Abdominal Injuries

Trauma and Abdominal Injuries

Introduction

• Efforts to reduce morbidity and mortality from abdominal trauma are ongoing.

Abdominal Cavity

• Largest body cavity, extending from the diaphragm to the pelvis.

• Assessment should be done quickly and cautiously.

Prevention Strategies

• Aim to reduce morbidity and mortality:

  • Use of safety equipment.

  • Prehospital education.

  • Advances in hospital care.

  • Development of trauma systems.

Anatomy Review

General Structure

• Boundaries: Diaphragm to pelvic brim.

• Sections: Anterior abdomen, flanks, posterior abdomen/back.

Abdominal Quadrants

• Right Upper Quadrant (RUQ):

  • Liver, gallbladder, duodenum, head of pancreas, right adrenal gland, part of right kidney.

• Right Lower Quadrant (RLQ):

  • Lower pole of right kidney, cecum and appendix, ascending colon, bladder (distended), female: ovary and salpinx, uterus (enlarged), male: right spermatic cord, right ureter.

• Left Upper Quadrant (LUQ):

  • Left lobe of liver, spleen, body of pancreas, left adrenal gland, part of left kidney, splenic flexure of colon, transverse and descending colon.

• Left Lower Quadrant (LLQ):

  • Lower pole of left kidney, sigmoid colon, descending colon, bladder (distended), female: ovary and salpinx, uterus (enlarged), male: left spermatic cord, left ureter.

Internal Abdomen

• Divided into three regions:

  • Peritoneal space.

  • Retroperitoneal space.

  • Pelvis.

• Types of organs:

  • Solid, hollow, vascular.

• Peritoneum is the membrane covering the abdominal cavity.

Common Abdominal Injuries

• OrgansCommonly Injured:

  • Blunt Trauma:

    • Most injuries in Canada due to blunt trauma - primarily motor vehicle collisions.

    • Compression or deceleration forces lead to crush injuries.

    • Common patterns: Shearing, crushing, and compression.

  • Penetrating Trauma:

    • Injury from gunshot or stab wounds, leading to open abdominal injuries.

Mechanism of Injury

• Trauma is a leading cause of death in adults, particularly in ages 1 to 44.

• Unrecognized abdominal trauma can cause unexplained deaths due to delayed surgical intervention.

• Two Types:

  • Blunt trauma.

  • Penetrating trauma.

Scene Assessment

• Important factors include:

  • Scene safety and personal protective equipment (PPE).

  • Mechanism of injury (M.O.I.).

  • Number of patients and available resources.

Initial Assessment

• Assess mental status, airway with cervical spine precautions, breathing, and circulatory status.

• Prioritize patient injuries and treatments.

Focused Examination

• DCAP-BTLS:

  • Deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, swelling.

• Blunt trauma evaluation factors:

  • Vehicle types, speed, collision patterns, seat belt use, airbag deployment, patient positioning in the vehicle.

• For penetrating trauma (gunshot):

  • Weapon type, number of shots fired, distance of gunman.

• For penetrating trauma (stabbing):

  • Knife type/length, angle of entrance wound, number of wounds, presence of defensive wounds.

Detailed Physical Examination

• Conducted en route to the hospital.

• Assess structures including the Cullen and Grey Turner signs.

Management of Abdominal Injuries

• Open airway with spinal precautions.

• Administer oxygen via non-rebreather mask.

• Establish two large-bore IV lines.

• Manage external hemorrhage promptly.

• Do not delay transport of the patient.

Pelvic Fractures

• Majority from blunt trauma.

• Signs: Pelvic pain, groin pain, visible hematomas, hypotension without external bleeding.

• Mechanisms include:

  • Anteroposterior compression, lateral compression, vertical sheer, saddle injuries.

• Quick assessment for entrance and exit wounds, necessity of transport to manage hypotension.

• In cases of open-book fractures, stabilize hips at the superior anterior iliac crests.

Summary

• Review of anatomy, injury mechanisms, pathophysiology, assessment and management, and specifics of pelvic fractures and trauma assessment.