abdominal trauma and trauma in pregnancy

7/27/2019 Abdominal Trauma and Trauma in Pregnancy

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7Abdominal

Trauma & Trauma

in Pregnancy

Lesson

Prehospital Trauma Life Support


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Developed by the

National Association ofEmergency Medical Technicians

In cooperation with

The Committee on Trauma,American College of Surgeons

This slide presentation is intended for use only

in approved PHTLS courses. 7-1B


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Abdominal Trauma

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Abdominal Trauma & Trauma

in Pregnancy


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Lesson 7 Abdominal Trauma Objectives

Associate blunt and penetrating abdominaltrauma with anatomy, physiology andpathophysiology.

Use mechanism of injury and index ofsuspicion when assessing, treating andprioritizing abdominal trauma.

Identify the appropriate assessment andmanagement of abdominal trauma, and thelimitations of each.

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Abdominal trauma often goesunrecognized.

Second leading cause of trauma death.

Extent of damage difficult to

determine. Massive blood loss can lead to shock

and death.

Abdominal Trauma

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Abdominal Assessment

Keys: Anatomy - to identify structures that may be

damaged. Mechanism.

Index of suspicion.

Tools: Observation for wounds, guarding, positioning. Palpation for rigidity, tenderness, and masses.

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Pitfall: Auscultation is a tool, but not

recommended in the prehospital setting.


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Penetrating Trauma

Your patient is the victim of multiplegunshot wounds to the abdomen.

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Pitfall: Injury significance missed due to

a lack of attention to kinematics.


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Anatomy

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How can you use anatomy toevaluate this patient?

Organ location.

Solid versus hollow.

Bleeding versus peritonitis. Associated chest injury.


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Frontal Impact

You are dispatched to a one-vehicle MVCwith one occupant. The scene is safe.

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Blunt Trauma

Your patient is the victim of an MVC. Her vanstruck a pole head on. Moderate damage to thevan. She was wearing a seatbelt, and it waspositioned over the soft part of her abdomen.

A- Airway clear. B- Breathing rapid and shallow.

C- Skin cool and diaphoretic, weak radials, rapidheart rate.

D- Confused and anxious.

E- Bruising to left clavicle area and abdomenabove the iliac crest. Abdomen is soft and

nontender. 7-9


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Mechanism of Injury

Is the patient in this scenario critical ornon-critical?

What was the speed? What type of impact occurred?

What do you see inside the car?

What internal organs might be involved?

Are there signs and symptoms of shock?

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Index of Suspicion

Reliable indicators for index ofsuspicion:

Mechanism of injury. Unexplained indicators of shock.

Outward signs of trauma.

Level of shock greater than explainedby other injuries.

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Index of Suspicion Pitfalls

Blood in the abdomen may not alwayscause abdominal pain or tenderness.

In most cases, retroperitoneal injuries

are initially asymptomatic.

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Mechanism of Injury

Which of these should increase your indexof suspicion that this patient might beseriously injured?

A - Airway clear.

B - Breathing 18 & labored; lungs clear &equal.

C - Skin cool & dry; radial pulse 110. D - Anxious, intoxicated.

E - Bruising to right thorax and hip;abdomen soft, non-tender.

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Other Assessment Findings

You respond to a patient involved in afight. Hes been hit in the back and flank

with a heavy piece of pipe. He has no

complaints of abdominal pain. Scene is

safe. What injuries would you suspect?

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Injuries to the back may involveretroperitoneal structures like the kidneys,

aorta, and vena cava.

They often present with back pain ratherthan abdominal complaints and findings.


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Evisceration & Impaled Objects

You respond to a patient stabbed in theabdomen. A piece of bowel is eviscerated

and the knife is still impaled. How would

you manage this patient?

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Cover the bowel with moist sterile dressings.Why?

Stabilize the knife in place. Do not removeimpaled objects.

PASG contraindicated.


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Pelvic Fractures

You respond to a rollover MVC. The patientspelvis was crushed when the small tractor

he was driving rolled over.

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What is significant about this injury? Blood loss is usually significant and

occurs retroperitoneal.

Can the PASG be used to stabilizefractures and control bleeding?


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Rapid evaluation.

Shock therapy.

Pneumatic antishock garment.

Rapid transport to the appropriate

facility with surgical interventionimmediately available.

IV therapy en route.

Abdominal Trauma Management

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Abdominal Trauma & Trauma

in Pregnancy

Trauma in Pregnancy

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Lesson 7 Trauma in Pregnancy Objectives

Identify the implications of the anatomicaland physiological changes of pregnancyfor the trauma patient.

Identify the appropriate assessment,management and priorities for thepregnant patient.

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Increased heart rate of 15 - 20 bpm.

Decreased blood pressure.

Increased cardiac output.

Increased blood volume.

Normal Changes with Pregnancy

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Increased size of uterus.

Decreased peristalsis.

Loosening of ligaments.

Normal Pregnancy Changes

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A- Clear.

B- Breathing: 20 bpm, slightly laboredand shallow; lungs clear.

C- Pulse 114. Skin warm and dry. D- Anxious.

E- No obvious injury noted.

Vitals: BP 92/56.

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Findings

Are these changes due to trauma or pregnancy?


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Resuscitation of the babydepends on aggressive

resuscitation of the mother.

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Trauma in Pregnancy

You are dispatched to the scene of a 23 y/ofemale who is 32 weeks pregnant. She waspushed down a flight of stairs, and is foundlying on her back.

A- Airway clear. B- Breathing 18 per minute, slightly labored. Clear

breath sounds.

C - Very weak radial pulse of 120. No external

hemorrhage. D - Responsive to verbal stimuli.

E - Contusion to right temporal region of head.

Vitals: BP 86/54. Secondary survey negative exceptfor head contusion.

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Discussion

How would you manage this patient?

What condition mimics a head injury?

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Abdominal Trauma Summary

The cornerstone of assessing and

managing the pregnant and non-

pregnant abdominal trauma patient is

maintaining a high index of suspicion.

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abdominal trauma and trauma in pregnancy

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