Chapter 31: Abdominal and Genitourinary Injuries

Key Learning Objectives

• Understanding management of abdominal and genitourinary trauma.
• Recognizing life threats and immediate interventions needed.
• Detailed anatomy, physiology, and pathophysiology of injuries.
• Assessment and management based on primary and secondary models.
• Discussion of specific injuries including blunt vs. penetrating, eviscerations, impaled objects, etc.
• Overview of emergency care skills.

Anatomy and Physiology of the Abdomen

• Abdominal Quadrants: Four quadrants help identify organ involvement based on bruise/pain locations.

  • Right Lower Quadrant: Common for swelling/inflammation (appendix).

• Hollow Organs: Stomach, intestines, ureters, bladder. Rupture can cause peritonitis.

  • Signs: Severe pain, tenderness, muscle spasms.

• Solid Organs: Liver, spleen, pancreas, kidneys.

  • Functions: Enzyme production, blood cleansing, endocrine function, energy production.
  • Retroperitoneal space: Includes kidneys, ureters, urinary bladder, majority of pancreas.

Types of Abdominal Injuries

• Closed Injuries: Generally from blunt trauma (e.g., crashes, falls).

  • Seatbelt/airbag injuries can cause significant internal injury.

• Open Injuries: Foreign objects penetrate the abdomen, opening the peritoneal cavity.

  • Velocity injuries: Low (knives), Medium (handguns), High (rifles).
  • Cavitation from projectiles causes tissue damage.

• Evisceration: Bowel protrusion from peritoneum, requires careful handling.

Assessment of Abdominal Injuries

• Scene Size-Up: Ensure scene safety and call for resources.
• Primary Assessment: Address external hemorrhage, airway, breathing, circulation.
• History Taking: SAMPLE history, inquire about nausea, vomiting, diarrhea, etc.
• Secondary Assessment: Inspect exposed body regions, palpate abdomen cautiously.
• Vital Signs: Monitor regularly; hypotension is a late shock sign.

Emergency Care for Abdominal Injuries

• Closed Injuries: Monitor for shock, provide oxygen, keep patient warm.
• Open Injuries: Inspect for exit wounds, apply sterile dressing, stabilize impaled objects.

Genitourinary System Overview

• Controls reproductive functions and waste discharge.
• Organs: Kidneys (solid), ureters, bladder, urethra (hollow).

Injuries Specific to the Genitourinary System

• Kidney Injuries: Often involve blunt/penetrating trauma. Signs include flank abrasions or bruising.
• Bladder Injuries: Can rupture from blunt trauma, particularly when full.
• External Genitalia Injuries: Painful but rarely life-threatening.
• Female Genitalia: Protection during pregnancy is crucial; internal organs are usually protected.

Patient Assessment for Genitourinary Injuries

• Maintain professionalism and provide privacy.
• Primary Assessment: Rapid scan, check for significant bleeding.
• History Taking: Investigate chief complaints, ask about urinary output.

Emergency Care for Specific Injuries

• Kidney: Treat for shock, monitor vital signs.
• Bladder: Address trauma symptoms, transport promptly.
• Male Genitalia: Use sterile compresses for injuries, handle evolved parts carefully.
• Female Genitalia: Use moist sterile dressings, avoid internal examination.

Sexual Assault Considerations

• Provide compassionate care and transport.
• Encourage preservation of evidence.
• Ensure EMT of same gender if possible.

Review Questions

• Peritonitis results from hollow organ spill.
• Liver most likely to bleed profusely if injured.
• Intra-abdominal bleeding common post-blunt trauma.
• Properly worn seatbelt injuries target iliac crest.
• Deformed steering wheel suggests abdominal injury.

Conclusion: This chapter emphasizes thorough assessment, cautious handling of injuries, and consideration of patient privacy and dignity. Understanding the anatomy and mechanisms of injury is crucial for effective emergency care.