Chest  &

Abdominal Trauma

 

History:

 

  • Time of injury
  • Type of injury
  • Mechanism (blunt vs. penetrating)
  • Open vs. closed wound/fracture
  • Wound contamination
  • Medical history
  • Medications
  • Tetanus history
  • Evidence for multi-trauma

 

Significant Findings:

 

  • Pain
  • Swelling/bleeding
  • Respiratory distress/failure
  • Altered sensation/motor function distal the injury
  • Diminished pulse/capillary refill distal the injury
  • Major traumatic mechanism of injury
  • Seat belt markings

 

Differential:

 

  • Hollow/solid organ trauma
  • Grey Turner's sign (bruising at flanks)
  • Cullen's sign (bruising around navel)
  • Referred pain (caused from the brain's inability to localize area of irritation
  • Parietal pain (caused by irritation to the parietal peritoneal wall)
  • Visceral pain (caused from acute stretching of the structure's wall)

 

Treatment:

 

 

  • Oxygen
  • Limit scene time to 10 min

 

 

 

  • Initiate IV

 

Penetrating ?

 

  • Yes

 

 

 

 

 

 

 

 

 

    • Vented chest seals if indicated

 

 

Blunt ?

 

  • Yes

 

 

 

 

 

 

 

 

 

 

    • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • Solid abdominal organs: lungs, liver, spleen, kidneys, pancreas. Presents with constant pain. May be referred.
  • Hollow organs: heart, stomach, intestines, bladder, gall bladder, uterus, diaphragm, appendix.  Presents with visceral, parietal or referred pain. Pain presents as intermittent ache or cramp or sharp, pinpoint pain.
  • Notify Greenville Memorial as soon as possible with:
    •  BP (or hemodynamic stability)
    • Airway status (patent, unstable or secured)
    • MOI
    • GCS
    • ETA.

NREMR

National Registry Emergency Medical Responder

NREMT-I

National Registry EMT-Intermediate

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic