Presentation Abdominal trauma patients can present in multiple ways ranging from frank shock to hemodynamic instability to completely stable vitals to polytrauma. [saem.org]

The presented case is nothing tremendly new, however, should be ever kept in mind. Case presentation An 18 year- old male patient, who suffered blunt abdominal trauma, was admitted to the trauma bay. [oatext.com]

Patients who presented with peritonism were six times more likely to have therapeutic laparotomy (Table 3 ). [cureus.com]

On physical examination, jaundice was present and the abdomen was distended predominantly on the right side with no tenderness on palpation. [scielo.isciii.es]

If peritonitis is present, abdominal rigidity, guarding and rebound tenderness may be present. [ncbi.nlm.nih.gov]

• Splenectomy

  For patients who undergo splenectomy, incidence of overwhelming post-splenectomy sepsis is thought to be about 0.8%, and the risk is greatest in the first 2 years. [mdedge.com]

  The decision for splenectomy should be made once a joint assessment of the clinical scenario with ARV/PIPER has determined that the patient is too critically unwell for transfer. [trauma.reach.vic.gov.au]

  After splenectomy, therefore, the patient must be immunized against pneumococci, hemophilus influenza, and meningococci. [mysurgery.de]

  Hilar injuries or pulverized splenic parenchyma are usually treated by splenectomy. [intechopen.com]

  As regards the outcome of studied populations, 44 (55%) individuals were discharged with permanent sequelae (30 splenectomies, eight nephrectomies, four cholecystectomies, and two distal pancreatectomies). [azmj.eg.net]

• Hypothermia

  Hypothermia contributes to CNS depression, cardiac irritability, coagulopathy, shivering, increased oxygen consumption, suboptimal wound healing, and altered liver and kidney function. [clinicalpainadvisor.com]

  The thought is that any increases in BP or excessive crystalloid administration further exacerbates the lethal trauma triad : coagulopathy, acidodis, and hypothermia which all eventually beget each other and cause the patient to spiral towards death.5 [saem.org]

  Injury serial examination serial measurement of laboratory parameters often strict bed rest optimise coagulation if deteriorates: laparotomy or interventional radiology Admission after Damage Control Surgery goal = avoidance of the triad of acidosis, hypothermia [litfl.com]

  Hypothermia in trauma patients is associated with significant mortality. Learning Bite Remember that an unconscious or spinal-injured patient will not be able to feel or localise abdominal tenderness. [rcemlearning.co.uk]

  The more extensive and lengthy the initial surgical procedure, the more likely such patients are to develop the highly lethal combination of acidosis, coagulopathy, and hypothermia with subsequent multiple organ dysfunction. [msdmanuals.com]

• Severe Pain

  You have new or severe pain, swelling, or firmness in your abdomen. When should I seek immediate care? You have nausea and are vomiting. You have blood in your urine or bowel movement. You have new or severe pain in your back. [drugs.com]

  Symptoms and signs – Not all may be present history of injury to the abdominal area bleeding wound or other obvious injury, possibly with visible intestines severe pain and possible muscle spasm across the abdominal wall nausea or vomiting bruising of [stjohn.org.nz]

  Due to persistently severe pain, the patient was taken to the operating room for diagnostic laparoscopy followed by exploratory laparotomy. Jejunal perforation was detected and was surgically treated. [oatext.com]

  Crit Care Med 38:831–837 Article PubMed Google Scholar Lvovschi V, Aubrun F, Bonnet P, et al (2008) Intravenous morphine titration to treat severe pain in the emergency department. [link.springer.com]

  On arrival, the Medic 4 crew finds the patient awake and complaining of severe pain along his right flank and abdomen. After the patient is immobilized and moved into the ambulance, a full assessment is performed. [emsworld.com]

• Multiple Organ Dysfunction Syndrome

  Sepsis or multiple organ dysfunction syndrome after severe abdominal trauma remains a substantial challenge and is expected to be the cause of late mortality. [onlinejets.org]

• Military Personnel

  The agency awarded the latest breakthrough designation to Critical Innovations, a medical research and development company focused on creating products to help military personnel injured in combat. [medtechdive.com]

• Abdominal Pain

  Isolated abdominal tenderness or pain = 8% had intra-abdominal injury Isolated abdominal pain = 3 % had intra-abdominal injury. GCS affects sensitivity of abdominal tenderness. [emdocs.net]

  Common complaints include abdominal pain/tenderness, shoulder pain, nausea and vomiting, and anemia. CT scan is 98% sensitive in identifying the injury. [mdedge.com]

  Over the next few hours he experienced worsening left-side abdominal pain. On presentation, six hours after the injury, he was pale and in pain. His pulse was 120/minute and blood pressure was 110/60 mmHg. [mja.com.au]

  In contrast, isolated findings of bruising without associated abdominal pain or guarding, was associated with low risk of intra-abdominal injury [8]. [oatext.com]

  […] or decreased risk of an abdominal injury. 1 The physician should focus on the physical examination because abdominal pain as a symptom does not confirm (LR 1.6; 95% CI, 1.3-2.0) or rule out an injury (LR 0.52; 95% CI, 0.34-0.79). 2 The most useful signs [jamaevidence.mhmedical.com]

• Vomiting

  […] provider Blood in urine (pink to dark red) Call 911 if you have: Blood in vomit or bowel movements (dark red or black color) Weakness, dizziness, or fainting © 2000-2019 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. [fairview.org]

  Blood stained vomit or urine. Breathing noises Tenderness Bruising, and/or swelling Protruding Intestines Treatment: Follow the Basic First Aid Plan to assess the casualty: Assist the casualty into a ü comfortable position. [hatraining.com]

  Symptoms and signs – Not all may be present history of injury to the abdominal area bleeding wound or other obvious injury, possibly with visible intestines severe pain and possible muscle spasm across the abdominal wall nausea or vomiting bruising of [stjohn.org.nz]

  […] intra-abdominal bleeding (bleeding in the belly) such as: Looking pale Lethargy (hard to keep awake) Blood in urine, stools (bowel movement) or vomitus (throw up) Fever (temperature greater than 101 degrees Fahrenheit or 38.5 degrees Celsius) Increased pain Vomiting [aftertheinjury.org]

  Dear Editor, We present the case of a 58-year-old man with a history of a heavy alcohol intake who was admitted to the hospital with a 3-week history of abdominal discomfort, nausea, vomiting and an increased abdominal girth that appeared progressively [scielo.isciii.es]

• Nausea

  Symptoms and signs – Not all may be present history of injury to the abdominal area bleeding wound or other obvious injury, possibly with visible intestines severe pain and possible muscle spasm across the abdominal wall nausea or vomiting bruising of [stjohn.org.nz]

  Dear Editor, We present the case of a 58-year-old man with a history of a heavy alcohol intake who was admitted to the hospital with a 3-week history of abdominal discomfort, nausea, vomiting and an increased abdominal girth that appeared progressively [scielo.isciii.es]

  Muscle guarding, back and flank pain, nausea, vomiting, and even shock are possible with significant trauma to the kidneys. With enough force transferred to the abdominal area, intestinal damage and even bowel perforation can occur. [ncbi.nlm.nih.gov]

  Common complaints include abdominal pain/tenderness, shoulder pain, nausea and vomiting, and anemia. CT scan is 98% sensitive in identifying the injury. [mdedge.com]

• Abdominal Guarding

  0.94) Abdominal distension 3.8 (1.9-7.6) 0.90 (0.83-0.98) Abdominal guarding 3.7 (2.3-5.9) 0.80 (0.70-0.91) Laboratory Base deficit < -6 mEq/L b 18 (11-30) 0.12 (0.06-0.24) Aspartate transaminase or alanine transaminase > 130 U/L 5.2 (3.5-7.9) 0.46 [jamaevidence.mhmedical.com]

  There are also the following abdominal injury symptoms: Abdominal pain and tenderness Abdominal distension Rigidity to the abdomen Lack of bowel sounds Abdominal guarding Pneumoperitoneum Evisceration in penetrating trauma Rib fractures Abdominal wall [autoaccident.com]

  Abdominal guarding is a tensing of the abdominal wall muscles to guard inflamed organs within the abdomen. Pneumoperitoneum, air or gas in the abdominal cavity, may be an indication of rupture of a hollow organ. [en.wikipedia.org]

• Severe Abdominal Pain

  She immediately experienced abdominal pain, which became increasingly severe. She recalled the board making contact with her abdomen during the fall. [mja.com.au]

  Mandatory exploration for the hemodynamically stable patient with an anterior SW, in the absence of peritonitis, severe abdominal pain, or evisceration, no longer is practiced. [reliasmedia.com]

• Hypotension

  IR) polytrauma, hypotension, free intraperitoneal fluid - immediate exploratory laparotomy isolated bleed for angioembolization Indications for laparotomy Blunt Anterior abdominal injury with hypotension Abdominal wall disruption Peritonitis Free air [wikem.org]

  Indications for emergency laparotomy – penetrating trauma: Penetrating abdominal trauma + hypotension. Peritonism. Free Air. Evisceration. GSW traversing peritoneum. [trauma.reach.vic.gov.au]

  Abdominal compartment syndrome can occur acutely with massive intra-abdominal hemorrhage, leading to vena cava compression, exacerbating hypotension. [clinicalpainadvisor.com]

  On examination, vital signs may show evidence of hypovolemia (tachycardia) or shock (eg, dusky color, diaphoresis, altered sensorium, hypotension). [msdmanuals.com]

  Level C Recommendations Patients with isolated abdominal trauma, for whom occult abdominal injury is being considered, are at low risk for adverse outcome and may not need abdominal CT scanning if the following are absent: abdominal tenderness, hypotension [acep.org]

• Irritability

  Diagnosis Spectrum from abdominal pain, signs of peritoneal irritation to hypovolemic shock Nausea or vomiting Labored respiration from diaphragm irritation or upper abdominal injury Left shoulder pain with inspiration (Kehr sign) from diaphragmatic irritation [emergency.unboundmedicine.com]

  SPLEEN INJURY DESCRIPTIONS • Most commonly injured organ with blunt abdominal trauma • Injured in penetrating trauma of the left upper quadrant CLINICAL MANIFESTATIONS • Hypotension, tachycardia, shortness of breath • Peritoneal irritation • Abdominal [slideshare.net]

  The most common signs of significant abdominal trauma are pain, gastrointestinal hemorrhage, hypovolemia, and peritoneal irritation. [amboss.com]

  When a hollow organ is injured, the contents of the organ (for example, stomach acid, stool, or urine) may enter the abdominal cavity and cause irritation and inflammation (peritonitis). [msdmanuals.com]

  The indications for operations were (a) protrusion of viscera, (b) signs, of peritoneal irritation, (c) blood in nasogastric tube, (d) positive peritoneal tap, (e) peritoneal penetration and (f) X-ray showing gas under diaphragm. [jpgmonline.com]

• Dizziness

  […] worsens Increasing abdominal swelling Repeated vomiting Fever of 100.4°F (38°C) or as directed by your healthcare provider Blood in urine (pink to dark red) Call 911 if you have: Blood in vomit or bowel movements (dark red or black color) Weakness, dizziness [fairview.org]

  Light-headedness, dizziness, or fainting can result from any source of internal bleeding once enough blood is lost. A large area of deeply purple skin (called ecchymosis) can result from bleeding into the skin and soft tissues. [webmd.com]

• Agitation

  Grade I Grade II Grade III Grade IV Blood loss 7501500ml 15002000ml >2000ml Pulse normal tachy tachy weak Blood pressure normal raised diastolic lowered systolic very low Mental state normal agitated confused obtunded Urine output 30ml/h 2030ml/h 515ml [rcemlearning.co.uk]

  Portable, Fast, Serial exams Can detect small amounts of hemoperitoneum with good specificity Non-invasive, safe Can find thoracic injuries Accuracy Variation Doesn’t image solid parenchymal damage, retroperitoneal, diaphragm injuries Limited in the obese, agitated [canadiem.org]

Imaging See “ Essential Workup .” Diagnostic Procedures/Other See “ Essential Workup ” Lower thoracic injury may cause abdominal pain. Treatment Titrate fluid resuscitation to clinical response. [emergency.unboundmedicine.com]

An adequate diagnostic workup must be completed in time and the priority of the treatment sequence determined. [mysurgery.de]

The workup and coexisting diseases reviewed here will primarily focus on concomitant traumatic injuries of organ systems, as opposed to chronic medical diseases. [clinicalpainadvisor.com]

See Workup for more detail. Management Treatment of blunt abdominal trauma begins at the scene of the injury and is continued upon the patient’s arrival at the ED or trauma center. [emedicine.medscape.com]

Many institutions have protocolized the workup of trauma to include full body scans and, as such, many injuries that previously were not seen now are being diagnosed. [reliasmedia.com]

• Pneumoperitoneum

  CPR / Heimlich – rib #s, perforation with pneumoperitoneum Tube thoracostomy – liver and splenic injury Liver Biopsy – hemoperitoneum Endoscopy / ERCP – perforation 2) List expected intra-abdominal seat-belt injuries Solitary lap belts are far worse [canadiem.org]

  Immediately after the FAST, whole body CT- scan including liver and spleen as well as arterial and venous phase was performed showing discrete accumulation of free fluid in the Douglas space but no sign of pneumoperitoneum (Figure 2). [oatext.com]

  J Trauma 69:302–307 Article PubMed Google Scholar Kane NM, Francis IR, Burney RE, et al (1991) Traumatic pneumoperitoneum. Implications of computed tomography diagnosis. [link.springer.com]

  Pneumoperitoneum, air or gas in the abdominal cavity, may be an indication of rupture of a hollow organ. [en.wikipedia.org]

  There are also the following abdominal injury symptoms: Abdominal pain and tenderness Abdominal distension Rigidity to the abdomen Lack of bowel sounds Abdominal guarding Pneumoperitoneum Evisceration in penetrating trauma Rib fractures Abdominal wall [autoaccident.com]

• Streptococcus Pneumoniae

  pneumoniae, Neisseria meningitidis ) [ 26 ]. [intechopen.com]

Rationale for inclusion: This was one of the first papers to describe a systematic approach to the non-operative treatment of splenic injury. The authors describe a large 35 year experience. [east.org]

Treatment Treatment for severe injuries to the abdominal organs may require surgical repair. During surgery, doctors will often make a vertical incision in the abdomen to open the abdominal cavity. [study.com]

The Defense Advanced Research Projects Agency (DARPA) launched the Wound Stasis System program in 2010 to study ways to stabilize the injured before transport to a medical treatment facility. [medtechdive.com]

An adequate diagnostic workup must be completed in time and the priority of the treatment sequence determined. [mysurgery.de]

Breathing noises Tenderness Bruising, and/or swelling Protruding Intestines Treatment: Follow the Basic First Aid Plan to assess the casualty: Assist the casualty into a ü comfortable position. [hatraining.com]

The goal of every trauma management is to determine the extent and prognosis of the injuries. An adequate diagnostic workup must be completed in time and the priority of the treatment sequence determined. [mysurgery.de]

[…] asymptomatic or unspecific findings (e.g., chest pain, dyspnea ) In case of rupture: signs of hemorrhagic shock ( tachycardia, hypotension ) Diagnostics Initial test: chest x-ray Mediastinal widening Tracheal deviation Hemothorax Further tests Treatment Prognosis [amboss.com]

Prognosis Overall prognosis for patients who sustain blunt abdominal trauma is favorable. [emedicine.medscape.com]

In general, the prognosis of patients with blunt abdominal trauma is good. [11] [12] [13] Complications Inadequate resusc i tation Missed abdominal injuries Delays in diagnosis and treatment Intraabdominal sepsis Delayed splenic rupture Consultations [ncbi.nlm.nih.gov]

Patient prognosis is dependent on early detection and the time interval between the time of injury and the time of therapeutic intervention. [oatext.com]

References: [1] [2] [3] [4] Blunt chest trauma Chest wall injury Etiology : mostly blunt trauma, pathologic fractures, nonaccidental trauma ( child abuse ) Clinical features Diagnostics Complications Pneumothorax Hemothorax Especially in the elderly: [amboss.com]

[…] pelvis, spine, ribs) Extra-abdominal structures (skin/soft tissue, muscle) Epidemiology True current incidence of blunt abdominal trauma unknown although most believed to involve motor vehicles in United States (crashes, pedestrian hit by vehicle) Other etiologies [dynamed.com]

Introduction Abdominal trauma caused by blunt force is a common presentation in the emergency room seen in adults and children. [1] [2] Etiology The chief cause of blunt abdominal trauma in the United States is motor vehicle accidents. [ncbi.nlm.nih.gov]

Etiology Vehicular trauma is by far the leading cause of blunt abdominal trauma in the civilian population. Auto-to-auto and auto-to-pedestrian collisions have been cited as causes in 50-75% of cases. [emedicine.medscape.com]

The goal of this study was to evaluate the epidemiological reports and clinical data that aim to illustrate the mechanisms of injury, etiology, warning signs, sequelae, and frequency of deaths resulting from pure abdominal injuries that underwent laparotomy [azmj.eg.net]

Keywords: abdominal injuries, emergency laparotomy, epidemiology How to cite this article: Saleem AEA, Abdul Raheem OA, Abdallah HA, Yousef A M. [azmj.eg.net]

Epidemiology of sepsis in patients with traumatic injury. Crit Care Med 2004;32:2234-40. 32. Wafaisade A, Lefering R, Bouillon B, Sakka SG, Thamm OC, Paffrath T, et al. [onlinejets.org]

OBJECTIVES Discuss the incidence and epidemiology of abdominal trauma Review abdominal anatomy Discuss the mechanisms of injury for abdominal trauma Explain an abdominal assessment as part of a trauma exam Discuss prehospital management Identify emergency [emsworld.com]

Ileocecal junction Mesenteric vessel injuries Retroperitoneal organs: duodenum, pancreas, kidneys/urogenital, aorta Diaphragm Minimal bleeding so may produce few symptoms Bones (pelvis, spine, ribs) Extra-abdominal structures (skin/soft tissue, muscle) Epidemiology [dynamed.com]

In children, the most common causes are due to motor vehicle injuries and bicycle accidents. [3] [4] Epidemiology Blunt trauma to the abdomen can occur in people of all ages and is associated with a high morbidity. [ncbi.nlm.nih.gov]

Pathophysiology Intra-abdominal injuries secondary to blunt force are attributed to collisions between the injured person and the external environment and to acceleration or deceleration forces acting on the person’s internal organs. [emedicine.medscape.com]

Coagulopathy: its pathophysiology and treatment in the injured patient. World J Surg. 2007 May;31(5):1055-64 OpenInNew Beekley AC. Damage control resuscitation: a sensible approach to the exsanguinating surgical patient. [dynamed.com]

PATHOPHYSIOLOGY OF ABDOMINAL INJURY DECELERATION • Rapid decelaration causes differential movement among adjacent structures. [slideshare.net]

Medical Center Department of Emergency Medicine 780 Prior Hall, 376 West 10th Ave, Columbus, OH 43210 Objectives Upon completion of this module, you should be able to: Diagnose, resuscitate, stabilize and manage abdominal trauma patients; Identify common pathophysiologic [saem.org]

Each year thousands of patients with blunt abdominal injury are seen in emergency departments, and this substantially increases the cost of healthcare. [5] [6] Pathophysiology Blunt abdominal trauma can cause damage to the internal organs, resulting in [ncbi.nlm.nih.gov]

Many traumatic injuries can be prevented, beginning with awareness and education. Blunt abdominal trauma is in the top three categories of preventable injuries. These include older adults falls and preventable motor vehicle accidents in teens. [ncbi.nlm.nih.gov]

Ice may also help prevent tissue damage. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel before you apply it to your skin. Place it on your injured area for 15 to 20 minutes every hour or as directed. [drugs.com]

The epidemic number of automobile crash injuries and deaths, despite great efforts to prevent accidents, has stimulated supplementary methods to reduce injuries under crash conditions. The simplest form of crashproofing is the lap or safety belt. [jamanetwork.com]

Doing so will only cause greater complications - remember that preventing further injury is one of the aims of first aid. [en.wikibooks.org]

Because coagulopathy is more easily prevented than treated, early administration of plasma to any patient who has lost or will lose this amount of blood is highly recommended. [clinicalpainadvisor.com]