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Chapter 23

Chapter 23. Abdomen and Genitalia Injuries. Objectives (1 of 2). 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.

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Chapter 23

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  1. Chapter 23 Abdomen and Genitalia Injuries

  2. Objectives(1 of 2) • 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.

  3. 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.

  4. Hollow Organs in the Abdominal Cavity

  5. Signs of Peritonitis • Abdominal pain • Tenderness • Muscle spasm • Diminished bowel sounds • Nausea/vomiting • Distention

  6. Solid Organs in the Abdominal Cavity

  7. Abdominal Quadrants

  8. 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

  9. Signs and Symptoms of Abdominal Injury • Pain • Tachycardia • Decreased blood pressure • Pale, cool, moist skin • A firm abdomen on palpation • Bruising

  10. 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.

  11. Evaluating Abdominal Injuries (2 of 2) • Follow DCAP-BTLS. • Inspect abdomen for wounds. • Immobilize any impaled objects.

  12. Severe bruises of the abdominal wall Laceration of the liver and spleen Rupture of the intestine Tears in the mesentery Blunt Abdominal Wounds (1 of 2)

  13. Rupture or tearing of the kidneys Rupture of the bladder Severe intra-abdominal hemorrhage Peritoneal irritation and inflammation Blunt Abdominal Wounds (2 of 2)

  14. Care of Blunt Abdominal Wounds • Place patient on backboard. • Protect airway. • Monitor vital signs. • Administer oxygen. • Treat for shock. • Arrange for prompt transport.

  15. Seat Belts and Airbags • If used inappropriately, seat belts may cause injuries. • Frontal airbags provide protection only during head-on collisions.

  16. 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.

  17. Anatomy of the Genitourinary System

  18. 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

  19. 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.

  20. Male Reproductive System

  21. 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.

  22. Female Reproductive System

  23. 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.

  24. Genitalia Injuries in Pregnant Women • Keepin 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.

  25. 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.

  26. 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.

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