abdominal trauma Flashcards
1
Q
introduction to abdominal injury
A
- One of body’s largest cavities
- Multiple vital organs.
- Large volumes of blood can be lost before signs and symptoms manifest.
- Must be alert for signs of transmitted injury -> Deformity, swelling, and ecchymosis
- Prevention:
- Highway safety- Seatbelt usage (Proper application)
- Airbags
2
Q
abdominal anatomy and physiology
A
- boundaries:
- superior- diaphragm
- inferior- pelvis
- posterior- vertebral column and posterior and inferior ribs
- lateral- muscles of the flank
- anterior- abdominal muscles
3
Q
abdominal anatomy and physiology: 3 specific spaces
A
- peritoneal space- organs covered by abdominal (peritoneal) lining
- retroperitoneal space- organs posterior to the peritoneal lining
- pelvic space- organs contained within pelvis
4
Q
upper right quadrant organs
A
- liver
- gal bladder
- stomach (small part)
- small and large intestine
- head of pancreas
- upper part of kidney
5
Q
upper left quadrant organs
A
- spleen
- stomach
- tail of pancreas
- tail of liver
- small and large intestine
- upper part of kidney
6
Q
lower right quadrant organs
A
- small and large intestine
- lower part of kidney
- half of bladder
- appendix
- female reproductive organs
7
Q
lower left quadrant organs
A
- small and large intestine
- lower part of kidney
- half bladder
- female reproductive organs
8
Q
hollow abdominal organs
A
- stomach
- small intestine
- large intestine
- gall bladder
- bladder
- uterus
9
Q
solid abdominal organs
A
- liver
- spleen
- pancreas
- kidneys
- ovaries
10
Q
digestive tract: function
A
- churn material to be digested
- excrete digestive juices
- absorb nutrients and water
11
Q
digestive tract: components
A
- STOMACH- food mixed with HCl and enzymes to form chyme
- SMALL BOWEL:
- food moved through bowel by peristalsis
- duodenum
- jejunum
- ileum
- LARGE BOWEL (COLON)
- RECTUM
- ANUS
12
Q
Liver
A
- located in upper right quadrant
- 2.5% of total body weight
- receives 25% of cardiac output and has greatest blood reserve
- suspended by ligamentum teres- can lacerate liver in deceleration trauma
- function:
- detoxifies blood
- removes damaged or aged erythrocytes
- stores glycogen and agents for metabolism
- liver tissue will grow to normal size following partial removal
13
Q
gal bladder
A
- small hollow organ located behind and beneath liver
- receives bile:
- waste product from reprocessing of RBCs
- used to digest fatty foods (emulsification)
14
Q
pancreas
A
- produces endocrine hormones and exocrine enzymes
- glucagon
- insulin
- digestive enzymes that return the chyme pH to normal and break down proteins
15
Q
spleen
A
- part of immune system
- located behind stomach and lateral to kidney in upper left quadrant
- function: immunology and stores large volume of blood
- most fragile abdominal organ
- commonly injured in blunt trauma affecting the left flank
16
Q
urinary system
A
- kidneys
- ureters
- urinary bladder- can contain as much as 500 mL of urine
- urethra
17
Q
kidneys
A
- collect waste products in blood stream
- concentrate products into urine
- reabsorb water and salt
- regulate body osmotic balance
- adrenal glands
18
Q
kidneys: adrenal glands
A
- superior and attached to kidneys
- component of endocrine system
- release epinephrine and norepinephrine
19
Q
pregnant uterus
A
- uterus and contents grow rapidly after conception and until delivery
- 1st trimester (0-12)- well protected
- 2nd trimester (12-24)- uterus displaces organs upward
- 3rd trimester (24 weeks to term)- fills entire abdominal cavity and displaces diaphragm upward
20
Q
pregnant uterus: effects on maternal physiology
A
- increases circulatory blood volume by 45%
- greater volume but fewer RBCs
- results in relative anemia
- cardiac output increases by 40%
- heart rate increases by 15 bpm
- compresses the vena cava in 3rd trimester
- reduces venous return- supine hypotensive syndrome
21
Q
penetrating trauma in abdomen
A
- energy transmitted to surrounding tissue
- projectile cavitation, pitch, and yaw
- results in:
- uncontrolled hemorrhage
- organ damage
- spillage of hollow organ contents
- irritation and inflammation of abdominal lining
- liver most commonly affected organ
- shotgun trauma- multiple projectiles
22
Q
blunt trauma: abdomen
A
- produces least visible signs of injury
- causes:
- deceleration- contents damaged by change in velocity
- compression- organs trapped between other structures
- shear- part of an organ is able to move while another part is fixed (ex. ligamentum teres)
23
Q
blast injuries: abdomen
A
- blunt and penetrating MOIs
- irregular shaped shrapnel and debris
- pressure wave- compresses and relaxes air-filled organs and/or contuses or ruptures organs
- abdominal injury is secondary concern during blast injury
24
Q
injury to abdominal wall
A
- skin and muscles transmit blunt trauma to internal structures
- typically only show erythema
- visible swelling and ecchymosis occur over several hours
- penetrating trauma may appear minimal externally in comparison to internal trauma
- muscle may mask the size of the external wound
- evisceration may be present
- trauma to thorax, buttocks, flanks, and back may penetrate abdomen
- lower chest may injure spleen, liver, stomach, or gallbladder
- diaphragmatic tears: herniation of abdominal contents into thorax
25
Q
injury to hollow organs
A
- may rupture with compression from blunt forces
- may tear due to penetrating trauma
- intestines have a large amount of bacteria- leakage can result in sepsis
- manifestations of blood loss
- hematochezia- blood in stool
- hematemesis- blood in emesis
- hematuria- blood in urine
- spillage of contents into:
- retroperitoneal space
- peritoneal space
- pelvic space
26
Q
injury to the solid organs
A
- dense and less strongly held together
- prone to contusion- bleeding/fracture (rupture)
- unrestricted hemorrhage if organ capsule is ruptured
- specific organs:
- spleen- pain referred to left shoulder
- pancreas- pain radiated to back
- kidneys- pain radiated from flank to groin and hematuria
- liver- pain referred to the right shoulder
27
Q
injury to the vascular structures
A
- abdominal aorta and vena cava- prone to direct blunt or penetrating trauma -> may be injured in deceleration injuries
- blood accumulates beneath diaphragm:
- irritation of muscular structures
- produces referred pain in the shoulder region
- greater volume of blood can be lost
- presence of blood in abdomen stimulates vagus nerve resulting in slowing of heart rate
- blood can isolate in ant of the abdominal spaces
28
Q
injury to mesentery and bowel
A
- provides bowel with circulation, innervation, and attachment
- disrupts blood vessels supplying the bowel- leads to ischemia, necrosis, or rupture
- blood loss minimal- peritoneal layers contain hemorrhage
- tear of mesentery may rupture bowel
- penetrating trauma to the lateral abdomen likely to injure large bowel
29
Q
injury to peritoneum
A
- delicate and sensitive lining of anterior abdomen
- PERITONITIS:
- inflammation of the peritoneum due to:
- bacterial irritation- due to torn bowel or open wound
- chemical irritation- caustic nature of digestive enzymes -> urine initiates inflammatory response
- blood does not induce peritonitis
- progression:
- slight tenderness at location of injury
- rebound tenderness
- guarding
- rigid, board like feel
30
Q
injury to the pelvis: serious skeletal injury
A
- life threatening hemorrhage
- potential injury to pelvis organs:
- ureters
- bladder
- urethra
- female genitalia
- prostate
- rectum
- anus
31
Q
injury during pregnancy
A
- trauma is the number one killer of pregnant females
- penetrating abdominal trauma accounts for 36% of maternal mortality
- gun shot wound (GSW) account for 40-70% of penetrating trauma
- blunt trauma due to improperly worn seatbelts- auto collisions are leading cause of mortality
- changes dimension of uterus- protects abdominal organs and endangers uterus and fetus
32
Q
injury during pregnancy: maternal changes
A
- increasing size and weight of uterus-compresses inferior vena cava and reduces venous return to heart
- increasing maternal blood volume protects mother from hypovolemia-> 30-35% of blood loss necessary before signs of shock
- uterus is thick and muscular distributes forces of trauma uniformly to fetus -> reduces chances of injury
33
Q
injury during pregnancy
A
- risk of uterine and fetal injury increases with the length of gestation- greatest risk during 3rd trimester
- penetrating trauma may cause fetal and maternal blood mixing
- blunt trauma complications:
- uterine rupture
- aburptio placentae
- premature rupture of amniotic sac
34
Q
injury to pediatric patients
A
- children have poorly developed abdominal musculature and smaller diameter
- rib cage more cartilaginous- transmits injury to organs beneath easier
- increased incidence of injury to:
- liver
- kidney
- spleen
- shock- compensate well for blood loss and may not show and symptoms until 50% of blood is lost
35
Q
scene size up
A
- must evaluate MOI to assess seriousness of injury
- identify strength and direction of forces:
- velocity of impact
- focus observations and palpation on that site
- develop a mental list of possible organs involved
- if auto crash- determine if seatbelts used properly, look for interior signs of impact, steering wheel and dashboard deformity
- initial assessment- LOC, drug or alcohol use, evaluate ABCs and immediate threats
36
Q
rapid trauma assessment
A
- rapid and full trauma assessment
- closely examine regions with a high index of suspicion
- expose and examine for DCAP-BTLS:
- if suspected pelvic injury, DO NOT test pelvis
- palpate entire abdomen
- evaluate for entrance and exit wounds
- OPQRST assessment- characteristics of pain -> tenderness versus rebound tenderness
- SAMPLE history
- vital assessment
37
Q
considerations with pregnant patients
A
- be observant for:
- signs of shock:
- PRETREAT- signs may not develop until 30% of blood volume lost
- body begins shunting blood from GI/GU to primary organs
- supine hypotensive syndrome
- premature contractions
- vaginal hemorrhage- uterine rupture versus abruptio placentae
- uterus development- abnormal asymmetry
38
Q
ongoing assessment
A
- trend vital signs- every 5 minutes for critical patients
- evaluate for:
- progressive hemorrhage:
- BP and capillary refill
- pulse rate and pulse oximetry
- mental status
- skin condition
- ineffective aggressive fluid resuscitation
39
Q
general management
A
- position patient in a position of comfort unless spinal injury -> flex knees or left lateral recumbent
- general shock care
- specific injury care- impaled objects or eviscerations
- impaled objects- secure in place
40
Q
fluid resuscitation
A
- large-bore IV with isotonic solution- consider 2 bolus if pulse does not slow
- large-bore IV lock for use if patients BP drops below 80 mmHg
- fluid challenge 20 mL/kg- limit to 3 L
- titrate to SBP of 80 mmHg
41
Q
management of pregnant patient: positioning
A
- left lateral recumbent
- if on backboard tilt backboard
- facilitates venous return
42
Q
management of the pregnant patient: oxygenation
A
- high flow O2
- consider PPV by BVM if hypoxia ensues
43
Q
management of the pregnant patient: maintain high index of suspicion for intra-abdominal bleeding
A
-consider IV and PASG
44
Q
evisceration care
A
