During abdominal trauma, a thorough assessment may help the clinician in identifying potential injuries and concerns. A full abdominal assessment may not be possible within the emergency/pre-hospital environment due to the amount of time it can take or potential patient positioning/environment factors. Management of time critical features and rapid transport to hospital should not be delayed by conducting a full abdomen assessment. In some cases, the clinician may be able to conduct a rapid assessment or modified assessment (depending on the situation and health of the patient) which may help identify further potential concerns.
When first assessing a patients’ abdomen, ideally you want them to be laying down flat in a supine position with their arms resting against their sides. Within the pre-hospital trauma environment this will likely be a challenge, and the clinician will have to try their best to adapt to the situation. Gain consent from the patient for the assessment, and keep them as comfortable as possible.
The first part of the abdominal assessment is inspect. You need to expose the abdominal area so that you can visually inspect the site. Be mindful of the environment and the patient potentially getting cold if outdoors.
Inspect the abdomen for any signs of injury or bruising, look for asymmetry and any abnormalities in the abdominal wall. Is there any pulsating or new masses present. The patient may have previous abdominal issues so ask them about their abdominal history to see whether there are new pathologies.
Certain signs can indicate potential pathologies such as Cullen’s Sign or Grey Turner’s Sign. Cullen’s Sign where there is bruising around the umbilical area, Grey Turning’s Sign where there is bruising along the flank. Both can be signs of retroperitoneal bleeding where there may have been trauma and bleeding from damaged tissues, organs, and/or blood vessels.
Auscultation of the abdomen can help determine potential issues with bowel movement. Through auscultation, the clinician can listen for bowel sounds and assess if they are normal, hyperactive, hypoactive, or absent. Auscultation can be difficult in the pre-hospital environment due to surrounding sounds and distractions. It can also take some time to identify sounds and listen correctly to each quadrant. Depending on different text books, the amount of auscultation time varies. Suggestions for optimal auscultation figures can range from 10 seconds to 7 minutes. The normal bowel sounds per minute can also range from 5-35 sounds auscultated.
When auscultating, listen to all quadrants of the abdomen working around each quadrant in quarters. Any abnormal sound presentation or absent sounds altogether could indicate issues with bowel movement and the underlying organs such as an obstruction, an ileus, trauma, and so on. If there are other associated symptoms, such as pain or abdominal distention, this may help further indicate potential abdominal pathophysiology.
Palpating the abdomen can help identify any areas of injury or pathology, however, this must be done with great consideration and care as not to aggravate or worsen any ongoing issues. Carefully review the need for palpation in abdominal trauma as it may cause more damage, for example, disrupting a clot or an internal bleed.
When palpating you want to start in the quadrant furthest from the pathology/pain, working your way around to the affected quadrant. Assess for any reactions from the patient such as pain, rebound tenderness, guarding, or rigidity. These may help indicate if there is injury or pathology ongoing within the abdomen. A hard or ‘woody’ feeling abdomen can indicate trauma and haemorrhage in the abdominal cavity.
Percussion within the pre-hospital and trauma environment can be difficult due to the surrounding sounds and distractions. Through percussing the abdomen, it can assist in identifying organ locations through hyper and hypo-resonance, it can also help identify if there is a build up of air or fluid within the organs or abdominal cavity. Hyper-resonance will indicate air, whereas hypo-resonance will indicate fluid. If there is wide spread hypo-resonance, this may be an indication of internal haemorrhage.
Beware when percussing that you don’t inadvertently cause further damage to any ongoing issues, such as disrupting any clots or aggravating internal haemorrhage.
These four aspects of the abdominal assessment may help the clinician further identify potential abnormalities or pathologies within the trauma and medical fields. Depending on the situation, you may be able to utilise all areas of the assessment, or conduct a rapid modified assessment. However, remember not to let an abdominal assessment delay transport to hospital or any life-saving treatment.