1. Injuries to the Abdomen, Pelvis, and Genitalia Injuries to the Abdomen, Pelvis, and Genitalia

2. Causes injuries to the abdomen, pelvis and genitalia are generally caused by accidents involving high kinetic energy and acceleration or deceleration forces

3. Causes (continued) injury can occur from: gunshots knife wounds motor vehicles snowmobiles falls skier or boarder collisions

4. Open vs. Closed Injuries abdominal injuries can be either open or closed abdominal injuries can be either open or closed open injuries are caused by sharp or high velocity objects that create an opening between the peritoneal cavity and the outside of the body open injuries are caused by sharp or high velocity objects that create an opening between the peritoneal cavity and the outside of the body closed injuries are caused by compression trauma associated with deceleration forces and include: closed injuries are caused by compression trauma associated with deceleration forces and include: contusions contusions ruptures ruptures lacerations lacerations shear injuries shear injuries

5. The type of injury will depend on whether the organ injured is solid or hollow. Hollow and Solid Organs hollow organs include: hollow organs include: stomach stomach intestines intestines gallbladder gallbladder bladder bladder solid organs include: solid organs include: liver liver spleen spleen kidneys kidneys

6. Hollow Organ Injuries when hollow organs rupture, their highly irritating and infectious contents spill into the peritoneal cavity, producing a painful inflammatory reaction called peritonitis when hollow organs rupture, their highly irritating and infectious contents spill into the peritoneal cavity, producing a painful inflammatory reaction called peritonitis

7. Solid Organ Injuries damage to solid organs such as the liver can cause severe internal bleeding damage to solid organs such as the liver can cause severe internal bleeding blood in the peritoneal cavity causes peritonitis blood in the peritoneal cavity causes peritonitis when patients injure solid organs, the symptoms of shock may overshadow those from peritonitis when patients injure solid organs, the symptoms of shock may overshadow those from peritonitis

8. Abdominal Injuries abdominal injuries can be obvious, such as an open wound, or subtle, such as a blow to the flank that initially causes little pain, but damages the liver or spleen abdominal injuries can be obvious, such as an open wound, or subtle, such as a blow to the flank that initially causes little pain, but damages the liver or spleen suspect abdominal internal injury in any patient who has a penetrating abdominal wound or has suffered compression trauma to the abdomen suspect abdominal internal injury in any patient who has a penetrating abdominal wound or has suffered compression trauma to the abdomen

9. Peritonitis Signs and Symptoms

10. pain and tenderness increase and spread from the injury site to the other parts of the abdomen, frequently the entire abdomen pain and tenderness increase and spread from the injury site to the other parts of the abdomen, frequently the entire abdomen the abdomen becomes tender, distended, and rigid the abdomen becomes tender, distended, and rigid bowel sounds disappear bowel sounds disappear

11. Signs and Symptoms (continued) the patient becomes progressively sicker, develops fever, and usually vomits the patient becomes progressively sicker, develops fever, and usually vomits signs and symptoms of shock may appear signs and symptoms of shock may appear respirations are shallow and rapid because it hurts to breathe deeply respirations are shallow and rapid because it hurts to breathe deeply

12. Signs and Symptoms (continued) abdominal pain is increased by moving, straightening the knees, or taking a deep breath abdominal pain is increased by moving, straightening the knees, or taking a deep breath the patient frequently prefers to lie quietly on his back or side with the knees flexed the patient frequently prefers to lie quietly on his back or side with the knees flexed

13. Injuries to the Pelvis and Genitourinary System

14. Kidney Injuries an injury to the lower back may involve one or both kidneys an injury to the lower back may involve one or both kidneys signs include: signs include: tenderness tenderness swelling swelling ecchymosis ecchymosis blood in the urine blood in the urine

15. Bladder Injuries pelvic fractures can lacerate the bladder or urethra pelvic fractures can lacerate the bladder or urethra always search for a pelvic fracture during assessment of the lower abdomen always search for a pelvic fracture during assessment of the lower abdomen

16. Male Genitalia Injuries these injuries are extremely painful these injuries are extremely painful the patient will have a high degree of anxiety and concern the patient will have a high degree of anxiety and concern manage contusions by applying cold pack and stabilizing the injury with clothing manage contusions by applying cold pack and stabilizing the injury with clothing

17. Female Genitalia the female organs are protected by the pelvis the female organs are protected by the pelvis the uterus of a pregnant woman is susceptible from compression trauma to the pelvis or abdomen the uterus of a pregnant woman is susceptible from compression trauma to the pelvis or abdomen soft tissue injury can cause anxiety and profuse bleeding soft tissue injury can cause anxiety and profuse bleeding

18. Female Genitalia Injuries control any bleeding with direct pressure control any bleeding with direct pressure anchor dressings with a diaperlike arrangement made from triangular bandages anchor dressings with a diaperlike arrangement made from triangular bandages never insert dressings or packs into the vagina never insert dressings or packs into the vagina

19. Assessment Patients with an Abdominal or Pelvic Injury

20. Assessment determine the mechanism of injury determine the mechanism of injury institute BSI institute BSI ask the patient ask the patient “what happened?” “what happened?” “where do you hurt?” “where do you hurt?” the location of the pain and its character the location of the pain and its character

21. Assessment (continued) assess the abdomen, lower chest, pelvis, and back giving urgent care as necessary assess the abdomen, lower chest, pelvis, and back giving urgent care as necessary investigate a positive mechanism of injury or abnormal pulse by: investigate a positive mechanism of injury or abnormal pulse by: performing rapid body survey performing rapid body survey obtaining SAMPLE history obtaining SAMPLE history

22. expose and assess the perineal area if you suspect a genitourinary injury expose and assess the perineal area if you suspect a genitourinary injury anticipate vomiting anticipate vomiting inspect vomit inspect vomit conduct non-urgent survey conduct non-urgent survey conduct whole body survey conduct whole body survey

23. assess and record vital signs assess and record vital signs assess and record any changes in location or character of pain assess and record any changes in location or character of pain watch and record change in any symptoms watch and record change in any symptoms inspect voided urine for visible blood inspect voided urine for visible blood

24. perform the ongoing survey perform the ongoing survey do ongoing monitoring and recording of: do ongoing monitoring and recording of: vital signs vital signs changes in location or character of pain, tenderness, abdominal distention and rigidity changes in location or character of pain, tenderness, abdominal distention and rigidity

25. assess for additional injuries if the level of shock is not explained by injuries found assess for additional injuries if the level of shock is not explained by injuries found arrange for rapid transport unless the injury is trivial arrange for rapid transport unless the injury is trivial

26. Emergency Care Patient with an Abdominal or Pelvic Injury

27. Emergency Care keep the patient warm keep the patient warm don’t give anything by mouth don’t give anything by mouth control external bleeding with direct pressure control external bleeding with direct pressure maintain the airway maintain the airway

28. Emergency Care (continued) bandage wounds bandage wounds protect eviscerated organs with a sterile, moist occlusive dressing protect eviscerated organs with a sterile, moist occlusive dressing stabilize an impaled object in place stabilize an impaled object in place

29. Emergency Care (continued) anticipate and treat shock anticipate and treat shock give high flow oxygen give high flow oxygen immobilize the patient with a fractured pelvis on a long spineboard immobilize the patient with a fractured pelvis on a long spineboard

30. Emergency Care (continued) Arrange to transport the patient rapidly to the hospital Arrange to transport the patient rapidly to the hospital