Abdominal trauma

Fitria Dewi Lestari

Preceptor: Liza Nursanty, dr, SpB

ABDOMINAL REGION
Abdominal quadrant
INTRODUCTION
Abdominal Trauma

• Abdominal injuries present in 7-10% of admission

• Peak 15-30 years old
• Present in ~ 20% of all trauma surgeries
• ½ of preventable trauma death are related to
inappropriate management of abdominal trauma
• Extra abdominal injuries are clues to the presence of
injuries within the abdomen
• Abdominal injuries should be suspect in all trauma
Diagnostic Methods
Abdominal Trauma
• Physical examination
• Bruises, abrasion over the abdomen
• Abdominal pain or tenderness
• Absent bowel sounds
• Unexplained hypotension
• P/E equivocal or misleading.!!!
• Peritoneal sign falsely negative in 40%
• Peritoneal sign falsely positive in 20%
• 10% of all injuries are initially overlook
PHYSICAL EXAMINATION
Abdominal Trauma

• Physical examination unreliable

• Head trauma
• Spinal cord injuries
• Alcohol intoxication
• Use of illicit drugs
• Injuries to adjacent structure
• Significant amount of blood present
• Analgesia
CLASSIFICATION
Abdominal Trauma

• Penetrating
• High velocity (85% penetrate peritoneum)
• Low velocity (95% need surgery)
• Stab(1/3 do not penetrate the peritoneum, of those 50% need Sx)
• Blunt trauma
• High energy transfer (car accident)
• Low energy transfer (fall, fight)
Blunt Trauma Abdomen
• Child abuse
• Domestic violence
• Iatrogenic injury
- Endoscopic/ laparoscopic procedures
- Bag-mask ventilations
- Inadvertent esophageal intubation
- External cardiac compressions
- Heimlich manoeuver
Prehospital Care
• Deliver patient to hospital for definitive care as rapidly as possible
“scoop and run”
• Maintain airway and start IV line
• Care of spinal cord
• Communicate to medical control
• Rapid transport to trauma center
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