Abdominal Trauma - Blunt

Assessment

Management

ASSESSMENT

The life-threatening consequences of Blunt Abdominal Trauma are:

1. Intra-abdominal bleeding from vascular injury or solid organ rupture
2. Hollow organ rupture
3. Renal Injury
4. Diaphragmatic Rupture

• Suspect severe injury if there is blunt injury to the abdomen or chest and any of the following: Early Surgical Referral
• Haemodynamic Instability or obvious GIT Haemorrhage
• Peritoneal Signs or Intraperitoneal Free Air
• Macroscopic Haematuria

NB: Abdominal Injuries frequently accompany multiple other injuries: ALWAYS look for co-existing injuries

• Use a standard ATLS Approach: Assess – Intervene – Reassess: Assessment and Management occur in tandem.
• The goal is to determine whether there Is a clinically significant intra- abdominal injury.
• DeMIST handover from ambulance
• TRIAGE PATIENT USING SATS SCORE
• Measure and Record Vital Signs

Examination:

Primary: Assess ABCDE’S Then Secondary Head to Toe Examination

Specifically for Blunt Abdominal Trauma:

• Check haemodynamic status and Hb.
• Look for potential sites of blood loss
• Screen for External Bleeding (NB: Look at the back)
• Screen for Internal Bleeding (Chest, abdomen, pelvis, long bones)
• Abdominal examination: Distension, Discolouration, Tenderness, Rebound, Peritonism
• Abdominal signs may be masked in head injury, intoxication or other severe injuries
• Look for associated pelvic fractures
• PR exam if indicated
• EFAST scan to look for intra-abdominal, pleural and pericardial fluid as well as pneumothorax

Attach: Monitors, ECG, SpO2, BP, Urine Catheter, NGT as needed

SAMPLE History:

• Signs and Symptoms: Abdominal Pain, Vomitting.
• Allergies. Medications.
• Past medical history: Previous Abdominal
• Last Meal.
• Events: Mechanism and Type of Injury.

INVESTIGATIONS:

• Hb.
• Urine Dipstix, specifically for haematuria
• Consider: FBC, U&E, X Match
• Trauma Xray series (C/Spine; CXR; Pelvis).
• Erect CXR for free air. AXR only if suspected foreign body.
• Other XRays as clinically indicated
• Point of Care EFAST US Scan.
• If stable, consider CT scan of abdomen.

MANAGEMENT