ABDOMINAL TRAUMA P 1018 1020 solid organs o liver and spleen o bleed profusely hollow organs o bladder stomach and intestines o peritonitis Common injuries o Lacerated liver ruptured spleen mesenteric artery tears diaphragm rupture urinary bladder rupture great vessel tears renal or pancreas injury and stomach or intestine rupture Complications o Massive blood loss o Hypovolemic shock o Compartment syndrome Organ dysfunction caused by intraabdominal hypertension Pressure caused by abdominal or retroperitoneal bleeding o Peritonitis o Sepsis Etiology Most often a result of blunt trauma or penetration injury o Motor vehicle accidents Blunt trauma Compression direct blow Shearing rapid deceleration o Gunshot wounds and stabbings Penetrating CLINICAL MANIFESTATION Careful assessment of type and severity of injury o Contusion or abrasion across the abdomen can indicate internal organ injury Guarding and splinting of the abdominal wall peritonitis Decreases or absent bowel sounds A hard distended abdomen intraabdominal bleeding o Bowel sounds heard in the chest ruptured diaphragm Contusion abrasion or bruising Abdominal or scapular phrenic nerve irritation from blood in the abdomen pain Hematemesis or hematuria Signs of hypovolemic shock Cullen s and Grey Turner s sign DIANOSTIC STUDIES CBC and urinalysis for a baseline H H may remain normal despite bleeding Arterial blood gases Prothrombin time Electrolytes BUN and creatinine Type and cross match Abdominal ultrasound and CT Diagnostic peritoneal lavage o Hollow organ injury o Insert a larger angiocatheter or peritoneal dialysis catheter into the abdomen attempt to aspirate blood if less than 10 mL of blood is aspirated 1 L of saline is infused and drained observe for blood and other abnormalities o Positive findings RBC 100 000 WBC 500 high amylase level and presence of bile bacteria or fecal material immediate surgery EMERGENCY MANAGEMENT Etiology Assessment findings o Hypovolemic shock o Blunt falls MVC pedestrian event assault with blunt object crush injuries and explosions o Penetrating knife gunshot and other missiles Decreased level of consciousness tachypnea tachycardia decreased blood pressure and decreased pulse pressure o Surface findings Abrasion or ecchymoses open wounds lacerations eviscerations puncture wounds gunshot wounds impaled objects and healed incisions or old scars o Abdominal gastrointestinal findings Nausea vomiting hematemesis decreased or absent bowel sounds hematuria abdominal distention rigidity pain rebound tenderness and pain radiating to shoulder and back Interventions Initial o Ensure patent airway o Administer oxygen via non rebreather mask o Control external bleeding with direct pressure of sterile pressure dressing o Two large bore IV catheter access o Infuse warm normal saline or LR o Obtain blood for type crossmatch and CBC o Stabilize impaled objects with bulking dressing DO NOT REMOVE o Cover protruding organs or tissue with sterile saline dressing o Insert indwelling urinary catheter o Obtain urine for urinalysis o Insert NG tube o Anticipate diagnostic peritoneal lavage Ongoing monitoring o Vital signs LOC oxygen saturation and urine output o Maintain patient warmth using blankets warm IV fluids and warm humidified oxygen
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