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Abdominal Trauma

Abdominal Trauma

Abdominal region is most difficult region to identify problems. Unrecognized abdominal injury is major cause of death in trauma patients. Rapid transport to surgery is their best hope.

Abdominal Quadrants and Organs To Consider

  • Blunt trauma: MVAs are the major cause
  • Compression injuries: organ of abdomen crushed between solid objects
  • Shear injuries: rupture of solid organs, tearing vessels and ligaments
  • Penetrating injuries: stabbing, GSW, impaled objects
    • Intestine is the most frequently injured organ in penetrating trauma
    • Do not remove impaled objects in the field. Stabilize and transport
  • Solid organs: loss of blood into the abdominal cavity will lead to shock. The most reliable indicator of intraabdominal bleeding is unexplained shock.
    • Liver and spleen primary sources of exsanguination
    • Blood, bile escape >>> shock and peritoneal irritation
    • Spleen injury refers pain to left shoulder (Kehr’s sign)
  • Hollow organs: release their contents: acids, enzymes or bacteria >peritonitis
    • Sepsis, infection, abscess formation
    • Pain, tenderness, guarding, rigidity, fever, distension (late sign)
  • Retroperitoneal Organ Injury: many times from pelvic/lumbar fractures >>> kidney
    and ureter contusion/lacerations
  • Pelvic Organ Injury: associated with severe retroperitoneal hemorrhage. 6.4-19% mortality rate.
  • Vascular Structure Injury: potential for massive hemorrhage>hypovolemia.
  • Inferior vena cava, renal, mesenteric, iliac arteries and veins
  • Evisceration: do not replace organs, cover with moist, sterile material

Abdominal Trauma in Pregnancy: keep in mind the normal changes of pregnancy when assessing a pregnant patient. Heart rate is normally higher, BP normally lower. 48% increase in blood volume.

Management:

  • High flow O2
  • Transport on backboard tilted to the left to minimize uterus weight on the inferior vena cava (Supine Hypotensive Syndrome)

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