Chapter 31: Abdominal and Genitourinary Injuries

Overview

• Focuses on managing patients with abdominal and genitourinary injuries.
• Emphasizes recognizing life-threatening conditions and the need for immediate intervention.
• Discusses anatomy, physiology, pathophysiology, complications, assessment, and management.
• Covers specific injuries such as blunt vs. penetrating trauma, eviscerations, impaled objects, and more.

Anatomy and Physiology

• Abdomen: Extends from diaphragm to pelvis, contains organs for digestion, urinary, and genitourinary systems.
• Quadrants: Divided into four quadrants, location of pain can indicate involved organs.
• Hollow Organs: Stomach, intestines, ureter, bladder. Rupture can cause peritonitis.
• Solid Organs: Liver, spleen, pancreas, kidneys. Rich blood supply; hemorrhage can be severe.
• Retroperitoneal Space: Includes kidneys, ureters, bladder.

Types of Abdominal Injuries

• Closed Injuries: Due to blunt trauma, may take time to become visible.
  • Examples: Car crashes, falls, rapid deceleration.
• Open Injuries: Foreign object enters abdomen; maintain suspicion for unseen injuries.
  • Velocity Categories: Low, medium, high (e.g., knives, handguns, rifles).
• Evisceration: Bowel protrudes from peritoneum.

Injury Specifics

• Hollow Organ Injuries: Result from blunt/penetrating trauma; can cause infection and septic shock.
• Solid Organ Injuries: Can bleed significantly, with less pain initially.
• Diaphragm Injuries: Bowels may herniate into thoracic cavity.
• Kidney Injuries: Can cause blood loss, hematuria.

Patient Assessment

1. Scene Size-up: Ensure scene safety, call for resources, consider spinal precautions.
2. Primary Assessment: Address hemorrhage before airway/breathing.
3. History Taking: Use SAMPLE history, check for nausea, vomiting, referred pain, etc.
4. Secondary Assessment: May not always be possible, focus on exposed body regions.
5. Vital Signs: Record early and repeat frequently in suspected serious injury cases.

Emergency Care

• Closed Injuries: Monitor for shock, provide oxygen, keep patient warm.
• Open Injuries: Clean, stabilize any impaled objects, apply sterile dressings.
• Evisceration: Use saline-moistened dressings, do not replace organs.

Genitourinary System

• Anatomy: Controls reproductive functions and waste discharge.
  • Male organs mostly external (except prostate, seminal vesicles).
  • Female organs mostly internal (except vulva, clitoris, labia).
• Injuries: Can include kidney damage, bladder rupture, genitalia injuries.

Specific Injury Care

• Kidneys: Treat for shock, monitor vital signs, transport promptly.
• Urinary Bladder: Look for blood in urinary tract, transport if shocked.
• Male Genitalia: Treat with moist compresses, stabilize any impaled objects.
• Female Genitalia: Use moist sterile compresses, ensure privacy and support.

Sexual Assault Care

• Maintain professionalism, provide privacy, prevent loss of evidence.
• Encourage victim not to wash or change before examination.
• Document and report all details accurately.

Review Questions

• Covered various questions on peritonitis, organ injuries, and treatment procedures.
• Emphasized understanding of injury mechanisms and appropriate emergency responses.

Conclusion

• Summarized the chapter and encouraged further review of key topics and procedures.