Abdominal Injuries

Pulse Points and Blood Pressure

• In trauma, understanding pulse quality can guide assessment of blood pressure.

  • Carotid Pulse: Indicates a minimum systolic BP of at least 60 mmHg.

  • Brachial Pulse: Minimum systolic BP is at least 70 mmHg.

  • Radial Pulse: Minimum systolic BP is at least 80 mmHg.

• Aiming for systolic BP of at least 90 mmHg to adequately perfuse vital organs.

• Lack of radial and brachial pulses indicates serious trouble:

  • If only carotid pulse is present, BP likely below 70 mmHg (in the range of 60s or lower).

Types of Abdominal Injuries

• Blunt vs. Penetrating Mechanisms: Both can cause significant damage but mechanisms are assessed similarly.

• Eviscerations: Unique to abdominal trauma, where organs protrude from the abdomen.

  • Impaled Objects: Do not remove; dress with moist and bulky dressings, keep warm.

• Structure of the abdomen: Extends from the diaphragm to the pelvis, encompassing multiple vital organs.

  • Understand the four quadrants of the abdomen:

    • Right Upper Quadrant (RUQ): Liver, gallbladder.

    • Left Upper Quadrant (LUQ): Stomach, spleen.

    • Right Lower Quadrant (RLQ): Appendix.

    • Left Lower Quadrant (LLQ): Intestines; contents typically associated with bowel.

  • Penetrating injuries can lead to injuries in deep structures.

Types of Organs in the Abdomen

• Solid Organs: Highly vascular; injury leads to significant bleeding (e.g., liver, spleen, pancreas).

  • Significant risk of hypovolemic shock.

• Hollow Organs: (e.g., stomach, intestines, bladder); if ruptured, contents leak and can cause infection and peritonitis leading to shock from sepsis.

  • Patients may appear stable immediately but can develop complications later.

  • Remember that sepsis may develop from hollow organ injuries rather than initial shock from blood loss.

  • Signs include abdominal tenderness, distension, and generalized pain.

  • Peritonitis: Inflammation of peritoneum due to spillage or injury; can kill due to infection.

Mechanisms of Injury

• Common mechanisms include:

  • Motor vehicle accidents, motorcycle accidents.

  • Falls, especially from heights.

  • Blast injuries and rapid deceleration.

  • High pressure or trauma to the abdomen (e.g., being trapped).

• Blood in the abdominal cavity can manifest as generalized pain and fluid distention.

Signs of Abdominal Injuries

• Initial signs may include:

  • Generalized pain.

  • Localized tenderness upon palpation.

  • Later signs such as bruising and discoloration indicate more severe internal trauma.

• Check for seatbelt signs in trauma patients to assess blunt injuries.

• An unstable blood pressure often indicates significant solid organ injury.

Specific Types of Abdominal Injuries

• Evisceration is trauma resulting in bowel or organ protrusion; needs immediate moist sterile dressing and is not to be replaced.

• Kolon's Sign: Bruising around the umbilicus indicating intra-abdominal bleeding, regardless of specific injury site.

• Kidney Injuries: Typically bleed slowly, and can present days after injury.

  • Signs: Blood in urine (hematuria) may appear later.

• Liver Injuries: Can cause referred pain to the right shoulder; most vascular organ in the abdomen and can bleed heavily.

• Spleen and Diaphragm Injuries: Prone to injury; diaphragm ruptures may cause respiratory issues and compress underlying organs.

Traumatic Assessment Process

• Initial assessment should focus on vital signs and changes in consciousness levels as indicators of shock progression.

• Questions surrounding nausea/vomiting should be asked during history taking. Assess for any signs of sepsis or infection risks from hollow organ injuries.

• Use the principle of assuming internal injuries until proven otherwise to guide treatment plans.