Abdominal Trauma ATCN – Questions And Answers
Physical Exam: Inspection ✔️Ans - 1. fully undress patient
2. examine anterior and posterior abdomen
3. examine chest and flank
4. inspect perineum, scrotum, and perianal area
5. logroll patient to inspect ack
AFTER INSPECTION, COVER THE PATIENT TO PREVENT HYPOTHERMIA
Signs of Pelvic Fracture ✔️Ans - 1. evidence of ruptured urethra (scrotal
hematoma or blood at the urethral meatus)
2. discrepancy in limb length
3. rotation deformity of a leg without obvious fracture
IN PATIENTS WITH THESE SIGNS, AVOID MANUALLY MANIPULATING THE
PELVIS
Hypotension and pelvic fracture = high mortality
Therefore... ✔️Ans - Sound, rapid diagnosis and treatment are critical to
patient outcome
Pelvic assessment key points ✔️Ans - 1. diagnose pelvic hemorrhage and
treat without delay
2. unexplained hypotension may be the only sign of pelvic disruption
3. place a pelvic binder of pelvic fractures, hypotension, and no other source of
blood loss
4. avoid pelvic manipulation and distraction
5. may gently palpate the bony pelvis for tenderness, not stability
Pelvic Farrctures: Initial Management ✔️Ans - 1. hemorrhage control
a. emergent: stabilization, with sheet, binder, internal rotation or lower
extremities
b. definitive: angiographic embolization, operative hemorrhage control
2. fluid resuscitation (avoid hypothermia)
3. early transfer
, Signs of urethral injury ✔️Ans - 1. blood at the urethral meatus, scrotal and
perineal ecchymosis
Rectal exam (blunt trauma) ✔️Ans - 1. assess sphincter tone and rectal
mucosal integrity, and identify palpale fractures of pelvis
rectal exam (penetrating trauma) ✔️Ans - assess sphincter tone and look for
gross blood
Vaginal Exam: Trauma ✔️Ans - Perform when injury supsected; bony
fragments from pelvic fractures and penetrating wounds can cause lacerations
Gluteal exam: Trauma ✔️Ans - look for penetrating injuries that can result in
significant intra-abdominal injuries (e.g., gunshot and stab wounds)
GASTRIC TUBE GOALS: ✔️Ans - 1. relieve gastric dilation and decompress
stomach
GASTRIC TUBE Hints ✔️Ans - 1. can prevent aspiration, but can trigger
vomiting
2. blood in gastric contents suggests esophageal or upper gastrointestinal
injury
3. in patients with facial fractures or possible basilar skull fracture, insert
through mouth
URINARY CATHETER GOALS: ✔️Ans - 1. relieve retention, identify bleeding,
monitor urinary output, decompress bladder
URINARY CATHETER HINTS ✔️Ans - 1. if FAST is an option, wait to place
catheter
2. confirm intact urethra before placing catheter
3. gross hematuria indicates genitourinary tract trauma
4. retrograde urethrogram if patient cannot void, require pelvic binder, blood
at the meatus, scrotal hematoma, perineal ecchymosis
PITFALL: in a patient with midface fractures, a nasogastric tube can pass into
the sinuses and cranial cavity ✔️Ans - Solution: avoid a nasogastric tube in
patients with midface injury; instead use an orogastric tube
Physical Exam: Inspection ✔️Ans - 1. fully undress patient
2. examine anterior and posterior abdomen
3. examine chest and flank
4. inspect perineum, scrotum, and perianal area
5. logroll patient to inspect ack
AFTER INSPECTION, COVER THE PATIENT TO PREVENT HYPOTHERMIA
Signs of Pelvic Fracture ✔️Ans - 1. evidence of ruptured urethra (scrotal
hematoma or blood at the urethral meatus)
2. discrepancy in limb length
3. rotation deformity of a leg without obvious fracture
IN PATIENTS WITH THESE SIGNS, AVOID MANUALLY MANIPULATING THE
PELVIS
Hypotension and pelvic fracture = high mortality
Therefore... ✔️Ans - Sound, rapid diagnosis and treatment are critical to
patient outcome
Pelvic assessment key points ✔️Ans - 1. diagnose pelvic hemorrhage and
treat without delay
2. unexplained hypotension may be the only sign of pelvic disruption
3. place a pelvic binder of pelvic fractures, hypotension, and no other source of
blood loss
4. avoid pelvic manipulation and distraction
5. may gently palpate the bony pelvis for tenderness, not stability
Pelvic Farrctures: Initial Management ✔️Ans - 1. hemorrhage control
a. emergent: stabilization, with sheet, binder, internal rotation or lower
extremities
b. definitive: angiographic embolization, operative hemorrhage control
2. fluid resuscitation (avoid hypothermia)
3. early transfer
, Signs of urethral injury ✔️Ans - 1. blood at the urethral meatus, scrotal and
perineal ecchymosis
Rectal exam (blunt trauma) ✔️Ans - 1. assess sphincter tone and rectal
mucosal integrity, and identify palpale fractures of pelvis
rectal exam (penetrating trauma) ✔️Ans - assess sphincter tone and look for
gross blood
Vaginal Exam: Trauma ✔️Ans - Perform when injury supsected; bony
fragments from pelvic fractures and penetrating wounds can cause lacerations
Gluteal exam: Trauma ✔️Ans - look for penetrating injuries that can result in
significant intra-abdominal injuries (e.g., gunshot and stab wounds)
GASTRIC TUBE GOALS: ✔️Ans - 1. relieve gastric dilation and decompress
stomach
GASTRIC TUBE Hints ✔️Ans - 1. can prevent aspiration, but can trigger
vomiting
2. blood in gastric contents suggests esophageal or upper gastrointestinal
injury
3. in patients with facial fractures or possible basilar skull fracture, insert
through mouth
URINARY CATHETER GOALS: ✔️Ans - 1. relieve retention, identify bleeding,
monitor urinary output, decompress bladder
URINARY CATHETER HINTS ✔️Ans - 1. if FAST is an option, wait to place
catheter
2. confirm intact urethra before placing catheter
3. gross hematuria indicates genitourinary tract trauma
4. retrograde urethrogram if patient cannot void, require pelvic binder, blood
at the meatus, scrotal hematoma, perineal ecchymosis
PITFALL: in a patient with midface fractures, a nasogastric tube can pass into
the sinuses and cranial cavity ✔️Ans - Solution: avoid a nasogastric tube in
patients with midface injury; instead use an orogastric tube
