Prehospital Trauma Life Support

Lesson

Abdominal Trauma

PROVIDER COURSE
Copyright 2003, Elsevier Science (USA). All rights reserved.

Objectives
Relate how kinematics applies to the assessment of a patient with abdominal trauma Identify the assessment and management of blunt and penetrating abdominal trauma Describe the differences in the assessment and treatment of the pregnant patient with abdominal trauma

7-2
Copyright 2003, Elsevier Science (USA). All rights reserved.

Abdominal Trauma
A leading cause of preventable trauma death Often goes unrecognized Internal injury difficult to assess in the field Massive blood loss can lead to shock and death

7-3
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Pathophysiology
Peritoneal cavity:
Solid organs (liver, spleen) hemorrhage Hollow organs (small intestine, colon) filled with enzymes and bacteria Can hold large volume of blood

7-4
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Pathophysiology
Retroperitoneal cavity: Solid organs (kidneys, pancreas) Large blood vessels (aorta and vena cava) Potential space that can hold massive amount of blood

7-5
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Assessment
Kinematics provides index of suspicion Observe for soft tissue wounds and distention Palpate for tenderness

Auscultation of the abdomen is rarely useful in the prehospital setting

7-6
Copyright 2003, Elsevier Science (USA). All rights reserved.

You are dispatched to a high-speed MVC. Your patient is the 18-year-old unrestrained male driver of the van.

On the basis of the kinematics, what internal injuries do you suspect?

7-7
Copyright 2003, Elsevier Science (USA). All rights reserved.

Primary Survey
A - Gurgling with breathing B - Rapid and shallow C - Minor bleeding from scalp laceration, radial pulse rapid and weak, skin cool and diaphoretic D - GCS score 8 (E-2, V-2, M-4) E - Obvious left wrist deformity

Why is this patient in shock?

7-8
Copyright 2003, Elsevier Science (USA). All rights reserved.

The patient is a victim of two stab wounds to the torso. One wound is along the left sixth intercostal space and one is in the right lower quadrant of the abdomen.

How could penetrating trauma to the lower thorax involve the abdomen?

7-9
Copyright 2003, Elsevier Science (USA). All rights reserved.

Primary Survey
A - Patent B - Rapid and shallow; decreased BS on left side C - No external hemorrhage, fast radial pulse, cool and clammy skin D - Anxious, GCS score 15 E - No other injuries noted

How would you manage this patient?

7-10
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A 45-year-old female pedestrian has been struck by a vehicle. She is anxious and complains of abdominal and pelvic pain. In the field, can we identify the specific organs injured? Does this matter?

7-11
Copyright 2003, Elsevier Science (USA). All rights reserved.

Primary Survey
A - Patent B - Rapid; BS equal C - No external hemorrhage; radial pulse absent; rapid carotid pulse; skin pale D - GCS score 13 (E-3, V-4, M-6) E - Crepitus of the pelvis noted on palpation

What are the potential causes of shock?

7-12
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Pelvic Fractures

How can pelvic fractures be recognized and managed in the prehospital setting?

7-13
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Your patient sustained a close-range shotgun blast to the abdomen. A segment of bowel is eviscerated.

How are eviscerations managed?

7-14
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Impaled Objects

How are impaled objects managed in the field?

7-15
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A 24-year-old female fell down a flight of stairs. She is 36 weeks pregnant. She is complaining of severe back pain.

What physiologic changes occur during pregnancy? What are the common causes of injury in the pregnant patient?

7-16
Copyright 2003, Elsevier Science (USA). All rights reserved.

Primary Survey
A - Patent B - Normal C - Pulse rapid, skin warm and dry D - Anxious E - No obvious injury noted Vitals: pulse, 114; VR, 20; BP, 92/56

Are these findings due to trauma or pregnancy?

7-17
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After immobilization to a long backboard, reassessment shows her radial pulse to be 140 and weak. Her BP is 80/60.

What could explain these findings? How would you manage this patient?

7-18
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7-19
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Summary
Maintain high index of suspicion - always consider kinematics Consider PASG Survival may depend on rapid transport to an appropriate facility where surgical intervention is immediately available Survival of the fetus depends on resuscitation of the mother

7-20
Copyright 2003, Elsevier Science (USA). All rights reserved.

Prehospital Trauma Life Support

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