What might damage to hollow organs result in?
Hemorrhage and spillage of their contents into the retroperitoneal, peritoneal, or pelvic spaces
___ organs such as the spleen, liver, pancreas, and kidneys are also subject to ___ and ___ trauma.
Solid ; blunt ; penetrating
What is evisceration?
Protrusion of organs from a wound
What is hematochezia?
Blood in the stool
What is hematemesis?
Vomiting of blood
What is hematuria?
Blood in the urine
___ organs like the stomach, small bowel, large bowel, rectum, urinary bladder, gallbladder, and pregnant uterus may rupture with compression from ___ forces, especially if the organ is full and ___.
hollow ; blunt ; distended
How is the liverr restrained from forward motion?
By the ligamentum teres
What happens to the liver during sever deceleration?
Weight of the liver forces it into the ligament, causing shear forces, laceration, and hemorrhage
What is peritonitis and the two cause mechanisms?
It is the inflammation of the peritoneum and is caused by chemical and bacterial irritation.
What is bacterial peritonitis?
Irritation due to infection, which is often released into the space by a torn bowel or open wound
What is chemical peritonitis?
Occurs more quickly because of caustic nature of digestive enzymes and acids (from stomach or duodenum), and (to a lesser degree) urine quickly irritate the peritoneum and induce the inflammatory response
What are the S/S of peritonitis?
- Progressive
- Usually begins with a slight tenderness at location of injury
- Overtime, the area of inflammation expands as does the area of tenderness
What is rebound tenderness?
Pain on release of examiner’s hands, allowing the patient’s abdominal wall to return to its normal position; associated with peritoneal irritation
What is guarding?
Protective tensing of the abdomen muscles by a patient suffering abdominal pain; may be voluntary or involuntary response
When is the greatest risk for injury during pregnancy?
3rd trimester
Whilea pregnant mother is somewhat protected from hypovolemia, the __ is not so protected.
Fetus
What is abruptio placentae?
Condition in which the placenta separates from the uterine wall
T or F. The internal damage correlates well to the appearance of the entrance or exit wound.
False - it does not; many factors can impact the internal damage (i.e. bouncing off a bone) because of the energy exchange characteristics
The abdomen may contain up to ___ liters of blood before distention becomes noticeable.
1.5
Abnormal pulsations in the abdomen suggest ___ injury.
arterial
___ for bowel sounds is not recommended during assessment of the ___ trauma patient.
Auscultation ; abdominal
Why are pregnant women more likely to have delayed S/S of hypovolemia?
Because maternal blood volume increases by up to 45% in the third trimester, so blood loss an exceed 30% before S/S reveal themselves
How should you care for abdominal trauma in pregnant women?
- Watch for earliest signs of shock
- Place on left side to prevent compression of the inferior vena cava
The normal uterus will be ___ and ___ to palpation. It will be palpable above the ___ ___ after the first ___ weeks of pregnancy and progress upward in the abdominal cavity until it reaches the ___ ___ at about ___ weeks.
firm ; round ; iliac crests ; 12 ; costal border ; 32
Do not identify ___ and ___ wounds in your written reports because they might confound the crime investigation.
entrance ; exit
What should you be prepared to do for any S/S of shock that develop and systolic BP drops below 80 mmHg?
Administer repeated fluid boluses
Prehopital infusion is usually limited to ___ mL of fluid.
3,000
Unlike other major body containers, the abdomen is bound by ___ rather than skeletal structures.
muscle
Blunt trauma to the abdomen causes injury through all f the following mechanisms except:
a. deceleration
b. torque
c. compression
d. shear
torque
Hollow organs like the stomach, bowel, bladder, and pregnant utur may ___ with compression from blunt forces.
rupture
Penetrating trauma most frequently involves the ___ and small bowel.
liver
A protrusion of organs from a wound is call an:
evisceration
Inflammation of the lining of the anterior abdomen, caused by bacterial or chemical irritation, is called:
Peritonitis
___ is the number one killer of pregnant females.
trauma
Significant blunt or penetrating trauma to the abdomen may cause internal hemorrhage and shock. First S/S of shock include all of the following except:
a. lethargy
b. diminishing level of consciousness
c. decreasing pulse pressure
d. increasing capillary refill time
a. lethargy
Palpation of an injured abdominal quadrant is most likely to:
cause guarding
It is very important to ensure early fluid resuscitation of the potentially hypotensive pregnant mother. This statement is true because it may take a maternal blood loss of between ___ percent before changes in maternal BP or heart rate are evident.
30 and 35
Why is it important for your assessment to determine the mechanism of injury ad region of the abdomen it affects?
S/S of injury are limited, non-specific, and do not often reflect the seriousness of abdominal pathology
What is another sign of continuing blood loss from an abdominal hemorrhage?
Aggressive fluid resuscitation that appears ineffective
Most vascular trauma is associated with ___ trauma.
penetrating
