Search

CEN and TCRN Abdominal Trauma

Updated: Jan 1

1. Ruptured diaphragm – penetrating injury below the 4th ICS. S/S: peristaltic gurgling sounds in left chest, progressively scaphoid abdomen, Kehr’s sign (left shoulder pain) worse when supine. TX: Emergent exploratory laparotomy, not thoracotomy.


2. Splenic injury (#1 injured in blunt trauma) – S/S: LUQ pain radiating to left shoulder (Kehr’s sign).

a. Grading – Grade IV - > 25% of spleen injured, Grade V – completely shattered.

b. Splenectomy – it is normal to have increased WBC post-op. Give pneumococcal, meningococcal, influenza vaccines if splenectomy; and seek medical attention if animal bites, risk of malaria.


3. Liver injury – (MVC with restraints – cavitation injury) – S/S: RUQ pain and signs of shock, Cullen’s sign (ecchymosis around umbilicus).

a. DX: Coagulation, H&H, LFT’s. Grading I (hematoma) to VI (vascular avulsion).

b. TX: Damage-control surgery (under 90 minutes) to control bleeding. Lower grade injury – monitor H&H closely.


4. Bowel rupture – Lap restraint injury, associated with Chance fracture (T12-L2); transverse colon most often injured. Stomach and bowel injury seen in GSW.


Abdominal Trauma Resources

· Emergency Nurses Association. Trauma Nursing Core Curriculum, 8th ed., 2019.

· Kent, Kendra. Trauma Certified Registered Nurse Examination Review. Springer, 2017.

· Sheehy, S. Sheehy’s Manual of Emergency Care, 7th ed. Elsevier, 2013.


· https://litfl.com/abdominal-trauma-blunt-or-penetrating/

· https://litfl.com/liver-trauma/

· https://litfl.com/spleen-trauma/

· https://pedemmorsels.com/splenic-injury/

· https://radiopaedia.org/articles/aast-spleen-injury-scale

· https://litfl.com/diaphragm-injury/


#CEN #TCRN #nursepassologist #certificationmentor

0 views