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trauma and trauma systems > abdominal trauma > Flashcards

abdominal trauma Flashcards

1
Q

introduction to abdominal injury

A
  • One of body’s largest cavities
  • Multiple vital organs.
  • Large volumes of blood can be lost before signs and symptoms manifest.
  • Must be alert for signs of transmitted injury -> Deformity, swelling, and ecchymosis
  • Prevention:
  • Highway safety- Seatbelt usage (Proper application)
  • Airbags
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2
Q

abdominal anatomy and physiology

A
  • boundaries:
  • superior- diaphragm
  • inferior- pelvis
  • posterior- vertebral column and posterior and inferior ribs
  • lateral- muscles of the flank
  • anterior- abdominal muscles
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3
Q

abdominal anatomy and physiology: 3 specific spaces

A
  • peritoneal space- organs covered by abdominal (peritoneal) lining
  • retroperitoneal space- organs posterior to the peritoneal lining
  • pelvic space- organs contained within pelvis
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4
Q

upper right quadrant organs

A
  • liver
  • gal bladder
  • stomach (small part)
  • small and large intestine
  • head of pancreas
  • upper part of kidney
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5
Q

upper left quadrant organs

A
  • spleen
  • stomach
  • tail of pancreas
  • tail of liver
  • small and large intestine
  • upper part of kidney
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6
Q

lower right quadrant organs

A
  • small and large intestine
  • lower part of kidney
  • half of bladder
  • appendix
  • female reproductive organs
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7
Q

lower left quadrant organs

A
  • small and large intestine
  • lower part of kidney
  • half bladder
  • female reproductive organs
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8
Q

hollow abdominal organs

A
  • stomach
  • small intestine
  • large intestine
  • gall bladder
  • bladder
  • uterus
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9
Q

solid abdominal organs

A
  • liver
  • spleen
  • pancreas
  • kidneys
  • ovaries
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10
Q

digestive tract: function

A
  • churn material to be digested
  • excrete digestive juices
  • absorb nutrients and water
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11
Q

digestive tract: components

A
  • STOMACH- food mixed with HCl and enzymes to form chyme
  • SMALL BOWEL:
  • food moved through bowel by peristalsis
  • duodenum
  • jejunum
  • ileum
  • LARGE BOWEL (COLON)
  • RECTUM
  • ANUS
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12
Q

Liver

A
  • located in upper right quadrant
  • 2.5% of total body weight
  • receives 25% of cardiac output and has greatest blood reserve
  • suspended by ligamentum teres- can lacerate liver in deceleration trauma
  • function:
  • detoxifies blood
  • removes damaged or aged erythrocytes
  • stores glycogen and agents for metabolism
  • liver tissue will grow to normal size following partial removal
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13
Q

gal bladder

A
  • small hollow organ located behind and beneath liver
  • receives bile:
  • waste product from reprocessing of RBCs
  • used to digest fatty foods (emulsification)
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14
Q

pancreas

A
  • produces endocrine hormones and exocrine enzymes
  • glucagon
  • insulin
  • digestive enzymes that return the chyme pH to normal and break down proteins
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15
Q

spleen

A
  • part of immune system
  • located behind stomach and lateral to kidney in upper left quadrant
  • function: immunology and stores large volume of blood
  • most fragile abdominal organ
  • commonly injured in blunt trauma affecting the left flank
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16
Q

urinary system

A
  • kidneys
  • ureters
  • urinary bladder- can contain as much as 500 mL of urine
  • urethra
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17
Q

kidneys

A
  • collect waste products in blood stream
  • concentrate products into urine
  • reabsorb water and salt
  • regulate body osmotic balance
  • adrenal glands
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18
Q

kidneys: adrenal glands

A
  • superior and attached to kidneys
  • component of endocrine system
  • release epinephrine and norepinephrine
19
Q

pregnant uterus

A
  • uterus and contents grow rapidly after conception and until delivery
  • 1st trimester (0-12)- well protected
  • 2nd trimester (12-24)- uterus displaces organs upward
  • 3rd trimester (24 weeks to term)- fills entire abdominal cavity and displaces diaphragm upward
20
Q

pregnant uterus: effects on maternal physiology

A
  • increases circulatory blood volume by 45%
  • greater volume but fewer RBCs
  • results in relative anemia
  • cardiac output increases by 40%
  • heart rate increases by 15 bpm
  • compresses the vena cava in 3rd trimester
  • reduces venous return- supine hypotensive syndrome
21
Q

penetrating trauma in abdomen

A
  • energy transmitted to surrounding tissue
  • projectile cavitation, pitch, and yaw
  • results in:
  • uncontrolled hemorrhage
  • organ damage
  • spillage of hollow organ contents
  • irritation and inflammation of abdominal lining
  • liver most commonly affected organ
  • shotgun trauma- multiple projectiles
22
Q

blunt trauma: abdomen

A
  • produces least visible signs of injury
  • causes:
  • deceleration- contents damaged by change in velocity
  • compression- organs trapped between other structures
  • shear- part of an organ is able to move while another part is fixed (ex. ligamentum teres)
23
Q

blast injuries: abdomen

A
  • blunt and penetrating MOIs
  • irregular shaped shrapnel and debris
  • pressure wave- compresses and relaxes air-filled organs and/or contuses or ruptures organs
  • abdominal injury is secondary concern during blast injury
24
Q

injury to abdominal wall

A
  • skin and muscles transmit blunt trauma to internal structures
  • typically only show erythema
  • visible swelling and ecchymosis occur over several hours
  • penetrating trauma may appear minimal externally in comparison to internal trauma
  • muscle may mask the size of the external wound
  • evisceration may be present
  • trauma to thorax, buttocks, flanks, and back may penetrate abdomen
  • lower chest may injure spleen, liver, stomach, or gallbladder
  • diaphragmatic tears: herniation of abdominal contents into thorax
25
Q

injury to hollow organs

A
  • may rupture with compression from blunt forces
  • may tear due to penetrating trauma
  • intestines have a large amount of bacteria- leakage can result in sepsis
  • manifestations of blood loss
  • hematochezia- blood in stool
  • hematemesis- blood in emesis
  • hematuria- blood in urine
  • spillage of contents into:
  • retroperitoneal space
  • peritoneal space
  • pelvic space
26
Q

injury to the solid organs

A
  • dense and less strongly held together
  • prone to contusion- bleeding/fracture (rupture)
  • unrestricted hemorrhage if organ capsule is ruptured
  • specific organs:
  • spleen- pain referred to left shoulder
  • pancreas- pain radiated to back
  • kidneys- pain radiated from flank to groin and hematuria
  • liver- pain referred to the right shoulder
27
Q

injury to the vascular structures

A
  • abdominal aorta and vena cava- prone to direct blunt or penetrating trauma -> may be injured in deceleration injuries
  • blood accumulates beneath diaphragm:
  • irritation of muscular structures
  • produces referred pain in the shoulder region
  • greater volume of blood can be lost
  • presence of blood in abdomen stimulates vagus nerve resulting in slowing of heart rate
  • blood can isolate in ant of the abdominal spaces
28
Q

injury to mesentery and bowel

A
  • provides bowel with circulation, innervation, and attachment
  • disrupts blood vessels supplying the bowel- leads to ischemia, necrosis, or rupture
  • blood loss minimal- peritoneal layers contain hemorrhage
  • tear of mesentery may rupture bowel
  • penetrating trauma to the lateral abdomen likely to injure large bowel
29
Q

injury to peritoneum

A
  • delicate and sensitive lining of anterior abdomen
  • PERITONITIS:
  • inflammation of the peritoneum due to:
  • bacterial irritation- due to torn bowel or open wound
  • chemical irritation- caustic nature of digestive enzymes -> urine initiates inflammatory response
  • blood does not induce peritonitis
  • progression:
  • slight tenderness at location of injury
  • rebound tenderness
  • guarding
  • rigid, board like feel
30
Q

injury to the pelvis: serious skeletal injury

A
  • life threatening hemorrhage
  • potential injury to pelvis organs:
  • ureters
  • bladder
  • urethra
  • female genitalia
  • prostate
  • rectum
  • anus
31
Q

injury during pregnancy

A
  • trauma is the number one killer of pregnant females
  • penetrating abdominal trauma accounts for 36% of maternal mortality
  • gun shot wound (GSW) account for 40-70% of penetrating trauma
  • blunt trauma due to improperly worn seatbelts- auto collisions are leading cause of mortality
  • changes dimension of uterus- protects abdominal organs and endangers uterus and fetus
32
Q

injury during pregnancy: maternal changes

A
  • increasing size and weight of uterus-compresses inferior vena cava and reduces venous return to heart
  • increasing maternal blood volume protects mother from hypovolemia-> 30-35% of blood loss necessary before signs of shock
  • uterus is thick and muscular distributes forces of trauma uniformly to fetus -> reduces chances of injury
33
Q

injury during pregnancy

A
  • risk of uterine and fetal injury increases with the length of gestation- greatest risk during 3rd trimester
  • penetrating trauma may cause fetal and maternal blood mixing
  • blunt trauma complications:
  • uterine rupture
  • aburptio placentae
  • premature rupture of amniotic sac
34
Q

injury to pediatric patients

A
  • children have poorly developed abdominal musculature and smaller diameter
  • rib cage more cartilaginous- transmits injury to organs beneath easier
  • increased incidence of injury to:
  • liver
  • kidney
  • spleen
  • shock- compensate well for blood loss and may not show and symptoms until 50% of blood is lost
35
Q

scene size up

A
  • must evaluate MOI to assess seriousness of injury
  • identify strength and direction of forces:
  • velocity of impact
  • focus observations and palpation on that site
  • develop a mental list of possible organs involved
  • if auto crash- determine if seatbelts used properly, look for interior signs of impact, steering wheel and dashboard deformity
  • initial assessment- LOC, drug or alcohol use, evaluate ABCs and immediate threats
36
Q

rapid trauma assessment

A
  • rapid and full trauma assessment
  • closely examine regions with a high index of suspicion
  • expose and examine for DCAP-BTLS:
  • if suspected pelvic injury, DO NOT test pelvis
  • palpate entire abdomen
  • evaluate for entrance and exit wounds
  • OPQRST assessment- characteristics of pain -> tenderness versus rebound tenderness
  • SAMPLE history
  • vital assessment
37
Q

considerations with pregnant patients

A
  • be observant for:
  • signs of shock:
  • PRETREAT- signs may not develop until 30% of blood volume lost
  • body begins shunting blood from GI/GU to primary organs
  • supine hypotensive syndrome
  • premature contractions
  • vaginal hemorrhage- uterine rupture versus abruptio placentae
  • uterus development- abnormal asymmetry
38
Q

ongoing assessment

A
  • trend vital signs- every 5 minutes for critical patients
  • evaluate for:
  • progressive hemorrhage:
  • BP and capillary refill
  • pulse rate and pulse oximetry
  • mental status
  • skin condition
  • ineffective aggressive fluid resuscitation
39
Q

general management

A
  • position patient in a position of comfort unless spinal injury -> flex knees or left lateral recumbent
  • general shock care
  • specific injury care- impaled objects or eviscerations
  • impaled objects- secure in place
40
Q

fluid resuscitation

A
  • large-bore IV with isotonic solution- consider 2 bolus if pulse does not slow
  • large-bore IV lock for use if patients BP drops below 80 mmHg
  • fluid challenge 20 mL/kg- limit to 3 L
  • titrate to SBP of 80 mmHg
41
Q

management of pregnant patient: positioning

A
  • left lateral recumbent
  • if on backboard tilt backboard
  • facilitates venous return
42
Q

management of the pregnant patient: oxygenation

A
  • high flow O2

- consider PPV by BVM if hypoxia ensues

43
Q

management of the pregnant patient: maintain high index of suspicion for intra-abdominal bleeding

A

-consider IV and PASG

44
Q

evisceration care

A

trauma and trauma systems (18 decks)

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