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EMRG 1130 > Module 22- Abdo Assessment and Treatment > Flashcards

Module 22- Abdo Assessment and Treatment Flashcards

1
Q

When abdominal trauma occurs the places where enough blood can be lost to cause shock are:

A
  • Abdominal cavity
  • Retroperitoneal space
  • Pelvis
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2
Q

Which organs most frequently injured after blunt trauma?

A
  • 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
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3
Q

What should you expect in unexplained states of shock?

A

Expect abdominal trauma

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4
Q

Which organs are more resilient to blunt trauma?

A
  • 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
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5
Q

What is peritonitis?

A

Life threatening inflammation of the lining of the abdomen

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6
Q

How to detect possible abdominal injury?

A
  • 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
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7
Q

What are the 2 types of abdominal trauma?

A
  • Blunt
  • Penetrating
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8
Q

Blunt trauma

A
  • Majority of significant abdominal injuries in Canada involve blunt trauma
  • Most are due to MVC’s
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9
Q

What are the results of compression injuries or deceleration forces?

A
  • Crush organs or rupture them
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10
Q

What are the 3 common injury patterns?

A
  • Shearing
  • Crushing
  • Compression
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11
Q

Shearing

A
  • 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
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12
Q

Crushinh

A
  • 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
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13
Q

Compression

A
  • 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`
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14
Q

Penetrating wounds

A

Most commonly from wounds involving gunshot or stabbing
- Gunshot wounds cause more injury than stab wounds

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15
Q

Low velocity

A

knife, ice pick, hand gun

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16
Q

Med velocity

A

9mm gun or shotgun

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17
Q

High velocity

A

high powered rifle or military weapon

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18
Q

What does the trajectory the projectile traveled and the distance it had to travel contribute to?

A

It contributes to the extent of the injury

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19
Q

Gunshot wounds most commonly involve injury to?

A
  • Small bowel
  • Colon
  • Liver
  • Vascular structures
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20
Q

Stab wounds most commonly involve injury to?

A
  • Liver
  • Small bowel
  • Diaphragm
  • Colon
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21
Q

What are the five patterns from MVC’s?

A
  1. frontal
  2. Lateral
  3. Rear
  4. Rotational
  5. Rollover
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22
Q

Motorcycle falls

A
  • Less structural protection
  • Rider protective devices:
    • Helmet
    • Gloves
    • Leather pants and/or jacket
    • Boots
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23
Q

When do falls usually occur?

A
  • During criminal activity, suicide, or intoxication
  • Note or observe position or orientation of the body at the moment of impact
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24
Q

Blast injuries

A
  • Commonly associated with military conflict
  • Seen in mines, chemical plants, and terroist activities
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25
Q

What are the 4 different mechanisms of blast injuries?

A

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

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26
Q

What is the major concern in abdominal trauma?

A
  • Hemorrhage
  • Hemorrhage can be internal or external
27
Q

Key indicators of hemorrhagic shock will come apparent with assessment of what?

A
  • Neurological and cardiovascular systems
28
Q

What are the solid organs?

A
  • liver
  • kidney
  • spleen
  • oancreas
  • diaphragm
29
Q

Liver

A
  • 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
30
Q

What is the most common cause of liver injury?

A

Blunt abdominal trauma, which is secondary to motor vehicle accidents in most instances

31
Q

Kidney

A
  • Very vascular
  • Renal trauma accounts for approx 10% of patients who sustain abdominal trauma
  • Blunt trauma is more common than penetrating trauma
32
Q

Divided into 3 groups (kidney’s)

A
  • Renal laceration
  • Renal contusion
  • Renal vascular injury
33
Q

Spleen

A
  • 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
34
Q

When can spleen injuries occur?

A
  • Even minor injuries can result in spleen injury
  • Especially if the spleen is enlarged due to mono or underlying disease
35
Q

What happen with a spleen injury?

A
  • When it ruptures blood spills into the peritoneum
  • Ultimately causes shock and death
36
Q

What is Kehr’s sign?

A
  • 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
37
Q

Pancreas

A

It is retroperitoneal location keeps it fairly protected

38
Q

Pancreas injuries

A
  • Injuries result from gunshots
  • Lacerations, contusions, tears
  • Upper and mid abdominal pain that radiates into the back
39
Q

Diaphragm

A
  • Diaphragmtic rupture
  • Can result from blunt or penetrating trauma and occurs in about 5% of cases of severe blunt trauma to the trunk
40
Q

S/S of Diaphragm injury

A

Signs and symptoms included chest and abdominal pain, difficulty breathing, and decreased lung sounds

41
Q

What do hollow organs include?

A
  • small/ large intestine
  • stomach
  • bladder
42
Q

Small/ large intestine

A
  • common in penetrating trauma
  • when ruptured spill their content which contains fecal matter and a large amount of bacteria
  • Results in peritonitis
43
Q

Stomach

A
  • common in penetrating trauma, rarely in blunt trauma
  • Results in spillage of acidic material into the peritoneal space
  • Produces abdominal pain
44
Q

Bladder

A
  • both blunt and penetrating trauma (pelvic injuries)
  • Depend on degree of distension
  • Hematuria
45
Q

What are the retroperitoneal Injuries?

A
  • Grey Turner sign
  • Cullen sign
  • Vascular injuries
  • Duodenal injuries
46
Q

What structures are contained within the retroperitoneal cavity?

A
  • Pancreas
  • Kidneys
  • Vascular structures
  • Duodenum
  • Don’t cause abdominal pain or distension
47
Q

Grey Turner Sign

A
  • Bruising along the flanks
  • Sign of retroperitoneal hemorrhage
  • Delayed hours to days
48
Q

Cullen’s Sign

A
  • Superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus
  • Sign of acute pancreatitis and retroperitoneal hemorrhage
  • Blunt trauma, abdominal aortic aneurysm
49
Q

Vascular Injuries

A
  • 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
50
Q

Duodenal Injuries

A
  • Rupture and spill its contents (sepsis)
  • Symptoms late to appear (hours to days)
  • Caused from high speed deceleration collisions
51
Q

What is the assessment of abdominal injuries?

A
  • Look for evidence of hemorrhage
  • Have a high index of suspicion
  • Priorities begin with adequate tissue perfusion
  • Evaluation must be systematic
  • Prioritize injuries
52
Q

What is included in initial assessment?

A
  • Mental status
  • Patient’s airway with c-spine precautions, breathing, and circulatory status
  • Prioritizing the patient
53
Q

What is included in focused history and physical examination?

A
  • Expose the abdomen
  • Inspect for signs of trauma (DCAP-BTLS)
54
Q

Palpate the abdomen

A
  • While looking at patient for a response
  • Spillage may produce peritonitis (patient guarding abdomen)
55
Q

In blunt trauma, determine

A
  • 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
56
Q

In penetrating trauma caused by gunshot determine

A
  • Type of weapon used
  • Number of shots
  • Distance from victim
57
Q

In penetrating trauma caused by stabbing, determine

A
  • The type of knife
  • Possible angle of entrance wound
  • Number of wounds
58
Q

Detailed Physical Examination

A
  • Should be conducted en route to hospital
  • Assess the same structures as a rapid trauma examination
    • Cullen sign
    • Grey Turner sign
59
Q

Ongoing Assessment

A
  • Repeat initial examination
  • Retake vital signs
  • Check interventions
60
Q

Management of abdominal injuries

A
  • 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
61
Q

Pelvic Fractures

A
  • The majority are a result of blunt trauma
  • Suspect multisystem
62
Q

S/S of Pelvic Fracture

A
  • Pain to pelvis, groin, or hip
  • Hematomas or contusions to pelvic region
  • Obvious bleeding
  • Hypotension without obvious external bleeding
63
Q

What types of MOI’s result in a pelvic fracture?

A
  • Anteroposterior compression in head-on collisions
  • Lateral compression in side impacts
  • Vertical shears in falls from heights
  • Saddle injuries from falling on objects

EMRG 1130 (13 decks)

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