![]() ![]() 1 is the most minor, like small laceration that requires no interventions. When it comes to liver injuries, they are graded 1-5. If the patient is showing signs like this, it's most likely they need some soft of surgical intervention.Īnd like i said on the last slide….if we suspect those bladder or urinary tract injuries….No Foleys. It's usually due to peritoneal irritation and indicates severe bleeding or some sort of perforation. This is basically sudden severe pain and discomfort to really any part of the abdomen and sometimes the pain is diffuse and hard to localize. We want to always stay alert for signs of an acute abdomen. He stays on monitor and we continue to trend the BP and the pulse and look for those changes that indicate that things are going south. The name at your facility may be different but it is the code for whatever gets you a lot of blood to the bedside for infusion very quickly.Īs we are giving all this blood, we need to keep an eye on our guys hemodynamic status. In these cases, if we suspect the bleeding that we do, we are going to call for a massive transfusion protocol. Either way.do not try to insert a foley into these patients. It is a usually a sign of a bladder injury, or an injury to the urinary tract. A conscious patient is a fountain of information if we just ask the right questions.īlood at the urinary meatus is bad. ![]() Is it dull, or sharp, or god forbid.tearing. We talked about referred pain but we want to assess all pain. ![]() Seatbelt sign is a reddened mark across the abdomen that is due to the force of the seatbelt keeping our patient in place. We can use our eyes and look for abdominal distention, the signs we just talked about on the last slide, and checking for a seatbelt sign. We want to get an idea of how bad our patient is bleeding. This procedure is done less and less as the FAST exam has taken its place and has been found to be an equal of not better diagnostic tool. They are looking to see if any, and how much fluid is in the belly. If nothing comes right out, then saline is infused and then drained to see what comes out. This is a procedure that is done in the ED where an incision is made in the abdomen and a catheter inserted to see what comes out. I want to also mention here the use of DPL or diagnostic peritoneal lavage. The FAST exam, or focused assessment with Sonography in Trauma is a great tool for quickly determining if there is blood in the belly. Of course, with our bleeding concerns, we want to watch for hypotension and use our radiology resources to check for free fluid in the abdomen. I know it seems weird to have an injury so low causing pain so high but it is due to the irritation of the diaphragm and the phrenic nerve which causes that shoulder pain. When it comes to abdominal trauma, pain in the left shoulder is usually a sign of a ruptured spleen. Grey-Turner sign is bruising to the flanks and is a sign of retroperitoneal bleeding.Īnd Kehr’s sign is pain to the tip of the shoulder. It can also lead us to injuries of the pancreas or in females, the fallopian tubes. Cullen sign is bruising around the umbilicus and is indicative of an intraperitoneal hemorrhage. With our abdominal injuries, there are some specific signs to be aware of. Don't start mashing on our guys belly and then listening for the result. As with any abdominal assessment, we inspect, auscultate, percuss and palpate.in that order. When assessing blunt abdominal trauma, we perform our usual ABCs. How the blunt force impacted the abdomen will have an effect on the severity of damage and which organ is injured will help to determine the severity of blood loss. Is it a solid organ, like the liver or spleen, or is it hollow like the stomach or intestines. We want to keep the type of organ in mind. Once we have that information we can focus on the damage. We need to know where everything is located in order to help us figure out all the possible injuries.Īs always, we want to try to get a good history, specifically focusing on the mechanism of injury. There are so many different organs in the abdomen and given enough force, any one of them can pop, or perforate.
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