TRAUMATIC ABDOMINAL INJURIES Flashcards
What is located below the diaphragm and contains major organs of the digestive, endocrine, urogenital systems and major vessels?
Abdominal Cavity
What 2 regions are the abdominal cavity divided into based on relation to the peritoneum?
- Peritoneal cavity “true abdomen”
2. Retroperitoneal space
What region of the abdominal cavity contains solid organs, portions of the large intestines, most of the small intestines, and the female reproductive organs?
Peritoneal cavity
What is the area located behind the peritoneum and contains the kidneys, ureters, inferior vena cava, aorta, pancreas, much of duodenum, ascending descending colon and rectum?
Retroperitoneal Space
Loss of blood in the abdominal cavity is a primary cause of what?
Hemorrhagic shock
The acids, enzymes, and bacteria from the GI tract results in what?
Sepsis and Peritonitis
Gunshot wounds to the abdomen most commonly injure what?
- Small bowel (50%)
- Colon (40%)
- Liver (30%)
- Abdominal Vessels (25%)
___% of GSW to the abdomen will require surgery for definitive intervention versus ___% of stab wounds
- 85%
2. 15%
What are some common causes of blunt trauma to the abdomen?
- Deceleration forces or compression when involved in MVC
- Struck by a vehicle
- Falling from a significant height
Compression of a solid structure may lead to splitting of its structure (hepatic laceration) versus compression to a hollow structure that may cause what?
Rupture
Injuries most commonly involved in abdominal trauma include what?
- Spleen 40-55%
- Liver 35-45%
- Small bowel 5-10%
Mild compensated shock will show what?
mild increase in ventilation rate
Severe hemorrhagic shock will show what?
Marked tachypnea
Injury to what will often manifest with breathing aberrations with contents herniating into the chest cavity and bowel sounds may be heard over the thorax?
Diaphragm
The most reliable indicator of intra-abdominal bleeding is the presence of what?
Hypovolemic shock from an unexplained source
What sign indicated a sudden force from deceleration and a 20% chance of intra-abdominal injuries in adults (bowel)?
Seat belt sign
Distended abdomen may result from greater than ____L of blood or a stomach filled with air
1.5L
What is historically thought to be a strong indicator of peritonitis; controversial - performed by deeply palpating then quickly releasing, if more pain is felt when releasing then it is a positive test?
Rebound tenderness
Auscultation
Hemorrhage or spillage of contents may result in what?
Ileus (cessation of peristalsis)
What should be considered if bowel sounds are heard over the thorax?
Diaphragmatic injury
Significant tenderness to percussion or pain with coughing is a strong indicator for what?
Peritonitis
What is often the definitive treatment for patients that have sustained abdominal injuries?
Surgical Intervention
What exams have become the primary bed side modality to assess for intra-abdominal injury?
FAST exams
What is the image acquisition for the FAST exam?
RUQ, LUQ, pelvic, pericardial
What cardiac view is a secondary cardiac option if unable to get the subxiphoid view?
PSLA
What is the probe used for the FAST exam?
Curvilinear or Phased-array
What are the scan planes for RUQ and LUQ in a FAST exam?
Sagittal
What are the scan planes for the Pelvic region in a FAST exam?
Transverse and Sagittal
What are the scan planes for the cardiac region in a FAST exam?
Subxiphoid or PSLA
Key images of the FAST Exam
In the RUQ, what 4 areas are visualized?
- Morrison’s Pouch
- Inferior tip of the liver
- R hemithorax
- Subdiaphragmatic space
Key images of the FAST Exam
In the LUQ, what 4 areas are visualized?
- Splenorenal Recess
- Inferior tip of the spleen
- L hemithorax
- Subdiaphragmatic space
True or False
Key images of the FAST Exam
In the pelvic region, obtain both transverse and sagittal view, be sure to look just above the dome of the bladder in the sagittal view
True
Key images of the FAST Exam
In the cardiac region what view should be your first attempt?
Subxiphoid
If unable to visualize, move to the PSLA
What part of the normal abdominal anatomy includes the following?
- Liver
- Kidney
- Diaphragm
- Morrison’s pouch
- Hemithorax (mirror image)
- Inferior tip of the liver
- Subdiaphargmatic space
RUQ and LUQ
What part of the normal abdominal anatomy includes the following?
Posterior to the bladder (men) and Pouch of Douglas (women)
Pelvic
What part of the normal abdominal anatomy includes the following?
Heart chambers in the subxiphoid view and PSLA view
Cardiac
Abdominal Injuries
Target goal in the absence if TBI is a systolic of ___ to ___ mmHg and in the presence of TBI systolic minimum is ___mmHg
- 80-90mmHg
2. 90mmHg
What is a section of the bowel that is displaced through an open wound and protrudes externally?
Eviscerated bowel
Treatment of an eviscerated bowel should focus on what?
Protecting the protruding segments and providing a moist environment
- clean or sterile dressings moistened with saline
- periodically re-moisten
- Initial dressing may be covered with large, dry dressing to keep warm
- Psychological support, keep patient calm. Any action that increases intraabdominal pressure can cause more contents to protrude.
