Injuries to the Abdomen, Pelvis, and Genitalia

By. Ns. Teguh Budi P. Skep. CWCS

Causes

injuries to the abdomen, pelvis and genitalia are generally caused by accidents involving high kinetic energy and acceleration or deceleration forces

Causes (continued)

injury can occur from: gunshots knife wounds motor vehicles snowmobiles falls skier or boarder collisions

Open vs. Closed Injuries

abdominal injuries can be either open or closed open injuries are caused by sharp or high velocity objects that create an opening between the peritoneal cavity and the outside of the body

closed injuries are caused by compression trauma associated with deceleration forces and include:

contusions ruptures lacerations shear injuries

Hollow and Solid Organs

The type of injury will depend on whether the organ injured is solid or hollow.

hollow organs include:

stomach intestines gallbladder bladder

solid organs include:

liver spleen kidneys

Hollow Organ Injuries

when hollow organs rupture, their highly irritating and infectious contents spill into the peritoneal cavity, producing a painful inflammatory reaction called peritonitis

Solid Organ Injuries

damage to solid organs such as the liver can cause severe internal bleeding blood in the peritoneal cavity causes peritonitis

when patients injure solid organs, the symptoms of shock may overshadow those from peritonitis

Abdominal Injuries

abdominal injuries can be obvious, such as an open wound, or subtle, such as a blow to the flank that initially causes little pain, but damages the liver or spleen

suspect abdominal internal injury in any patient who has a penetrating abdominal wound or has suffered compression trauma to the abdomen

Peritonitis

Signs and Symptoms

Signs and Symptoms

pain and tenderness increase and spread from the injury site to the other parts of the abdomen, frequently the entire abdomen the abdomen becomes tender, distended, and rigid bowel sounds disappear

Signs and Symptoms (continued)

the patient becomes progressively sicker, develops fever, and usually vomits signs and symptoms of shock may appear respirations are shallow and rapid because it hurts to breathe deeply

Signs and Symptoms (continued)

abdominal pain is increased by moving, straightening the knees, or taking a deep breath the patient frequently prefers to lie quietly on his back or side with the knees flexed

Injuries to the Pelvis and Genitourinary System

Kidney Injuries

an injury to the lower back may involve one or both kidneys signs include:
tenderness swelling ecchymosis blood in the urine

Bladder Injuries

pelvic fractures can lacerate the bladder or urethra always search for a pelvic fracture during assessment of the lower abdomen

Male Genitalia Injuries

these injuries are extremely painful the patient will have a high degree of anxiety and concern manage contusions by applying cold pack and stabilizing the injury with clothing

Female Genitalia

the female organs are protected by the pelvis the uterus of a pregnant woman is susceptible from compression trauma to the pelvis or abdomen soft tissue injury can cause anxiety and profuse bleeding

Female Genitalia Injuries

control any bleeding with direct pressure anchor dressings with a diaperlike arrangement made from triangular bandages never insert dressings or packs into the vagina

Assessment

Patients with an Abdominal or Pelvic Injury

Assessment

determine the mechanism of injury ask the patient

what happened? where do you hurt? the location of the pain and its character

Assessment (continued)

assess the abdomen, lower chest, pelvis, and back giving urgent care as necessary investigate a positive mechanism of injury or abnormal pulse by:

performing rapid body survey

expose and assess the perineal area if you suspect a genitourinary injury anticipate vomiting inspect vomit conduct non-urgent survey conduct whole body survey

assess and record vital signs

assess and record any changes in location or character of pain watch and record change in any symptoms
inspect voided urine for visible blood

perform the ongoing survey do ongoing monitoring and recording of:

vital signs
changes in location or character of pain, tenderness, abdominal distention and rigidity

assess for additional injuries if the level of shock is not explained by injuries found arrange for rapid transport unless the injury is trivial

Emergency Care

Patient with an Abdominal or Pelvic Injury

Emergency Care

keep the patient warm dont give anything by mouth control external bleeding with direct pressure maintain the airway

Emergency Care (continued)

bandage wounds protect eviscerated organs with a sterile, moist occlusive dressing stabilize an impaled object in place

Emergency Care (continued)

anticipate and treat shock give high flow oxygen immobilize the patient with a fractured pelvis on a long spineboard

Emergency Care (continued)

Arrange to transport the patient rapidly to the hospital