Ch.31 Abdominal And Genitourinary Injuries Flashcards
Significant abdominal trauma can arise from blunt and/or penetrating forces. In the absence of obvious external trauma, internal injuries in this region may be overlooked. Indeed, unrecognized and untreated abdominal injuries are a leading cause of traumatic death. Despite the fact that 10% of all trauma patients have some form of genitourinary injury, such injuries are frequently missed. These oversights may increase the patient’s risk for incontinence, infertility, impotence, or other life-altering consequences. Therefore, when assessing patients with a mechanism of injury (MOl) capable of causing abdominal or genitourinary injury, the EMT must maintain a___. Relevant findings should be relayed to the receiving hospital expeditiously to ensure prompt delivery of definitive care.
high index of suspicion
___contains the gallbladder, the duodenum of the intestines, the majority of the liver, and a small portion of the pancreas.
the right upper quadrant
__contains the spleen, most of the stomach, and the larger portion of the pancreas.
The left upper quadrant
__contains portions of the large and small intestines (most notably, the descending colon and the left half of the transverse colon).
The left lower quadrant
__also contains large portions of the large and small intestines (including the ascending colon and the right half of the transverse colon), as well as the appendix, which is situated at the proximal end of the ascending colon.
The right lower quadrant
In__, the liver and spleen are very large in proportion to the size of the abdominal cavity and are more easily injured. The soft, flexible ribs of infants and young children do not protect these two organs very well and may allow injury to underlying organs, even without fracturing the ribs.
pediatric patients
The abdomen contains hollow and solid organs.___ include the stomach, large and small intestines, gallbladder, ureters, and urinary bladder (FIGURE 31-2). It is through these hollow structures that an assortment of materials pass, with most containing food in various stages of digestion. Exceptions include the urinary bladder and ureters, through which urine passes for release, and the gallbladder, which plays a supportive role in the breakdown of fats passing through the intestine.
Hollow organs
When ruptured or lacerated, these organs may spill their contents into the abdominal cavity, resulting in intense inflammation and possible infection. For example, the intestines and stomach contain acidic substances that aid in digestion, but when leaked into the abdominal cavity, these substances may irritate the lining of the cavity (called the peritoneum), resulting in inflammation and pain. This condition is called___, and it is a potentially life-threatening emergency. The first signs of___ are severe abdominal pain, tenderness, and muscular spasm. Later, bowel sounds diminish or disappear, because bowel functioning has been impaired. The patient may complain of nausea and vomiting, the abdomen may become distended and rigid, and signs of infection may be present.
peritonitis
The small intestine comprises the
Duodenum, the jejunum, and the ileum
The large intestine includes the
Cecum, the colon, and the rectum.
The term___ refers to any fold of tissue that attaches an organ to the body wall. However, the majority of the time this term is used specifically in reference to the intestinal____: a fold of tissue that contains a web of vessels, both arteries and veins, as well as nerves and lymphatic tissues. It connects the small intestine to the posterior of the abdominal wall. Both blunt and penetrating abdominal injuries can affect this vasculature, and patients with injuries to the mesentery can bleed significantly into the peritoneal cavity.
Although abdominal distention and rigidity may be indicative of infiammation, they can also alert the attentive EMT to the possibility that the patient is bleeding internally into the peritoneal cavity. Occasionally, bruising or ecchymosis may appear around the umbilicus (periumbilical bruising).
mesentery
As the name implies, ____are solid masses of tissue.___ such as the liver, spleen, pancreas, and kidneys carry out numerous chemical processes in the body, including enzyme production, blood cleansing, endocrine functions, and energy production (FIGURE 31-3). Because these organs have a rich blood supply, their injury can result in severe unseen hemorrhage. The same holds true for the aorta and inferior vena cava. And similar to contents spilled from hollow organs, blood that has escaped solid organs can cause peritoneal irritation, resulting in abdominal pain; however, this is not always the case. Therefore, the absence of abdominal pain and tenderness does not necessarily rule out the possibility of major bleeding in the abdomen.
solid organs
Along with the abdominal aorta and a portion of the inferior vena cava, many solid organs are considered___, because they are situated primarily in the posterior aspect of the abdominal cavity and behind the peritoneum. This region is referred to as the retroperitoneum. It also houses the kidneys, ureters, and urinary bladder. The majority of the pancreas is located in this region, which is why the pancreas is referred to as a retroperitoneal organ. The last portion of a hollow organ, the colon, occupies the lowest portion of the retroperitoneal space.
retroperitoneal (retro- means “behind”)
The potential space located posterior to the peritoneal cavity of the abdomen
Retroperitoneum
The membrane lining the abdominal cavity (parietal peritoneum) and covering the abdominal organs ( visceral peritoneum)
Peritoneum
Behind the abdominal cavity
Retroperitoneal
Falls are the most common mechanism of injury in__. The trauma sustained in a fall is not limited to musculoskeletal injuries. For a number of reasons, the EMT should maintain a high index of suspicion for internal injuries, even in patients who have experienced relatively “minor” falls. With advancing age, the abdominal organs lose some of their elasticity, making them more prone to injury when exposed to the forces present in a fall. The aorta, liver, and spleen are particularly vulnerable. Furthermore, if the geriatric patient’s bones are brittle, they can fracture even with falls from standing height. The sharp edges of broken bones have the potential to puncture internal organs.
geriatric patients
When a traumatic injury to the abdomen occurs without breaking the skin, it is considered a__.-
Examples include an assault victim struck in the abdomen by a baseball bat or a rapid deceleration injury from a fall or front-end motor vehicle collision (FIGURE 31-4). MOls capable of causing closed injuries include the following: • Motor vehicle collisions
• Motorcycle crashes
• Falls
• Blast injuries (barotrauma)
• Pedestrian versus vehicle
• Rapid deceleration
• Compression
closed abdominal injury
___may initially appear as abrasions to the surface of the skin, depending on the MOl, such as a physical assault or a pedestrian struck by a motor vehicle. In some circumstances, depending on how deep in the abdomen the injury occurs, it may take several minutes to hours for the contusion or hematoma to become visible on the surface.
Therefore, an EMT cannot rule out the possibility of injury merely on the basis of absence of these findings.
Closed abdominal injuries
Despite the undeniable benefits, seat belts occasionally contribute to blunt trauma to abdoininal organs. Worn properly, a seat belt lies below the__. Positioned too high, it can squeeze abdominal organs or great vessels against the spine when the vehicle rapidly decelerates or comes to a sudden stop (FIGURE 31-5). Fractures of the lumbar spine have also been reported. In later stages of pregnancy, the gravid uterus displaces the urinary bladder to the anterior, making it more susceptible to injury. Pregnant patients who adjust the lap belt for comfort as opposed to functionality can sustain further injuries.
anterior superior iliac spines of the pelvis and against the hip joints
As the name implies, in an ___the peritoneal cavity has been opened to the outside. Penetrating traumatic injuries such as stab wounds and gunshot wounds are examples of open injuries. Although some open wounds may not extend any deeper than the muscular wall of the abdomen, this cannot be reliably determined in the prehospital setting. Therefore, the EMT should maintain a high index of suspicion for unseen injuries and potential life threats and expedite transport to the nearest appropriate hospital, usually a designated trauma center.
open abdominal injury
A major determining factor in the severity of a penetrating MO! is the velocity of the object that penetrated the abdominal wall. The velocity correlates to the amount of energy transmitted to the tissues and therefore to the amount of damage incurred. There are three levels of velocity commonly used in the discussion of traumatic injuries:
• Low velocity. Caused by handheld or hand-powered objects such as knives and other edged weapons
• Medium velocity. Caused by small-caliber handguns and shotguns
• High velocity. Caused by more powerful weapons such as high-powered rifles and handguns of higher caliber
In addition to entrance and exit wounds, medium- and high-velocity projectiles create temporary wound channels or cavities.___ occurs as the pressure wave from the projectile is transferred to the tissues. This causes microscopic tears to blood vessels and nerves, expanding the width and length of the wound beyond what can be seen on physical examination. Depending on the velocity of the projectile, cavitation can produce significant tissue destruction and bleeding.
The higher the velocity, the larger the cavity created and, subsequently, the greater the extent of damaged tissue.
Cavitation
Despite the absence of cavitation, low-velocity penetrations can cause substantial damage to underlying organs. A visual
inspection of the entry wound does not necessarily convey the severity of the internal damage. This is an especially important consideration when treating patients with penetrating trauma in the region of the diaphragm, the muscle that separates the thoracic cavity from the peritoneal cavity. Because the diaphragm rises and falls as we breathe, its location is somewhat variable from one moment to the next. For that reason, it should be assumed that any penetrating abdominal injury at or below the ____may have punctured the diaphragm. The resulting opening could create a passageway through which abdominal contents might pass, or herniate, into the thoracic cavity, potentially hindering chest expansion and causing respiratory complications.
xiphoid process
