Abdominal Trauma PDF

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 ...

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