Abdomen and Genitalia Injuries

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Chapter 23

• Abdomen and Genitalia Injuries

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Objectives (1 of 2)

• State the steps in the care of a patient with a
  blunt or penetrating abdominal injury.
• Describe how solid and hollow organs can be
  injured.
• State the steps in the care of a patient with an
  object impaled in the abdomen.
• State the steps in the care of a patient with an
  abdominal evisceration wound.

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Objectives (2 of 2)

• State the steps in the care of a patient with a
  genitourinary injury.
• Demonstrate proper treatment of a patient who has
  an object impaled in the abdomen.
• Demonstrate how to apply a dressing to an
  abdominal evisceration wound.

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Hollow Organs in the Abdominal Cavity
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Signs of Peritonitis

• Abdominal pain
• Tenderness
• Muscle spasm
• Diminished bowel sounds
• Nausea/vomiting
• Distention

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Solid Organs in the Abdominal Cavity
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Abdominal Quadrants
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Injuries of the Abdomen

• Closed injury (blunt)
• Severe blows that damage the abdomen without
  breaking the skin
• Open injury (penetrating)
• Foreign body enters the abdomen and opens the
  peritoneal cavity to the outside

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Signs and Symptoms of Abdominal Injury

• Pain
• Tachycardia
• Decreased blood pressure
• Pale, cool, moist skin
• A firm abdomen on palpation
• Bruising

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Evaluating Abdominal Injuries (1 of 2)

• Determine the type of injury, extent of damage,
  and presence of shock.
• Keep airway clear and watch for vomiting.
• Place patient supine with knees bent.
• Obtain baseline vital signs.

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Evaluating Abdominal Injuries (2 of 2)

• Follow DCAP-BTLS.
• Inspect abdomen for wounds.
• Immobilize any impaled objects.

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Blunt Abdominal Wounds (1 of 2)

• Severe bruises of the abdominal wall
• Laceration of the liver and spleen
• Rupture of the intestine
• Tears in the mesentery

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Blunt Abdominal Wounds (2 of 2)

• Rupture or tearing of the kidneys
• Rupture of the bladder
• Severe intra-abdominal hemorrhage
• Peritoneal irritation and inflammation

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Care of Blunt Abdominal Wounds

• Place patient on backboard.
• Protect airway.
• Monitor vital signs.
• Administer oxygen.
• Treat for shock.
• Arrange for prompt transport.

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Seat Belts and Airbags

• If used inappropriately, seat belts may cause
  injuries.
• Frontal airbags provide protection only during
  head-on collisions.

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Abdominal Evisceration

• Internal organs or fat protrude through the open
  wound.
• Never try to replace organs.
• Cover the organs with a moist gauze, then secure
  with a dressing.
• Organs must be kept warm and moist.
• Arrange for prompt transport.

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Anatomy of the Genitourinary System
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Injuries to the Kidneys

• Suspect kidney damage if patient has a history or
  physical evidence of
• Abrasion, laceration, or contusion in the flank
• A penetrating wound in the region of the lower
  rib cage or upper abdomen
• Fractures on either side of the lower rib cage or
  of the lower thoracic or lumbar vertebrae

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Injury of the Urinary Bladder

• Blunt or penetrating injury can rupture the
  bladder.
• Urine will spill into surrounding tissues.
• Suspect injury if you see blood at the urethral
  opening or physical signs of trauma on the lower
  abdomen, pelvis, or perineum.
• Monitor vital signs.
• The presence of associated injuries or shock will
  dictate the urgency of transport.

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Male Reproductive System
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Caring for Injury to the External Male Genitalia

• These injuries are painful make patient
  comfortable.
• Use sterile, moist compresses to cover areas
  stripped of skin.
• Apply direct pressure to control bleeding.
• Never manipulate any impaled objects.
• Identify and bring avulsed parts to the hospital.

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Female Reproductive System
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Injuries of the Female Genitalia

• Female internal genitalia are well protected and
  usually not injured.
• The exception is the pregnant uterus, which is
  vulnerable to both blunt and penetrating injuries.

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Genitalia Injuries in Pregnant Women

• Keep in mind that the unborn child is also at
  risk.
• Expect to see signs and symptoms of shock.
• Provide all necessary support.
• Place the mother on her left side to reduce
  pressure on her vena cava.
• Arrange for prompt transport.

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Caring for Injuries of the Female Genitalia (1
of 2)

• Injuries to the external genitalia are very
  painful but not usually life threatening.
• Treat lacerations, abrasions, and avulsions with
  moist, sterile compresses.

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Caring for Injuries of the Female Genitalia (2
of 2)

• Use local pressure and a diaper-type bandage to
  hold dressing in place.
• Urgency of transport will be determined by
  associated injuries, amount of hemorrhage, and
  presence of shock.