Overview
This lecture covers abdominal and genitourinary injuries, focusing on assessment, types of trauma, pathophysiology of organ injuries, and emergency management for both external and internal injuries.
Abdominal Anatomy and Organ Location
- Abdomen spans from the diaphragm to the pelvis and contains digestive, urinary, and genitourinary organs.
- Divided into four quadrants: RUQ (liver, gallbladder, duodenum, pancreas), LUQ (stomach, spleen), LLQ (descending/transverse colon), RLQ (intestines, appendix).
- Solid organs (liver, spleen, pancreas, kidneys) are highly vascular and prone to severe bleeding.
- Hollow organs (stomach, intestines, bladder) can spill contents into the peritoneal cavity if damaged, leading to peritonitis.
Mechanisms and Types of Injury
- Blunt trauma: vehicle collisions, falls, compression, blast injuries.
- Penetrating trauma: knives, bullets, arrows—damage varies by velocity.
- Evisceration: abdominal contents protrude through the wound—never push back in; keep moist and covered.
- Kidney injuries often present as blood in urine and flank trauma; bladder can rupture, especially with pelvic fractures.
Signs, Symptoms, and Assessment
- Blood in the peritoneal cavity causes widespread abdominal pain and distension.
- Seat belts, especially when worn improperly, can cause abdominal injuries.
- Hollow organ rupture may take hours/days to cause peritonitis; solid organ injury bleeds rapidly or slowly.
- Referred pain (e.g., liver injury may cause right shoulder pain).
- Assessment: Scene safety, mechanism of injury, ABCs, check for shock, palpate all quadrants, look for external/internal bleeding.
Emergency Management
- Closed injuries: treat for shock, oxygen if needed, rapid transport to trauma center.
- Open injuries: control external bleeding, do not remove impaled objects, cover eviscerations with moist sterile dressings (then occlusive), seek exit wounds.
- Reassess interventions and vitals, communicate findings to hospital staff.
Genitourinary System Injuries
- Kidneys: protected but can bleed internally from trauma; look for flank pain and hematuria.
- Bladder: may rupture with pelvic fracture; urine leakage may occur.
- Male genitalia: control bleeding with pressure, do not remove objects, preserve amputated parts for possible reattachment.
- Female genitalia: treat external bleeding with moist dressings, never pack the vagina, maintain privacy, and use same-gender EMT when possible.
Special Considerations: Sexual Assault
- Maintain patient privacy and dignity; same-gender provider preferred.
- Do not allow the patient to bathe, change clothes, or eat; preserve evidence.
- Provide supportive care and transport to a trauma center when necessary.
Key Terms & Definitions
- Peritonitis — inflammation of the peritoneal cavity due to spilled organ contents.
- Evisceration — protrusion of internal organs through an abdominal wound.
- Hematuria — blood in the urine.
- Solid organs — highly vascular organs (e.g., liver, spleen).
- Hollow organs — organs with empty cavities (e.g., stomach, intestines).
Action Items / Next Steps
- Review abdominal organ locations and associated injuries.
- Memorize management steps for evisceration and impaled objects.
- Complete assigned readings on abdominal trauma and genitourinary injuries.
- Practice physical assessment skills for abdominal and pelvic trauma scenarios.