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This document covers a range of topics related to abdominal trauma, from introductory concepts to detailed discussions on anatomy, physiology, assessment, and management.

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m it I Tsana Abdominal Trauma Topics ï‚— Introduction to Abdominal Injury ï‚— Abdominal Anatomy and Physiology ï‚— Pathophysiology of Abdominal Injury ï‚— Assessment of the Abdominal Injury Patient ï‚— Management of the Abdominal Injury Patient ...

m it I Tsana Abdominal Trauma Topics  Introduction to Abdominal Injury  Abdominal Anatomy and Physiology  Pathophysiology of Abdominal Injury  Assessment of the Abdominal Injury Patient  Management of the Abdominal Injury Patient Introduction to Abdominal Injury* Abdominal said  One of body’s largest cavities. I c a I  Multiple vital organs. 4M  Large volumes of blood can be lost before signs and symptoms manifest. 4T  Must be alert for signs of transmitted injury: Deformity, swelling, and ecchymosis   Prevention: w̅  Highway safety xD  Seatbelt usage  Proper application  Airbags Abdominal Anatomy and Physiology (1 of 2) Edi 9 541  Boundaries  Superior: Diaphragm  is Inferior: Pelvis it  Posterior: Vertebral column and posterior and inferior ribs  Lateral: Muscles of the flank  Anterior: Abdominal muscles Abdominal Anatomy and Physiology (2 of 2) jspAI wd.tw  Three Specific Spaces Is 8 161 1  Peritoneal Space I 5565420  Organs covered by abdominal (peritoneal) lining 2 Retroperitoneal Space   Organs posterior to the peritoneal lining  Pelvic Space 3  Organs contained within pelvis Organs by Abdominal Quadrant* Liver, Gallbladder, Stomach, U Stomach (Small Part) Tail of Pancreas p Small and Large Intestine Tail of Liver p Head of Pancreas Small and Large Intestine e Upper Part of Kidney Upper Part of Kidney r Small and Large Intestine Small and Large Intestine L Lower part of Kidney Lower part of Kidney o Half of Bladder, Appendix, Half of Bladder, Female w Female Reproductive Reproductive Organs e Organs r Right Left what are Hollow and Solid Abdominal Organs* 4.1 III  Solid  Hollow  Liver  Stomach  Spleen  Small intestine  Pancreas  Large intestine  Kidneys  Gall bladder  Ovaries  Bladder famale  Uterus a tamale Abdominal Anatomy and Physiology what is the Major Abdominal Structures*  Digestive Tract  Urinary System Als  AKA: Alimentary canal  Kidneys  Structures  Ureter  Stomach  Urinary Bladder  Small Intestine  Urethra  Large Intestine  Immune System  Rectum  Spleen  Accessory Organs  Genitals  Liver  Ovaries  Gallbladder  Fallopian tubes  Pancreas  Uterus  Vagina Abdominal Anatomy and Physiology Digestive Tract  Function aim www.ii  Food materials to be digested 55520  Excrete digestive juices  Absorb nutrients and water  Components  Stomach  Food mixed with HCl and enzymes to form chyme  Small bowel  Food moved through bowel by peristalsis  Duodenum  Jejunum  Ileum  Large bowel (Colon)  Rectum  Anus Abdominal Anatomy and Physiology WhatatetheAccessory Organs* (1 of 3)  Liver I  Located in the upper right quadrant 94g  2.5% of total body weight 5295  Receives 25% of cardiac output and has greatest blood reserve 9.4.4140  Suspended by ligamentum teres 4.6550  Can lacerate liver in deceleration trauma 1K  Function 56 70  Detoxifies blood  Removes damaged or aged erythrocytes  Stores glycogen and agents for metabolism  Liver tissue will grow to normal size following partial removal. Abdominal Anatomy and Physiology WhatatetheAccessory Organs (2 of 3) so_  Gallbladder 46520 side  Small hollow organ located behind and beneath liver  Receives bile  Waste product from reprocessing of RBCs  Used to digest fatty foods (emulsification)  Pancreas  Produces endocrine hormones and exocrine enzymesanti  Glucagon  Insulin 9  Digestive enzymes that return the chyme pH to normal and break down proteins and fats Abdominal Anatomy and Physiology WhatatetheAccessory Organs* (3 of 3)  Spleen Sid  Part of immune system e it  Located behind stomach and lateral to kidney in upper left quadrant  Function 9 6540  Immunology  Stores large volume of blood  Most fragile abdominal organ Mfdm  Commonly injured in blunt trauma affecting the left flank Abdominal Anatomy and Physiology What is theUrinary System* contain  Components  Kidneys job  Collect waste products in blood stream  Concentrate products into urine  Reabsorb water and salt  Regulate body osmotic balance  Ureters  Urinary bladder  Can contain as much as 500 mL of urine  Urethra  Adrenal glands  Superior and attached to kidneys  Component of endocrine system  Release epinephrine and norepinephrine Abdominal Anatomy and Physiology* ① contain  Genitalia ② Joo  Female sexual organs ①  Represent an open passage to the interior of the abdominal cavity ② Components   Ovaries  Fallopian tubes  Uterus  Vagina Male sexual organs ①  External to the abdomen  ② Components  Testes   Penis Abdominal Anatomy and Physiology Stagesandrange of Pregnant Uterus* 7 (1 of 2)  Uterus and contents grow rapidly after conception and until delivery  1st Trimester (0–12 weeks)  Well protected  2nd Trimester (12–24 weeks)  Uterus displaces organs upward  3rd Trimester (24 weeks to term)  Fills entire abdominal cavity  Displaces diaphragm upward Abdominal Anatomy and Physiology changes of Pregnant Uterus* (2 of 2)  Effects on Maternal Physiology I Increases circulatory blood volume by 45% results  Greater volume but fewer RBCs athe  Results in relative anemia 2  Cardiac output increases by 40%  Heart rate increases by 15 bpm 3  Compresses the vena cava in 3rd trimester Y  Reduces venous return results WHY uld  Supine hypotensive syndrome HIM bit Gsians andsymptom www.hiv Dizzeness cynosis canatedley Treatment laying on left side left lateralposition Abdominal Anatomy and Physiology what is Vasculature (1 of 2)  Key Vessels Arteries I 111 5481  Abdominal aorta 4063 7 Blood supply to abdomen  Left of spinal column  Iliac arteries EF of aorta at the upper sacral level  Bifurcation 2  Inferior vena cava 2 Adjacent to spinal column Abdominal Anatomy and Physiology what.is Vasculature (2 of 2)  Portal System Venous suffawdiblipby  Venous subsystem which  Collects venous blood, fluid, and nutrients absorbed by the bowel  Transports to liver T z  Detoxification, storage of excess nutrients  Adds deficient nutrients Abdominal Arteries Abdominal Anatomy and Physiology Peritoneum Ñ  Serous membrane that surrounds the interior of most of the abdominal cavity  Covers most of small bowel and some of the abdominal organs  Small amount of fluid between peritoneal layers kids  Mesentery 1681 If Id 641  Double foldwe of peritoneum  Supports and suspends small bowel from posterior abdominal wall  Omentum  Additional fold  Insulates and protects anterior surface of abdomen what Retroperitoneal Structures*contain  Kidneys  Duodenum  Pancreas  Urinary Bladder  Posterior portions of ascending and descending colon  Rectum  Major vascular structures Reflections of the Peritoneum Pathophysiology of Abdominal Injury How the Mechanism of Injury*happen (1 of 3) what is the most affected I Penetrating Trauma 02am  Energy transmitted to surrounding tissue  Projectile cavitation, pitch, and yaw  Results in:  Uncontrolled hemorrhage  Organ damage  Spillage of hollow organ contents  Irritation and inflammation of abdominal lining  Liver most commonly affected organ  Shotgun trauma  Multiple projectiles Pathophysiology of Abdominal Injury How the Mechanism of Injury*happen (2 of 3) 2 Blunt Trauma  Produces least visible signs of injury  Causes  Deceleration  Contents damaged by change in velocity 2 Compression  Organs trapped between other structures  Shear  Part of an organ is able to move while another part is fixed  Example: ligamentum teres Pathophysiology of Abdominal Injury How the Mechanism of Injury*happen (3 of 3) 3 Blast Injuries  Blunt and penetrating MOIs  Irregular shaped shrapnel and debris  Pressure wave  Compresses and relaxes air-filled organs  Contuses or ruptures organs  Abdominal injury is secondary concern during blast injury. Pathophysiology of Abdominal Injury* (1 of 12) signs  Injury to the Abdominal Wall  Skin and muscles transmit blunt trauma to internal structures. Blues  Typically only show erythema. VD  Visible swelling and ecchymosis occur over several hours. pendants12Penetrating trauma may appear minimal externally in comparison to internal trauma.  Muscle may mask the size of the external wound.  Evisceration may be present. Trauma to thorax, buttocks, flanks, and back may penetrate É  has 6143 abdomen.  Lower chest may injure spleen, liver, stomach, or gallbladder. Diaphragmatic tears: y  Herniation of abdominal contents into thorax. Wind 561 Pathophysiology of Abdominal Injury* (2 of 12)  Injury to the Hollow Organs happen tow  May rupture with compression from blunt forces  May tear due to penetrating trauma  E Spillage of contents into: what happen is intestine  Retroperitoneal space 2 injured  Peritoneal space  Pelvic space hemorage signs  Intestines have a large amount of bacteria:  Leakage can result in sepsis  Manifestations of Blood Loss  Hematochezia: blood in stool f i m.sk  Hematemesis: blood in emesis v1 o Hematuria: blood in the urine  04127 Pathophysiology of Abdominal Injury* (3 of 12) W5 biiski.hr  Injury to the Solid Organs  Dense and less strongly held together  Prone to contusion 3USD  Bleeding is  Fracture (rupture) hit SIa aan  Unrestricted hemorrhage if organ capsule is ruptured  Specific Organs It's www.hiwfl in I  Spleen: pain referred to left shoulder  Pancreas: pain radiates to back HI  Kidneys: pain radiates from flank to groin and hematuria  Liver: pain referred to the right shoulder Pathophysiology of Abdominal Injury* (4 of 12)  Injury to the Vascular Structures happend tow  Abdominal aorta and vena cava:  is to direct blunt or penetrating trauma Prone  May be injured in deceleration injuries  Blood accumulates beneath diaphragm. 47 d IF of muscular structures  Irritation 1  Produces referred pain in the shoulder region  Greater volume of blood can be lost H  Presence of blood in abdomen stimulates vagus nerve resulting in slowing of heart rate Blood can isolate in any of the abdominal spaces. 3294169 L  Pathophysiology of Abdominal Injury* (5 of 12) Mesentery11 6  Injury to the Mesentery and Bowel  Provides bowel with circulation, innervation, and attachment wet  Disrupts blood vessels supplying the bowel test in  Leads to ischemia, necrosis, or rupture  w Blood loss minimal Results  Peritoneal layers contain hemorrhage  Tear of mesentery may rupture bowel in  Penetrating trauma to the lateral abdomen likely to injure large bowel Pathophysiology of Abdominal Injury* (6 of 12) what is the  Injury to the Peritoneum of  Delicate and sensitive lining of anterior abdomen in case  Peritonitis injury  Inflammation of the peritoneum due to:  Bacterial irritation w̅ 2 Due to torn bowel or open wound  Chemical irritation so Caustic nature of digestive enzymes Urine initiates inflammatory response  Blood does not induce peritonitis  Progression so   Slight tenderness at location of injury Rebound tenderness  Guarding  Rigid, board-like feel Pathophysiology of Abdominal Injury* (7 of 12) waxist  Injury to the Pelvis  Serious skeletal injury Life-threatening hemorrhage include what is Potential injury to pelvic organs  Ureters  Bladder  Urethra  Female genitalia  Prostate  Rectum  Anus Pathophysiology of Abdominal Injury* (8 of 12) is the what  Injury During Pregnancy  Trauma is the number one killer of pregnant females.  Penetrating abdominal trauma accounts for 36% of maternal mortality. GEE GSW account for 40–70% of penetrating trauma.   Blunt trauma due to improperly worn seatbelts.  Auto collisions are leading cause of mortality. Changing dimensions of uterus:   Protects abdominal organs. 1 1 Jb  Endangers uterus and fetus. 6 1 ibsim.IN ME Pathophysiology of Abdominal Injury (9 of 12) Pathophysiology of Abdominal Injury* (10 of 12) position if  Injury During Pregnancy Recovery side  Maternal Changes is left 1 Increasing size and weight of uterus  Compresses inferior vena cava  Reduces venous return to heart REEF Increasing maternal blood volume  Protects mother from hypovolemia  30–35% of blood loss necessary before signs of shock  Uterus is thick and muscular  Distributes forces of trauma uniformly to fetus Reduces chances for injury Pathophysiology of Abdominal Injury* (11 of 12)  Injury During Pregnancy  Risk of uterine and fetal injury increases with the length of gestation.  Greatest risk during 3rd trimester  Penetrating trauma may cause fetal and maternal blood mixing.  Blunt trauma complications:  Uterine rupture  Abruptio placentae  Premature rupture of amniotic sac Pathophysiology of Abdominal Injury* (12 of 12)  Injury to Pediatric Patients II dd iwg.tv  Children have poorly developed abdominal musculature and smaller diameter  Rib cage more cartilaginous images Iowsses dial  Transmits injury to organs beneath easier 44 7 5 Rest Increased incidence of injury to downewis  Liver  Kidney A  Spleen  Shock  Compensate well for blood loss  May not show signs and symptoms until 50% of blood is lost Assessment of the Abdominal Injury Patient EMS * job(1 of 6)  Scene Size-up  Must evaluate MOI to assess seriousness of injury  Identify strength and direction of forces  Velocity of impact  Focus observations and palpation on that site  Develop a mental list of possible organs involved  If auto crash  Determine if seatbelts used properly  Interior signs of impact  Steering wheel and dashboard deformity Assessment of the Abdominal Injury Patient * (2 of 6)  Scene Size-up  Auto Crash Injury Patterns mention I  Frontal impact  Compress abdomen  Liver, spleen, and rupture of hollow organs 7 Right impact  Liver, ascending colon, and pelvis 7 Left impact  Spleen, descending colon, and pelvis 4 Children and pedestrians  Abdominal injuries common 14 Gunshot Wounds  Check whether assailant still on scene  Type and caliber of weapon Assessment of the Abdominal Injury Patient *(3 of 6) House what  Initial Assessment I LOC level of Causice mess 2 Drug or alcohol use  Evaluate ABCs and immediate threats 3 Assessment of the Abdominal Injury Patient *(4 of 6) do to see hat  Rapid Trauma Assessment I  Rapid and full trauma assessment. 2 Closely examine regions with a high index of suspicion.  Expose and examine for DCAP-BTLS.  If suspected pelvic injury, DO NOT test pelvis.  Palpate entire abdomen.  Evaluate for entrance and exit wounds.  OPQRST Assessment  Characteristics of pain Tenderness versus rebound tenderness  SAMPLE History 6 Vital Assessment Assessment of the Abdominal Injury Patient *(5 of 6) it  Considerations with Pregnant Patients G  Be observant for I Signs  of shock  PRETREAT: signs may not develop until 30% of blood volume lost  Body begins shunting blood from GI/GU to primary organs 2 Supine hypotensive syndrome  Premature contractions msn.ie 3 Y Vaginal hemorrhage i.mu 39123  Uterine rupture versus abruptio placentae Uterus development g   Abnormal asymmetry gains Assessment of the Abdominal Injury Patient look * (6 of 6) what we iy  Ongoing Assessment I  Trend vital signs  Every 5 minutes for critical patients  Evaluate for 2  Progressive peritonitis  Progressive hemorrhage 1s ADD  BP and capillary refill  Pulse rate and pulse oximetry  Mental status  Skin condition  Ineffective aggressive fluid resuscitation Management of the Abdominal Injury Patient *(1 of 2) what will.HU  General Management  Position patient I  Position of comfort unless spinal injury  Flex knees or left lateral recumbent 2 General  shock care  PASG application 3 y Specific injury care  Impaled objects or eviscerations How can 12 Evisceration Care*2 do Use sterile non adherent a hip and moist dressing covet with plastic fell wrap Avoid movementof organ IV Management of the Abdominal Injury Patient *(2 of 2)  Fluid Resuscitation canoe  Large-bore IV with isotonic solution  Consider 2 bolus if pulse does not slow Is  Large-bore IV lock for use if patient’s BP drops below 80 2 mmHg  3 Fluid challenge 250 mL or 20 mL/kg FIG  Limit to 3 L mar 4 Titrate to SBP of 80 mmHg 6111451 anti Management of the Abdominal Injury Patient – PASG* 99545 EÑ  Contraindications  Indications  Concurrent penetrating  Intra-abdominal bleeding chest trauma  Shock  Evisceration If SBP