Ch 30 Abdominal and Genitourinary Injuries Flashcards
Closed abdominal injuey
Injury in which there is soft-tissue damage inside the body but the skin remains in tact
Evisceration
The displacement of organs outside of the body
Never try to replace an organ; Keep the organ moist and warm, cover the injury site with a large, sterile, moist, bulky dressing (and an occlusive dressing if specified by local protocol)
Flank
The region below the rib cade and above the hip
Guarding
Contracting the stomach muscles to minimize the pain of abdominal movement; a sign of peritonitis
Can make it difficult to locate pain in patient with voluntary/involuntary guarding
Most often the rectus abdominis muscles are held tight
Hematuria
Blood in the urine
Hollow organs
Structures through which materials pass, such as the stomach, small intestines, large intestines, ureters and the bladder
Injuries may have delayed signs and symptoms
Melena
Black, tarry stools
Open abdominal injury
Injury in which there is a break in the surface of the skin or mucous membrane, exposing deeper tissue to potential contamination
Peritoneal cavity
The abdominal cavity
Peritoneum
The membrane lining of the abdominal cavity (parietal peritoneum) and covering the abdominal organs (visceral peritoneum)
Solid organs
Solid masses of tissue where much of the chemical work of the body takes place, such as the liver, spleen pancreas and kidneys
Can bleed significantly and cause rapid blood loss that can be hard to identify
Abdominal injuries are categorized as either _____ or _____
Open (penetrating trauma) or closed (blunt force trauma)
What type of abdominal injury(s) can injury solid or hollow organs and cause life threatening bleeding?
Open and/or closed
Blunt force trauma that causes closed injuries results from _____
An object striking the body without breaking the skin
Penetrating trauma is _____
The result of a GSW or stab wound
Injury to solid organs often causes _____
significant internal bleeding that can be life threatening
Injury to hollow organs of the abdomen may cause _____
Irritation and inflammation to the peritoneum as caustic digestive juices leak into the peritoneum; Serious infection may occur hours later
Always maintain an index of suspicion for serious intra-abdominal injuries in ____
trauma patients who exhibit signs of shock
Impaled objects in the abdominal region
Never remove; secure it in place with a large, bulky dressing and provide rapid transport
Treatment for shock
Always be prepared to treat
Place the patient supine, keep them warm, and provide high-flow O2
Injuries to the kidneys
May be difficult to detect because they are located in a well-protected region; be alert for bruising or a hematoma in the flank region
Common funding is hematuria
Injury to external M or F genetalia
Very painful but usually not life-threatening
Treatment for sexual assault or rape
Treat for shock if necessary and record all facts in detail; follow any crime scene policy established in your system to protect the scene and evidence; advise the patient not to wash, bathe, shower, douche or void until a physician has examined them
Do not examine the genitalia of the victim unless obvious bleeding must be controlled
Organs of the Right Upper Quadrant (RUQ)
Liver, gallbladder, duodenum of the intestines and a small portion of the pancreas
Organs of the Left Upper Quadrant (LUQ)
Spleen and stomach, pancreas (mostly posterior region)
Organs of the Left Lower Quadrant (LLQ)
Large and small intestines, notably the descending colon and L half of the transverse colon
Organs of the Right Lower Quadrant (RLQ)
Appendix, large and small intestines, notably the ascending colon and R half of the transverse colon
Appendix rupture
Severe infection and septic shock may occur
Peritonitis
Caused by the leaking of stomach and/or intestinal fluids to the peritoneal cavity. May become life threatening
First signs are severe abdominal pain, tenderness and muscular spasm; Later signs are diminished bowel sounds or function; nausea, vomiting, abdomen may be become distended
Small intestines
Duodenum, jejunum, ileum
Large intestines
Cecum, colon, rectum
Mesentery
Supplies blood to the intestines; a fold of tissue containing vessels, nerves and lymphatic tissues; it connects the small intestine to the posterior of abd. wall
Retroperitoneal region
Where many solid organs, great vessels, abdominal aorta, inferior vena cava, kidneys, ureters, pancreas and bladder are housed
Compression injuries
Typically caused by a poorly placed seatbelt; creates a pattern called a clasp-knife injury, an exaggerated resistance of muscles, resembling the opening of a penknife or clasp knife
Can also be caused when a person is run over or rolled over
Deceleration injuries
Commonly occur when a person or vehicle the person is in strike a large immovable mass
Injury to the liver and spleen, and bleeding into the peritoneal space can result in pain that is
Pain is often referred (transferred) to the shoulder and can easily be overlooked
An abdominal aneurysm that is dissecting can result in pain that is
Tearing pain and describes it as going from the abdomen posteriorly
Damage to the kidneys or ureters can result in pain that is
Pain that is following the angle from the lateral hip to the midline of the groin
An inflamed or ruptured appendix can result in pain that is
Pain primarily located in the RLQ
Direct injury or inflammation of the gallbladder can result in pain that is
Pain that can be found just under the margin of the ribs on the right side or between the shoulder blades
Acute pain in the entire abdomen is
A common response to blood and fluid from damaged organs flowing into the peritoneal cavity; rebound tenderness may occur if exposed to any jarring motion
Abdominal distention or swelling between the xiphoid process and groin is often the result of
Free fluid, blood or organ contents spilling into the peritoneal cavity
May also be the result of air or gases in the bowel or from infection
Lower rib fractures
If trauma was forceful enough to break ribs, it may have damaged internal organs
Because it make take several minutes to hours for contusion or hematoma to become present
Do not rule out serious abdominal injury based on the absence of bruising or discoloration
When worn properly, the seatbelt sits
Below the anterior superior iliac spines of the pelvis and against the hip joints
If a seatbelt is too high
It can squeeze abdominal organs or great vessels against the spine when the vehicle suddenly decelerates; occasionally fractures to the lumbar spine may occur
This anatomic change allows the normally protected bladder to become more susceptible to injuries from impacts and the seat belt
Later stages of pregnancy where the gravid uterus displaces the bladder to the anterior
Pregnant patients who adjust the lap belt for comfort can sustain further injuries
When a patient sustains a penetrating injury to the abdomen, it is important to
Attempt to determine the velocity of the object because it can predict the amount of damage to tissue
Low-velocity injuries
Caused by hand-held or hand powered objects such as knives
Bleeding at the entrance wound may hide how far the the object went into the body, which is especially important to remember when an injury occurs in the region of the diaphragm
Medium velocity injuries penetrating wounds
Caused by smaller caliber handguns and shotguns; has temporary wound channels (caused by cavitation) in addition to the exit and entrance wounds
High velocity injuries
Caused by larger weapons such as rifles and higher-power handguns; has temporary wound channels (caused by cavitation) in addition to the exit and entrance wounds
Cavitation
When a cavity forms as the pressure wave from a projectile is transferred to the tissues causing microscopic tears to blood vessels and nerves, expanding the width and length of the wound
Can produce significant bleeding
Higher velocity = larger amount of cavitation and tissue damage
Any time there is an injury at or below the xiphoid process
Assume both thoracic and peritoneal cavities have been affected
Signs of abdominal injury
Early sign - tachycardia
Later signs - signs of shock, decreased BP, pale, cool and moist skin, and changes to the abdomen
Free air in the peritoneal cavity
Abnormal and typically indicates that a hollow organ or loop of the bowel has been perforated; very painful
The liver
The largest organ in the abdomen and very vascular; Can contribute to hypoperfusion of injured
Pain is commonly referred to the shoulder
Pancreas and spleen
Bleed heavily when affected by blunt or penetrating trauma
Spleen often injured in MVA, especially with improper seatbelt placement, steering wheel impact, bike crashes; Pain may refer to shoulder
If the diaphragm is penetrated
The bowel may herniate into the thoracic cavity and patients will exhibit dyspnea; may be worsened when patients are placed in a supine position
In pediatric patients in MVA or car v. bike accidents
The chest and abdomen are less protected and may experience significant transfer of energy
The ribcage is flexible and can lead to extreme compression in the chest and abdomen but very few outward signs of injury
Falls in geriatric patients may lead to
Risk of injury to the aorta, liver, spleen because the abdominal organs have lost some elasticity
Rectal bleeding
May occur after sexual assault, colitis, ulcers, etc.
Significant rectal bleeding can occur after hemorrhoid surgery and can lead to significant blood loss and shock
The first signs of peritonitis include all of the following EXCEPT: Severe abdominal pain Tenderness Muscular spasms Nausea
Nausea
Late signs of abdominal injury include all of the following EXCEPT Distention Increased BP Change in mental status Pale, cool, moist skin
Increased BP
