Abdominal Trauma • Penetrating- these are from gunshot or stab wounds which frequently damages the small bowel

. in gunshot wounds, the most important factor is the velocity at which the bullet enters because high velocity ones create an extensive damage. All abdominal gunshot wounds that cross the peritoneum require surgical exploration. Stab wounds may be managed non-operatively. Blunt- from motor accidents, falls, blow or explosions commonly associated with extra-abdominal injuries like on the chest, head or extremities. This cases are a challenge because of hidden injuries and difficulty in detection. Complications are greater here than with penetrating trauma

Assessment and Diagnostics • While eliciting history, inspect abdomen for signs of visible injures • Auscultate bowel sounds in which absence may mean peritoneal involvement or stress • Hypotension • Signs of peritoneal irritation: 1. Abdominal distention 2. Involuntary guarding 3. Tenderness 4. Pain 5. Muscular rigidity 6. Rebound tenderness • Lab: urinalysis, CBC andserum amylase levels • CT scans and Ultrasound • Diagnostic peritoneal lavage may also to detect internal bleeding Management • Priority is ABC • Apply direct pressure on external bleeds to control bleeding • IVF and blood components to maintain circulating volume • Monitor signs and symptoms of shock while administering blood transfusion because is signals internal hemorrhage • For blunt cases, keep patient on stretcher to immobilize spine; use backboard to transport to x-ray or surgery; maintain cervical collar until cervical spine injury is ruled out • Locate, count and document wounds • Cover protruding abdominal viscera with sterile saline dressings • Withhold oral fluids in anticipation of surgery and aspirate stomach contents via NGT

blood loss. free air under he diaphragm. evisceration or hematuria Non-operative: most cases of blunt liver and spleen injuries .• • • • Administer tetanus prophylaxis and broad-spectrum antibiotics Continous monitoring for any changes in baseline assessment while at the ER Transport to surgery in the following events: shock.

Abdominal trauma: Colo-Rectal Injuries In partial fulfillment of the requirements of NCM 132-RLE Submitted by: Christina Soriano .

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