Chapter 36
Abdominal and
Genitourinary
Trauma
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36-1
Objectives
36-2
Abdominal Trauma
36-3
Mechanism of Injury
Blunt Forces
Penetrating Forces
• Motor vehicle crashes
• Falls
• Assaults
• Guns
• Knives
36-4
Mechanism of Injury
Considerations
• Type of trauma
– Motor vehicle crash, fall injury, assault
• Object involved during impact
– Bullet, knife, car, motorcycle, handlebars,
tree
• Energy exchanged
– Estimated speed of the vehicle at impact,
size/caliber of gun, length of knife,
distance of a fall
• Restraints / protective gear used
36-5
Abdominal Injuries
36-6
Location of Injuries
36-7
Abdominal Organs
Hollow Organs
Stomach
Solid Organs
Liver
Intestines
Spleen
Gallbladder
Pancreas
Urinary bladder
Kidneys
Uterus (female)
Adrenal glands
Ovaries (female)
36-8
Types of Injuries
• Open injuries
• Closed injuries
• May involve multiple organs
and major blood vessels
36-9
Closed Abdominal Injuries
• Common mechanisms of injury involving
blunt trauma to the abdomen
– Compression
– Deceleration
– Motor vehicle crash
– Motorcycle collision
– Pedestrian injury
– Fall
– Assault
– Blast injury
36-10
Open Abdominal Injuries
• Low energy weapons
– Knife, ice pick
• Medium energy weapons
– Handguns and shotguns
• High-energy weapons
– Military and hunting rifles
36-11
Liver
• Largest organ of the body
• Very vascular
• Injury can result in
hemorrhage, leading to
shock
• Suspect injury with:
– Lower right rib
fractures
– Penetrating trauma to
RUQ
36-12
Spleen
• Vascular organ
• Susceptible to injury
• Suspect injury with:
– Lower left rib fractures
– Penetrating trauma to LUQ
• Kehr’s sign
– Suggests injury or rupture of the spleen or
injury to the diaphragm
36-13
Pancreas
• Injury is uncommon
– Can occur from both
blunt and penetrating
trauma
• Initial signs and symptoms
– Upper abdominal pain
– Flank tenderness
• Later signs and symptoms
– Abdominal distention
– Shock
36-14
Diaphragm
• Both blunt and penetrating trauma can cause
injury to the diaphragm.
• Injury more commonly occurs on the left side
36-15
Stomach and Intestines
• Injury can result in leakage
of organ contents into the
peritoneum resulting in
peritonitis and shock.
• Injuries to the large
intestine are usually the
result of gunshot wounds
and stabbings.
36-16
Abdominal Vessels
• Injury to vascular
structures in the abdomen
can result in:
– Significant hemorrhage
– Peritoneal irritation
– Abdominal distention
– Shock
36-17
Genitourinary Trauma
36-18
Kidneys and Ureters
• Injury to the kidney
– Usually caused by blunt
trauma
– Penetrating injury can result
from gunshot or stab
wounds
• Injury to a ureter is uncommon
36-19
Bladder and Urethra
• Empty bladder lies in
the pelvis
• Full bladder rises above
the umbilicus
– Less protected
– Increased likelihood
of injury
36-20
External Male Genitalia
36-21
External Female Genitalia
36-22
Patient Assessment
36-23
Patient Assessment
• Ensure scene safety
• Assess the ABCs
• Manual stabilization of the
patient’s head and neck if
head or spinal injury
suspected
36-24
Patient Assessment
• Remove the patient’s clothing
• Make sure that the patient is supine
• Assess the abdomen
– DCAP-BTLS
– Abdominal distention
– Entrance and exit wounds
36-25
Patient Assessment
• If the patient is responsive, ask him to point
to the area that hurts.
– Assess the area that hurts last.
• Ask the patient to rate his pain on a 0 to 10
scale
• Determine if the abdomen feels soft or hard.
• Document your findings.
36-26
Patient Assessment
• Look for signs of impending shock that can
include:
– Restlessness
– Anxiety
– Decreasing level of responsiveness
– Pallor
– Tachycardia
– Narrowing pulse pressure
36-27
Patient Assessment
Male
• If the male patient with a genitourinary injury
is responsive:
– Explain to him that you will need to view
the area and then obtain permission from
him to proceed.
– Be aware that he will most likely be
anxious and may be embarrassed.
– Offer emotional support, maintain the
patient’s privacy, and protect his modesty.
36-28
Patient Assessment
Female
• Looking at the external female genitalia is
necessary if the patient complains of
bleeding from the vaginal or rectal area.
• Before visualizing the area, tactfully explain
that you will need to view the area and obtain
permission from the patient to do so.
• If possible, it is advisable to have a female
EMS professional in attendance during the
assessment.
36-29
Patient Assessment
Female
• Your assessment of the female genitalia is
limited to looking at the area, while
maintaining the patient’s privacy and
protecting her modesty.
• You must never insert anything into the
vagina or attempt to examine the internal
female genitalia.
– These actions are outside the Emergency
Medical Technician’s scope of practice.
36-30
Emergency Care
• Put on appropriate PPE.
• Keep on-scene time to a minimum.
• If spinal injury is suspected, take spinal
precautions.
• If a spinal injury is not suspected, place the
patient in a position of comfort.
• Establish and maintain an open airway.
– If the patient is unresponsive, insert an
oral airway. Suction if needed.
• Give oxygen.
36-31
Emergency Care
• Expose the wound site.
– Control external bleeding by applying
direct pressure.
• If signs of shock are present or if internal
bleeding is suspected, treat for shock.
• Do not remove penetrating objects; rather,
stabilize in place with bulky dressings.
• Manage avulsed or amputated parts as other
soft tissue injuries.
36-32
Emergency Care
• Do not touch protruding organs.
– Evisceration management
• Protect patient’s modesty.
• Transport promptly.
• Reassess at least every 5 minutes en route.
• Record all patient care information, including
the patient’s medical history and all
emergency care given, on a PCR.
36-33
Questions?
24-34