreases mortality and morbidity.
How can a patient handeling be minimised?
15 degree log rolls.
Minimising casualty movement on and off medevac platforms.
Using appropriate stretchers and extraction devices.
Selecting suitable medevac platforms.
Can permissive hypotension be used on Abdo and Pelvic patients
Yes but only for one hour.
What is the dose and interval for TXA
1g over 10minutes followed by 1g over 8 hours as an infusion
Why should you not be falsely reassured with health young patients?
Their injury may not become apparent till they stop compensating.
What is highly likely with Pelvic injury?
Further injury to the surrounding soft tissues.
Why can Pelvic injuries cause major Hemorage?
Good blood supply to bones
Jaggared edges of bones can cause further injury to surrounding vessels.
Sacrum has alot of veins.
If Pelvic ring is disrupted there is a greater volume and greater area to blled into.
What should you never do with a pelvis?
Spring it.
What can you for assess in a pelvis?
Gentle symotanious palpation to assess for asymmetry.
Splaying of the legs external rotation of the feet.
Wounds to buttocks, genitals
Pain
Unexplained hypovolimia
Orifice bleeding
What is the prehospital management for Pelvic injury
Same as abdomin.
Reduce volume using sam sling and natural alignment.
What might specialists be carrying
Raboa
Blood products
