Chapter 26: Abdominal Trauma

-Because the abdomen is bound by muscles rather than skeletal structures, there is a freer transmission of the energy of trauma to the internal organs and structures. -Penetrating trauma most frequently involves the liver and small bowel. Injury to the Abdominal Wall With trauma to the abdomen, the discoloration of Ecchymosis and noticeable swelling require several hours to develop. Evisceration- a protrusion of organs from a wound. o Tx: moist sterile dressing Injury to the Hollow Organs; the stomach, small bowel, large bowel, rectum, urinary bladder, gallbladder, and pregnant uterus may rupture w/compression form blunt forces, especially if the organ is full and distended. Peritonitis- inflammation of the peritoneal from rupture of Hollow organs and spilling of its contents; may lead to Sepsis. o Rebound tenderness- pain on release of the examiners hands, allowing the patients abdominal wall to return to its normal position; associated w/peritoneal irritation. o Guarding- protective tensing of the abdominal muscles by a patient suffering abdominal pain. Hematochezia- blood in the stool. Hematemesis- the vomiting of blood. Hematuria- blood in the urine. Injury of the Solid Organs; the spleen, liver, pancreas, and kidneys. Blunt trauma most frequently involves the spleen and liver. The liver by deceleration injury when the liver is lacerated by the ligamentum teres (supports the bowel). Left Lateral Trauma breaks a rib and lacerates the spleen. Injury to the Vascular Structures Most vascular trauma is associated w/penetrating injury. Injury During Pregnancy Trauma is the #1 killer of pregnant females and penetrating abdominal trauma alone accounts for as much as 36% of overall maternal mortality. A pregnant Pt. may not show signs of shock, but maybe shunting blood flow to the fetus to save herself without anyone knowing it until it is to late. Listen for Fetal Heart sounds (HR). Abruptio Placentae- a condition in which the placenta separates from the uterine wall. Assessment of the Abdominal Injury Patient o Scene Size-Up o Initial Assessment o General Impression o Level of Conscousness

 Alert Verbal Pain Unconscious o MOI o Cervical Injury o ABCs o Life-threatening Bleeding o Rapid Trauma Assessment- Head to toe Exam <60sec o Present Injury Onset of problem Pain Quality Region/radiation Severity Time Tenderness Instability Crepitus o Vital Signs o Ongoing Assessment ABCs Physical Exam History Taking Signs/Symptoms Allergies Medications Past Medical History Last Oral intake Events leading up to illness/injury