Advanced Trauma Life Support ATLS Student Course Manual 2018
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Advanced Trauma Life Support ATLS Student Course Manual 2018

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04.12.2017 Views

CHAPTER 5 Outline Objectives iNtroduction ANAtomy of the Abdomen Teamwork Chapter Summary BibliogRAphy Mechanism of Injury • Blunt • Penetrating • Blast Assessment and Management • History • Physical Examination • Adjuncts to Physical Examination • Evaluation of Specific Penetrating Injuries • Indications for Laparotomy • Evaluation of Other Specific Injuries OBJECTIVES After reading this chapter and comprehending the knowledge components of the ATLS provider course, you will be able to: 1. Identify the anatomic regions of the abdomen that are critical in assessing and managing trauma patients. 2. Recognize a patient who is at risk for abdominal and pelvic injuries based on the mechanism of injury. 4. Use the appropriate diagnostic procedures to determine if a patient has ongoing hemorrhage and/or other injuries that can cause delayed morbidity and mortality. 5. Describe the acute management of abdominal and pelvic injuries. 3. Identify patients who require surgical consultation and possible surgical and/or catheter-based intervention. n BACK TO TABLE OF CONTENTS 83

84 CHAPTER 5 n Abdominal and Pelvic Trauma The assessment of circulation during the primary survey includes early evaluation for possible intra-abdominal and/or pelvic hemorrhage in patients who have sustained blunt trauma. Penetrating torso wounds between the nipple and perineum must be considered as potential causes of intraperitoneal injury. The mechanism of injury, injury forces, location of injury, and hemodynamic status of the patient determine the priority and best method of abdominal and pelvic assessment. Unrecognized abdominal and pelvic injuries continue to cause preventable death after truncal trauma. Rupture of a hollow viscus and bleeding from a solid organ or the bony pelvis may not be easily recognized. In addition, patient assessment is often compromised by alcohol intoxication, use of illicit drugs, injury to the brain or spinal cord, and injury to adjacent structures such as the ribs and spine. Significant blood loss can be present in the abdominal cavity without a dramatic change in the external appearance or dimensions of the abdomen and without obvious signs of peritoneal irritation. Any patient who has sustained injury to the torso from a direct blow, deceleration, blast, or penetrating injury must be considered to have an abdominal visceral, vascular, or pelvic injury until proven otherwise. ANAtomy of the abdomen A review of the anatomy of the abdomen, with emphasis on structures that are critical in assessment and management of trauma patients, is provided in (n FIGURE 5-1). The abdomen is partially enclosed by the lower thorax. The anterior abdomen is defined as the area between the costal margins superiorly, the inguinal ligaments and symphysis pubis inferiorly, and the anterior axillary lines laterally. Most of the hollow viscera are at risk when there is an injury to the anterior abdomen. The thoracoabdomen is the area inferior to the nipple line anteriorly and the infrascapular line posteriorly, and superior to the costal margins. This area encompasses the diaphragm, liver, spleen, and stomach, and is somewhat protected by the bony thorax. Because the diaphragm rises to the level of the fourth intercostal space during full expiration, fractures of the lower ribs and penetrating wounds below the nipple line can injure the abdominal viscera. The flank is the area between the anterior and posterior axillary lines from the sixth intercostal space to the iliac crest. The back is the area located posterior to the posterior axillary lines from the tip of the scapulae to the iliac crests. This includes the posterior thoracoabdomen. Musculature in the flank, back, and paraspinal region acts as a partial protection from visceral injury. The flank and back contain the retroperitoneal space. This potential space is the area posterior to the peritoneal lining of the abdomen. It contains the abdominal aorta; inferior vena cava; most of the duodenum, pancreas, kidneys, and ureters; the posterior aspects of the ascending colon and descending colon; and the retroperitoneal components of the pelvic cavity. Injuries to the retroperitoneal visceral structures are difficult to recognize because they occur deep within the abdomen and may not initially present with signs or symptoms of peritonitis. In addition, the retroperitoneal space is not sampled by diagnostic peritoneal lavage (DPL) and is poorly visualized with focused assessment with sonography for trauma (FAST). The pelvic cavity is the area surrounded by the pelvic bones, containing the lower part of the retroperitoneal and intraperitoneal spaces. It contains the rectum, n FIGURE 5-1 Anatomy of the Abdomen. A. Anterior abdomen and thoraco-abdomen. B. Flank. C. Back. D. Pelvic Cavity. n BACK TO TABLE OF CONTENTS

CHAPTER 5 Outline<br />

Objectives<br />

iNtroduction<br />

ANAtomy of the Abdomen<br />

Teamwork<br />

Chapter Summary<br />

BibliogRAphy<br />

Mechanism of Injury<br />

• Blunt<br />

• Penetrating<br />

• Blast<br />

Assessment and Management<br />

• History<br />

• Physical Examination<br />

• Adjuncts to Physical Examination<br />

• Evaluation of Specific Penetrating Injuries<br />

• Indications for Laparotomy<br />

• Evaluation of Other Specific Injuries<br />

OBJECTIVES<br />

After reading this chapter and comprehending the knowledge<br />

components of the <strong>ATLS</strong> provider course, you will be able to:<br />

1. Identify the anatomic regions of the abdomen that are<br />

critical in assessing and managing trauma patients.<br />

2. Recognize a patient who is at risk for abdominal and<br />

pelvic injuries based on the mechanism of injury.<br />

4. Use the appropriate diagnostic procedures to<br />

determine if a patient has ongoing hemorrhage<br />

and/or other injuries that can cause delayed<br />

morbidity and mortality.<br />

5. Describe the acute management of abdominal and<br />

pelvic injuries.<br />

3. Identify patients who require surgical consultation and<br />

possible surgical and/or catheter-based intervention.<br />

n BACK TO TABLE OF CONTENTS<br />

83

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