Abdominal Trauma

Courtesy of Roy Alson, MD

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

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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

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Abdominal Regions
Thoracic abdomen Retroperitoneal

True abdomen
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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

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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

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Abdominal Trauma
Scene Size-up

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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

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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

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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

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Penetrating Abdominal
Projectile pathway not always obvious
• Abdominal injury is chest; chest is abdominal
• Gluteal area in 50% of significant injuries

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Abdominal Assessment
BTLS Primary Survey: Abdomen
• Deformities
• Contusions
• Abrasions
• Punctures
• Evisceration
• Distension
• Tenderness
• Tenseness
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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

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Stabilization

Signs usually do not appear early.

If present, injury is significant.

Assess and treat for shock.

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Special Situations
Evisceration
• Do not push viscera back into abdomen.
• Gently cover with moistened gauze.
• Apply nonadherent material to prevent drying.

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Special Situations
Impaled object
• Do not remove.
• Uncontrollable hemorrhage

• Gently stabilize object.

• Avoid movement.

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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.

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Discussion

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