Transcript File - Huff Hills Ski Patrol

Chapter 24
Abdominal and Pelvic
Trauma
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
24.1 Identify and locate the major anatomical
structures within the abdominopelvic
cavity.
24.2 List the functions of the major
anatomical structures within the
abdominopelvic cavity.
24.3 List and describe at least six
abdominopelvic injuries.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
24.4 Describe and demonstrate how to
assess a patient with abdominopelvic
trauma.
24.5 Describe and demonstrate how to
manage a patient with abdominopelvic
trauma.
24.6 Describe and demonstrate how to
manage an evisceration.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
24.7 Describe and demonstrate how to
manage an impaled object in the
abdomen or pelvis.
24.8 Describe and demonstrate how to
manage a pelvic fracture.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Topics
 Anatomy
and Physiology
 Common Abdominal and Pelvic
Injuries
 Assessment
 Management
 Chapter Summary
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Presentation
A teenage girl’s ski pole jams into her abdomen as
she falls. She is clutching her abdomen and gasping
for air when you arrive. Her mother is near the scene.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
 Abdominal
cavity extends from
diaphragm to pelvic brim
◦ Organs are relatively unprotected
 Pelvic
cavity is encased in the pelvic
bones
◦ Organs are somewhat protected
 Some
organs process blood
 Major blood vessels are present
continued
◦ Bleeding can be life threatening
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
 Each
of four quadrants holds specific
organs:
◦ RUQ= liver; LUQ= spleen; RLQ and
LLQ= intestines, bladder
◦ Medical emergencies may have nonlocalized pain
◦ Trauma injuries may be localized by pain
and tenderness
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common Abdominal and
Pelvic Injuries
 Abdominal
BRADY
wall contusion
 Blunt force tends to injure solid
organs
 Penetrating trauma may injure solid or
hollow organs
 Multiple organs may be involved
 Muscles/organs can tear or rupture
 Fractures of pelvic or hip
 Evisceration
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Solid Organ Injuries
 Liver,
spleen, pancreas
 May have blunt or penetrating trauma
 Bleeding may be severe
 Hypovolemic shock and peritonitis
may result
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Vascular Injuries and
Diaphragm Tears, Ruptures
 Blood
vessels, diaphragm, intestines,
bladder
 May be from blunt injury,
deceleration, penetrating injuries, or
bone fragments
 Organs may migrate into thoracic
cavity through diaphragm rupture
 Results may be severe bleeding,
infection, peritonitis
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Impaled Objects and
Evisceration
 Impaled
Objects
◦ Impaled objects may cause life
threatening injuries, or miss organs and
vessels
◦ Bleeding and infection may result
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Impaled Objects and
Evisceration
continued
Copyright Candace Horgan
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Impaled Objects and
Evisceration
 Evisceration
◦ Evisceration exposes organs to outside
environment
◦ Bleeding, heat loss, and infection may
result
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Pelvic and Hip Fractures
 Pelvis
◦ Require large amount of force
◦ Multiple fractures are likely
◦ May damage internal structures, cause
bleeding
 Hip
◦ May fracture or dislocate
◦ Review Chapter 20 for more details
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Hip Dislocations
anterior dislocation
BRADY
posterior dislocation
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Straddle / Genital Injuries
 Blunt
or sharp trauma
 Groin strikes an object, external
structures are involved
◦ Often less problematic for females
 Bleeding,
hematomas may result
 Pain and modesty are issues
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Pelvic Injury
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
assessment procedures –
ABCDs, SAMPLE, and vitals
 Emphasis is on existence of injury
 Location of pain may lead to
suspicion of organs involved
 Use OPQRST - note if pain goes from
local to general or general to local
 Look for distention, discoloration, continued
symmetry
 Standard
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 Palpate
each quadrant, lower rib
cage, and pelvis
 Genital exams require discretion
 Monitor for shock due to internal
bleeding
 Serial vitals, follow-up exams are
essential
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Update
Her mother permits you to evaluate her daughter.
Her ABCDs are intact; there is no spine pain. During
secondary assessment, she has severe pain in her
stomach. Palpation reveals tenderness in the left
upper quadrant. Her pulse is 124; respirations are
16. She says she has no problems, is not taking any
medications, has no allergies to medications, and ate
at breakfast three hours ago. She is breathing ok but
states her “stomach really hurts.”
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Activate
EMS for transport
 Position patient for comfort
 Protect C-spine as needed
 High flow oxygen
 Treat soft tissue injuries
 Do not remove impaled objects stabilize
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Cover
eviscerations with moist sterile
dressings, keep patient warm
 Assist ventilations for diaphragm tear
 Full spinal immobilization for pelvic
fracture
◦ Use pelvic binder
◦ Keep knees flexed
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
dislocations – position of comfort
 Femoral neck fractures, use spine
board
 Treat for shock
 Monitor vitals and condition
 Hip
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
Copyright Candace Horgan
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Disposition
You administer oxygen to the patient. Because she
has significant abdominal pain, you radio for ALS
transport. You suspect shock. Further assessment
reveals more abdominal tenderness. There is no
abdominal distention. Her pulse is now 132, blood
pressure is 98/50. Her injury was to her spleen.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 The
most obvious injury is not always
the most serious one.
 The initial presentation may be
relatively benign; shock may
 develop over time.
 Assessment of abdominal trauma
includes examining all four quadrants
and taking serial sets of vital signs. continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 Do
not give a patient with abdominal
trauma anything by mouth.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ