CHAPTER 28: ABDOMINAL & GENITOURINARY INJURIES PATIENT ASSESSMENT & CARE II EMS 246 Dr.Bushra Bilal

ABDOMINAL CAVITY Abdomen is major body cavity extending from diaphragm to pelvis. Contains organs that make up digestive, urinary, and genitourinary systems.

ANATOMY AND PHYSIOLOGY OF THE ABDOMEN (1 OF 5) Abdominal quadrants Right upper quadrant (RUQ) Liver gallbladder,duodenumpancreas Left upper quadrant (LUQ) Stomach, Spleen Right lower quadrant (RLQ) Large and small intestine,the appendix Left lower quadrant (LLQ) Descending colon ,left half of transverse colon

ANATOMY AND PHYSIOLOGY OF THE ABDOMEN (2 OF 5) RLQ is a common location for swelling and inflammation. The appendix is a source of infection if it ruptures.

ANATOMY AND PHYSIOLOGY OF THE ABDOMEN (3 OF 5) A hollow organ is a visceral organ that forms a hollow tube or pouch Stomach, intestines, ureters, bladder Most of these contain digested food, urine, or bile. When ruptured or lacerated, contents spill into peritoneal cavity and can cause infections such as peritonitis.

ANATOMY AND PHYSIOLOGY OF THE ABDOMEN (4 OF 5) Small intestine Duodenum, jejunum, and ileum Large intestine Cecum, colon, and rectum Intestinal blood supply comes from mesentery.

ANATOMY AND PHYSIOLOGY OF THE ABDOMEN (5 OF 5) Liver, spleen, pancreas, kidneys Solid masses of tissue Perform chemical work of the body: enzyme production, blood cleansing, energy production Because of rich blood supply, hemorrhage can be severe.

INJURIES TO THE ABDOMEN Injuries to the abdomen are considered either open or closed.

CLOSED ABDOMINAL INJURIES (1 OF 2) Blunt trauma to abdomen without breaking the skin MOIs: Steering wheel Bicycle handlebars Motorcycle collisions Falls Compression Poorly placed lap belt Deceleration Fast-moving vehicle strikes an immoveable object.

CLOSED ABDOMINAL INJURIES (2 OF 2) Signs and symptoms Pain : Diffuse, may be referred to another body location (such as the Kehr sign) Blood in peritoneal cavity Guarding: stiffening of abdominal muscles Abdominal distention: result of free fluid, blood, or organ contents spilling into peritoneal cavity Abdominal bruising and discoloration

OPEN ABDOMINAL INJURIES (1 OF 3 ) Foreign object enters abdomen and opens peritoneal cavity to outside. Also called penetrating injuries example stab wounds, gunshot wounds Injury depends on velocity of object.

OPEN ABDOMINAL INJURIES (2 OF 3) Evisceration: bowel protrudes from peritoneum. Can be painful and visually shocking Do not push down on abdomen. Only perform visual assessment. Never pull on clothing stuck to or in the wound channel.

Evisceration

OPEN ABDOMINAL INJURIES (3 OF 3) Signs and symptoms Pain Tachycardia Heart increases pumping action to compensate for blood loss Later signs include: Evidence of shock Changes in mental status Distended abdomen

HOLLOW ORGAN INJURIES A hollow organ is a visceral organ that forms a hollow tube or pouch, such as the stomach or intestine, or that includes a cavity, like the heart or urinary bladder Often have delayed signs and symptoms Spill contents into abdomen. Infection develops. Both blunt and penetrating trauma can cause hollow organ injuries Blunt: causes organ to “pop” Air in peritoneal cavity causes pain, ischemia and infarction.

SOLID ORGAN INJURIES (1 OF 3) Liver is the largest organ in abdomen. Vascular, can lead to hypoperfusion Often injured by fractured lower right rib or penetrating trauma Kehr sign is common finding with injured liver. is the occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated. Spleen and pancreas prone to heavy bleeding

SOLID ORGAN INJURIES (3 OF 3) Diaphragm When penetrated or ruptured, loops of bowels invade thoracic cavity. May cause bowel sounds during auscultation of lungs dyspnea. Kidneys blood loss blood in urine (hematuria).

PATIENT ASSESSMENT OF ABDOMINAL INJURIES Patient assessment steps Scene size-up Primary assessment History taking Secondary assessment Reassessment

SCENE SIZE-UP Scene Safety Standard precautions of gloves and eye protection should be a minimum Be sure scene is safe for you

PRIMARY ASSESSMENT (1 OF 2) Evaluate patient’s ABCs. Form a general impression. Check for responsiveness using AVPU scale Airway and breathing Ensure airway is clear and patent. Clear airway of vomitus (note the nature)

PRIMARY ASSESSMENT (2 OF 2) Circulation Superficial abdominal injuries usually do not produce significant external bleeding. Internal bleeding can be profound specially trauma to liver, kidneys and spleen. Transport decision Abdominal injuries generally indicate a quick transport to the hospital.

HISTORY TAKING Investigate chief complaint, focus on MOI SAMPLE history If patient is not responsive, obtain history from family or friends. Ask if there is nausea, vomiting, diarrhea and appearance of any bowel and urinary output.

SECONDARY ASSESSMENT Physical examinations Inspect for bleeding. Evaluate the bowel sounds. Hypoactive = cannot hear sounds Hyperactive = lots of gurgling and gas moving about Use DCAP-BTLS Perform full-body scan to identify injuries, beginning with head Vital signs Many abdominal emergencies can cause a rapid pulse and low blood pressure.

REASSESSMENT Repeat the primary assessment and reassess vital signs. Interventions Manage airway and breathing problems. Provide spinal stabilization, treatment for shock Cover wounds Communication and documentation Communicate all relevant information to staff at receiving hospital.

EMERGENCY MEDICAL CARE OF ABDOMINAL INJURIES (1 OF 4) Closed abdominal injuries Patient requires immediate transport. Apply high-flow oxygen. Treat for shock. Patient with blunt abdominal injury should be log rolled to a supine position on a backboard. Monitor vital signs

EMERGENCY MEDICAL CARE OF ABDOMINAL INJURIES (2 OF 4) Open abdominal injuries Patients with penetrating injuries Inspect patient’s back and sides for exit wound. Apply dry, sterile dressing to all open wounds. If penetrating object is still in place, apply stabilizing bandage around it.

EMERGENCY MEDICAL CARE OF ABDOMINAL INJURIES (3 OF 4) Evisceration: Severe lacerations of abdominal wall may result in internal organs or fat protruding through wound.

EMERGENCY MEDICAL CARE OF ABDOMINAL INJURIES (4 OF 4) Open abdominal injuries (cont’d) Never try to replace a protruding organ. Keep the organs moist and warm. Cover with moistened, sterile gauze or occlusive dressing. Secure dressing with bandage. Secure bandage with tape.

SUMMARY Abdominal injuries are categorized as either open (penetrating trauma) or closed (blunt force trauma). Blunt force trauma that causes closed injuries results from an object striking the body without breaking the skin, such as being hit with a baseball bat or when the patient’s body strikes the steering wheel during a motor vehicle crash. Penetrating trauma is often a result of a gunshot wound or stab wound. Other MOIs such as a fall on an object can also cause penetrating trauma to the abdomen.

SUMMARY Always maintain a high index of suspicion for serious intra-abdominal injury in the trauma patient, particularly in the patient who exhibits signs of shock. Assess the abdomen for signs of bruising, rigidity, penetrating injuries, and pain. Never remove an impaled object from the abdominal region. Secure it in place with a large bulky dressing and provide prompt transport. Be prepared to treat the patient for shock. Place the patient in the modified shock position, keep the patient warm, and provide high-flow oxygen.

SUMMARY Never replace an organ that protrudes from an open injury to the abdomen (evisceration). Instead, keep the organ moist and warm. Cover the injury site with a large sterile, moist, bulky dressing. Injury to the external genitalia of male and female patients is very painful but not usually life threatening. In the case of sexual assault or rape, treat for shock if necessary, and record all the facts in detail. Follow any crime scene policy established by your system to protect the scene and any potential evidence. Advise the patient not to wash, douche, or void until after a physician has examined him or her.

UNIT ASSESSMENT List three signs and symptoms associated with abdominal injuries What is the displacement of abdominal organs outside of the body called?   What findings would suggest damage to the kidneys?