C1 - Basic Abdominal Trauma Care

Basic Trauma Abdominal Care

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Let's take a closer look at how to treat Abdominal Trauma. What are the necessary steps that need to be taken in case of an emergency.

Video

DID YOU KNOW?

What is the most commonly injured abdominal organ?The liver is the most commonly injured organ in blunt abdominal trauma and the second most commonly injured organ in penetrating abdominal trauma. The liver is a highly vascular organ located in the right upper quadrant of the abdomen and is susceptible to injury from traumatic mechanisms.

DID YOU KNOW?

What is the most common abdominal trauma?Blunt abdominal trauma usually results from motor vehicle collisions (MVCs), assaults, recreational accidents, or falls. The most commonly injured organs are the spleen, liver, retroperitoneum, small bowel, kidneys, bladder, colorectum, diaphragm, and pancreas.

DID YOU KNOW?

Can you bleed internally without knowing it?It is important to remember that an injured person may be bleeding internally even if you can't see any blood. An internal injury can sometimes cause bleeding that remains contained within the body; for example, within the skull or abdominal cavity.

VOCABULARY

abdominal cavity

distention

palpation

hypovolemic shock

evisceration

impaled

penetrating trauma

blunt force trauma

peritonitis

sepsis

haemorrhage

retroperitoneal

peritoneum

ascending aorta

inferior vena cava

umbilicus

diaphragm

thorax

Your idiom for today

UNDER THE KNIFE

Your idiom for today

NOT HAVE THE STOMACH FOR SOMETHING

Let's check what you remember

TRUE OR FALSE

We need to keep patients with abdominal trauma warm as they could easily go into hypothermia.

TRUE OR FALSE

Abdominal injuries can be fixed by paramedics.

TRUE OR FALSE

Abdominal trauma always needs to be palpated.

QUESTION TIME

What is the diaphragm and where is it located?

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How is the stomach divided?

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What does each of the stomach quadrants contain?

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What are the functions of ascending aorta and inferior vena cava?

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Where are bladder and kidneys located?

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How are abdominal organs protected?

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What does it mean that organs are retroperitoneal?

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What happens when solid organs are injured?

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What happens when hollow organs are injured?

QUESTION TIME

What is a blunt force trauma?

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What is penetrating trauma?

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What do we need to look for first when evaluating abdominal trauma?

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How do we evaluate mechanical injury?

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What does the visual assessment of abdominal trauma look like?

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When and how should palpation be done?

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How does treating the blunt force trauma differ (or not) from attending to penetrating trauma?

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How to treat eviscerations?

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How do we assist a patient with an impaled object?

QUESTION TIME

How can we control bleeding in the abdomen?

Thank you!

The diaphragm is a large muscle that contracts and that allows you to inspire air. The diaphragm is right above the stomach.

Inferior vena cava is a large vein which brings blood to the heart. Descending aorta is a large artery which takes blood away from the heart.

If somebody’s organs are protruding from their abdominal cavity, we need a bulky dressing and wet it with sterile saline or sterile water. We need to put it over the eviscerated section without pushing the organs back down. We then apply dry dressing on top.The wet dressing prevents the organ from drying out and beginning to go into necrosisThe dry dressing prevents from heat loss.

In right upper quadrant ther are liver and gall bladder. In left upper quadrant – stomach, spleen, large intestine, small intestine. Left lower quadrant consists of small and large intestines. Right lower quadrant contains small and large intestines and the appendix.

In blunt force trauma we need to treat a person for shock, keep them warm, put in a position of comfort and get them to the hospital as fast as possible. For penetrating trauma we simply need a bulky dressing, lay it on top of the abdomen to prevent anything from getting into the wound to prevent further infection, and get them to a hospital as quickly as possible.

Standard penetrating trauma can be caused by a knife wound or a gunshot – something which cause intrusion into the abdominal cavity. There can be an impaled object which is an object sticking out of the abdomen. There’s also evisceration where the organ is protruding from the abdomen.

We must never remove the object. We need to stabilise the object while controlling the bleeding around it. For example, we can put gauze around a knife to prevent bleeding, and then we stabilise the knife.

What we need to look at is the mechanism of the patient’s injury. For example, if the patient was in a motor vehicle crush, we should look at how fast the vehicle was going and what safety devices were used by the patient e.g., a seatbelt. If it was a gunshot wound, we would want to determine the calibre of the gun, and how many times they were shot. If it was a stab wound, we would want to check how long the knife was.

We need to visualize the abdomen and see if there is any obvious distention or areas of the abdomen which are protruding where they should not. We need to look for any outward signs of trauma e.g., impaled objects, penetrating wounds, bleeding, or eviscerations. We can look for Cullen sign which is bruising around the umbilicus which is a sign of retroperitoneal bleed. We can also look for bruising on the flanks which is Grey Turner’s sign.

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thoraxdiaphragmumbilicusinferior vena cavaascending aortaabdominal cavityperitoneumretroperitonealhaemorrhagesepsis peritonitisblunt force traumapenetrating traumaimpaledeviscerationhypovolemic shockpalpationdistention

Blunt force trauma happens when a compressive force is being exerted on the abdomen, and this can cause both, ruptures in the hollow organs and bleeding in the solid organs.

We need to understand what we are looking for and make sure we don’t miss anything. First, we need to evaluate the patient for signs of shock. Signs of hypovolemic shock are elevated heart rate, low blood pressure, cool pale diaphoretic skin or altered mental status.

Bladder is located at the centre of the abdomen, and kidneys are either side, towards the back and closer to the rib cage.

Abdominal is divided into four distinct quadrants - right upper quadrant, left upper quadrant, right lower and left lower quadrants.

A hollow organ will usually rupture and spill its contents into the abdominal cavity causing sepsis and peritonitis.

If we don’t see anything obvious indicating abdominal trauma, we can move on to palpation. Always palpate from the point where it doesn’t hurt and move to the point which hurts the most. We need to be gentle and not press too hard. When palpating, we’re looking for any rigid areas of distention or guarding by the patient. If they tense their abdominal muscles before we push down or they’re in obvious pain, that’s a clear sign of something going on in their deeper abdominal area that we need to be clued into so we can send them to trauma centre immediately.

Organs in the abdominal cavity are surrounded by the peritoneum which is a protective case that goes around them.

It can’t be done in the pre-hospital setting. We can’t pack the abdominal wound in as there’s a lot of space in the abdomen, and we haven’t got enough gauze to provide pressure on whatever artery is bleeding. We could cause more damage and further infection.

Solid organs are going to bleed and haemorrhage, and a person will go into a hypovolemic shock after a time.

Retroperitoneal organs sit outside the peritoneum.