5607TNCC-Abdominal trauma.ppt

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ABDOMINAL

TRAUMA

Prepared bySamah shtieh

MSN. Mangement

17\3\2011

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OBJECTIVES:

Identify the common mechanisms ofinjury associated with abdominal

trauma. Describe the pathophysiologic

changes as a basis for signs and

symptoms. Identify selected abdominal injuries

(S &S ).

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OBJECTIVES

Discuss the NURSING of patients

with abdominal trauma.

Identify appropriate nursingdiagnosis.

Plan appropriate interventions forpatients with abdominal trauma.

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INTRODUCTION

Abdominal injuries are common in patients who

sustain major trauma.

Unrecognized abdominal injuries are frequently

the cause of preventable death.

Approximately one-fifth of all traumatized pt

requiring operative intervention havesustained trauma to the abdomen.

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Abdominal trauma

Abdominal trauma is an injury to the

abdomen. It may be blunt or penetrating

and may involve damage to the abdominalorgans.

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http://en.wikipedia.org/wiki/Abdomenhttp://en.wikipedia.org/wiki/Blunt_traumahttp://en.wikipedia.org/wiki/Penetrating_traumahttp://en.wikipedia.org/wiki/Organ_(anatomy)http://en.wikipedia.org/wiki/Organ_(anatomy)http://en.wikipedia.org/wiki/Penetrating_traumahttp://en.wikipedia.org/wiki/Blunt_traumahttp://en.wikipedia.org/wiki/Abdomen


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TYPES OF INJURIES

Blunt abdominal trauma is a leading

cause of morbidity and mortality among all

age groups.Blunt trauma: liver spleen (most common).

Penetrating: liver, small bowel andstomach.

Penetrating: present with single or multiple

injuries

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http://emedicine.medscape.com/article/433404-overviewhttp://emedicine.medscape.com/article/433404-overviewhttp://emedicine.medscape.com/article/433404-overviewhttp://emedicine.medscape.com/article/433404-overviewhttp://emedicine.medscape.com/article/433404-overviewhttp://emedicine.medscape.com/article/433404-overview


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Penetrating abdominal trauma (PAT) is

usually diagnosed based on clinical signs,blunt abdominal trauma is more likely to be

missed because clinical signs are less

obvious.

Penetrating trauma is further subdivided

into stab wounds and bullet wounds, whichhave different treatments.

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http://en.wikipedia.org/wiki/Penetrating_traumahttp://en.wikipedia.org/wiki/Penetrating_traumahttp://en.wikipedia.org/wiki/Penetrating_traumahttp://en.wikipedia.org/wiki/Penetrating_traumahttp://en.wikipedia.org/wiki/Penetrating_traumahttp://en.wikipedia.org/wiki/Penetrating_trauma


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Multiple injuries, abdominal trauma can

lead to hemorrhage, hypovolemic shock, anddeath. Yet even a serious, life-threatening

abdominal injury may not cause obvious signs

and symptoms, especially in cases of blunttrauma.

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Key responses to decrease mortality and

morbidity include :

- aggressive resuscitation efforts,

- adequate volume replacement,

- early diagnosis of injuries, and- surgical intervention if warranted

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ORGANS

Solid Organs

LiverSpleen

Kidneys

Pancreas

Hollow Organs

StomachSmall bowel

Large bowel

Bladder

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Mechanisms of injury

Forces applied to solid organ can rupture asurrounding capsule & injury the

parenchyma as well. Structures attached by ligaments or blood

vessels may be stressed at their attachment

points

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Mechanisms of injury

Belts if improperly positioned cause

deceleration injuries to the lower abdomen ,

Frontal impact crashes with a bent steering

wheel associated with spleen & liver injuries as

well as head &chest trauma.

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PATHOPHYSIOLOGY

Blood loss: (mesenteric attachments of the

intestines ) semi fixed by ligaments, stressed,

tears , bleeding.

Liver & spleen ( rich blood supply) &

capsulated , compression, rupture, hemorrhage.

Pain: rigidity, spasm, rebound tendernessIrritants(blood or gastric contents or enzymes)

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Pancreatic & duodenal injury: diffuse

abdominal, tenderness and pain radiating from

epigastric to the back.

Splenic injury: referred shoulder pain (Kehr`s

sign) . Because of: stress, blood in the abdominal

cavity and direct bowel injury

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Spleen injury is usually associated with blunt

trauma. Fractures of ribs 10 to 12 on the left

should raise your suspicion of spleen damage,

which ranges from laceration of the capsule or

a nonexpanding hematoma to ruptured

subcapsular hematomas or parenchymallaceration.

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Spleen injury

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CT scan showing the Spleen

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Liver injury is common because of the

livers size and location.Severity ranges from a controlled

subcapsular hematoma and lacerations of the

parenchyma to hepatic avulsion or a severeinjury of the hepatic veins. ( )

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Because liver tissue is very friable and the

liversblood supply and storage capacity areextensive, a patient with liver injuries can

hemorrhage profusely and may need surgery

to control the bleeding.

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Liver injury

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LIVER INJURY

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PANCERAS INJURY

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The most common kidney injury is a

contusion from blunt trauma; suspect thistype of injury if your patient has fractures of

the posterior ribs or lumbar vertebrae.

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KIDNEY & BLADDER

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Other renal injuries include lacerations

or contusion of the renalparenchyma caused by shearing

and compression forces; the deeper

a laceration, the more serious the bleeding.

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Deceleration forces may damage the renal

artery; collateral circulation in that area islimited, so any ischemia is serious and may

trigger acute tubular necrosis.

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Hollow organ injuries, which can occur with

blunt or penetrating trauma, most commonlyinvolve the small bowel. Deceleration

with shearing may tear the small bowel,

generally in relatively fixed or looped areas

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Blunt forces cause most bladder injuries. Thebladder rises into the abdominal cavity when

full, so its more susceptible to injury. If a

distended bladder ruptures or is perforated,

urine is likely to escape into the abdomen.

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If the bladder isntfull when ruptured, urine

may leak into the surrounding pelvictissues, vulva, or scrotum.

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Genitourinary tract - Perinephric hematomas

should be entered only after vascular controlhas been obtained. Repair of many renal

injuries (including partial nephrectomy) is

now possible. When nephrectomy is

required, it is reassuring to know that the

contra lateral kidney is functioning.

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DIAPHRAGM

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Diaphragmatic injuries are notoriously

difficult to diagnose. Small diaphragmatic

injuries on the right side may heal withoutincident, and the liver protects against

potential hernias. Small injuries on the left

side may result in symptomatic diaphragmatichernias. Acute diaphragmatic defects are best

approached through the diaphragm.

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Colon/Rectum - In contrast to military

teaching, an increasing number of surgeonsutilize primary repair for simple colon

injuries without associated shock or

significant fecal soilage. Even a small

missed colon injury may be lethal

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NURSING CARE

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As always, your primary priorities are to

maintain thepatientsairway, breathing, andcirculation. Next, perform a rapid neurologic

examination and assess him head to toe

to identify obvious injuries and signs of

prolonged exposure to heat or cold.

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Ask the patient (or his family, emergency

personnel, or bystanders) about his historyallergies, medications, preexisting medical

conditions, when he last ate, and events

immediately preceding or related to his

injury.

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If your patient sustained blunt trauma, as in a

motor vehicle crash (MVC), keep his neck

and spine immobilized until X-rays rule out aspinal injury. If his viscera are protruding,

cover them with a sterile dressing moistened

with 0.9% sodium chloride solution to preventdrying.

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The following interventions

are routine for a patientwith abdominal trauma:

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Insert two large-bore intravenous

(I.V.) lines to infuse 0.9% sodium

chloride or lactated Ringers solution,according to facility protocol.

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Control thepatientspain without sedating

him, so you can continue to assess hisinjuries and ask him questions. Generally,

I.V. analgesics such as morphine can

adequately manage pain without sedation.

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Insert an indwelling urinary catheter, unless

you suspect a urinary tract injury. Forexample, bloody urine or a prostate gland

found to be in a high position during

a rectal exam could indicate damage to theurinary tract

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If the patient is to have a rectalexamination, delay catheter insertion until

afterward

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Draw blood specimens stat for baseline

lab values.

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Insert a gastric tube to decompress the

patients stomach, prevent aspiration, and

minimize leakage of gastric contents andcontamination of the abdominal cavity. This

also gives you access to gastric contents to

test for blood

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Administer tetanus prophylaxis and

antibiotics as ordered.

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The FAST option Focused abdominal

sonography for trauma (FAST) offers 98% to

100% specificity in blunt abdominal trauma,and is accurate 98% of the time. FAST is

especially helpful for pregnant patients or those

bleeding from multiple injuries.

Its also useful in identifying pericardial

fluid in penetrating trauma.

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FAST can demonstrate the presence

or absence of pericardial fluid, abdominalfluid, and some parenchymal injuries via a 2-

to 3-minute exam. A hand-held transducer is

positioned on four key areas to evaluatefluid collection.

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Unstable patients with penetrating

abdominal trauma, such as gunshotwounds, stab wounds, or other

impalements, usually proceed directly

to the operating department without

DPL or FAST.

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hanks for good

listening

Documents

5607TNCC-Abdominal trauma.ppt