Module 22- Abdo Assessment and Treatment Flashcards
When abdominal trauma occurs the places where enough blood can be lost to cause shock are:
- Abdominal cavity
- Retroperitoneal space
- Pelvis
Which organs most frequently injured after blunt trauma?
- Spleen- 50%
- Liver- 30% b/c of it’s size most frequently injured in penetrating trauma
- Both solid organs can be easily crushed by external blunt trauma
- Both have large blood supply and bleed profusely
What should you expect in unexplained states of shock?
Expect abdominal trauma
Which organs are more resilient to blunt trauma?
- Hollow organs and less likely to be injured by trauma unless they are full
- When full they can burst
- Hold toxins that can spill into abdominal cavity
- Can cause peritonitis
What is peritonitis?
Life threatening inflammation of the lining of the abdomen
How to detect possible abdominal injury?
- Not always evident based on history and physical examination
- Must have a high index suspicion and a clear understanding of MOI trauma pt was exposed to
What are the 2 types of abdominal trauma?
- Blunt
- Penetrating
Blunt trauma
- Majority of significant abdominal injuries in Canada involve blunt trauma
- Most are due to MVC’s
What are the results of compression injuries or deceleration forces?
- Crush organs or rupture them
What are the 3 common injury patterns?
- Shearing
- Crushing
- Compression
Shearing
- Caused by rapid deceleration forces
- Internal organs cont to move forward
- Causes organs to tear at the point of attachment to abdominal wall
- Includes liver, kidneys, small & lrg intestines and spleen
Crushinh
- Contents crushed between the anterior abdominal wall and the spinal column
- Solid organs such as kidneys, liver, and spleen are at greater risk
- Caused by the dashboard or steering wheel striking abdominal cavity of unrestrained driver
Compression
- Direct blow or external compression from a fixed object
Increases abdominal pressure and can cause a rupture of small intestines or diaphragm - Leads to uncontrollable hemorrhage and peritonitis`
Penetrating wounds
Most commonly from wounds involving gunshot or stabbing
- Gunshot wounds cause more injury than stab wounds
Low velocity
knife, ice pick, hand gun
Med velocity
9mm gun or shotgun
High velocity
high powered rifle or military weapon
What does the trajectory the projectile traveled and the distance it had to travel contribute to?
It contributes to the extent of the injury
Gunshot wounds most commonly involve injury to?
- Small bowel
- Colon
- Liver
- Vascular structures
Stab wounds most commonly involve injury to?
- Liver
- Small bowel
- Diaphragm
- Colon
What are the five patterns from MVC’s?
- frontal
- Lateral
- Rear
- Rotational
- Rollover
Motorcycle falls
- Less structural protection
- Rider protective devices:
- Helmet
- Gloves
- Leather pants and/or jacket
- Boots
When do falls usually occur?
- During criminal activity, suicide, or intoxication
- Note or observe position or orientation of the body at the moment of impact
Blast injuries
- Commonly associated with military conflict
- Seen in mines, chemical plants, and terroist activities
What are the 4 different mechanisms of blast injuries?
Primary: injury from pressure wave
Secondary: injury from debris
Tertiary: victim is propelled through air and strikes object
Miscellaneous: burns and resp injuries from gasses and chemicals
What is the major concern in abdominal trauma?
- Hemorrhage
- Hemorrhage can be internal or external
Key indicators of hemorrhagic shock will come apparent with assessment of what?
- Neurological and cardiovascular systems
What are the solid organs?
- liver
- kidney
- spleen
- oancreas
- diaphragm
Liver
- Largest solid abdominal organ with a relatively fixed position
- Making it prone to injury
- 2nd most commonly injured organ in abdominal trauma
- Damage to liver is the most common cause of death in abdo injury
What is the most common cause of liver injury?
Blunt abdominal trauma, which is secondary to motor vehicle accidents in most instances
Kidney
- Very vascular
- Renal trauma accounts for approx 10% of patients who sustain abdominal trauma
- Blunt trauma is more common than penetrating trauma
Divided into 3 groups (kidney’s)
- Renal laceration
- Renal contusion
- Renal vascular injury
Spleen
- Blunt splenic trauma most often occurs in automobile accident victims
- Can occur in less obvious injury patterns, such as sports
- Leading cause of internal bleeding
When can spleen injuries occur?
- Even minor injuries can result in spleen injury
- Especially if the spleen is enlarged due to mono or underlying disease
What happen with a spleen injury?
- When it ruptures blood spills into the peritoneum
- Ultimately causes shock and death
What is Kehr’s sign?
- Is the presence of shoulder tip pain associated with abdominal pain and often relates to referred pain from organ injury or damage within the abdomen
- Right shoulder tip pain associated with right upper quadrant abdominal pain in a person with cholecystitis
- Left shoulder tip pain post abdominal trauma, which often indicates damage to or a ruptured spleen
Pancreas
It is retroperitoneal location keeps it fairly protected
Pancreas injuries
- Injuries result from gunshots
- Lacerations, contusions, tears
- Upper and mid abdominal pain that radiates into the back
Diaphragm
- Diaphragmtic rupture
- Can result from blunt or penetrating trauma and occurs in about 5% of cases of severe blunt trauma to the trunk
S/S of Diaphragm injury
Signs and symptoms included chest and abdominal pain, difficulty breathing, and decreased lung sounds
What do hollow organs include?
- small/ large intestine
- stomach
- bladder
Small/ large intestine
- common in penetrating trauma
- when ruptured spill their content which contains fecal matter and a large amount of bacteria
- Results in peritonitis
Stomach
- common in penetrating trauma, rarely in blunt trauma
- Results in spillage of acidic material into the peritoneal space
- Produces abdominal pain
Bladder
- both blunt and penetrating trauma (pelvic injuries)
- Depend on degree of distension
- Hematuria
What are the retroperitoneal Injuries?
- Grey Turner sign
- Cullen sign
- Vascular injuries
- Duodenal injuries
What structures are contained within the retroperitoneal cavity?
- Pancreas
- Kidneys
- Vascular structures
- Duodenum
- Don’t cause abdominal pain or distension
Grey Turner Sign
- Bruising along the flanks
- Sign of retroperitoneal hemorrhage
- Delayed hours to days
Cullen’s Sign
- Superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus
- Sign of acute pancreatitis and retroperitoneal hemorrhage
- Blunt trauma, abdominal aortic aneurysm
Vascular Injuries
- Structures found in the retroperitoneal space include the descending aorta, superior/ inferior phrenic artery, inferior vena cava and mesenteric vessels
- Penetrating trauma most common but can occur with blunt trauma
- Assessment finding depends on whether bleeding in contained (hematoma) or is an active hemorrhage
Duodenal Injuries
- Rupture and spill its contents (sepsis)
- Symptoms late to appear (hours to days)
- Caused from high speed deceleration collisions
What is the assessment of abdominal injuries?
- Look for evidence of hemorrhage
- Have a high index of suspicion
- Priorities begin with adequate tissue perfusion
- Evaluation must be systematic
- Prioritize injuries
What is included in initial assessment?
- Mental status
- Patient’s airway with c-spine precautions, breathing, and circulatory status
- Prioritizing the patient
What is included in focused history and physical examination?
- Expose the abdomen
- Inspect for signs of trauma (DCAP-BTLS)
Palpate the abdomen
- While looking at patient for a response
- Spillage may produce peritonitis (patient guarding abdomen)
In blunt trauma, determine
- The types of vehicles involved
- The speed they were traveling
- Collision patterns
- Use of seat belts
- Air bag deployment
- The patient’s position in the vehicle
In penetrating trauma caused by gunshot determine
- Type of weapon used
- Number of shots
- Distance from victim
In penetrating trauma caused by stabbing, determine
- The type of knife
- Possible angle of entrance wound
- Number of wounds
Detailed Physical Examination
- Should be conducted en route to hospital
- Assess the same structures as a rapid trauma examination
- Cullen sign
- Grey Turner sign
Ongoing Assessment
- Repeat initial examination
- Retake vital signs
- Check interventions
Management of abdominal injuries
- Open airway with spinal precautions
- Oxygen via NRB mask
- Two large-bore IV lines
- Monitor
- Minimize external hemorrhage
- Do not delay transport
- Use of pain medications is somewhat controversial
Pelvic Fractures
- The majority are a result of blunt trauma
- Suspect multisystem
S/S of Pelvic Fracture
- Pain to pelvis, groin, or hip
- Hematomas or contusions to pelvic region
- Obvious bleeding
- Hypotension without obvious external bleeding
What types of MOI’s result in a pelvic fracture?
- Anteroposterior compression in head-on collisions
- Lateral compression in side impacts
- Vertical shears in falls from heights
- Saddle injuries from falling on objects
