Critical to identify but easily missed, traumatic abdominal injuries present some of the most confounding cases that EMS providers can encounter. Using “real-life” case studies this presentation discusses the sequelae of blunt and penetrating trauma and gives you the tools to help identify abdominal trauma based on either presentation or mechanism of injury so that you can prioritize life saving interventions in multi-system trauma. More at www.romduck.com and www.RescueDigest.com

7. • Difficult Assessment
• Confounding Factors
• Distracting Injuries
• Delayed Reactions
• Satisficing

8. • Improve our sensitivity and specificity for
critical abdominal traumatic injury.
• Improve our care during patient contact.
• Improve our coordination with in-hospital
trauma teams.

12. – Scalp
- Chest
- Abdomen
- Long Bones
– Pelvis
- External
– Retroperitoneal

13. • Hollow organs
– Loss of function
– Leaking fluids cause septicemia
– Delayed signs and symptoms

14. • Solid organs
– Loss of function
– Bleeding
– Shock

15. • MOI as a predictor of outcome
• MOI in your own Trauma System & Protocols
• MOI as a Clue

17. • Penetrating Trauma
• Work accidents, MVAs and impaled objects.
• Stab wounds occur three times as often as GSWs
• Lower mortality.
• Gunshot wounds have greater kinetic energy
• Fragmentation and cavitation.
• Most commonly injured organ: Penetrating?
17

19. • Blunt Trauma
• Different energy forces can cause blunt injuries.
• Deceleration
• Crushing
• Compression
• Most commonly injured organ in blunt trauma?

21. Laparoscopy CT Scan
Ultrasound
Diagnostic
Peritoneal
Lavage

22. Physical VS /
Exam Secondary
Patient
History
Mechanism of
Injury

23. • Scene Safety
• Cause and Effect
– Location
– Injury
– Further Assessment

24. irway
– Ensure airway is clear and patent.
– Consider spinal injury.
reathing
– A painful or distended abdomen may prevent adequate inhalation.
irculation
– Superficial abdominal injuries usually do not produce significant
external bleeding.
– Internal bleeding can be profound.

25. isability
xpose and Examine
– Not Patty-Cake
ind the Bleeding
– DCAP-BTLS 4 Quads / 6 Sides
– Tenderness / Guarding
– Shock > obvious cause
– Kehr’s Sign
– Cullen’s & Grey-Turner’s signs
– Findings lead to questions!

26. • SAMPLE: Rapidly identify comorbid &
complicating factors.
• OPQRST: Codify & clarify signs and sx.

27. • Vital Signs
– Observe for trends.
• Detailed Physical Exam
– Expose and Examine
– Patient should remain in position of comfort.

28. • Awesome Abdominal Assessment!
• Expedient Transport and Pre-Notification.
• Position for comfort.
• Don’t pop the clot.
• Anticipate shock.
• Treat Sx.
• Ongoing Assessment.
• Continuum of Care!

29. • Penetrating injuries
– External bleeding.
– High index of suspicion for unseen blood loss.
– Find and stop bleeding.
– Apply dry, sterile dressing to open wounds.
– If penetrating object is still in place, apply stabilizing
bandage around it.

30. • Eviscerations
– Keep organs moist and warm.
– Cover with moistened, sterile gauze / occlusive dressing.
– Secure dressing with bandage.
– Do not replace organs.

31. • ALS Care
– Fluid Resuscitation
• IV Solution per protocol
• Maintain SBP approx. 90-100 mm/Hg
– NG / OG Tubes
• Protects stomach and intestines by emptying contents
• Allows evaluation of blood and materials in the GI tract.

32. • ALS Care cont’d
– Pain Management
– Anti-emetics
– Anxiolytics
– Other care as necessary

33. • Local Hospital
• Trauma Center
• Transport
Method

35. • Difficult Assessment
• Confounding Factors
• Distracting Injuries
• Delayed Reactions
• Satisficing

36. • Improve our sensitivity and specificity for
critical abdominal traumatic injury.
• Improve our care during patient contact.
• Improve our coordination with in-hospital
trauma teams.

37. Collect
Call
Care
Collaborate / Continuum