PEC11 Chap 35 Abdominal Trauma.pdf

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Prehospital: Emergency Care

Eleventh Edition

Chapter 35

Abdominal and Genitourinary Trauma

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Learning Readiness

• EMS Education Standards, text p. 1041.

• Chapter Objectives, text p. 1041.

• Key Terms, text p. 1041.

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Setting the Stage

• Overview of Lesson Topics

– The Abdomen

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Case Study Introduction

Vanessa Judy, a 35-year-old woman, is the driver of a vehicle hit on the driver’s side door. There is about 12

inches of intrusion into the driver’s compartment at the site of impact. She is awake and alert, complaining of left

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Case Study

• What organ do you suspect may have been injured with this mechanism of injury?

• What are the consequences of injury to this organ?

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Introduction

• Abdominal trauma has the potential to cause severe bleeding and hemorrhagic shock.

• It is important to recognize mechanisms of injury and signs and symptoms of abdominal trauma.

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The Abdomen

(1 of 21)

• Anatomy of the Abdominal Cavity

– The abdominal cavity is bounded by the diaphragm, abdominal and back muscles, the spine, and pelvis.

– The abdomen contains organs of the digestive, urinary, and endocrine systems.

– The visceral peritoneum supports the organs. The parietal peritoneum adheres to the walls of the

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The Abdomen

(2 of 21)

– Space between the visceral and parietal peritonea is called the peritoneal space.

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The Abdomen

(3 of 21)

– Types of Abdominal Organs and Structures

▪ Hollow abdominal organs are not as vascular, but if their contents are leaked into the abdominal

cavity, peritonitis results.

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The Abdomen

(4 of 21)

▪ Solid organs are vascular and can bleed profusely when injured.

▪ Bleeding may not produce severe abdominal pain.

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The Abdomen

(5 of 21)

▪ Vascular Structures

– Abdominal aorta

– Inferior vena cava

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The Abdomen

(6 of 21)

– Additional Structures

▪ Diaphragm

– Muscle of respiration that separates the thoracic and abdominal cavities.

– If injured by penetrating or blunt trauma, breathing can be impaired and abdominal organs can enter the thoracic cavity.

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The Abdomen

(7 of 21)

– Additional Structures

▪ Abdominal Wall

– An open wound in the abdominal wall can allow evisceration of the abdominal contents.

– Protect the exposed organs from further injury or contamination.

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Click on the Problem of Most Immediate Concern

for a Patient with Abdominal Injury Who has a

Ruptured Diaphragm

a. Impaired respiration

b. Hemorrhage

c. Abdominal distention

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The Abdomen

(8 of 21)

• Abdominal Injuries

– Mechanisms of injury can be blunt or penetrating.

– Injuries may be open or closed.

– Open wounds to the abdomen are much more

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The Abdomen

(9 of 21)

• Assessment-Based Approach: Abdominal Trauma

– Scene Size-Up

▪ Ensure scene safety.

▪ Assess the mechanism of injury; determine the characteristics of weapons.

▪ With penetrating trauma, anticipate multiple wounds.

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The Abdomen

(10 of 21)

– Primary Assessment

▪ In the general impression, note the patient’s position.

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The Abdomen

(11 of 21)

– Primary Assessment

▪ If spinal injury is suspected, use in-line stabilization.

▪ Establish and maintain a patent airway; suction as needed.

▪ Maintain an SpO₂ greater than or equal to 94%

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The Abdomen

(12 of 21)

– Secondary Assessment

▪ Consider the patient’s complaints and mechanism of injury.

▪ Perform a rapid secondary assessment.

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The Abdomen

(13 of 21)

▪ Inspect the abdomen.

– Look for contusions, lacerations, abrasions, and punctures.

– Look for distention.

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The Abdomen

(14 of 21)

▪ Palpate the abdomen.

– Start at the point farthest away from the point of pain.

– Note any masses or tenderness.

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The Abdomen

(15 of 21)

▪ Assess the extremities, including pulses and sensory and motor function.

▪ Inspect the posterior body.

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The Abdomen

(16 of 21)

▪ Assess vital signs.

▪ Obtain a history.

▪ OPQRST can be used to assess symptoms.

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The Abdomen

(17 of 21)

– General Emergency Medical Care — Abdominal Trauma

▪ Establish and maintain an open airway.

– Maintain spine motion restriction and adequate oxygenation.

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The Abdomen

(18 of 21)

▪ Treat for hemorrhagic shock.

▪ Control external bleeding; treat evisceration.

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The Abdomen

(19 of 21)

▪ Stabilize an impaled object.

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The Abdomen

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– General Emergency Medical Care — Abdominal Evisceration

▪ Do not touch or attempt to replace the organs.

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E

M

T Skills 35-1

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Place a Premoistened Dressing over the Wound

(Follow Local Protocol) and Gently Tape it in Place

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The Abdomen

(21 of 21)

– Reassessment

▪ Repeat the primary and secondary assessments.

▪ Repeat vital signs.

▪ Observe for indications of deterioration.

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Genital Trauma

(1 of 3)

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Genital Trauma

(2 of 3)

• Injuries to the Male Genitalia

– Control bleeding with direct pressure.

– Apply cold if the scrotum is injured.

– If the penis is avulsed or amputated, wrap the part in a sterile, saline-moistened dressing and keep it cool.

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Genital Trauma

(3 of 3)

• Injuries to the Female Genitalia

– Control external bleeding with direct pressure.

– Do not pack or place dressings in the vagina.

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Case Study Conclusion

The EMTs recognize the potential for injury to the spleen and the associated risk of bleeding. They provide spine

motion restriction and begin transport, obtaining a baseline set of vital signs and carefully monitor the patient for signs of shock.

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Lesson Summary

(1 of 2)

• Abdominal injuries may present subtly, but can result in peritonitis and life-threatening hemorrhage.

• Eviscerations are treated with a moist, sterile dressing covered by an occlusive dressing.

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Lesson Summary

(2 of 2)

• Genital trauma can be painful and bleed profusely.

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Correct!

The diaphragm is the primary muscle of respiration. If it is torn or ruptured, it interferes with generating the negative intrathoracic pressure needed for ventilation. Abdominal organs may migrate through the opening, further impairing ventilation.

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Incorrect

(1 of 3)

Significant hemorrhage is primarily a concern with damage to solid organs, such as the liver, spleen, and kidney.

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Incorrect

(2 of 3)

Abdominal distention occurs in trauma when there is

significant accumulation of blood in the abdominal cavity.

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Incorrect

(3 of 3)

Peritonitis, inflammation of the peritoneum, occurs early with perforation of hollow organs, and later with bleeding into the abdominal cavity.

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