Chapter 23

Chapter 23

Abdomen and Genitalia Injuries

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Chapter 23: Abdomen and Genitalia Injuries

• State the steps in the care of a patient with a blunt or penetrating abdominal injury.

• Describe how solid and hollow organs can be injured.

• State the steps in the care of a patient with an object impaled in the abdomen.

• State the steps in the care of a patient with an abdominal evisceration wound.

Objectives (1 of 2)

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Objectives (2 of 2)

• State the steps in the care of a patient with a genitourinary injury.

• Demonstrate proper treatment of a patient who has an object impaled in the abdomen.

• Demonstrate how to apply a dressing to an abdominal evisceration wound.

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Hollow Organs in the Abdominal Cavity

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Signs of Peritonitis• Abdominal pain

• Tenderness

• Muscle spasm

• Diminished bowel sounds

• Nausea/vomiting

• Distention

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Solid Organs in the Abdominal Cavity

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Abdominal Quadrants

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Injuries of the Abdomen

• Closed injury (blunt)

– Severe blows that damage the abdomen without breaking the skin

• Open injury (penetrating)

– Foreign body enters the abdomen and opens the peritoneal cavity to the outside

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Signs and Symptoms of Abdominal Injury

• Pain

• Tachycardia

• Decreased blood pressure

• Pale, cool, moist skin

• A firm abdomen on palpation

• Bruising

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Evaluating Abdominal Injuries (1 of 2)

• Determine the type of injury, extent of damage, and presence of shock.

• Keep airway clear and watch for vomiting.

• Place patient supine with knees bent.

• Obtain baseline vital signs.

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Evaluating Abdominal Injuries (2 of 2)

• Follow DCAP-BTLS.• Inspect abdomen for wounds.• Immobilize any impaled objects.

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Blunt Abdominal Wounds (1 of 2)

• Severe bruises of the abdominal wall

• Laceration of the liver and spleen

• Rupture of the intestine

• Tears in the mesentery

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Blunt Abdominal Wounds (2 of 2)

• Rupture or tearing of the kidneys

• Rupture of the bladder

• Severe intra-abdominal hemorrhage

• Peritoneal irritation and inflammation

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Care of Blunt Abdominal Wounds

• Place patient on backboard.

• Protect airway.

• Monitor vital signs.

• Administer oxygen.

• Treat for shock.

• Arrange for prompt transport.

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Seat Belts and Airbags

• If used inappropriately, seat belts may cause injuries.

• Frontal airbags provide protection only during head-on collisions.

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Abdominal Evisceration• Internal organs or fat protrude through the

open wound.

• Never try to replace organs.

• Cover the organs with a moist gauze, then secure with a dressing.

• Organs must be kept warm and moist.

• Arrange for prompt transport.

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Anatomy of the Genitourinary System

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Injuries to the Kidneys• Suspect kidney damage if patient has a

history or physical evidence of:

– Abrasion, laceration, or contusion in the flank

– A penetrating wound in the region of the lower rib cage or upper abdomen

– Fractures on either side of the lower rib cage or of the lower thoracic or lumbar vertebrae

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Injury of the Urinary Bladder• Blunt or penetrating injury can rupture the

bladder.

• Urine will spill into surrounding tissues.

• Suspect injury if you see blood at the urethral opening or physical signs of trauma on the lower abdomen, pelvis, or perineum.

• Monitor vital signs.

• The presence of associated injuries or shock will dictate the urgency of transport.

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Male Reproductive System

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Caring for Injury to the External Male Genitalia

• These injuries are painful; make patient comfortable.

• Use sterile, moist compresses to cover areas stripped of skin.

• Apply direct pressure to control bleeding.

• Never manipulate any impaled objects.

• Identify and bring avulsed parts to the hospital.

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Female Reproductive System

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Injuries of the Female Genitalia

• Female internal genitalia are well protected and usually not injured.

• The exception is the pregnant uterus, which is vulnerable to both blunt and penetrating injuries.

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Genitalia Injuries in Pregnant Women

• Keep in mind that the unborn child is also at risk.

• Expect to see signs and symptoms of shock.

• Provide all necessary support.• Place the mother on her left side to reduce

pressure on her vena cava.• Arrange for prompt transport.

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Caring for Injuries of the Female Genitalia (1 of 2)

• Injuries to the external genitalia are very painful but not usually life threatening.

• Treat lacerations, abrasions, and avulsions with moist, sterile compresses.

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Caring for Injuries of the Female Genitalia (2 of 2)

• Use local pressure and a diaper-type bandage to hold dressing in place.

• Urgency of transport will be determined by associated injuries, amount of hemorrhage, and presence of shock.

Chapter 23

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