Abdominal Trauma

Abdominal trauma is extremely common and its basic management follows the principles of the ABCs and basic wound care. There are two special situations involving the abdomen that will be discussed in this section, eviscerations and impaled objects. This section will also review the basic anatomy of the abdomen and the concept of "abdominal quadrants."

Eviscerations

EVISCERATION: any injury where the contents of the abdominal cavity protrude through the wound or are removed from the body.

The intestines, liver, spleen, and stomach are commonly involved in eviscerations. These injuries are dangerous as they expose the organs to the outside environment--unprotected--risking injury due to dehydration and infection.

MANAGEMENT: Management of these injuries is focused on keeping the exposed organs as moist and sterile as possible.

• Sterile gauze or abdominal pads should be irrigated with sterile saline and draped gently over the wound.
• DO not attempt to push the abdominal contents back into the body cavity: this risks further injury and is unlikely to succeed.

Impaled Objects

IMPALEMENT: A foreign object protruding from the body is managed the same way as evisceration, regardless of the location.

• Impaled objects should never be removed.
• The clothing should be cut away from around the object,
• the area irrigated and dressed with a bulky dressing to control bleeding,
• seal the wound entrance from further contamination, and
• anchor the object in place.

The only modification to this rule is if the patient requires CPR and an impaled object prevents chest compressions on the sternum.

Anatomical Areas

A basic understanding of anatomy is important to target and inform the remainder of your assessment and assist you in identifying co-dominant injuries. The abdomen is divided into quadrants with the belly button (umbilicus) being the center. They are named the upper right, upper left, lower right, and lower left quadrants.

UPPER QUADRANTS: Injury to the upper quadrants can result in damage to the

• diaphragm,
• liver,
• spleen, and
• stomach.

This can result in significant blood loss extremely quickly, and/or may compromise the patient's ability to breathe in the case of diaphragm injury.

LOWER QUADRANTS: Mostly occupied by the

• intestines,
• ovaries, and
• blood vessels.

These injuries can still be serious but are usually less so than injuries to the upper quadrants.