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Abdominal trauma


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Abdominal trauma

  1. 1. ABDOMINAL TRAUMA PRESENTER- Ms. Anshu M.Sc Nursing 1st yr KGMU Institute of Nursing
  2. 2. INTRODUCTION- • Abdominal trauma is regularly encountered in the emergency department • One of the leading cause of death and disability.
  3. 3. • Identification of serious intra-abdominal injuries is often challenging. • Many injuries may not manifest during the initial assessment and treatment period.
  4. 4. EPIDEMIOLOGY- • Peak incidence abdominal trauma is in 15-30 yrs of age. Blunt abdominal trauma accounts for the 80% of abdominal injuries seen in emergency department and is responsible for substantial morbidity and mortality.
  5. 5. • 75% case of abdominal trauma are caused by motor vehicle accident. • 15% cases are caused by blows to abdomen. • 6-9% cases are caused due to fall.
  6. 6. ANATOMY OF ABDOMEN Abdomen consist of:- • Anterior abdomen • Flank • Posterior abdomen
  7. 7. CONTI….. • Abdomen divided into four quadrants by body mid-line, horizontal plane through umbilicus • Right upper quadrant • Left upper quadrant • Right lower quadrant • Left lower quadrant
  9. 9. Conti…. Organs can be classified as:- • Hollow • Solid • Major vascular
  10. 10. When solid organs are injured, they bleed heavily and cause shock.
  11. 11. • Rupture of hollow organs causes content spillage, inflammation of peritoneum
  12. 12. ETIOLOGY • Fall • Sports injury • Road traffic accident • Gun shot • Stab by knife • Any home accident • Work place accident
  13. 13. MECHANISM OF INJURY Blunt trauma  Motor vehicle accident  Seat belt injury Penetrating injury  Stab wound  Gun shot wound Blast injury  bomb
  14. 14. BLUNT TRAUMA
  16. 16. BLAST INJURY
  17. 17. BLUST INJURY
  18. 18. PATHOPHYSIOLOGY Abdominal trauma Solid organ injury Bleed profusely hypovolemia shock death Hollow organ injury Spill their content into abdominal cavity sepsis Septic shock death
  19. 19. SIGNS AND SYMPTOMS FOR BLUNT TRAUMA- • nausea, vomiting • blood in the urine • fever
  20. 20. Rib fractures, vertebral fractures, pelvic fractures, and injuries to the abdominal wall. Conti.....
  21. 21. Pneumoperitoneum , air or gas in the abdominal cavity, may be an indication of rupture of a hollow organ Conti....
  22. 22. Conti... • abdominal pain, tenderness, distension, or rigidity to the touch, and bowel sounds may be diminished or absent
  23. 23. Conti... • "seat belt sign
  24. 24. Conti... • In penetrating injuries, an evisceration (protrusi on of internal organs out of a wound) may be present.
  26. 26. DIAGNOTIC TEST- FOCUSED ASSESSMENT SONOGRAPHY IN TRAUMA (FAST) • Ultrasound technology is used by properly trained individuals to detect the presence of hemoperitoneum. 70-95% sensitivity
  27. 27. • Used in 4 regions: 1. RUQ 2. splenorenal recess 3. pelvis 4. subxipoid: pericardial space + rough assessment of contractility and filling
  28. 28. ADVANTAGES (FAST)- • Quick to perform with immediate results • Repeatable • Patient doesn’t have to leave Emergency department • Sensitivity approaching 96% in detecting >800mls blood
  29. 29. DISADVANTAGES (FAST)- • Operator dependent • Doesn’t specify anatomical structures injured • Does not distinguish other causes of intraperitioneal fluid (e.g. ascites, residual fluid after DPL, bladder rupture) • Can be technically difficult in obese patients, those with lots of bowel gas.
  30. 30. DIAGNOSTIC PERITONEAL LAVAGE (DPL) • DPL is now rarely performed due to the advent of the FAST scan. It’s main role is when FAST and CT are unavailable. • The modified procedure of diagnostic peritoneal aspirate (DPA) is useful in the hemodynamically unstable abdominal trauma with a negative FAST scan — a positive DPA indicates a false negative FAST scan and such patients require emergency laparotomy
  31. 31. DPL Procedure:- • minilaparotomy with placement of lavage catheter into peritoneal cavity directed towards pelvis • Blood more than 10 ml will show positive DPL
  32. 32. • if negative: 1L of warm saline in; effluent sent for identification of:- RBC, WBC, food, bile and bacteria
  33. 33. ADVANTAGES (DPL):- • Highly sensitive for intraperitoneal hemorrhage (>97%) • Rapid • Performed at the bedside
  34. 34. DISADVANTAGES (DPL) • Invasive • Doesn’t specify anatomical structures injured • Rarely performed, practitioner’s have become deskilled • Residual fluid following DPL makes subsequent FAST scans unreliable • Modified technique required if pregnant, pelvic fracture or midline scarring
  35. 35. CT ABDOMEN/PELVIS • for haemodynamically stable patients INDICATIONS- • Trauma patients with abdominal tenderness • Trauma patients with altered sensorium • Distracting injuries or injuries to adjacent structures
  36. 36. ADVANTAGES (CT)- • Identifies specific anatomical structures injured, allows grading of severity and helps guide management • Concurrent imaging of other body compartments is frequently indicated • Images retroperitoneal structures
  37. 37. DISADVANTAGES (CT)- • Patient usually has to leave the ED • Patient transfers are time consuming • Radiation exposure • Less sensitive with pancreatic, diaphragmatic and hollow organ injuries • Requires additional skilled staff (CT radiographers and radiologists)
  38. 38. LAPAROSCOPY • Diagnostic as well as therapeutic intervention. • There are 4 ports:- 1. gas administration 2. laparoscope 3. grasper 4. extractor
  40. 40. MANAGEMENT • Assessment of abdominal trauma requires the identification of immediately life-threatening injuries on primary survey, and delayed life threats on secondary survey. • 1. Primary survey 2. Resuscitation 3. Secondary survey 4. Diagnostic evaluation 5. Definitive care • Abdominal trauma is classified as blunt or penetrating, assessment and management is modified accordingly
  41. 41. PRIMARY SURVEY- It is based on ABCD resuscitation system. • Airway • Breathing • Circulation • Disability • exposure
  42. 42. USE OF TRIAGE- TRIAGE 1= immediate care needed • Requires immediate life saving intervention. Colour code- red. TRIAGE 2= intermediate or urgent care needed- • requires significant intervention within 2-4 hrs. colour code-yellow TRIAGE 3= delayed care • Needs medical treatment, but this can be safely delayed. Colour code- green TRIAGE 4= death cases. colour code- black
  43. 43. MANAGEMENT FOR:-
  44. 44. MANAGEMENT FOR PENETRATING WOUND Penetrating wound stable Local wound exploration No penetration to peritoneal cavity Penetration to peritoneal cavity unstable Open wound exploratory laparotomy
  45. 45. No intra abdominal injury Laparoscopic diagnostic DPL positive Open exploratory laparotomy negative observation
  46. 46. NURSING MANAGEMENT- ASSESSMENT- 1. Assess for history of the injury, onset and progression of the symptoms. 2. use of triage in providing care. 3. Assess presence of signs and symptoms of internal bleeding or acute abdomen (pain, bowel distention) . 4. Assess vital signs, CVP, fluid balance and urine output.
  47. 47. NURSING DIAGNOSIS- 1. Increased risk of hypovolemia and shock related to abdominal trauma and internal bleeding. 2. Increased risk of sepsis related to acute inflammatory process and peritonitis.
  48. 48. 3. Increased risk of severe fluid, electrolyte, and metabolic imbalances related to injury or inflammation. 4. Pain and bowel distention , related to diagnosis. 5. Anxiety related to the symptoms of disease and fear of death.
  49. 49. GOALS- 1. Promote adequate respiratory and cardiovascular function. 2. Provide measures for prevention of the shock and sepsis. 3. Prevent avoidable injury and complications. 4. Relief or diminish symptoms.
  50. 50. NURSING INTERVENTIONS- 1. Increased risk of hypovolemia and shock related to abdominal trauma and internal bleeding- • Assess vital signs of patient. • Assess for internal and external bleeding. • Give iv fluids as prescribed by physician. • Do blood transfusion if needed.
  51. 51. 2. Increased risk of sepsis related to acute inflammatory process and peritonitis. • Assess for sources of infection. • In case of visceral organ rupture, do peritoneal lavage. • Regular aseptic dressing. • Antibiotic therapy as told by physician.
  52. 52. 3. Increased risk of severe fluid, electrolyte, and metabolic imbalances related to injury or inflammation. • Assess general condition of patient. • Observe for any site of bleeding. • Check & document RBS level. • Check & document intake and output ratio. • Give iv fluids as prescribe by physician.
  53. 53. HEALTH EDUCATION AND DISCHARGE TEACHING- • Prevention of infection. • Prevention of further injury. • Assist the patient in activities of daily life (ADL). • Prevention of bed sores if patient is bed ridden. • Provide high caloric diet. • Follow medication regimen • Come for follow up care.
  54. 54. EVALUATION
  55. 55. Q1. which one is hollow organ among following? A.Liver B.Spleen C. Stomach D.Kidney • Ans- c
  56. 56. Q2. Which one of the following in the diagnostic as well as therapeutic intervention? A.FAST B.CT Scan C. Laproscopy D.None of the above • Ans- c
  57. 57. • Q3. FAST stands for ? • Ans- focused abdominal sonography in trauma
  58. 58. CONCLUSION • Road traffic accidents, sports injuries, blast injuries are the major cause of abdominal trauma. • Its very important to identify whether its blunt or penetrating injury. • Immediate management is necessary to prevent complication