ABDOMINAL ABDOMINAL TRAUMATRAUMA

RIFLES LIFESAVERSRIFLES LIFESAVERS

Abdominal Trauma: Abdominal Trauma: The KEY to Saving The KEY to Saving

LivesLives The abdomen is the “Black Box”The abdomen is the “Black Box”

– I.e., it is impossible to know I.e., it is impossible to know what specific injuries have what specific injuries have occurred at initial evaluationoccurred at initial evaluation

The key to saving lives in The key to saving lives in abdominal trauma is NOT to make abdominal trauma is NOT to make an accurate diagnosis, but rather an accurate diagnosis, but rather to recognize that there is an to recognize that there is an abdominal injuryabdominal injury

Examples of Examples of Abdominal InjuriesAbdominal Injuries

Blunt TraumaBlunt Trauma– Aortic ruptureAortic rupture– Splenic ruptureSplenic rupture– Liver rupture or Liver rupture or

lacerationlaceration– Diaphragmatic tearDiaphragmatic tear– Pelvic fracturePelvic fracture– Intestinal tearIntestinal tear– Bladder ruptureBladder rupture

Penetrating TraumaPenetrating Trauma– Laceration of Laceration of

blood vesselsblood vessels– Splenic ruptureSplenic rupture– Liver rupture or Liver rupture or

lacerationlaceration– Kidney lacerationKidney laceration– Intestinal Intestinal

lacerationslacerations– Bladder ruptureBladder rupture

Causes of Abdominal Causes of Abdominal InjuriesInjuries BLUNT

TRAUMA– Motor vehicle

accidents– Auto vs.

pedestrian– Falls– Blast injuries

PENETRATING TRAUMA– Gunshot Gunshot

woundswounds– Stab woundsStab wounds– Shrapnel Shrapnel

woundswounds– ImpalementsImpalements

Signs and Symptoms Signs and Symptoms of Abdominal Injuriesof Abdominal Injuries

Blunt TraumaBlunt Trauma– Significant Significant

mechanismmechanism– Abdominal painAbdominal pain– DistensionDistension– Discoloration of Discoloration of

abdomen or flankabdomen or flank– Unexplained shockUnexplained shock

Penetrating traumaPenetrating trauma– Visible truncal Visible truncal

injury including injury including chest or abdomenchest or abdomen

– Abdominal painAbdominal pain– BleedingBleeding– Impaled objectImpaled object– EviscerationEvisceration– ShockShock

Blunt Abdominal Blunt Abdominal TraumaTrauma

Flank ecchymosis from internal bleeding

Blunt Abdominal Blunt Abdominal TraumaTrauma

Compressive or Compressive or shearing forces may shearing forces may deform and rupture deform and rupture abdominal organsabdominal organs

Bruising across the Bruising across the lower abdomen is lower abdomen is characteristic of a characteristic of a seat belt injuryseat belt injury

Visible signs may Visible signs may not reflect severity not reflect severity of underlying injuryof underlying injury The Seat Belt Sign

Penetrating Abdominal Penetrating Abdominal TraumaTrauma

Visible wounds may Visible wounds may not reflect severity not reflect severity of underlying injuryof underlying injury

Significant internal Significant internal bleeding likelybleeding likely

Bowel injury likelyBowel injury likely Patient may be in Patient may be in

shockshock

Abdominal Injuries: Abdominal Injuries: CARE UNDER FIRECARE UNDER FIRE

Casualty and RLS/medic return fireCasualty and RLS/medic return fire– ““““The best medicine on any battlefield is The best medicine on any battlefield is

fire superiority”fire superiority” Apply tourniquet to severely bleeding Apply tourniquet to severely bleeding

extremitiesextremities Wounded soldiers who are unable to Wounded soldiers who are unable to

fight should lay flat and motionless if fight should lay flat and motionless if no cover is available or move as quickly no cover is available or move as quickly as possible to any nearby coveras possible to any nearby cover

Abdominal Injuries: Abdominal Injuries: TACTICAL FIELD CARETACTICAL FIELD CARE Remember the ABCsRemember the ABCs Position casualty on back with Position casualty on back with

flexed kneesflexed knees Expose the woundExpose the wound Stabilize any protruding objectsStabilize any protruding objects Cover protruding abdominal organs Cover protruding abdominal organs

with moist gauze or clothwith moist gauze or cloth Prepare to evacuate to surgical Prepare to evacuate to surgical

assetsassets– 9-line MEDEVAC9-line MEDEVAC

Evaluation and Evaluation and ExaminationExamination

Visually note wounds and Visually note wounds and abrasionsabrasions

Palpate abdomen for Palpate abdomen for localized vs. diffuse localized vs. diffuse tendernesstenderness

Consider possible internal Consider possible internal injuriesinjuries

Diffuse, severe tenderness Diffuse, severe tenderness is a sign of internal is a sign of internal bleedingbleeding

Don’t forget the backDon’t forget the back Turn the casualty over Turn the casualty over

when you can do so when you can do so safelysafely

Visually inspect backVisually inspect back Palpate ribs, spine, Palpate ribs, spine,

sacrum for tenderness sacrum for tenderness and irregularities and irregularities

Dress the wound with Dress the wound with an occlusive dressingan occlusive dressing

Don’t count on a Don’t count on a “down-side sweep” to “down-side sweep” to discover injuries this discover injuries this sizesize

Impalement Impalement InjuryInjury

Impalement InjuriesImpalement Injuries

DO NOT REMOVE DO NOT REMOVE OBJECT OR EXERT OBJECT OR EXERT ANY FORCE UPON IT!ANY FORCE UPON IT!– Severe bleeding may Severe bleeding may

occur causing shockoccur causing shock Check pulses distal to Check pulses distal to

impaled objectimpaled object Immobilize the objectImmobilize the object Apply bulky support Apply bulky support

bandages to hold in bandages to hold in placeplace

Impalement Injuries: Impalement Injuries: How to make a SAM How to make a SAM SplintSplint

Make a box shape large Make a box shape large enough to surround the enough to surround the object and dressingsobject and dressings

Cut V notches into box Cut V notches into box toptop

Place box over object and Place box over object and dressings and tape in dressings and tape in placeplace

Tie cravats or ACE Wraps Tie cravats or ACE Wraps around torso for stability, around torso for stability, using V notches in box to using V notches in box to ensure stabilityensure stability

EviscerationEvisceration

Extrusion of abdominal contents secondary to penetrating abdominal

trauma

Management of Management of Evisceration InjuriesEvisceration Injuries Use sterile side of dressing to place Use sterile side of dressing to place

protruding organs near the wound protruding organs near the wound (NOT into wound)(NOT into wound)

Cover organs and wound completely Cover organs and wound completely with sterile or clean moist dressingwith sterile or clean moist dressing

DO NOT APPLY PRESSURE TO WOUND DO NOT APPLY PRESSURE TO WOUND or expose internal partsor expose internal parts

Tie dressing tails loosely around Tie dressing tails loosely around woundwound

Prepare evacuation to surgical assetsPrepare evacuation to surgical assets

QUESTIONS?QUESTIONS?