Abdominal Injuries Assessment

Abdominal Injuries Assessment

• Maintain a professional presence and expose only what is needed during the assessment, covering the patient as much as possible.
• Ensure the scene is safe, follow standard precautions, and consider early spinal precautions if the wound is penetrating.
• Inspect the object of penetration if the wound is penetrating.

Patient Interaction

• Be open and trusting with the patient, as they may avoid discussing the injury to avoid a physical exam.
• Obtain a sample history from friends or family members if the patient is not responsive.

Primary Assessment

• Follow the ABCDE and immediately care for any life-threatening problems.
• Control any external hemorrhage and look for indications of internal bleeding.
• Perform a rapid full-body scan of the patient and stop to treat any life-threatening problems found.

Abdominal Injury Signs and Symptoms

• Pain is the principal complaint of patients with blunt injuries.
• Teoc cardiogram is a common sign of significant abdominal injury.
• Other signs and symptoms of blunt injuries include:
  • Bruises or visible marks indicating underlying structures.
  • Kerosine sign (pain in the tip of the left shoulder due to bleeding into the perianal space).
  • Gray Turner sign (bruising in the right upper quadrant, left upper quadrant, or flank indicating liver, spleen, or kidney injury).
  • Cullen sign (bruising around the umbilicus indicating internal abdominal bleeding).
  • Guarding (patient stiffening muscles to protect themselves from painful palpation).

Blunt Abdominal Injuries

• Patients may have severe bruising, laceration of the liver and spleen, rupture of the intestine, gallbladder, or stomach, rupture of the kidneys, or evulsion of the kidneys from their supporting structures.
• Monitor for signs of shock and keep the patient warm.

Penetrating Abdominal Injuries

• Assume that an object has penetrated the peritoneum and entered the abdominal cavity, possibly injuring one or more organs.
• Stabilize the object in its position and do not remove it.
• Initiate two 18-gauge IV lines or larger and follow local protocol.
• Fluid needs to be given in a volume to maintain perfusion to vital organs, increasing blood pressure can increase internal bleeding.

Abdominal Evisceration

• Do not push down on the patient's abdomen, only perform a visual assessment.
• Cover the protruding organ with a sterile gauze moistened with sterile saline solution and secure it with a dry sterile dressing.

Kidney Injuries

• Signs of shock may be present if the injury is associated with significant blood loss.
• Blood in the urine may be present.

General Guidelines

• Assume that injuries to the genitalia are very painful and make the patient as comfortable as possible.
• Use sterile and moist dressings to cover areas that have been stripped of skin.
• Apply pressure with dry sterile gauze to control any bleeding.
• Never move or manipulate impaled instruments or foreign bodies in the urethra.
• Identify and take any amputated parts to the hospital with the patient.

Abdominal Injuries Assessment

• Maintain a professional presence and respect patient's privacy during assessment.
• Ensure scene safety and follow standard precautions, considering early spinal precautions if the wound is penetrating.

Patient Interaction

• Establish open and trusting communication with the patient to encourage disclosure.
• Obtain a sample history from friends or family members if the patient is unresponsive.

Primary Assessment

• Follow the ABCDE approach and prioritize life-threatening problems.
• Control external hemorrhage and look for signs of internal bleeding.
• Perform a rapid full-body scan to identify and treat life-threatening problems.

Abdominal Injury Signs and Symptoms

• Pain is the primary complaint of patients with blunt injuries.
• Teoc cardiogram is a common sign of significant abdominal injury.
• Other signs and symptoms of blunt injuries include:
  • Bruises or visible marks indicating underlying structure damage.
  • Kerosine sign (pain in the left shoulder tip due to perianal space bleeding).
  • Gray Turner sign (bruising in the right or left upper quadrant, or flank indicating liver, spleen, or kidney injury).
  • Cullen sign (bruising around the umbilicus indicating internal abdominal bleeding).
  • Guarding (patient stiffening muscles to protect themselves from painful palpation).

Blunt Abdominal Injuries

• Injuries may include severe bruising, liver and spleen lacerations, intestinal rupture, gallbladder or stomach rupture, kidney rupture, or evulsion of kidneys from supporting structures.
• Monitor for signs of shock and keep the patient warm.

Penetrating Abdominal Injuries

• Assume that an object has penetrated the peritoneum and entered the abdominal cavity, potentially injuring one or more organs.
• Stabilize the object in its position and do not remove it.
• Initiate two 18-gauge IV lines or larger and follow local protocol.
• Fluid management should prioritize perfusion to vital organs, avoiding increased blood pressure that may worsen internal bleeding.

Abdominal Evisceration

• Perform a visual assessment only, without palpating the abdomen.
• Cover the protruding organ with a sterile, saline-moistened gauze and secure it with a dry sterile dressing.

Kidney Injuries

• Signs of shock may be present if the injury is associated with significant blood loss.
• Blood in the urine may be present.

General Guidelines

• Assume that genitalia injuries are very painful and prioritize patient comfort.
• Use sterile, moist dressings to cover skin-denuded areas.
• Apply pressure with dry, sterile gauze to control bleeding.
• Never move or manipulate impaled instruments or foreign bodies in the urethra.
• Identify and transport any amputated parts to the hospital with the patient.