Overview
This lecture covers assessment and management of abdominal injuries in trauma patients, including anatomy, types of injuries, key assessment findings, diagnostics, and initial interventions.
Abdominal Quadrants and Common Injuries
- The abdomen is divided into four quadrants for injury assessment.
- Left upper quadrant injuries commonly involve the spleen (penetrating/blunt) and stomach (blast).
- Right upper quadrant injuries affect the liver (lacerations), gallbladder, and duodenum (blast rupture).
- Left lower quadrant injuries often affect the colon and arteries (penetrating), or any organ (blunt/blast).
- Right lower quadrant injuries impact arteries, intestines, appendix, bladder, and pelvis.
Types of Abdominal Injuries
- Penetrating injuries are usually from gunshot or stab wounds; do not remove impaled objects.
- Hollow organ injuries include the small bowel; solid organs like the liver are most frequently injured.
- Blunt injuries result from MVAs, falls, explosions, and involve more internal, difficult-to-detect bleeding.
Assessment and Diagnostics
- Perform a full abdominal and hemodynamic assessment including vitals.
- Watch for peritoneal irritation: absent bowel sounds, distension, guarding, tenderness, pain, and rigidity.
- Shock signs include hypotension, tachycardia, hypoxemia, and the feeling of impending doom.
- Labs: CBC (hemoglobin, hematocrit, WBC), lactate, ABGs, and INR for clotting.
- Referred pain: Left shoulder (Kehr's sign) = spleen rupture; right shoulder = liver laceration.
- Imaging: CT scan, FAST exam, X-ray, and assess all quadrants, including back and flanks.
Signs of Internal Bleeding
- Cullen's sign: bruising around the belly button.
- Grey Turner's sign: bruising at the hips/flanks.
- Additional findings: tenderness, rebound, rigidity, increased distension, asymmetry, contusions.
Emergency Management
- Follow ABCs and address internal/external hemorrhage; prevent the "triad of death."
- Blood transfusions and emergency surgery may be needed.
- For blunt trauma, immobilize spine until spinal injury is excluded.
- For protruding viscera, cover with moist sterile saline dressing; do not remove objects.
- Administer tetanus boosters and prophylactic antibiotics.
Pelvic and Genitourinary Trauma
- Pelvic injury signs: instability, limb shortening/external rotation, crepitus.
- Genitourinary signs: hematuria, scrotal/perineal ecchymosis, inability to urinate.
- Apply pelvic binder for unstable patients.
- Do not insert Foley catheter if blood at meatus or ecchymosis; wait for imaging.
- Prepare for surgery and assess distal pulses.
- Stool occult blood test may be required.
Key Terms & Definitions
- Kehr's Sign — Referred left shoulder pain from splenic hemorrhage.
- Cullen's Sign — Periumbilical bruising indicating internal bleeding.
- Grey Turner's Sign — Flank bruising from retroperitoneal bleeding.
- FAST Exam — Bedside ultrasound to detect internal bleeding.
Action Items / Next Steps
- Review abdominal quadrant anatomy and associated organ injuries.
- Learn signs and symptoms of shock and internal bleeding.
- Practice abdominal trauma assessment and emergency interventions.