Abdominal trauma: Clinical

Abdominal trauma is defined as injury anywhere between the nipple line and inguinal creases, and can be blunt, like from motor vehicle accidents, or penetrating, like from stab wounds or gunshot wounds.

As with any trauma, evaluation begins with the primary survey, which includes the ABCDEs; airway, breathing, circulation, disability and exposure.

The main goal of the primary survey is to assess and treat for immediately life-threatening injuries.

Okay, so if the individual is talking to you with a clear voice, their airway is intact. If not, assess their ability to maintain the airway, or if they needed assisted ventilation with a bag-valve mask or even endotracheal intubation.

As for “breathing”, look for tracheal deviation and listen to the breath sounds.

Also, if the individual is hypoxic, provide 100% oxygen using a non-rebreather mask.

Next, look at the heart rate and blood pressure, as tachycardia or hypotension may indicate hemorrhagic shock.

Assess for signs of inadequate end-organ perfusion, such as altered mental status, decrease urine output, cool or pale skin, and delayed capillary refill.

Also, insert two large-bore intravenous lines, and prepare for the need for blood products.

Bedside ultrasound can also be used in the primary survey - and it’s called focused assessment with sonography for trauma, or the FAST exam.

The ultrasound probe explores the pericardial cavity, then the right flank, also called the hepatorenal recess or Morison’s pouch, and then the left flank which looks for perisplenic fluid, and finally the suprapubic region to look for fluid around the bladder.

When views are added to look for a pneumothorax, hemothorax, or cardiac tamponade, it’s called an extended FAST or E-FAST.