ABDOMINAL TRAUMA :8/15/2008 1 ABDOMINAL TRAUMA Penetrating abdominal Trauma Blunt Abdominal Trauma]


Definition :8/15/2008 2 Definition Penetrating Abdominal trauma- causes an open wound, such as from the gunshot or stabbing.The solid organs can bleed profusely when injured.The hollow organs generally don’t bleed significantly but are likely to cause peritonitis if damaged. Blunt abdominal trauma- a force to the abdomen that doesn’t leave an open wound, commonly occurs with motor vehicle crashes or falls. Compression and shearing are examples.


GUNSHOT :8/15/2008 3 GUNSHOT


STAB WOUND :8/15/2008 4 STAB WOUND


COMPRESSION :8/15/2008 5 COMPRESSION


SHEARING- PORTION OF TISSUE CONTINUES TO MOVE FORWARD WHILE ANOTHER REMAINS STATIONARY. :8/15/2008 6 SHEARING- PORTION OF TISSUE CONTINUES TO MOVE FORWARD WHILE ANOTHER REMAINS STATIONARY.


Emergency Assessment :8/15/2008 7 Emergency Assessment Primary Assessment (ABCD) Secondary assessment (EFGH)


Primary assessment (ABCD): :8/15/2008 8 Primary assessment (ABCD): Immediately life-threatening problems are identified during the primary assessment. Airway, breathing, and circulation are evaluated while maintaining stability of the cervical spine. D is for neurological deficit, including level of consciousness and pupillary reaction.3


Secondary assessment (EFGHI): :8/15/2008 9 Secondary assessment (EFGHI): The secondary assessment is a brief (two to three minute) examination of the patient intended to detect and prioritize injuries. E is for exposure: Remove clothing to check for signs of injury. F is for full set of vital signs and five interventions (monitors, pulse oximetry, indwelling urinary catheter, nasogastric tube, and labs). G: Give comfort measures. H is for head-to-toe examination. I: Inspect the back — turn the patient over to look for unseen injury


Focused assessment: :8/15/2008 10 Focused assessment: At this point, a more detailed examination of injuries identified in the secondary assessment is performed, with concentration on problems with the pulmonary, cardiovascular, or neurological system, if any. In the case of abdominal trauma, the abdomen is inspected for open wounds, external hemorrhage, foreign objects, or unusual patterns of bruising that might indicate internal bleeding. Auscultation will identify the absence or presence of bowel sounds or bruits.


General Interventions :8/15/2008 11 General Interventions Goals are to control bleeding, maintain blood volume and prevent infection Keep the patient quiet and on the stretcher, because movement may fragment pr dislodge a clot in a large vessel and produce massive hemorrhage. Cut the clothing away from the wound. Look for entrance and exit of wound Count the number of wounds If the patient is comatose, immobilize the cervical spine until after cervical films are taken and cleared.


General Interventions (cont.) :8/15/2008 12 General Interventions (cont.) Apply compression to external bleeding Insert two large-bore IV lines and infuse Ringer’s. Insert a nasogastric tube to decompress the abdomen Cover protruding abdominal vicera; do not attempt to replace the protruding organs into the abdomen. Use sterile saline dressings to protect the vicera from drying. Cover open wounds with dry dressing. Withhold oral fluids to prevent vomiting and increased peristalsis.


General Interventions (cont.) :8/15/2008 13 General Interventions (cont.) Insert an indwelling catheter to ascertain the presence of hematuria and to monitor urinary output.


Pharmacological Interventions :8/15/2008 14 Pharmacological Interventions Tetanus prophylaxis Broad-spectrum antibiotics. Prepare for surgery of the patient shows evidence of unexplained shock, unstable vital signs, peritoneal irritation,bowel protrusion and evisceration, significant penetrating injury, significant gastrointestinal bleeding, or peritoneal air.


Prepare patient for diagnostic procedures :8/15/2008 15 Prepare patient for diagnostic procedures Catheterization and urinalysis Serial Hemoglobin and hematocrit. CBC Serum amylase CT scan Abdominal and chest xrays FAST – for blunt abdominal trauma


Penetrating GSW :8/15/2008 16 Penetrating GSW


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GSW epigastrium area :8/15/2008 19 GSW epigastrium area


Blood in NG tube :8/15/2008 20 Blood in NG tube


Anterior wall of stomach :8/15/2008 21 Anterior wall of stomach


Slide 22:8/15/2008 22 THANK YOU!