Abdominal Injuries 1

7/27/2019 Abdominal Injuries 1

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Injuries to the Abdomen,Pelvis, and Genitalia


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Causes

injuries to theabdomen, pelvis

and genitalia are

generally causedby accidents

involving high

kinetic energy and

acceleration or

deceleration forces


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Causes (continued)

injury can occur from:

gunshots

knife wounds

motor vehicles

snowmobiles

falls

skier or boarder

collisions


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Open vs. Closed Injuries

abdominal injuries canbe either open or

closed

open injuries are

caused by sharp or

high velocity objects

that create an opening

between the peritonealcavity and the outside

of the body

closed injuries arecaused by compression

trauma associated with

deceleration forces and

include:

contusions

ruptures

lacerations shear injuries


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The type of injury will depend on whether the organ

injured is solid or hollow.

Hollow and Solid Organs

hollow organs include:

stomach intestines

gallbladder

bladder

solid organs

include:

liver

spleen

kidneys


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Hollow Organ Injuries

when hollow organs

rupture, their highly

irritating and

infectious contentsspill into the peritoneal

cavity, producing a

painful inflammatory

reaction calledperitonitis


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Solid Organ Injuries

damage to solid organs

such as the liver can

cause severe internal

bleeding blood in the peritoneal

cavity causes

peritonitis

when patients injure

solid organs, the

symptoms of shock

may overshadow thosefrom peritonitis


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Abdominal Injuries

abdominal injuries can

be obvious, such as an

open wound, or subtle,

such as a blow to theflank that initially

causes little pain, but

damages the liver or

spleen

suspect abdominal

internal injury in any

patient who has a

penetrating abdominalwound or has suffered

compression trauma to

the abdomen


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Peritonitis

Signs and Symptoms


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Signs and Symptoms

pain and tenderness increase and spread from

the injury site to the other parts of the abdomen,

frequently the entire abdomen

the abdomen becomes tender, distended, and

rigid

bowel sounds disappear


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Signs and Symptoms (continued)

the patient becomes progressively sicker,

develops fever, and usually vomits

signs and symptoms of shock may appear

respirations are shallow and rapid because it

hurts to breathe deeply


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Signs and Symptoms (continued)

abdominal pain is increased by moving,

straightening the knees, or taking a deep breath

the patient frequently prefers to lie quietly on his

back or side with the knees flexed


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Injuries to the Pelvis and

Genitourinary System


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Kidney Injuries

an injury to the lower back may involve one or

both kidneys

signs include:

tenderness

swelling

ecchymosis

blood in the urine


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Bladder Injuries

pelvic fractures can lacerate the bladder or

urethra

always search for a pelvic fracture during

assessment of the lower abdomen


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Male Genitalia Injuries

these injuries are extremely painful

the patient will have a high degree of anxiety andconcern

manage contusions by applying cold pack andstabilizing the injury with clothing


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Female Genitalia

the female organs are protected by the pelvis

the uterus of a pregnant woman is susceptible

from compression trauma to the pelvis orabdomen

soft tissue injury can cause anxiety and profusebleeding


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Female Genitalia Injuries

control any bleeding with direct pressure

anchor dressings with a diaperlike arrangementmade from triangular bandages

never insert dressings or packs into the vagina


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Assessment

Patients with an Abdominal orPelvic Injury


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Assessment

determine the mechanism of injury

institute BSI

ask the patient what happened?

where do you hurt?

the location of the pain and its character


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Assessment (continued)

assess the abdomen, lower chest, pelvis, and

back giving urgent care as necessary

investigate a positive mechanism of injury or

abnormal pulse by:

performing rapid body survey

obtaining SAMPLE history


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expose and assess the perineal area if you

suspect a genitourinary injury

anticipate vomiting

inspect vomit

conduct non-urgent survey

conduct whole body survey


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assess and record vital signs

assess and record any changes in location or

character of pain

watch and record change in any symptoms

inspect voided urine for visible blood


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perform the ongoing survey

do ongoing monitoring and recording of:

vital signs

changes in location or character of pain, tenderness,

abdominal distention and rigidity


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assess for additional injuries if the level of shock

is not explained by injuries found

arrange for rapid transport unless the injury is

trivial


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Emergency Care

Patient with an Abdominal or

Pelvic Injury


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Emergency Care

keep the patient warm

dont give anything by

mouth

control external bleeding

with direct pressure

maintain the airway


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Emergency Care (continued)

bandage wounds

protect eviscerated

organs with a sterile,moist occlusive dressing

stabilize an impaledobject in place


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anticipate and treatshock

give high flow oxygen

immobilize the patient

with a fractured pelvis

on a long spineboard


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Arrange to

transport the

patient rapidly to

the hospital

Abdominal Injuries 1

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