Abdominal Trauma part 1

The abdomen contains numerous organs and blood vessels, including the lower parts of the aorta and inferior vena cava. This makes major trauma to the abdomen a high risk for internal and/or external haemorrhage and complications. The abdomen can store a large amount of fluid in the space between organs, potentially up to half of the body’s circulating volume. This means a patient with internal haemorrhage could quickly become hypovolaemic following a traumatic incident.

When suspecting trauma to the abdomen, there are several considerations such as the MOI and surrounding factors, what signs/symptoms/injuries the patient is displaying, and what primary survey deficits and observations are found. Abdominal trauma and haemorrhage symptoms can include:

  • A hard/solid/’woody’ abdomen on palpation
  • A hypo-resonant sound on percussion
  • Reduced bowel sounds on auscultation
  • Severe pain in the abdomen
  • Signs for hypovolaemic shock

When managing an abdominal trauma patient, review the primary survey and treat any deficits found, consider oxygen for a critical trauma patient, consider use of Tranexamic Acid for traumatic bleeding (following your local guidelines), consider fluid therapy, a targeted systolic of 60 mmHg or central carotid pulse should be aimed for in penetrating torso trauma, and systolic of 90 mmHg or peripheral radial pulse in blunt trauma or penetrating limb trauma.

Open abdominal wounds where muscle and peritoneal tissues have been lacerated can cause some abdominal contents, like the intestines, to protrude out. In these situations, cover any protruding organs with warm moist dressings, manage any further primary survey deficits, and consider rapid extrication and transport to hospital.