•   Difficult Assessment•   Confounding Factors•   Distracting Injuries•   Delayed Reactions•   Satisficing
• Improve our sensitivity and specificity for  critical abdominal traumatic injury.• Improve our care during patient conta...
– Scalp- Chest - Abdomen- Long Bones– Pelvis- External– Retroperitoneal
• Hollow organs  – Loss of function  – Leaking fluids cause septicemia  – Delayed signs and symptoms
• Solid organs  – Loss of function  – Bleeding  – Shock
• MOI as a predictor of outcome• MOI in your own Trauma System & Protocols• MOI as a Clue
• Penetrating Trauma  • Work accidents, MVAs and impaled objects.  • Stab wounds occur three times as often as GSWs     • ...
• Blunt Trauma  • Different energy forces can cause blunt injuries.     •   Deceleration     •   Crushing     •   Compress...
Laparoscopy                CT Scan              Ultrasound Diagnostic Peritoneal  Lavage
Physical                   VS / Exam                    Secondary               Patient               HistoryMechanism of ...
• Scene Safety• Cause and Effect  – Location  – Injury  – Further Assessment
irway– Ensure airway is clear and patent.– Consider spinal injury.reathing– A painful or distended abdomen may prevent ade...
isabilityxpose and Examine– Not Patty-Cakeind the Bleeding–   DCAP-BTLS 4 Quads / 6 Sides–   Tenderness / Guarding–   Shoc...
• SAMPLE: Rapidly identify comorbid &  complicating factors.• OPQRST: Codify & clarify signs and sx.
• Vital Signs  – Observe for trends.• Detailed Physical Exam  – Expose and Examine  – Patient should remain in position of...
•   Awesome Abdominal Assessment!•   Expedient Transport and Pre-Notification.•   Position for comfort.•   Don’t pop the c...
• Penetrating injuries   – External bleeding.   – High index of suspicion for unseen blood loss.   – Find and stop bleedin...
• Eviscerations   – Keep organs moist and warm.   – Cover with moistened, sterile gauze / occlusive dressing.   – Secure d...
• ALS Care  – Fluid Resuscitation     • IV Solution per protocol     • Maintain SBP approx. 90-100 mm/Hg  – NG / OG Tubes ...
• ALS Care cont’d  – Pain Management  – Anti-emetics  – Anxiolytics  – Other care as necessary
• Local Hospital• Trauma Center• Transport  Method
•   Difficult Assessment•   Confounding Factors•   Distracting Injuries•   Delayed Reactions•   Satisficing
• Improve our sensitivity and specificity for  critical abdominal traumatic injury.• Improve our care during patient conta...
CollectCallCareCollaborate / Continuum
Abominable Abdominal Trauma SlideShare Version
Abominable Abdominal Trauma SlideShare Version
Abominable Abdominal Trauma SlideShare Version
Abominable Abdominal Trauma SlideShare Version
Abominable Abdominal Trauma SlideShare Version
Abominable Abdominal Trauma SlideShare Version
Abominable Abdominal Trauma SlideShare Version
Abominable Abdominal Trauma SlideShare Version
Abominable Abdominal Trauma SlideShare Version
Abominable Abdominal Trauma SlideShare Version
Abominable Abdominal Trauma SlideShare Version
Abominable Abdominal Trauma SlideShare Version
Abominable Abdominal Trauma SlideShare Version
Abominable Abdominal Trauma SlideShare Version
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Abominable Abdominal Trauma SlideShare Version

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Critical to identify but easily missed, traumatic abdominal injuries present some of the most confounding cases that EMS providers can encounter. Using “real-life” case studies this presentation discusses the sequelae of blunt and penetrating trauma and gives you the tools to help identify abdominal trauma based on either presentation or mechanism of injury so that you can prioritize life saving interventions in multi-system trauma.

More at www.romduck.com and www.RescueDigest.com

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  • This slide can be used as a background before the presentation begins.
  • Bounded by the diaphragm and the pelvis.
  • MOI of deceleration or compression.MOI of abdominal penetration.Soft tissue injuries 360.Tenderness or guarding.Bleeding or leaking.Shock > obvious cause.Cullen's sign is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.It is named for Thomas S. Cullen (1869-1953),[1] an obstetrician who first described the sign in ruptured ectopic pregnancy in 1916.[2]This sign takes 24-48 hours to appear and can predict acute pancreatitis, with mortality rising from 8-10% to 40%. It may be accompanied by Grey Turner's sign[3] (bruising of the flank), which may then be indicative of pancreatic necrosis with retroperitoneal or intraabdominal bleeding.Grey Turner's sign refers to bruising of the flanks.This sign takes 24–48 hours. It can predict a severe attack of acute pancreatitis,[1] with mortality rising from 8-10% to 40%.[citation needed]It is a sign of retroperitoneal hemorrhage.It may be accompanied by Cullen's sign, which may then be indicative of pancreatic necrosis with retroperitoneal or intraabdominal bleeding.It is named for British surgeon George Grey Turner.[2][3
  • dilutional coagulopathy impaired oxygen delivery due to dilutionalanaemia hypothermia worsening metabolic acidosis (especially hyperchloremic non-anion gap metabolic acidosis from normal saline administration) clot dislodgement and haemorrhage from blood pressure elevation
  • Abominable Abdominal Trauma SlideShare Version

    1. 1. • Difficult Assessment• Confounding Factors• Distracting Injuries• Delayed Reactions• Satisficing
    2. 2. • Improve our sensitivity and specificity for critical abdominal traumatic injury.• Improve our care during patient contact.• Improve our coordination with in-hospital trauma teams.
    3. 3. – Scalp- Chest - Abdomen- Long Bones– Pelvis- External– Retroperitoneal
    4. 4. • Hollow organs – Loss of function – Leaking fluids cause septicemia – Delayed signs and symptoms
    5. 5. • Solid organs – Loss of function – Bleeding – Shock
    6. 6. • MOI as a predictor of outcome• MOI in your own Trauma System & Protocols• MOI as a Clue
    7. 7. • Penetrating Trauma • Work accidents, MVAs and impaled objects. • Stab wounds occur three times as often as GSWs • Lower mortality. • Gunshot wounds have greater kinetic energy • Fragmentation and cavitation. • Most commonly injured organ: Penetrating? 17
    8. 8. • Blunt Trauma • Different energy forces can cause blunt injuries. • Deceleration • Crushing • Compression • Most commonly injured organ in blunt trauma?
    9. 9. Laparoscopy CT Scan Ultrasound Diagnostic Peritoneal Lavage
    10. 10. Physical VS / Exam Secondary Patient HistoryMechanism of Injury
    11. 11. • Scene Safety• Cause and Effect – Location – Injury – Further Assessment
    12. 12. irway– Ensure airway is clear and patent.– Consider spinal injury.reathing– A painful or distended abdomen may prevent adequate inhalation.irculation– Superficial abdominal injuries usually do not produce significant external bleeding.– Internal bleeding can be profound.
    13. 13. isabilityxpose and Examine– Not Patty-Cakeind the Bleeding– DCAP-BTLS 4 Quads / 6 Sides– Tenderness / Guarding– Shock > obvious cause– Kehr’s Sign– Cullen’s & Grey-Turner’s signs– Findings lead to questions!
    14. 14. • SAMPLE: Rapidly identify comorbid & complicating factors.• OPQRST: Codify & clarify signs and sx.
    15. 15. • Vital Signs – Observe for trends.• Detailed Physical Exam – Expose and Examine – Patient should remain in position of comfort.
    16. 16. • Awesome Abdominal Assessment!• Expedient Transport and Pre-Notification.• Position for comfort.• Don’t pop the clot.• Anticipate shock.• Treat Sx.• Ongoing Assessment.• Continuum of Care!
    17. 17. • Penetrating injuries – External bleeding. – High index of suspicion for unseen blood loss. – Find and stop bleeding. – Apply dry, sterile dressing to open wounds. – If penetrating object is still in place, apply stabilizing bandage around it.
    18. 18. • Eviscerations – Keep organs moist and warm. – Cover with moistened, sterile gauze / occlusive dressing. – Secure dressing with bandage. – Do not replace organs.
    19. 19. • ALS Care – Fluid Resuscitation • IV Solution per protocol • Maintain SBP approx. 90-100 mm/Hg – NG / OG Tubes • Protects stomach and intestines by emptying contents • Allows evaluation of blood and materials in the GI tract.
    20. 20. • ALS Care cont’d – Pain Management – Anti-emetics – Anxiolytics – Other care as necessary
    21. 21. • Local Hospital• Trauma Center• Transport Method
    22. 22. • Difficult Assessment• Confounding Factors• Distracting Injuries• Delayed Reactions• Satisficing
    23. 23. • Improve our sensitivity and specificity for critical abdominal traumatic injury.• Improve our care during patient contact.• Improve our coordination with in-hospital trauma teams.
    24. 24. CollectCallCareCollaborate / Continuum

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