Abdominal Trauma

Question 1

Any penetrating injury at or below what intercostal space is suspected to be in the abdomen?

Answer 1

4th

Question 2

Injuries in what region are are difficult to evaluate in the field and why?

Answer 2

Retroperitoneal
Because of its location away from the anterior body surface

Question 3

Types of Injuries of Abdominal Trauma

Answer 3

(a) Blunt Trauma
(b) Penetrating Trauma
(c) A combination of blunt and penetrating trauma

Question 4

True Abdomen contains what?

Answer 4

(a) Large and small intestines
(b) Portion of the liver and the bladder
(c) In females
1) Uterus
2) Fallopian tubes
3) Ovaries

Question 5

Retroperitoneal space contains what?
“SADPUCKER”

Answer 5

S: suprarenal (adrenal) gland
A: aorta/IVC
D: duodenum (second and third part)
P: pancreas (except tail)
U: ureters
C: colon (ascending and descending)
K: kidneys
E: esophagus
R: rectum

Question 6

Intrathoracic region contains what?

Answer 6

Liver, Gallbladder, Spleen, Stomach, Transverse colon

Question 7

Labs:
Generally, all trauma patients should get …

Answer 7

1) CBC/Diff
2) UA
3) Fecal Occult Blood
4) Type and Screen
5) Females: Beta-HCG

Question 8

Radiology/Imaging:

Answer 8

Depends on the injury location and type of injury sustained:
1) Upright abdominal X-Ray
2) CT with contrast
3) Ultrasound

Question 9

What is the bullet rule?

Answer 9

The sum of the number of bullet wounds and actual bullets seen on diagnostic imaging should always be an even number.

Question 10

Pathophysiology: Abdominal Trauma
Types of Injuries

Answer 10

(a) Blunt Trauma
(b) Penetrating Trauma
(c) A combination of blunt and penetrating trauma

Question 11

Deceleration injury: Associated with high speed MVA’s and falls from heights.
What are the common affected organs/structures?

Answer 11

duodenal and aortic rupture

Question 12

When should you medivac ABD trauma PT?

Answer 12

if evidence of peritonitis, unstable vital signs or questionable diagnosis.

Question 13

Initial Treatment: Abdominal Trauma

Answer 13

Follow TCCC guidelines for initial stabilization

Question 14

Treatment: Abdominal Trauma

Answer 14

(1) Largely dependent on presenting symptoms, type and location of injury
(2) All patients with abdominal trauma should have serial abdominal exams performed
(3) NPO
(4) O2 NC if SpO2 < 94%
(5) 2 large bore IVs
(6) PROPAQ monitor
(7) IV antibiotics if signs of infection/peritonitis
(8) Pain meds (monitor for respiratory distress if using morphine)
(9) Consider NG tube with intermittent suction.
(10) Monitor I/O’s
(a) If no GU trauma Insert foley to better assess resuscitation status

Question 15

What is the resuscitative fluid of choice for hypovolemic shock caused by blood loss?

Answer 15

Fresh
Whole Blood