abdominal damage

  1. Blunt force must be considered to have
    an abdomnial, visceral , vascula or pelvic damage until proven so otherwise.
  2. Anterior abdomen
    hollow visceral organs, costal margins to inguinal to symfysis to ant axillary
  3. thoraco abdomnial
    inferior to nipple line to superior costal margins. 

    diaphragm, stomach, liver spleen stomach
  4. flank
    inbetween axillary lines

    thick muscles
  5. back area
    post axillary to scapulae inf to iliac crests

    retroperitoneal organs (aorta, VC, duodenum, pancreas, kidneys, asc/desc colon, retroperitoneal components of pelvic cavity)

    OBS no peritonitis during damage! lavage and  FAST limited value
  6. pelvic cavity
    pelvic bounds surround the cavity

    rectum, reproducitve organs, bladder, iliac vessels

    OBS significant blood loss from organs or bones possible here!
  7. Blunt trauma - direct blow
    compression and crushing of vessels and hollow organs

    - secondary rupture, contamination, peritonitis, hemorraghe
  8. shearing injuries
    -fixed and nofixed decelration ( i e lacerations of liver and spleen, intesinte bucket handle ligaments)
  9. blunt trauma damaged organs
    spleen 40 - 55 %, live 35-45%, small bowel 5-10%
  10. Penetrating Trauma
    stab wounds ( liver, bowel, diaphragm colon

    gunshot (bowel, colon, liver, vessels)
  11. Ait bagdamage
    • corneal abrasions
    • face, neck and chest abrasions
    • cardiac rupture
    • cervical spine
    • thoracic spine fracture
  12. lap seat belt
    • tear or avulsion of mesentary (Bucket Handle)
    • rupture of small bowel and colon
    • thrombosis in aorta or iliac
    • lumbal vertebra chance fracture
    • pancreatic or duodenal damage
  13. shoulder harness
    (i e sliding under the seat belt, compression)
    • intimal tear or thrombosis in upper vessels
    • cervical spine damage
    • costa damage
    • pulmonary contusion
    • rupture of upper abdominal viscera
  14. Inspection
    • signs of damage or wounds
    • flank scrotum and perianal area (blood from uretal meatus) dan laceration/bruising of reprodcutive and buttocks (pelvic damage!)

    OBS warm blankets afterwards!
  15. Auscultation

    changes of abdomnial sounds are essential
  16. Percussion and Palaption
    peritoenal irriation

    superficial or deep tenderness


    high riding prostate gland (pelvic fracutre)
  17. pelvic stability
    OBS hypotension due to blood loss --> test only once and NOT if hypotension present)

    confirm with x ray

    • pelvic fracture signs:
    • -riding prostate, scrotal hematoma, urethral meatus blood
    • - limb length discrepancy
    • -rotational deformity
  18. urethral, perineal, PR
    • blood at meatus (suprapubic catheter)
    • scrotal hematoma
    • high riding prostate
    • sfincter tone
    • blood from bowel damage
  19. vaginal
    if injury suspected (gunshot, lacerations, pelvic fracture with penetration fragments)
  20. gluteal examination
    often associated with intraabdominal damage
  21. gastric tube
    pros: easier DPL, aspiration reduced, relieve acute dilatation, blood diagnostically

    cons: cause vomiting, facal damage/fractures oro tube instead of naso!
  22. urinary catheter
    pros: monitonr urinary output, decompress, eaiser DPL, heaturia diagnostics

    cons: if damage suspected suprapubical catheter or urethogram, absence of hematuria low diagnostic value
  23. additional studies
    FAST, DPL, CT, X-RAY, cystography, uretrography, iv pyelogram, GI contrast studies

    change of neurologics, lap belt sign, injury to adjacent bone structures, before long x rays

    NOT if laparatomy is necessary! No delay of definive care!!
  24. laparotomy with penetrating trauma need if:
    • hemodynamically unstable
    • gunshot with transperitoneal trajectory
    • signs of peritoneal irritation
    • sigs of fascia penetration
Card Set
abdominal damage
flash cards about ambodminal and pelvic trauma