L3 Abdominal Injuries v3 Feb2024.pdf

Support the management of trauma in the Emergency and Urgent Care Setting Component 8 Abdominal Injuries  Abdominal Injuries - Component 8 Objectives Understand signs and symptoms, complications and treatment for abdominal i...

Support the management of trauma in the Emergency and Urgent Care Setting Component 8 Abdominal Injuries  Abdominal Injuries - Component 8 Objectives Understand signs and symptoms, complications and treatment for abdominal injuries. Explain when interventions from a clinician are required. Describe time critical injuries and when action should be taken. © Department of Clinical Education & 2 Standards  Abdominal Injuries - Component 8 Trauma of the abdomen can be extremely difficult to assess. There is little protection of organs and structures in the abdomen Identifying that abdominal trauma has occurred is more important than identifying what structure is affected There may be few initial indications that a serious injury has occurred © Department of Clinical Education & 3 Standards  Abdominal Injuries - Component 8 The three anatomical areas of the abdomen are: : Abdominal cavity Pelvis Retro-peritoneal area © Department of Clinical Education & 4 Standards  Abdominal Injuries - Component 8 Retro-peritoneal Area The retro-peritoneal area lies against the posterior abdominal wall and contains: Kidneys and ureters, pancreas, abdominal aorta, vena cava and part of the duodenum. The structures are attached to the posterior abdominal wall, and are often injured by shearing, due to rapid forces. © Department of Clinical Education & 5 Standards  Abdominal Injuries - Component 8 Types of abdominal injuries Blunt Penetrating © Department of Clinical Education & 6 Standards  Abdominal Injuries - Component 8 Blunt Injuries The most common pattern of abdominal injury seen Caused by direct blows, rapid deceleration or blast injuries and results in a closed abdominal injury © Department of Clinical Education & 7 Standards  Abdominal Injuries - Component 8 Structures that can be injured: Spleen Liver Small bowel Duodenum Aorta Tethered structures are the most commonly injured © Department of Clinical Education & 8 Standards  Abdominal Injuries - Component 8 Examples of causes of blunt trauma: Assault without a weapon Assault with a weapon Falls RTC’s Shockwaves from a blast © Department of Clinical Education & 9 Standards  Abdominal Injuries - Component 8 Type of injuries caused by blunt trauma: Internal bleeding Ruptured organ(s) (e.g. spleen) Diaphragmatic injury Vascular injury (e.g. aorta) Fractured ribs Be aware of pregnancy You do not have X-Ray eyes – you will not be able to diagnose the injury! © Department of Clinical Education & Standards 10  Abdominal Injuries - Component 8 Penetrating Injuries Results in an open abdominal injury May cause injury to adjacent structures/organs, such as the chest Higher risk of death than blunt trauma © Department of Clinical Education & 11 Standards  Abdominal Injuries - Component 8 Structures that can be injured: Spleen Liver Small bowel Duodenum Aorta Lungs Heart © Department of Clinical Education & 12 Standards  Abdominal Injuries - Component 8 Causes of penetrating trauma include: Assault with weapons RTC Blast material/shrapnel Gunshot wound Evisceration injury © Department of Clinical Education & 13 Standards  Abdominal Injuries - Component 8 Examples of injuries caused: Internal bleeding Ruptured organs (e.g. spleen) Diaphragmatic injury Vascular injury (e.g. aorta) Genitalia injuries (be aware of pregnancy) You do not have X-Ray eyes – you will not be able to diagnose the injury! © Department of Clinical Education & Standards 14  Abdominal Injuries - Component 8 Do not remove penetrating object if still in situ, secure the object before transport, but allow movement if the object is pulsating. © Department of Clinical Education & 15 Standards  Abdominal Injuries - Component 8 Evisceration Injuries Evisceration is the protrusion of abdominal organs outside the body © Department of Clinical Education & 16 Standards  Abdominal Injuries - Component 8 Management evisceration injuries: Do not push any protruding organs back into the abdominal cavity Apply appropriate dressing Do not wet the dressing- warm dressing become cold dressings Dressing: Blast dressing Place the plastic sheet against organ Apply the dressing to the wound Secure using the conforming bandage © Department of Clinical Education & 17 Standards  Abdominal Injuries - Component 8 Important considerations: Personal safety – DANGER! Ensure police have declared the scene as safe © Department of Clinical Education & 18 Standards  Abdominal Injuries - Component 8 Mechanism of Injury - MOI Remember to ascertain the MOI, giving you a very important guide to the likelihood of significant injuries : Stabbing – Consider length of penetrating object/ Angle of insertion/Has it entered the thoracic cavity. Gunshot – Type and range of firearms/ Distance from firearm to victim/ Is there an entrance and an exit wound. RTC – Look at impact speed/use of seat belts/Vehicle damage. © Department of Clinical Education & 19 Standards  Abdominal Injuries - Component 8 Assessment Assess C ABCDE Is there a catastrophic haemorrhage Is there an airway issue Is there a breathing issue Is there a circulation issue Does the patient require other interventions - request APP, HEMS, Paramedic, ASAP © Department of Clinical Education & 20 Standards  Abdominal Injuries - Component 8 Assessment Is the patient TIME CRITICAL – Refer to Major Trauma Tool Is there a disability issue Expose and Examine Abdomen – Looking for bruising, swelling, lacerations, evisceration, impaled objects. Ascertain MOI © Department of Clinical Education & 21 Standards Abdominal Conditions – Component 5 History Taking - Pain © Department of Clinical Education & 22 Standards  Abdominal Injuries - Component 8 Secondary Survey Done enroute to hospital if patient is time critical Assess for all other injuries (top to toe examination) think of associated areas – Chest, Spinal, Pelvic Pain Score Thorough review of MOI © Department of Clinical Education & 23 Standards  Abdominal Injuries - Component 8 Management Administer Oxygen as per JRCALC Plus guidelines Analgesia as required (AAP’s can only give Entonox) Monitor Vital signs – ECG If required Apply relevant dressings if required Transport to appropriate hospital © Department of Clinical Education & 24 Standards  Abdominal Injuries - Component 8 Significant intra-abdominal trauma may not show signs immediately Do not rule out significant injury based on vital signs alone © Department of Clinical Education & 25 Standards  Abdominal Injuries - Component 8 Red Flags- Warning Signs Catastrophic haemorrhage Major primary survey problems Decreased LOC Shoulder tip pain Tachycardia RR 30 Oxygen saturations