5607tncc-abdominal Trauma 2x1f45
This document was ed by and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this report form. Report l4457
Overview 6h3y3j
& View 5607tncc-abdominal Trauma as PDF for free.
More details h6z72
- Words: 1,427
- Pages: 65
ABDOMINAL TRAUMA Prepared by Samah Ishtieh MSN. Mangement
17\3\2011 10/14/2014
1
OBJECTIVES:
Identify the common mechanisms of injury associated with abdominal trauma. Describe the pathophysiologic changes as a basis for signs and symptoms. Identify selected abdominal injuries (S &S ). 10/14/2014
2
OBJECTIVES
Discuss the NURSING of patients with abdominal trauma. Identify appropriate nursing diagnosis. Plan appropriate interventions for patients with abdominal trauma.
10/14/2014
3
INTRODUCTION Abdominal injuries are common in patients who sustain major trauma. Unrecognized abdominal injuries are frequently the cause of preventable death. Approximately one-fifth of all traumatized pt requiring operative intervention have sustained trauma to the abdomen. 10/14/2014
4
Abdominal trauma
Abdominal trauma is an injury to the abdomen. It may be blunt or penetrating and may involve damage to the abdominal organs.
10/14/2014
5
TYPES OF INJURIES Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. Blunt trauma: liver …spleen (most common).
Penetrating: liver, small bowel and stomach. Penetrating: present with single or multiple injuries 10/14/2014
6
Penetrating abdominal trauma (PAT) is usually diagnosed based on clinical signs, blunt abdominal trauma is more likely to be missed because clinical signs are less obvious.
Penetrating trauma is further subdivided into stab wounds and bullet wounds, which have different treatments. 10/14/2014
7
Multiple injuries, abdominal trauma can lead to hemorrhage, hypovolemic shock, and death. Yet even a serious, life-threatening abdominal injury may not cause obvious signs and symptoms, especially in cases of blunt trauma. 10/14/2014
8
Key responses to decrease mortality and morbidity include : - aggressive resuscitation efforts, - adequate volume replacement, - early diagnosis of injuries, and - surgical intervention if warranted 10/14/2014
9
ORGANS Solid Organs
Hollow Organs
Liver Spleen Kidneys Pancreas
Stomach Small bowel Large bowel Bladder
10/14/2014
10
10/14/2014
11
10/14/2014
12
10/14/2014
13
Mechanisms of injury The most common mechanism of blunt injury is MVC (motor vehicle crash). Firearm , stabbings, are associated with Penetrating trauma. Injuries result from acceleration, deceleration, or both forces. Crushing forces compress the duodenum Or the pancreas against the vertebral column.
10/14/2014
14
Mechanisms of injury Forces applied to solid organ can rupture a surrounding capsule & injury the parenchyma as well. Structures attached by ligaments or blood vessels may be stressed at their attachment points
10/14/2014
15
Mechanisms of injury Belts if improperly positioned cause deceleration injuries to the lower abdomen , Frontal impact crashes with a bent steering wheel associated with spleen & liver injuries as
well as head &chest trauma.
10/14/2014
16
PATHOPHYSIOLOGY
Blood loss: (mesenteric attachments of the intestines ) semi fixed by ligaments, stressed, tears , bleeding. Liver & spleen ( rich blood supply) & capsulated , compression, rupture, hemorrhage. Pain: rigidity, spasm, rebound tenderness Irritants(blood or gastric contents or enzymes) 10/14/2014
17
Pancreatic & duodenal injury: diffuse abdominal, tenderness and pain radiating from epigastric to the back.
Splenic injury: referred shoulder pain (Kehr`s sign) . Because of: stress, blood in the abdominal cavity and direct bowel injury 10/14/2014
18
10/14/2014
19
10/14/2014
20
10/14/2014
21
10/14/2014
22
10/14/2014
23
10/14/2014
24
Spleen injury is usually associated with blunt trauma. Fractures of ribs 10 to 12 on the left should raise your suspicion of spleen damage, which ranges from laceration of the capsule or a nonexpanding hematoma to ruptured subcapsular hematomas or parenchymal laceration. 10/14/2014
25
Spleen injury
10/14/2014
26
CT scan showing the Spleen
10/14/2014
27
Liver injury is common because of the liver’s size and location. Severity ranges from a controlled subcapsular hematoma and lacerations of the parenchyma to hepatic avulsion or a severe injury of the hepatic veins. ((التمزيق الكبدي 10/14/2014
28
Because liver tissue is very friable and the liver’s blood supply and storage capacity are extensive, a patient with liver injuries can hemorrhage profusely and may need surgery to control the bleeding.
10/14/2014
29
Liver injury
10/14/2014
30
LIVER INJURY
10/14/2014
31
PANCERAS INJURY
10/14/2014
32
The most common kidney injury is a contusion from blunt trauma; suspect this type of injury if your patient has fractures of the posterior ribs or lumbar vertebrae.
10/14/2014
33
KIDNEY & BLADDER
10/14/2014
34
Other renal injuries include lacerations or contusion of the renal parenchyma caused by shearing and compression forces; the deeper a laceration, the more serious the bleeding.
10/14/2014
35
Deceleration forces may damage the renal artery; collateral circulation in that area is limited, so any ischemia is serious and may trigger acute tubular necrosis.
10/14/2014
36
Hollow organ injuries, which can occur with blunt or penetrating trauma, most commonly involve the small bowel. Deceleration with shearing may tear the small bowel, generally in relatively fixed or looped areas
10/14/2014
37
Blunt forces cause most bladder injuries. The bladder rises into the abdominal cavity when full, so it’s more susceptible to injury. If a distended bladder ruptures or is perforated, urine is likely to escape into the abdomen.
10/14/2014
38
If the bladder isn’t full when ruptured, urine may leak into the surrounding pelvic tissues, vulva, or scrotum.
10/14/2014
39
Genitourinary tract - Perinephric hematomas should be entered only after vascular control has been obtained. Repair of many renal injuries (including partial nephrectomy) is now possible. When nephrectomy is required, it is reassuring to know that the contra lateral kidney is functioning. 10/14/2014
40
DIAPHRAGM
10/14/2014
41
Diaphragmatic injuries are notoriously difficult to diagnose. Small diaphragmatic injuries on the right side may heal without incident, and the liver protects against potential hernias. Small injuries on the left side may result in symptomatic diaphragmatic hernias. Acute diaphragmatic defects are best approached through the diaphragm. 10/14/2014
42
10/14/2014
43
Colon/Rectum - In contrast to military teaching, an increasing number of surgeons utilize primary repair for simple colon injuries without associated shock or significant fecal soilage. Even a small missed colon injury may be lethal 10/14/2014
44
NURSING CARE
10/14/2014
45
As always, your primary priorities are to maintain the patient’s airway, breathing, and circulation. Next, perform a rapid neurologic examination and assess him head to toe to identify obvious injuries and signs of prolonged exposure to heat or cold. 10/14/2014
46
Ask the patient (or his family, emergency personnel, or bystanders) about his history— allergies, medications, preexisting medical conditions, when he last ate, and events immediately preceding or related to his injury. 10/14/2014
47
If your patient sustained blunt trauma, as in a motor vehicle crash (MVC), keep his neck and spine immobilized until X-rays rule out a spinal injury. If his viscera are protruding, cover them with a sterile dressing moistened with 0.9% sodium chloride solution to prevent drying. 10/14/2014
48
The following interventions are routine for a patient with abdominal trauma:
10/14/2014
49
• Insert two large-bore intravenous (I.V.) lines to infuse 0.9% sodium chloride or lactated Ringer’s solution, according to facility protocol.
10/14/2014
50
• Control the patient’s pain without sedating him, so you can continue to assess his injuries and ask him questions. Generally, I.V. analgesics such as morphine can adequately manage pain without sedation.
10/14/2014
51
Insert an indwelling urinary catheter, unless you suspect a urinary tract injury. For example, bloody urine or a prostate gland found to be in a high position during a rectal exam could indicate damage to the urinary tract 10/14/2014
52
If the patient is to have a rectal examination, delay catheter insertion until afterward
10/14/2014
53
• Draw blood specimens stat for baseline lab values.
10/14/2014
54
• Insert a gastric tube to decompress the patient’s stomach, prevent aspiration, and minimize leakage of gastric contents and contamination of the abdominal cavity. This also gives you access to gastric contents to test for blood
10/14/2014
55
ister tetanus prophylaxis and antibiotics as ordered.
10/14/2014
56
10/14/2014
57
10/14/2014
58
10/14/2014
59
10/14/2014
60
10/14/2014
61
The FAST option Focused abdominal sonography for trauma (FAST) offers 98% to 100% specificity in blunt abdominal trauma, and is accurate 98% of the time. FAST is especially helpful for pregnant patients or those bleeding from multiple injuries. It’s also useful in identifying pericardial fluid in penetrating trauma. 10/14/2014
62
FAST can demonstrate the presence or absence of pericardial fluid, abdominal fluid, and some parenchymal injuries via a 2to 3-minute exam. A hand-held transducer is positioned on four key areas to evaluate fluid collection. 10/14/2014
63
Unstable patients with penetrating abdominal trauma, such as gunshot wounds, stab wounds, or other impalements, usually proceed directly to the operating department without DPL or FAST. 10/14/2014
64
Thanks for good listening
10/14/2014
65
17\3\2011 10/14/2014
1
OBJECTIVES:
Identify the common mechanisms of injury associated with abdominal trauma. Describe the pathophysiologic changes as a basis for signs and symptoms. Identify selected abdominal injuries (S &S ). 10/14/2014
2
OBJECTIVES
Discuss the NURSING of patients with abdominal trauma. Identify appropriate nursing diagnosis. Plan appropriate interventions for patients with abdominal trauma.
10/14/2014
3
INTRODUCTION Abdominal injuries are common in patients who sustain major trauma. Unrecognized abdominal injuries are frequently the cause of preventable death. Approximately one-fifth of all traumatized pt requiring operative intervention have sustained trauma to the abdomen. 10/14/2014
4
Abdominal trauma
Abdominal trauma is an injury to the abdomen. It may be blunt or penetrating and may involve damage to the abdominal organs.
10/14/2014
5
TYPES OF INJURIES Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. Blunt trauma: liver …spleen (most common).
Penetrating: liver, small bowel and stomach. Penetrating: present with single or multiple injuries 10/14/2014
6
Penetrating abdominal trauma (PAT) is usually diagnosed based on clinical signs, blunt abdominal trauma is more likely to be missed because clinical signs are less obvious.
Penetrating trauma is further subdivided into stab wounds and bullet wounds, which have different treatments. 10/14/2014
7
Multiple injuries, abdominal trauma can lead to hemorrhage, hypovolemic shock, and death. Yet even a serious, life-threatening abdominal injury may not cause obvious signs and symptoms, especially in cases of blunt trauma. 10/14/2014
8
Key responses to decrease mortality and morbidity include : - aggressive resuscitation efforts, - adequate volume replacement, - early diagnosis of injuries, and - surgical intervention if warranted 10/14/2014
9
ORGANS Solid Organs
Hollow Organs
Liver Spleen Kidneys Pancreas
Stomach Small bowel Large bowel Bladder
10/14/2014
10
10/14/2014
11
10/14/2014
12
10/14/2014
13
Mechanisms of injury The most common mechanism of blunt injury is MVC (motor vehicle crash). Firearm , stabbings, are associated with Penetrating trauma. Injuries result from acceleration, deceleration, or both forces. Crushing forces compress the duodenum Or the pancreas against the vertebral column.
10/14/2014
14
Mechanisms of injury Forces applied to solid organ can rupture a surrounding capsule & injury the parenchyma as well. Structures attached by ligaments or blood vessels may be stressed at their attachment points
10/14/2014
15
Mechanisms of injury Belts if improperly positioned cause deceleration injuries to the lower abdomen , Frontal impact crashes with a bent steering wheel associated with spleen & liver injuries as
well as head &chest trauma.
10/14/2014
16
PATHOPHYSIOLOGY
Blood loss: (mesenteric attachments of the intestines ) semi fixed by ligaments, stressed, tears , bleeding. Liver & spleen ( rich blood supply) & capsulated , compression, rupture, hemorrhage. Pain: rigidity, spasm, rebound tenderness Irritants(blood or gastric contents or enzymes) 10/14/2014
17
Pancreatic & duodenal injury: diffuse abdominal, tenderness and pain radiating from epigastric to the back.
Splenic injury: referred shoulder pain (Kehr`s sign) . Because of: stress, blood in the abdominal cavity and direct bowel injury 10/14/2014
18
10/14/2014
19
10/14/2014
20
10/14/2014
21
10/14/2014
22
10/14/2014
23
10/14/2014
24
Spleen injury is usually associated with blunt trauma. Fractures of ribs 10 to 12 on the left should raise your suspicion of spleen damage, which ranges from laceration of the capsule or a nonexpanding hematoma to ruptured subcapsular hematomas or parenchymal laceration. 10/14/2014
25
Spleen injury
10/14/2014
26
CT scan showing the Spleen
10/14/2014
27
Liver injury is common because of the liver’s size and location. Severity ranges from a controlled subcapsular hematoma and lacerations of the parenchyma to hepatic avulsion or a severe injury of the hepatic veins. ((التمزيق الكبدي 10/14/2014
28
Because liver tissue is very friable and the liver’s blood supply and storage capacity are extensive, a patient with liver injuries can hemorrhage profusely and may need surgery to control the bleeding.
10/14/2014
29
Liver injury
10/14/2014
30
LIVER INJURY
10/14/2014
31
PANCERAS INJURY
10/14/2014
32
The most common kidney injury is a contusion from blunt trauma; suspect this type of injury if your patient has fractures of the posterior ribs or lumbar vertebrae.
10/14/2014
33
KIDNEY & BLADDER
10/14/2014
34
Other renal injuries include lacerations or contusion of the renal parenchyma caused by shearing and compression forces; the deeper a laceration, the more serious the bleeding.
10/14/2014
35
Deceleration forces may damage the renal artery; collateral circulation in that area is limited, so any ischemia is serious and may trigger acute tubular necrosis.
10/14/2014
36
Hollow organ injuries, which can occur with blunt or penetrating trauma, most commonly involve the small bowel. Deceleration with shearing may tear the small bowel, generally in relatively fixed or looped areas
10/14/2014
37
Blunt forces cause most bladder injuries. The bladder rises into the abdominal cavity when full, so it’s more susceptible to injury. If a distended bladder ruptures or is perforated, urine is likely to escape into the abdomen.
10/14/2014
38
If the bladder isn’t full when ruptured, urine may leak into the surrounding pelvic tissues, vulva, or scrotum.
10/14/2014
39
Genitourinary tract - Perinephric hematomas should be entered only after vascular control has been obtained. Repair of many renal injuries (including partial nephrectomy) is now possible. When nephrectomy is required, it is reassuring to know that the contra lateral kidney is functioning. 10/14/2014
40
DIAPHRAGM
10/14/2014
41
Diaphragmatic injuries are notoriously difficult to diagnose. Small diaphragmatic injuries on the right side may heal without incident, and the liver protects against potential hernias. Small injuries on the left side may result in symptomatic diaphragmatic hernias. Acute diaphragmatic defects are best approached through the diaphragm. 10/14/2014
42
10/14/2014
43
Colon/Rectum - In contrast to military teaching, an increasing number of surgeons utilize primary repair for simple colon injuries without associated shock or significant fecal soilage. Even a small missed colon injury may be lethal 10/14/2014
44
NURSING CARE
10/14/2014
45
As always, your primary priorities are to maintain the patient’s airway, breathing, and circulation. Next, perform a rapid neurologic examination and assess him head to toe to identify obvious injuries and signs of prolonged exposure to heat or cold. 10/14/2014
46
Ask the patient (or his family, emergency personnel, or bystanders) about his history— allergies, medications, preexisting medical conditions, when he last ate, and events immediately preceding or related to his injury. 10/14/2014
47
If your patient sustained blunt trauma, as in a motor vehicle crash (MVC), keep his neck and spine immobilized until X-rays rule out a spinal injury. If his viscera are protruding, cover them with a sterile dressing moistened with 0.9% sodium chloride solution to prevent drying. 10/14/2014
48
The following interventions are routine for a patient with abdominal trauma:
10/14/2014
49
• Insert two large-bore intravenous (I.V.) lines to infuse 0.9% sodium chloride or lactated Ringer’s solution, according to facility protocol.
10/14/2014
50
• Control the patient’s pain without sedating him, so you can continue to assess his injuries and ask him questions. Generally, I.V. analgesics such as morphine can adequately manage pain without sedation.
10/14/2014
51
Insert an indwelling urinary catheter, unless you suspect a urinary tract injury. For example, bloody urine or a prostate gland found to be in a high position during a rectal exam could indicate damage to the urinary tract 10/14/2014
52
If the patient is to have a rectal examination, delay catheter insertion until afterward
10/14/2014
53
• Draw blood specimens stat for baseline lab values.
10/14/2014
54
• Insert a gastric tube to decompress the patient’s stomach, prevent aspiration, and minimize leakage of gastric contents and contamination of the abdominal cavity. This also gives you access to gastric contents to test for blood
10/14/2014
55
ister tetanus prophylaxis and antibiotics as ordered.
10/14/2014
56
10/14/2014
57
10/14/2014
58
10/14/2014
59
10/14/2014
60
10/14/2014
61
The FAST option Focused abdominal sonography for trauma (FAST) offers 98% to 100% specificity in blunt abdominal trauma, and is accurate 98% of the time. FAST is especially helpful for pregnant patients or those bleeding from multiple injuries. It’s also useful in identifying pericardial fluid in penetrating trauma. 10/14/2014
62
FAST can demonstrate the presence or absence of pericardial fluid, abdominal fluid, and some parenchymal injuries via a 2to 3-minute exam. A hand-held transducer is positioned on four key areas to evaluate fluid collection. 10/14/2014
63
Unstable patients with penetrating abdominal trauma, such as gunshot wounds, stab wounds, or other impalements, usually proceed directly to the operating department without DPL or FAST. 10/14/2014
64
Thanks for good listening
10/14/2014
65
Related Documents 543cg
Trauma 5b4u5p
September 2022 0
Refrat Trauma Abdomen, Trauma Abdomen 2u1zp
December 2020 0
Trauma Kapitis Dan Trauma Spinal 3c2r2t
April 2020 26
Trauma Abdomen 683d3d
November 2020 0
Trauma Termal 19b1j
December 2020 0
Trauma Persalinan 392m1n
September 2020 0More Documents from "bagus " 5j1u8
Bhelagu.blogspot.co.id-lirik Dan Kunci Gitar Lagu Afgan - Bukan Cinta Biasa.pdf 2z1e3e
November 2019 298
Salinan A.dpthp3-kpu Full Bandung_bulus_001 5x122p
May 2020 58
Pelatihan Tekla 301915
April 2020 74
Kalender Islam 2014 - Penanggalan Hijriyah Ummul Qura 41568
November 2019 184
7 Liver - Spleen Trauma 623w36
August 2021 0