ABDOMINAL

TRAUMA

Prepared by
MSN. Mangement
17\3\2011
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OBJECTIVES:
Identify the common mechanisms of
injury associated with abdominal
trauma.
Describe the pathophysiologic
changes as a basis for signs and
symptoms.
Identify selected abdominal injuries
(S &S ).

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OBJECTIVES
Discuss the NURSING of patients
with abdominal trauma.
Identify appropriate nursing
diagnosis.
Plan appropriate interventions for
patients with abdominal trauma.


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INTRODUCTION
Abdominal injuries are common in patients who
sustain major trauma.
Unrecognized abdominal injuries are frequently
the cause of preventable death.
Approximately one-fifth of all traumatized pt
requiring operative intervention have
sustained trauma to the abdomen.
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Abdominal trauma
Abdominal trauma is an injury to the
abdomen. It may be blunt or penetrating
and may involve damage to the abdominal
organs.

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TYPES OF INJURIES
Blunt abdominal trauma is a leading
cause of morbidity and mortality among all
age groups.
Blunt trauma: liver spleen (most common).

Penetrating: liver, small bowel and
stomach.
Penetrating: present with single or multiple
injuries
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Penetrating abdominal trauma (PAT) is
usually diagnosed based on clinical signs,
blunt abdominal trauma is more likely to be
missed because clinical signs are less
obvious.

Penetrating trauma is further subdivided
into stab wounds and bullet wounds, which
have different treatments.
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Multiple injuries, abdominal trauma can
lead to hemorrhage, hypovolemic shock, and
death. Yet even a serious, life-threatening
abdominal injury may not cause obvious signs
and symptoms, especially in cases of blunt
trauma.


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Key responses to decrease mortality and
morbidity include :

- aggressive resuscitation efforts,
- adequate volume replacement,
- early diagnosis of injuries, and
- surgical intervention if warranted

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ORGANS
Solid Organs
Liver
Spleen
Kidneys
Pancreas
Hollow Organs
Stomach
Small bowel
Large bowel
Bladder

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Mechanisms of injury
The most common mechanism of blunt injury
is MVC (motor vehicle crash).
Firearm , stabbings, are associated with
Penetrating trauma.
Injuries result from acceleration, deceleration,
or both forces.
Crushing forces compress the duodenum Or
the pancreas against the vertebral column.

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Mechanisms of injury
Forces applied to solid organ can rupture a
surrounding capsule & injury the
parenchyma as well.
Structures attached by ligaments or blood
vessels may be stressed at their attachment
points
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Mechanisms of injury
Belts if improperly positioned cause
deceleration injuries to the lower abdomen ,
Frontal impact crashes with a bent steering
wheel associated with spleen & liver injuries as
well as head &chest trauma.
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PATHOPHYSIOLOGY
Blood loss: (mesenteric attachments of the
intestines ) semi fixed by ligaments, stressed,
tears , bleeding.
Liver & spleen ( rich blood supply) &
capsulated , compression, rupture, hemorrhage.
Pain: rigidity, spasm, rebound tenderness
Irritants(blood or gastric contents or enzymes)
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Pancreatic & duodenal injury: diffuse
abdominal, tenderness and pain radiating from
epigastric to the back.

Splenic injury: referred shoulder pain (Kehr`s
sign) . Because of: stress, blood in the abdominal
cavity and direct bowel injury



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Spleen injury is usually associated with blunt
trauma. Fractures of ribs 10 to 12 on the left
should raise your suspicion of spleen damage,
which ranges from laceration of the capsule or
a nonexpanding hematoma to ruptured
subcapsular hematomas or parenchymal
laceration.

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Spleen injury
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CT scan showing the Spleen
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Liver injury is common because of the
livers size and location.
Severity ranges from a controlled
subcapsular hematoma and lacerations of the
parenchyma to hepatic avulsion or a severe
injury of the hepatic veins. ( (

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Because liver tissue is very friable and the
livers blood supply and storage capacity are
extensive, a patient with liver injuries can
hemorrhage profusely and may need surgery
to control the bleeding.
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Liver injury
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LIVER INJURY
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PANCERAS INJURY
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The most common kidney injury is a
contusion from blunt trauma; suspect this
type of injury if your patient has fractures of
the posterior ribs or lumbar vertebrae.

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KIDNEY & BLADDER
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Other renal injuries include lacerations
or contusion of the renal
parenchyma caused by shearing
and compression forces; the deeper
a laceration, the more serious the bleeding.

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Deceleration forces may damage the renal
artery; collateral circulation in that area is
limited, so any ischemia is serious and may
trigger acute tubular necrosis.

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Hollow organ injuries, which can occur with
blunt or penetrating trauma, most commonly
involve the small bowel. Deceleration
with shearing may tear the small bowel,
generally in relatively fixed or looped areas

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Blunt forces cause most bladder injuries. The
bladder rises into the abdominal cavity when
full, so its more susceptible to injury. If a
distended bladder ruptures or is perforated,
urine is likely to escape into the abdomen.

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If the bladder isnt full when ruptured, urine
may leak into the surrounding pelvic
tissues, vulva, or scrotum.

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Genitourinary tract - Perinephric hematomas
should be entered only after vascular control
has been obtained. Repair of many renal
injuries (including partial nephrectomy) is
now possible. When nephrectomy is
required, it is reassuring to know that the
contra lateral kidney is functioning.
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DIAPHRAGM
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Diaphragmatic injuries are notoriously
difficult to diagnose. Small diaphragmatic
injuries on the right side may heal without
incident, and the liver protects against
potential hernias. Small injuries on the left
side may result in symptomatic diaphragmatic
hernias. Acute diaphragmatic defects are best
approached through the diaphragm.
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Colon/Rectum - In contrast to military
teaching, an increasing number of surgeons
utilize primary repair for simple colon
injuries without associated shock or
significant fecal soilage. Even a small
missed colon injury may be lethal
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NURSING CARE
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As always, your primary priorities are to
maintain the patients airway, breathing, and
circulation. Next, perform a rapid neurologic
examination and assess him head to toe
to identify obvious injuries and signs of
prolonged exposure to heat or cold.

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Ask the patient (or his family, emergency
personnel, or bystanders) about his history
allergies, medications, preexisting medical
conditions, when he last ate, and events
immediately preceding or related to his
injury.

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If your patient sustained blunt trauma, as in a
motor vehicle crash (MVC), keep his neck
and spine immobilized until X-rays rule out a
spinal injury. If his viscera are protruding,
cover them with a sterile dressing moistened
with 0.9% sodium chloride solution to prevent
drying.

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The following interventions
are routine for a patient
with abdominal trauma:

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Insert two large-bore intravenous
(I.V.) lines to infuse 0.9% sodium
chloride or lactated Ringers solution,
according to facility protocol.


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Control the patients pain without sedating
him, so you can continue to assess his
injuries and ask him questions. Generally,
I.V. analgesics such as morphine can
adequately manage pain without sedation.
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Insert an indwelling urinary catheter, unless
you suspect a urinary tract injury. For
example, bloody urine or a prostate gland
found to be in a high position during
a rectal exam could indicate damage to the
urinary tract
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If the patient is to have a rectal
examination, delay catheter insertion until
afterward

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Draw blood specimens stat for baseline
lab values.

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Insert a gastric tube to decompress the
patients stomach, prevent aspiration, and
minimize leakage of gastric contents and
contamination of the abdominal cavity. This
also gives you access to gastric contents to
test for blood

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Administer tetanus prophylaxis and
antibiotics as ordered.

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The FAST option Focused abdominal
sonography for trauma (FAST) offers 98% to
100% specificity in blunt abdominal trauma,
and is accurate 98% of the time. FAST is
especially helpful for pregnant patients or those
bleeding from multiple injuries.
Its also useful in identifying pericardial
fluid in penetrating trauma.

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FAST can demonstrate the presence
or absence of pericardial fluid, abdominal
fluid, and some parenchymal injuries via a 2-
to 3-minute exam. A hand-held transducer is
positioned on four key areas to evaluate
fluid collection.

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Unstable patients with penetrating
abdominal trauma, such as gunshot
wounds, stab wounds, or other
impalements, usually proceed directly
to the operating department without
DPL or FAST.

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Thanks for good
listening