Chapter 30 Abdomen and Genitalia Injuries Abdominal Injuries labdomen is major body cavity extending from to pelvis. lcontains organs that make up

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1 Chapter 30 Abdomen and Genitaia Injuries Abdomina Injuries Abdomen is major body cavity extending from to pevis. Contains organs that make up digestive, urinary, and genitourinary systems. Significant trauma to the abdomen can occur from bunt trauma, penetrating trauma, or both. Injuries to the abdomen that go unrecognized or are not repaired in surgery are a eading cause of traumatic death. Abdomina Quadrants Right upper quadrant (RUQ) Liver,, duodenum, pancreas Left upper quadrant (LUQ) Stomach and speen Left ower quadrant (LLQ) Descending coon, eft haf of transverse coon Right ower quadrant (RLQ) Large and sma intestine, the Abdomina Quadrants Hoow Organs in the Abdomina Cavity Structures through which materias pass, intestines, ureters, badder Most contain digested food, urine, or bie Peritonitis Infammation of the ining of the abdomen Caused by hoow organs spiing content into the peritonea cavity Can ead to a etha infection 1

2 Can ead to a etha infection S/S of Peritonitis Abdomina pain Tenderness Musce spasm Diminished bowe sounds Nausea/vomiting Soid Organs in the Abdomina Cavity Soid masses of tissue Perform chemica work of the body: enzyme production, bood ceansing, energy production Because of rich bood suppy, can be severe. Liver The iver is the organ in abdomen. Vascuar, can ead to hypoperfusion Often injured by fractured ower right rib or penetrating trauma Speen and Pancreas and prone to heavy beeding Speen is often injured. Motor vehice coisions Steering whee trauma Fas from heights Bicyce and motorcyce accidents invoving handebars Kidneys and Diaphragm Kidneys Can cause significant bood oss Common finding is bood in (hematuria). 2

3 Common finding is bood in (hematuria). Diaphragm When penetrated or ruptured, oops of invade thoracic cavity. May cause bowe sounds during auscutation of ungs May have dyspnea Injuries of the Abdomen Cosed injury Severe bows that damage the abdomen without breaking the skin Open injury Foreign body enters the abdomen and opens the cavity to the outside Signs and Symptoms of Abdomina Injury Pain Tachycardia Decreased bood pressure Pae, coo, moist skin A firm abdomen on papation Bruising Evauating Abdomina Injuries Determine the type of injury, extent of damage, and presence of shock. Keep airway cear and watch for vomiting. Pace the patient supine with knees bent. Obtain baseine vitas. Foow. Inspect abdomen for wounds. Immobiize any impaed objects. Bunt Abdomina Wounds Severe bruises of the abdomina wa of the iver and speen Rupture of the intestine Tears in the mesentery Rupture or tearing of the kidneys 3

4 Tears in the mesentery Rupture or tearing of the kidneys Rupture of the badder Severe intra-abdomina hemorrhage Peritonea irritation and infammation Care of Bunt Abdomina Wounds Pace patient on backboard. Protect airway. Monitor vita signs. Administer oxygen. Treat for. Provide prompt transport. Seat Bets and Airbags Prevent many injuries and save ives If used inappropriatey, seat bets may cause injuries. Fronta airbags provide protection ony during head-on coisions. Airbags must be used in with seatbets Seat Bet Positions The proper position of a seat bet is beow the anterior superior iiac spines and against the hip joints (C). A and B show incorrect positions. Care for Penetrating Injuries Inspect patient s back and sides for exit wounds. Appy a dry, sterie dressing to a open wounds. If the penetrating object is sti in pace, appy a bandage around it to contro beeding and minimize movement. Open Abdomina Injuries (1 of 2) Damage depends on veocity of object. Low-veocity injuries Knives, other edged weapons Medium-veocity injuries Smaer caiber and shotguns High-veocity injuries High-powered rifes and handguns Open Abdomina Injuries (2 of 2) High- and medium-veocity injuries 4

5 High- and medium-veocity injuries Have temporary wound channes Caused by Low-veocity injuries Interna injury may not be apparent. Injury at or beow xiphoid process may affect thoracic and peritonea cavities. Abdomina Evisceration (1 of 2) Interna organs or fat protrude through the open wound. Never organs. Cover the organs with a moist gauze, then secure with a dressing. Organs must be kept warm and moist. Transport prompty. Abdomina Evisceration (2 of 2) Can be painfu and visuay shocking Do not down on abdomen. Ony perform visua assessment. Cut cothing cose to wound. Never pu on cothing stuck to or in the wound channe. Treatment for Evisceration Genitourinary System Contros reproductive functions and waste discharge Generay considered together Mae genitaia ie outside pevic cavity. Except gand and semina vesices Femae genitaia ie within pevic cavity. Except vuva, citoris, abia Anatomy of the Genitourinary System Femae Reproductive System Mae Reproductive System 5

6 Mae Reproductive System Injuries to the Kidneys (1 of 2) Suspect kidney damage if patient has a history or physica evidence of: Abrasion, aceration, or contusion in A penetrating wound in the region of the ower rib cage or upper abdomen Fractures on either side of the ower rib cage or of the ower thoracic or umbar vertebrae A hematoma in the fank region Injuries to the Kidneys (2 of 2) Kidney injuries may resut from a direct bow, such as in a tacke in footba. Injury of the Urinary Badder (1 of 2) Either a bunt or penetrating injury can rupture the badder. Urine wi spi into the surrounding tissues. Suspect if you see bood at the opening or physica signs of trauma on the ower abdomen, pevis, or perineum. Monitor vitas signs. The presence of associated injuries or shock wi dictate the urgency of transport. Injury of the Urinary Badder (2 of 2) Fracture of the pevis can resut in a aceration of the badder. Care for Injury to the Externa Mae Genitaia (1 of 3) These injuries are very but rarey are ife threatening. Shoud never take priority over more severe injuries Make the patient comfortabe. Use sterie moist compresses to cover areas stripped of skin. Care for Injury to the Externa Mae Genitaia (2 of 3) Appy direct pressure to contro beeding. Never manipuate any impaed objects or objects incarcerating the penis. 6

7 Never manipuate any impaed objects or objects incarcerating the penis. Identify and bring parts to the hospita. Be professiona. Care for Injury to the Externa Mae Genitaia (3 of 3) Zipper Trauma If ony 1 or 2 teeth caught, cut zipper ends and pu apart If more than 2 teeth caught, cut out zipper and eave on the patient Bunt Trauma Causes sweing, appy ice Can cause rupture of testice and bood in scrotum Care for Injuries of the Femae Genitaia (2 of 3) Femae interna genitaia is we protected and usuay not injured. The exception is the pregnant which is vunerabe to both bunt and penetrating injuries. Keep in mind that the unborn chid is aso at risk. Expect to see signs and symptoms of shock. Provide a necessary support. Transport prompty. Care for Injuries of the Femae Genitaia (3 of 3) Injuries to the externa genitaia are very painfu but not ife threatening. Treat acerations, abrasions, and avusions with moist, sterie compresses. Use oca pressure and a bandage to hod the dressing in pace. Care for Injuries of the Femae Genitaia (3 of 3) The urgency of transport wi be determined by the associated injuries, amount of, and the presence of shock. Do not put dressings in the vagina. 7

8 39 40 shock. Do not put dressings in the vagina. Comfort patient and transport Leave any foreign bodies in pace after stabiizing with bandages. Recta Beeding Common compaint Bood may appear in undergarments or may be passed during a bowe movement. Can be caused by sexua assaut,, coitis, or ucers of the digestive tract Acute beeding shoud never be passed off as something minor. Pack the crease between the buttocks with compresses and consut with medica contro. Sexua Assaut Do not examine genitaia uness there is obvious beeding. The patient shoud not wash the area, douche, defecate, eat, or drink unti examined. Offer to ca the oca rape crisis center. Document carefuy and preserve evidence. Use same EMT if possibe 8

Muscle spasm Diminished bowel sounds Nausea/vomiting

Muscle spasm Diminished bowel sounds Nausea/vomiting 3 4 5 6 7 8 9 0 Chapter 8: Abdomen and Genitalia Injuries Abdominal Injuries Abdomen is major body cavity extending from to pelvis. Contains organs that make up digestive, urinary, and genitourinary systems.