1. Abdominal and Genitourinary Trauma
Chapter 35

2. Objectives Review anatomy of the abdominal cavity
Discuss Abdominal Trauma
Discuss Genital Trauma

3. Abdominal cavity Peritoneum – 2 layer sheath like membrane
Visceral peritoneum – innermost lining
Parietal peritoneum – outer lining that adheres to the walls of the abdominal cavity
Peritoneal cavity – the potential space between the visceral and parietal peritonea
Retroperitoneal cavity – Posterior space

4. Hollow Organs Stomach Gall bladder Urinary bladder Ureters
Internal urethra
Fallopian tubes
Small intestines
Large intestines

5. Solid Organs
Liver
Spleen
Pancreas
Kidneys

6. Vascular and Additional Structures
Vascular Structures
Abdominal aorta
Inferior Vena Cava
Additional structures
Diaphragm
Abdominal wall

7. Abdominal Injuries
Blunt or penetrating trauma can cause abdominal injuries
MOI are similar to those of chest injury
Blunt trauma is especially lethal due to the large number of organs present
Open abdominal injuries result from penetrating trauma such as gunshot, stabbing or other hard sharp objects
Gunshot wounds, always examine for an exit wound
Open wounds are easier to see, but may be less dangerous than closed wounds
Always maintain suspicion of the existence of a closed abdominal injury

8. Assessment based approach
Scene size-up
BSI
Scan scene for MOI
Ask police/bystanders what happened, especially if gunshots were heard
Attempt to determine the following, for vehicle collisions;
Type of vehicle
Approximate speed
Type of collision/point of impact
Was patient driver, passenger, or pedestrian
Where was patient found, in what position
Was patient ejected?
Impact marks on windshield, steering wheel, and dashboard
Was patient wearing a seatbelt?

9. Primary Assessment Form a general impression
Is patient lying still with knees flexed?
Is patient moaning and complaining of severe pain?
Spinal injury suspected, in-line stabilization
Ensure open airway
Check for vomit, prepare for suctioning
Oxygen via 15 lpm, if adequate respirations
Ventilation, if inadequate
Assess circulation and look for signs of shock and abdominal injury
Weak or absent radial pulse
Abnormally rapid heart rate
Moist, pale, cool skin
If signs are present, patient is priority to immediate transport

10. Secondary Assessment Consider complaints and MOI
Expose the entire body and perform a rapid secondary assessment: head, neck, and chest first
Apply cervical immobilization, if spinal injury suspected
Inspect abdomen for open wounds, distension
Inspect around the navel and flanks for discoloration and bruising
Look for bruising in lower abdomen
Inspect and provide emergency care for abdominal evisceration

11. Secondary Assessment
Palpate abdomen, noting tenderness, masses or signs of pain
Assess extremities for injuries; check and compare pulses
Assess motor and sensory function
Log roll the patient and inspect back and lumbar region; log roll onto backboard if spinal injury is suspected
Assess baseline vitals
Obtain history; if patient is unresponsive, ask bystanders

12. Secondary Assessment
Be alert for the following signs and symptoms of abdominal injury
Contusions, abrasions, lacerations, punctures, or other signs of blunt or penetrating trauma
Pain that continues to get worse
Tenderness on palpation to areas besides injury site
Rigid abdominal muscles
Patient has drawn up legs to his chest to reduce pain
Distended abdomen
Discoloration around the navel or the flank (late sign)
Rapid, shallow breathing
Signs of hemorrhagic shock
Decreasing blood pressure, narrowing pulse pressure, increasing heart rate, increasing respiratory rate
Nausea/vomiting
Abdominal cramping
Pain that radiates to either shoulder
Weakness

13. General emergency care – abdominal trauma
Maintain open airway and appropriate spinal protection
Oxygen therapy
Reassess breathing status
Treat for shock if symptoms apparent
Control external bleeding
Supine position with knees flexed
Stabilize an impaled object
Apply PASG if appropriate
Transport quickly

14. Emergency care - Evisceration
Expose the wound
Position patient supine with knees flexed
Prepare clean, sterile dressing
Cover the moist dressing with an occlusive dressing
Administer high-flow, high-concentration oxygen
Treat for shock
Reassess for effectiveness
Assess for further deterioration
Reassess vital signs

16. Genital Trauma Injuries to male genitalia
Lacerations, abrasions, avulsions, penetrations, amputations, contusions
Usually excruciatingly painful and causes great concern for the patient
Penis is very vascular
Treat as soft-tissue injury; apply direct pressure and cold compress
Wrap avulsed parts in sterile, moist dressing; place on ice; and transport with patient
Oxygen via 15 lpm
Assess for signs of shock and transport

17. Injuries to Female genitalia
Include straddle injuries, sexual assault, blunt trauma, abortion attempts, lacerations after childbirth, and foreign bodies inserted into vagina
Usually produces excruciating pain and causes concern for the patient
Area is highly vascular
Apply direct pressure to any bleeding; use moist compress
Never pack or place dressings inside vagina
Assess for shock
Oxygen via 15 lpm
Transport

18. Rectal Injury Weightlifter in competition. (prolapse)
How would you treat and package for transport?

19. Other Rectal Insults

20. Just a medical oddity……

21. Any questions???????????