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PROBLEM: TRAUMA Definition Trauma is sudden accidents or purposeful acts leading to injury, disability or death Impact Initial physical

al injuries and long term effects; rehabilitation and psychosocial effects on clients and family members Components of Trauma 1. Host person or group at risk of injury !. Mec"anism source of energy that causes trauma, and the most common mechanical energy from Motor Vehicles Accidents (MVA) #. Intention deliberate or unintentional $. En%ironment location and under hat circumstances (at home, work, highway) PROBLEM: ABDOMI&AL TRAUMA Definition Injury to the structures located bet een the diaphragm and pel!is" Abdominal trauma is often combination of blunt and penetrating injuries T'PE(: B)unt or Penetratin* traumas # Intra a+,omina) in-uries # 1. BLU&T TRAUMA hene!er there has been application of forces/penetrating injuries in the area from the $th rib to the hip Results when energy from a force to the abdomen is diffused into the abdominal cavity Causes % MVA (steering heel mark to chest, contact sports, and physical abuse& '(')pain and rigidity of abdomen, presence of palpable masses, shock, and Cullen's sign (hemorrhagic patches around the umbilicus indicate retroperitoneal hemorrhage)) !. PE&ETRATI&. TRAUMA Result from many types of injuries which becomes impeded into the tissue *auses # gunshot, stabs ounds, broken e+tremity '(') bleeding from an open injuries 3.I&TRA ABDOMI&AL I&/UR' # associated with low rib fracture, femur fracture, pelvic fracture and thoracic injuries

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Pre "ospita) Care an, Transport Emer*enc1 Me,ica) (er%ices 2EM(3 at the location of the accident rapid comprehensi!e trauma assessment ,etermine need for trauma center and rapid transport !irway, "reathing, Circulation # -ife support (C#R $ e%ternal pacemaker) -e!el of consciousness .ossible spinal cord injuries # Immobili/e cer!ical spine Any ob!ious injuries needs to be stabili/ed &reat hemorrhage and shock ' !pply direct pressure over bleeding wounds 0apid Transport (to the closest ())

In-uries of A+,omina) Or*ans Although all organs of the abdomen can be injured ith blunt or penetrating trauma, some organs are more !ulnerable than others" 1. (tomac" 'igns of shock most fre1uently occur ith penetrating diagnosis !ssess for hypovolemic shock, !. Li%er -argest abdominal organ and anterior location makes if prone to injuries" 2emodynamic instability occurs immediately due to its high !ascularity Clinical evidences of blood loss are # tachycardia, hypotension4 tachypnea, and increased abdominal distension" #. (p)een Injury of the normal spleen occurs more often ith blunt trauma" .eritoneal irritation3 pain, tenderness, guarding, rigidity (4ehr5s sign) Clinical evidence of blood loss 'urgery # splenectomy $. Pancreas 6sually a result of a penetrating trauma -a!age # check for the presence of amylase Peritonea) La%a*e % the trauma doctor inserts a large bore catheter into abdomen allo s fluid to enter the abdominal ca!ity If return drainage from the abdomen is pink or grossly bloody patient must go to the OR
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5. 6i,ne1s *an be contused ith blunt trauma &urner's sign (purplish discoloration on flank) 7. B)a,,er An empty bladder is not usually injured by blunt trauma" 8. (ma)) Intestine 8re1uently injured ith blunt trauma because of their anterior location and lack of protection structure and high !ascularity hypovolemic shock * may occur 9. Lar*e Intestine .eritoneal irritation3 pain, tenderness, guarding, rigidity Dia*nostics# peritoneal la!age, and *T 'can, hypovolemic shock % 9:* ith differentials to identify septic shock, :lood cultures # identify causati!e organism in septic shock; treatment Treatments # same as peritonitis :. A+,omina) ;esse)s The abdominal aorta, hepatic !eins and inferior !ena ca!a are the major !essels in the abdomen that maybe damaged ith trauma Assess # 2;2 hypovolemic shock ' hemodynamic instability Treatments # surgery, blood !olume replacement &UR(I&. DIA.&O(I( 1. 0)ui, ;o)ume Deficit hemorrhages !. Ris< for In-ur1: potential for falls, fractures #. Ris< for Infection .OAL(: <"0apid shock identification; rapid diagnosis of cause; rapid aggressi!e treatment and better outcome for patient 7" Impro!ing arterial o+ygenation and tissue perfusion =" ,etermine type of shock and focus on treating underlying cause to stop progression through stages of shock I&DEPE&DE&T = DEPE&DE&T I&TER;E&TIO&( A&D E;ALUATIO& Me,ications 1. Inotropic A*ents !. ;asoacti%e A*ents # #. O>1*en T"erap1 ?
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.atent air ay and ade1uate o+ygenation critical inter!entions Monitor ith A:>s, pulse o+ymetry $. 0)ui, Rep)acement % essential for hypo!olemic shock ?" B)oo, transfusions

Luci Mendona-Cali Ph.D., RN (2010)

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