ABDOMINAL  They may hold their left shoulder elevated, so that

the diaphragm is raised on the left side, to keep this

from happening
TRAUMA  Child notices radiated left shoulder pain while lying
in a supine position (Kehr’s sign)
Course Outline
Note: Broken rib over the spleen suggesting the extent of the
 Definition trauma.
 Assessment
 Diagnostics Diagnostics
 Complications of Abdominal Trauma
- Splenic Rupture □ IV pyelogram
- Live Rupture □ MRI
□ FAST
□ CBC

DEFINITION □ Blood typing

It is a result from object striking the abdomen, such as Management

baseball bat or a seatbelt drawn tight in a motor vehicle
crash.
ASSESSMENT
 Assess vital signs frequently until stable
 Hypotension (less than 80mmHg systolic
pressure in an older child; less than 60mmHg in
an infant) usually suggests hemorrhage, which
may be hidden abdominal bleeding
 May have increasing pallor
 May have rapid respirations
 If internal bleeding is present, blood pressure
will show little improvement when IV fluid is
administered.
 Nasogastric Tube (NGT) is passed and stomach
contents are aspirated to be checked visually
for blood and to test for occult blood
 Low intermittent suction was done to if
presence of blood is established.
 Foley Catheter (IFC) is also inserted to evaluate urine
for blood and urine output
 Evidence of blood in the urine or decreased
output may indicate accompanying kidney or
bladder trauma.
DIAGNOSTICS
□ Abdominal X-Ray
□ FAST
□ Pelvic X-Ray
Note:
- Air under the diaphragm on the radiograph suggest gastric
or intestinal rupture with escape of air from these organs into
the peritoneal cavity
 Admission
 IVF
 “E” explore laparotomy
 Antibiotics
LIVER RUPTURE
- More prone to rupture in children rather than adults
- Because it is not completely not shattered by the rib
cage.
Assessment
 Severe abdominal pain that is most marked on
inspiration, when the diaphragm descends and
touches the liver
 Symptoms of blood loss: tachycardia, hypotension,
anxiety and pallor
 Hematocrit is low or falling
Note:
- Communication between an artery and the bile duct occurs
at the time of trauma. (symptoms are not immediate)
- Gastrointestinal (GI) bleeding such as hematemesis or
melena, may occur in a few days
- May have colicky upper abdominal pain that is relieved by
emesis
- Liver arteriogram are necessary to reveal the extent of the
problem
After either liver or spleen surgery, children need careful
observation for return of bowel function, assessment for the
possibility that peritonitis may develop, and careful
reintroduction of oral nutrition.

- Free fluid in the abdomen, shown on the radiograph when

the child is turned on the side; suggest leakage of bowel fluid
or splenic rupture and pooling of blood.

COMPLICATIONS OF ABDOMINAL TRAUMA

SPLENIC RUPTURE
- Most frequently injured organ, because it is usually
palpable under the lower left ribs
- Frequently injured by inappropriately applied seat
belts and by handlebar injuries in bicycle accidents

Assessment

 Have tenderness in the left upper quadrant,

especially on deep inspiration, when the diaphragm
moves down and touches the spleen

@NurseMD_