3. INTRODUCTION-
• Abdominal trauma is regularly encountered
in the emergency department
• One of the leading cause of death and
disability.
4. • Identification of serious intra-abdominal
injuries is often challenging.
• Many injuries may not manifest during the
initial assessment and treatment period.
5. 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.
6. • 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.
8. 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
20. PATHOPHYSIOLOGY
Abdominal trauma
Solid organ injury
Bleed profusely
hypovolemia
shock
death
Hollow organ injury
Spill their content into abdominal
cavity
sepsis
Septic shock
death
21. SIGNS AND SYMPTOMS FOR
BLUNT TRAUMA-
• nausea, vomiting
• blood in the urine
• fever
27. Conti...
• In penetrating injuries,
an evisceration (protrusi
on of internal organs
out of a wound) may be
present.
28. DIAGNOSTIC TEST
• Complete history of patient
• physical examination.
• DPL –DIAGNOSTIC PERITONEAL LAVAGE
• FAST –FOCUSED ABDOMINAL
SONOGRAPHY IN TRAUMA
• CT Scan – COMPUTED TOMOGRAPHY
29. 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
30. • Used in 4 regions:
1. RUQ
2. splenorenal recess
3. pelvis
4. subxipoid: pericardial
space + rough assessment of
contractility and filling
31. ADVANTAGES (FAST)-
• Quick to perform with immediate results
• Repeatable
• Patient doesn’t have to leave Emergency
department
• Sensitivity approaching 96% in detecting >800mls
blood
32. 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.
33. 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
35. • if negative: 1L of
warm saline in;
effluent sent for
identification of:-
RBC, WBC, food, bile
and bacteria
36. ADVANTAGES (DPL):-
• Highly sensitive for intraperitoneal hemorrhage
(>97%)
• Rapid
• Performed at the bedside
37. 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
38. 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
39. 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
40. 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)
41. LAPAROSCOPY
• Diagnostic as well as
therapeutic
intervention.
• There are 4 ports:-
1. gas administration
2. laparoscope
3. grasper
4. extractor
44. 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
45. PRIMARY SURVEY-
It is based on ABCD resuscitation system.
• Airway
• Breathing
• Circulation
• Disability
• exposure
46. 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
49. MANAGEMENT FOR
PENETRATING WOUND
Penetrating wound
stable
Local wound exploration
No penetration to
peritoneal cavity
Penetration to
peritoneal cavity
unstable
Open wound exploratory
laparotomy
50.
51. No intra abdominal injury
Laparoscopic diagnostic DPL
positive
Open exploratory
laparotomy
negative
observation
52. 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.
53. 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.
54. 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.
55. 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.
56. 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.
57. 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.
58. 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.
59. 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.
61. Q1. which one is hollow organ among
following?
A.Liver
B.Spleen
C. Stomach
D.Kidney
• Ans- c
62. 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
63. • Q3. FAST stands for ?
• Ans- focused abdominal sonography in
trauma
64. 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
