Abdominal Trauma
ABDOMINAL TRAUMA
Blunt
- Compression or crush
- Seat belt
- Acceleration/deceleration
Penetrating
- Penetrating
- Gunshot wounds
- Stab wounds
Deep or fixed penetrating foreign bodies should be removed only under controlled conditions in theatre
- 20% of patients with acute traumatic hemoperitoneum have no initial signs of peritoneal irritation
- The importance of repeated abdominal examinations cannot be overstressed
- Intra-abdominal bleeding, gastrointestinal perforation may be present without external evidence
- Suspect intra-abdominal bleeding in multiple trauma, especially if there is unexplained hypotension
ABDOMINAL TRAUMA IN CHILDREN
- Blunt and penetrating injury to abdomen may injure a variety of organs
- Splenic injuries from blunt injury especially common
- Assume that penetrating wound to the abdominal wall has entered the abdominal cavity and that there are injuries to abdominal organs
ABDOMINAL TRAUMA: Pregnant Woman
- Risk of:
- Uterine irritability
- Premature labor
- Incomplete, complete uterine rupture
- Placental separation (may occur up to 48 hours after injury)
- If pelvic fracture present, severe blood loss potential
- Splenic injuries from blunt injury especially common
- Assume that penetrating wound to the abdominal wall has entered the abdominal cavity and that there are injuries to abdominal organs
- ABCDE
- Resuscitate in left lateral position to avoid aortocaval compression. Tilt the patient to the left.
- Vaginal examination with speculum for bleeding, cervical dilatation
- Record fundal height, note any tenderness
- Record, monitor fetal heart rate
- Consideration of pregnancy should always be given to any woman of childbearing age
- Pregnant patient at term can usually be effectively resuscitated only after delivery
- If mother and child are both critically ill, it is your clear duty to attend to the mother first
- Best treatment for the fetus is resuscitation of the mother