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?