1. International Trauma Life Support for Prehospital Care Providers Sixth Edition for Prehospital Care Providers Sixth Edition Patricia M. Hicks, MS, NREMTP Roy Alson, PhD, MD, FACEP Donna Hastings, EMT-P John Emory Campbell, MD, FACEP and Alabama Chapter, American College of Emergency Physicians Patricia M. Hicks, MS, NREMTP Roy Alson, PhD, MD, FACEP Donna Hastings, EMT-P John Emory Campbell, MD, FACEP and Alabama Chapter, American College of Emergency Physicians Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Chapter 13 Abdominal Trauma Chapter 13 Abdominal Trauma

2. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Abdominal Trauma Courtesy of Roy Alson, MD

3. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Overview Basic abdominal anatomy How abdominal and chest injuries are related Blunt and penetrating injuries Complications associated with each Treatment for protruding viscera Relationship of exterior and underlying injuries Possible intra-abdominal injuries History, physical examination, mechanism of injury Abdominal trauma ALS interventions 2Abdominal Trauma -

4. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Abdominal Trauma Difficult to evaluate Attention to scene and mechanism of injury Major cause of preventable death Hemorrhage Anticipate shock: immediate or delayed Require surgical intervention Infection Gross contamination prevention 3Abdominal Trauma -

5. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Abdominal Regions Thoracic abdomenRetroperitoneal 4Abdominal Trauma - True abdomen

6. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Abdominal Region Injury Thoracic region Life-threatening hemorrhage: liver, spleen True abdomen Infection, peritonitis, shock: intestines Severe hemorrhage with signs Retroperitoneal abdomen Severe hemorrhage hidden: major vessels 5Abdominal Trauma -

7. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Abdominal Trauma Blunt Most common: mortality 10–30% Penetrating Gunshots: mortality 5–15% Stabbings: mortality 1–2% Concern: Intra-abdominal bleed with hemorrhagic shock Sepsis and/or peritonitis 6Abdominal Trauma -

8. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Abdominal Trauma Scene Size-up 7Abdominal Trauma -

9. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Blunt Abdominal Mechanism Direct compression of abdomen Fracture of solid organs (spleen/liver) Blowout of hollow organs (intestines) Deceleration forces Tearing of organs and blood vessels Accompanying injuries Head, chest, extremity: 70% MVC victims 8Abdominal Trauma -

10. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Blunt Abdominal Liver and spleen injury most common Evidence of injury Often no or minimal external evidence Significant blood volume concealed in regions Seat-belt sign: 25% intra-abdominal Pain or tenderness Often no pain or overshadowed by other pain 9Abdominal Trauma -

11. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Penetrating Abdominal Mechanism Direct trauma to organ and vasculature Projectile and fragments Energy transmitted from mass and velocity Caution: Vigorous fluid resuscitation may do more harm PASG may do more harm 10Abdominal Trauma -

12. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Penetrating Abdominal Projectile pathway not always obvious Abdominal injury is chest; chest is abdominal Gluteal area in 50% of significant injuries 11Abdominal Trauma -

13. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Abdominal Assessment ITLS Primary Survey: Abdomen Deformities Contusions Abrasions Punctures Evisceration Distension Tenderness Tenseness 12Abdominal Trauma -

14. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Signs and Symptoms Splenic injury Referred left posterior shoulder pain Liver injury Referred right posterior shoulder pain Severe hemorrhage Distention, tenderness, tenseness Pelvic tenderness or bony crepitation 13Abdominal Trauma -

15. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Stabilization 14 Signs usually do not appear early. Abdominal Trauma - If present, injury is significant. Assess and treat for shock.

16. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Special Situations Evisceration Do not push viscera back into abdomen. Gently cover with moistened gauze. Apply nonadherent material to prevent drying. 15Abdominal Trauma -

17. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Special Situations Impaled object Do not remove. Uncontrollable hemorrhage Gently stabilize object. Avoid movement. 16Abdominal Trauma -

18. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Summary Intra-abdominal injury must be recognized and treated immediately. Scene Size-up and detailed history Rapid patient assessment Early shock treatment Minimize delays to maximize survival. 17Abdominal Trauma -

19. Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ Discussion 18Abdominal Trauma -