chap 27 abdominal trauma
TRANSCRIPT
-
7/28/2019 Chap 27 Abdominal Trauma
1/50
Chapter 27Chapter 27
Abdominal TraumaAbdominal Trauma
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
2/50
ObjectivesObjectives
Describe mechanisms of injury, signs andDescribe mechanisms of injury, signs and
symptoms, and complications associated withsymptoms, and complications associated with
injuries of:injuries of:
Abdominal solid organsAbdominal solid organs Hollow organsHollow organs
Retroperitoneal organsRetroperitoneal organs
Pelvic organsPelvic organs
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
3/50
ObjectivesObjectives
Outline the significance of injury toOutline the significance of injury to
intraabdominal vascular structuresintraabdominal vascular structures
Describe assessment priorities for the patientDescribe assessment priorities for the patientsuspected to have abdominal injurysuspected to have abdominal injury
Outline the prehospital care of the patient withOutline the prehospital care of the patient withabdominal traumaabdominal trauma
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
4/50
ScenarioScenario
The size-up from the first unit on the scene said, OneThe size-up from the first unit on the scene said, Onevehicle into a tree, major damage. Your patient, anvehicle into a tree, major damage. Your patient, anunrestrained male, is still seated in the front of an oldunrestrained male, is still seated in the front of an oldpick-up truck, behind the severely bent steering wheel.pick-up truck, behind the severely bent steering wheel.He is pale, anxious and confused, and has a small headHe is pale, anxious and confused, and has a small headwound. You cant feel a radial pulse, but his carotid iswound. You cant feel a radial pulse, but his carotid isfast and thready. His lungs are clear, but he moansfast and thready. His lungs are clear, but he moanswhen you touch the large reddened area over his upperwhen you touch the large reddened area over his upperabdomen. Get a line set up, you shout to your partnerabdomen. Get a line set up, you shout to your partneras you apply a cervical collar and oxygen, and prepareas you apply a cervical collar and oxygen, and preparefor a rapid extrication. You can sense that time will befor a rapid extrication. You can sense that time will becritical on this call.critical on this call.
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
5/50
DiscussionDiscussion
Was the mechanism of injury on this callWas the mechanism of injury on this callsuspicious for abdominal injury?suspicious for abdominal injury?
Which abdominal organs may be injured?Which abdominal organs may be injured?
What signs and symptoms lead you to believeWhat signs and symptoms lead you to believethat an abdominal injury is likely?that an abdominal injury is likely?
What are your priorities of care for this man?What are your priorities of care for this man?
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
6/50
Abdominal TraumaAbdominal Trauma
Blunt or penetrating traumaBlunt or penetrating trauma
MVC major cause of abdominal traumaMVC major cause of abdominal trauma
OtherOther Blows to abdomenBlows to abdomen
FallsFalls
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
7/50
Abdominal TraumaAbdominal Trauma
Difficult to evaluate due to:Difficult to evaluate due to: Wide spectrum of potential injuries to multipleWide spectrum of potential injuries to multiple
organsorgans
Physical findings sometimes lacking orPhysical findings sometimes lacking orexaggeratedexaggerated
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
8/50
Abdominal TraumaAbdominal Trauma
Assessment may be compromised by:Assessment may be compromised by:Alcohol and/or recreational drugsAlcohol and/or recreational drugs
Injury to brain, spinal cordInjury to brain, spinal cord
Injury to ribs, spine, pelvisInjury to ribs, spine, pelvis
High degree of suspicion based on mechanismHigh degree of suspicion based on mechanism
of injury and kinematicsof injury and kinematics
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
9/50
Boundaries of the AbdomenBoundaries of the Abdomen
DiaphragmDiaphragm
Anterior abdominal wallAnterior abdominal wall
Pelvic bonesPelvic bones
Vertebral columnVertebral column
Muscles of theMuscles of the
abdomen and flanksabdomen and flanks
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
10/50
Surface Anatomy of the AbdomenSurface Anatomy of the Abdomen
QuadrantsQuadrants UpperUpperright, leftright, left
LowerLowerright, leftright, left
XiphoidXiphoid
Symphysis pubisSymphysis pubis
UmbilicusUmbilicus
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
11/50
Peritoneal CavityPeritoneal Cavity
True abdominal cavityTrue abdominal cavity
QuadrantsQuadrants
UpperUpperright, leftright, left LowerLowerright, leftright, left
Liver, spleen, stomach, small intestine, colon,Liver, spleen, stomach, small intestine, colon,gallbladder, female reproductive organsgallbladder, female reproductive organs
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
12/50
Pelvic CavityPelvic Cavity
Surrounded by pelvic bonesSurrounded by pelvic bones
Lower part of retroperitonealLower part of retroperitoneal
spacespace
ContentsContents
RectumRectum
BladderBladder
UrethraUrethra
Iliac vesselsIliac vessels In women, internal genitaliaIn women, internal genitalia
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
13/50
Retroperitoneal SpaceRetroperitoneal Space
Potential spacePotential space
Behind true abdominal cavityBehind true abdominal cavity
ContentsContents Abdominal aortaAbdominal aorta Inferior vena cavaInferior vena cava Most of duodenumMost of duodenum PancreasPancreas KidneysKidneys UretersUreters Ascending and descending colonAscending and descending colon
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
14/50
Mechanisms of Abdominal InjuryMechanisms of Abdominal Injury
Blunt traumaBlunt trauma Compression orCompression or
crushing forcescrushing forces
Shearing forcesShearing forces Deceleration forcesDeceleration forces
Marks of impact sustained by the front-seat
passenger in a car crash
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
15/50
Mechanisms of Abdominal InjuryMechanisms of Abdominal Injury
Degree of injury related to:Degree of injury related to: Quantity and duration of forceQuantity and duration of force
Abdominal structure injuredAbdominal structure injured
Fluid filledFluid filled Gas filledGas filled
SolidSolid
HollowHollow
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
16/50
Blunt TraumaBlunt Trauma
Motor vehicle collisionsMotor vehicle collisions
Motorcycle collisionsMotorcycle collisions
Pedestrian injuriesPedestrian injuries
FallsFalls
AssaultAssault
Blast injuriesBlast injuries
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
17/50
Penetrating TraumaPenetrating Trauma
Energy imparted to bodyEnergy imparted to body Low velocity: Knife, ice pickLow velocity: Knife, ice pick
Medium velocity: Gunshot wounds, shotgun woundsMedium velocity: Gunshot wounds, shotgun wounds
High velocity: High-power hunting rifles, military weaponsHigh velocity: High-power hunting rifles, military weapons
BallisticsBallistics
TrajectoryTrajectory
DistanceDistance
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
18/50
Solid and Hollow OrgansSolid and Hollow Organs
Solid organsSolid organs LiverLiver
SpleenSpleen
PancreasPancreas KidneysKidneys
AdrenalsAdrenals
Ovaries (female)Ovaries (female)
Hollow organsHollow organs StomachStomach
IntestinesIntestines
GallbladderGallbladder Urinary bladderUrinary bladder
Uterus (female)Uterus (female)
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
19/50
Hollow, Solid, and Retroperitoneal OrgansHollow, Solid, and Retroperitoneal Organs
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
20/50
Hollow, Solid, and Retroperitoneal OrgansHollow, Solid, and Retroperitoneal Organs
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
21/50
LiverLiver
Largest organ in abdominal cavityLargest organ in abdominal cavity
Right upper quadrantRight upper quadrant
Injured from trauma to:Injured from trauma to: Eighth through twelfth ribs on right side of bodyEighth through twelfth ribs on right side of body
Upper central part of abdomenUpper central part of abdomen
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
22/50
LiverLiver
Suspect liver injury when:Suspect liver injury when: Steering wheel injurySteering wheel injury
Lap belt injuryLap belt injury
Epigastric traumaEpigastric trauma
After injury, blood and bile leak into peritonealAfter injury, blood and bile leak into peritoneal
cavitycavity ShockShock
Peritoneal irritationPeritoneal irritation
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
23/50
SpleenSpleen
Upper left quadrantUpper left quadrant
Rich blood supplyRich blood supply
Slightly protected by organs surrounding itSlightly protected by organs surrounding it
and by lower rib cageand by lower rib cage
Most commonly injured organ from blunt traumaMost commonly injured organ from blunt traumaAssociated intraabdominal injuries commonAssociated intraabdominal injuries common
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
24/50
SpleenSpleen
Suspect splenic injury in:Suspect splenic injury in: Motor vehicle crashesMotor vehicle crashes
Falls or sports injuries involving was an impact toFalls or sports injuries involving was an impact to
the lower left chest, flank, or upper left abdomenthe lower left chest, flank, or upper left abdomen
Kehrs signKehrs sign Left upper quadrant pain radiates to left shoulderLeft upper quadrant pain radiates to left shoulder
Common complaint with splenic injuryCommon complaint with splenic injury
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
25/50
StomachStomach
Not commonly injured by blunt traumaNot commonly injured by blunt trauma
Protected location in abdomenProtected location in abdomen
Penetrating trauma may cause gastric transection orPenetrating trauma may cause gastric transection or
lacerationlaceration Signs of peritonitis from leakage of gastric contentsSigns of peritonitis from leakage of gastric contents
Diagnosis confirmed during surgeryDiagnosis confirmed during surgery Unless nasogastric drainage returns bloodUnless nasogastric drainage returns blood
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
26/50
Colon and Small IntestineColon and Small Intestine
Usually injured by penetrating traumaUsually injured by penetrating trauma
May be injured by compression forces:May be injured by compression forces:
High-speed motor vehicle crashesHigh-speed motor vehicle crashes Deceleration injuries associated with wearingDeceleration injuries associated with wearing
personal restraintspersonal restraints
Bacterial contamination commonBacterial contamination common
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
27/50
Retroperitoneal Organ InjuryRetroperitoneal Organ Injury
Blunt or penetrating trauma to:Blunt or penetrating trauma to:Anterior abdomenAnterior abdomen
Posterior abdomenPosterior abdomen
Particularly flankParticularly flank Thoracic spineThoracic spine
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
28/50
KidneysKidneys
High on posterior wall of abdominal cavity inHigh on posterior wall of abdominal cavity in
retroperitoneal spaceretroperitoneal space Held in place by renal fasciaHeld in place by renal fascia
Cushioned by layer of adipose tissueCushioned by layer of adipose tissue Partially protected by lower rib cagePartially protected by lower rib cage
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
29/50
KidneysKidneys
Injuries may involve fracture and lacerationInjuries may involve fracture and laceration Resulting in hemorrhage, urine extravasation, or bothResulting in hemorrhage, urine extravasation, or both
Contusions usually self-limitingContusions usually self-limiting Heal with bed rest and forced fluidsHeal with bed rest and forced fluids
Fractures and lacerations may need surgicalFractures and lacerations may need surgicalrepairrepair
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
30/50
UretersUreters
Hollow organsHollow organs
Rarely injured in blunt traumaRarely injured in blunt trauma
Flexible structureFlexible structure
Injury from penetrating abdominal or flankInjury from penetrating abdominal or flank
wounds (stab wounds, firearm injuries)wounds (stab wounds, firearm injuries)
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
31/50
PancreasPancreas
Solid organ in peritoneal spaceSolid organ in peritoneal space
Blunt injury usually from crushing injuryBlunt injury usually from crushing injury
between spine and a steering wheel, handlebar,between spine and a steering wheel, handlebar,or blunt weaponor blunt weapon
Most pancreatic injuries are due to penetratingMost pancreatic injuries are due to penetratingtraumatrauma
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
32/50
DuodenumDuodenum
Lies across lumbar spineLies across lumbar spine
Seldom injured due to location in retroperitonealSeldom injured due to location in retroperitoneal
area, near pancreasarea, near pancreas
May be crushed or lacerated when great force ofMay be crushed or lacerated when great force of
blunt trauma or penetrating injury occursblunt trauma or penetrating injury occurs Usually associated with pancreatic traumaUsually associated with pancreatic trauma
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
33/50
Pelvic Organ InjuryPelvic Organ Injury
Usually from motor vehicle crashes thatUsually from motor vehicle crashes that
produce pelvic fracturesproduce pelvic fractures
Less frequent causesLess frequent causes Penetrating traumaPenetrating trauma
Straddle-type injuries from fallsStraddle-type injuries from falls
Pedestrian accidentsPedestrian accidents
Some sexual actsSome sexual acts
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
34/50
Urinary BladderUrinary Bladder
Hollow organHollow organ
Ruptured by blunt or penetrating trauma or pelvicRuptured by blunt or penetrating trauma or pelvic
fracturefracture Rupture more likely if bladder is distended at time ofRupture more likely if bladder is distended at time of
injuryinjury
Suspect bladder injury in inebriated patientsSuspect bladder injury in inebriated patientssubjected to lower abdominal traumasubjected to lower abdominal trauma
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
35/50
Vascular Structure InjuryVascular Structure Injury
Intraabdominal arterial and venous injuries may beIntraabdominal arterial and venous injuries may belife threateninglife threatening
Usually occur from penetrating traumaUsually occur from penetrating trauma
Also from compression or deceleration forces appliedAlso from compression or deceleration forces appliedto abdomento abdomen
Often presents as hypovolemiaOften presents as hypovolemia
May be a palpable abdominal massMay be a palpable abdominal mass
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
36/50
Vascular Structure InjuryVascular Structure Injury
Major vessels most frequently injured:Major vessels most frequently injured:AortaAorta
Inferior vena cavaInferior vena cava
Renal, mesenteric, and iliac arteries and veinsRenal, mesenteric, and iliac arteries and veins
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
37/50
Pelvic FracturesPelvic Fractures
Disruption of pelvis from:Disruption of pelvis from: Motorcycle crashesMotorcycle crashes Pedestrian-vehicle collisionsPedestrian-vehicle collisions Direct crushing injury to pelvisDirect crushing injury to pelvis
Falls from heights greater than 12 feetFalls from heights greater than 12 feet
Blunt or penetrating injury may result in:Blunt or penetrating injury may result in: FractureFracture Severe hemorrhageSevere hemorrhageAssociated injury to urinary bladder and urethraAssociated injury to urinary bladder and urethra
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
38/50
Pelvic FracturesPelvic Fractures
Suspicion of pelvic injury should be based on:Suspicion of pelvic injury should be based on: Mechanism of injuryMechanism of injury Presence of tenderness on palpation of iliac crestsPresence of tenderness on palpation of iliac crests
Direct or indirect forceDirect or indirect force
Assessment findingsAssessment findings
ManagementManagement
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
39/50
EviscerationEvisceration
Protrusion of internalProtrusion of internal
organ through woundorgan through wound Common with stab woundsCommon with stab wounds
Do not replace organs intoDo not replace organs into
abdomenabdomen Protect from damageProtect from damage
Cover with sterile salineCover with sterile saline
dressingdressing
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
40/50
Focused History and PhysicalFocused History and Physical
Head injury, drugs, alcohol mask signs andHead injury, drugs, alcohol mask signs and
symptomssymptoms
Hemoperitoneum (solid organ/vascular injuries)Hemoperitoneum (solid organ/vascular injuries)Adult abdomen holds 1.5 L with no distentionAdult abdomen holds 1.5 L with no distention
May have normal abdominal examMay have normal abdominal exam
Unexplained shockUnexplained shock
Shock out of proportion to known injuriesShock out of proportion to known injuries
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
41/50
PeritonitisPeritonitisSigns and SymptomsSigns and Symptoms
Pain (subjective symptom from patient)Pain (subjective symptom from patient) Tenderness (objective sign with percussion/palpation)Tenderness (objective sign with percussion/palpation) Guarding/rigidityGuarding/rigidity Distention (late finding)Distention (late finding) AbrasionsAbrasions EcchymosisEcchymosis Visible woundsVisible wounds Mechanism of injuryMechanism of injury Unexplained shockUnexplained shock
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
42/50
Critical FindingsCritical Findings
Rapid assessment and transportRapid assessment and transport
Detailed assessmentDetailed assessment
Ongoing assessmentOngoing assessment
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
43/50
Noncritical FindingsNoncritical Findings
Focused history and physical examinationFocused history and physical examination
Other interventions and transport considerationsOther interventions and transport considerations
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
44/50
Comprehensive AssessmentComprehensive Assessment
Vital signsVital signs
InspectionInspection
AuscultationAuscultation
PercussionPercussion
PalpationPalpation
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
45/50
Comprehensive AssessmentComprehensive Assessment
Absence of signs and symptoms does notAbsence of signs and symptoms does not
rule out abdominal injuriesrule out abdominal injuries
Remember to examine the backRemember to examine the back
Differential diagnosisDifferential diagnosis
Continued managementContinued management
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
46/50
Management/Treatment PlanManagement/Treatment Plan
Surgical intervention only effective therapySurgical intervention only effective therapy
Rapid evaluationRapid evaluation
Shock resuscitationShock resuscitation
Rapid packaging and transport to nearest appropriateRapid packaging and transport to nearest appropriatefacilityfacility
Facility must have immediate surgical capabilityFacility must have immediate surgical capability
Crystalloid fluid en route (per protocol)Crystalloid fluid en route (per protocol)
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
47/50
Indications for Rapid TransportIndications for Rapid Transport
Critical findingsCritical findings Surgical intervention required to control hemorrhageSurgical intervention required to control hemorrhage
and/or contaminationand/or contamination
High index of suspicion for abdominal injuryHigh index of suspicion for abdominal injury Unexplained shockUnexplained shock
Physical signs of abdominal injuryPhysical signs of abdominal injury
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
48/50
Indications for Rapid TransportIndications for Rapid Transport
HemorrhageHemorrhage
Survival related to time from injury to surgicalSurvival related to time from injury to surgical
control of hemorrhagecontrol of hemorrhageAny delay in the field negatively affects this timeAny delay in the field negatively affects this time
periodperiod
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
49/50
ConclusionConclusionAbdominal trauma is often difficult to evaluateAbdominal trauma is often difficult to evaluate
in the prehospital setting. Therefore thein the prehospital setting. Therefore the
paramedic must exercise a high degree ofparamedic must exercise a high degree ofsuspicion based on the mechanism of injurysuspicion based on the mechanism of injury
and kinematics. Death from abdominal injuryand kinematics. Death from abdominal injury
usually results from hemorrhage and delayedusually results from hemorrhage and delayed
surgical repair.surgical repair.
Copyright 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
-
7/28/2019 Chap 27 Abdominal Trauma
50/50
Questions?Questions?
Copyright 2007 2006 2001 1994 by Mosby Inc an affiliate of Elsevier Inc