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By

Tony Suharsono

tony/en-b 2007

Introduction
13 -15 of traumatic death are a direct result of injury

to abdominal structure, making this the third leading


cause of trauma related mortality (trauma nursing
core course)
In UK the incidence of life threatening abdominal and
genitourinary trauma is low, just over 1% of all trauma
admissions to hospital
Injury to the abdomen can be a difficult condition to
evaluate even in the hospital . In the field it is usually
more so
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Anatomy of abdomen
Abdomen is traditionally divided into three region :
- The thoracic abdomen
- The true abdomen
- The retroperitoneal abdomen

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Thoracic abdomen
Located underneath the thin

sheet muscle, the diaphragm,


and is enclosing by the lower
ribs
It contains the liver, gall
bladder, spleen, stomach and
transverse colon.
Injury to the liver and spleen
can result in life-threatening
hemorrhage
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True Abdomen
It contains intestines and the

bladder
Damage to the intestines can
result in infection, peritonitis
and shock

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The retroperitoneal Abdomen


It lies behind the thoracic and

true portion of the abdomen


This area include kidneys,
ureters, pancreas, posterior
duodenum, ascending and
descending colon , abdominal
aorta, the inferior vena cava
Injuries here difficult to
evaluate

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Types of injuries
Blunt trauma, (have relative high rate mortality

rates of 10-30%, fracture solid organ, blow out of


hollow organ and tearing of organ and their blood
vessel )
Penetrating trauma (Stab wound and gunshot
wound, gunshot caused greater incidence of injury
to abdominal viscera from the higher energy
imparted to the intra abdominal organ
in the prehospital phase , with both blunt and
penetrating trauma , you must be concerned about
intra abdominal bleeding with hemorrhagic shock
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General considerations
although penetrating injuries may be restricted to the
abdomen, blunt abdominal trauma is rarely in isolated
event

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Assessment abdominal trauma


patient
Primary survey : rapid visual evaluation and palpation
DCAPBLS
Evisceration
Distention
Tenderness
Gentle palpate iliac crest (tenderness and crepitus

associated with fracture)

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Sign and symptoms patient with


abdominal injuries
Contusions, abrasion, laceration, punctures, or other

signs of blunt or penetrating injuries


Pain that may initially be mild, than worsening
Tenderness on palpation to areas other than the site of
injury
Rigid abdominal muscle
Patient lies with his legs drawn up to the chest in an
attempt to reduce pain
Distended abdomen
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Sign and symptoms patient


with abdominal injuries
Discoloration around the umbilical or to the flank
Rapid shallow breathing
Signs of shock
Nausea and vomiting
Abdominal cramping may be present
Pain may radiate to either shoulder
Weakness

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Management abdominal trauma


Immediate determination of specific structure that

have been injured is not essential : the most important


management decision is whether the patient requires
immediate surgery. With this mind, care is focused on
basic stabilization, frequent reassessment, and
diagnostic testing.
Airway
Assessment
Ensure the patient has a patent airway
Intervention
Clear the airway and use adjuncts as indicated
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Management abdominal trauma


Breathing
Assessment

Evaluate the respiratory rate, depth, effectiveness, and work of


breath. Consider the possibility of concurrent thoracic injury

Intervention

Administer supplemental oxygen via a non rebreather mask or


tracheal tube
Assisst ventilations as needed with a bag valve mask or
mechanical ventilation

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Management abdominal trauma


Circulation
Assessment

Assess circulatory status: pulses, skin status, and blood pressure.


Patient with abdominal injuries can lose tremendous amounts of
blood

Intervention

Insert two (or more) large bore (14-16 G) intravenous catheter


Infuse warmed, isotonic crystalloid solution
Transfuse blood component as needed
Administer fluid based on clinical status and test result (a Judicial
approach to volume replacement is recommended)
Consider central line placement in unstable patient for infusion of
large fluid volume and central venous pressure monitoring
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Management abdominal trauma


Miscellaneous
Assessment

Identify the mechanism of injury and prehospital event


Determine medical history
Inspect the anterior and posterior abdomen to identify all wounds
Check for major injuries to other body sites

Intervention

Place an orogastric or nasogastric tube for stomac decompression


Insert inwelling urinary catheter and monitor output
Cover open abdominal wound with sterile saline dressing, do not
allow exposed to dry
Facilitate diagnostic studies and surgical intervention
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Summary
Scene size up for mechanism and pertinent history

from the patient


Rapid patient assessment
Rapid transport to appropriate hospital
Other intervention as needed

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Suggested reading
Brady Basic trauma life support
Emergency care, textbook for paramedic, second

edition
Sheehys Manual of emergency care
Prehospital emergency care

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tony/en-b 2007