Abdominal Trauma

[NousDefionsDoc]

In patients with abdominal injury, whether blunt, stab, missile, or crush in which you you suspect abdominal vascular injury, avoid lower extremity IV access.

Stab wound patients sustain major abdominal vascular injury 10% of the time, which causes a clean transection or laceration.

25% of GSW patients have a major abdominal vascular injury, the extent of which is variable based on wound ballistics.

Blunt trauma results in major abdominal vascular injury 5-10% of the time. Injury occurs primarily by deceleration, producing shear injuries, or by crushing, often times seen in MVA's.

[IMUA]

3 days before Christmas, EMS brought me a 93 year old white female, restrained front seat passenger in a Mercedes driven by her daughter who had pulled thru a stopped line of traffic into the opposiing direction of traffic only to be struck on her side by an oncoming Jeep Cherokee at about 55 MPH. Side and front airbags deployed. Incident happened less than 2 miles from the ER, but the EMS crew brought her to the ER despite her being hypotensive at the scene without IV access. I get inserted into the loop after she's already been in the ER for sometime while IV access is repeatedly attempted and fluid resuscitation commenced. CT scan reveals multiple fractured pelvis with hematoma, as well as pulmonary contusion and likely pericardial effusion. At any rate, despite fluids, pressors, blood and surgical consult...the patient ends up being coded and expires. Diagnosis:pelvic hemorrhage from fractured pelvis, et al.
You are very right...blunt abdominal trauma can result in hemorrhagic misadventures that kill.

[Surgicalcric]

34 y/o female unrestrained driver of Dodge Neon ejected through drivers window during roll-over.

Upon arrival of fire/EMS I found her supine on ground complaining of right flank and upper abdominal pain only. Patient immobilized, loaded and high flow ambulance to ER. She had severe circumferential bruising of the torso and a rigid belly and degrading LOC enroute. We RSI'd her and initiated (2) IV's NS while rolling

Upon arrival at the trauma center she got an ultrasound, skipped the belly CT and straight to the OR. She died on the table due to hemorraging from her liver. I was told by the attending surgeon her liver looked like hamburger.

I am guestimating here but from time of accident to OR could not have been more than 45 minutes. It does not take long to bleed out when you are bleeding from the filter for the system.

James D

[Doc T]

Originally posted by HFCUIDOC
In patients with abdominal injury, whether blunt, stab, missile, or crush in which you you suspect abdominal vascular injury, avoid lower extremity IV access.

Stab wound patients sustain major abdominal vascular injury 10% of the time, which causes a clean transection or laceration.

25% of GSW patients have a major abdominal vascular injury, the extent of which is variable based on wound ballistics.

Blunt trauma results in major abdominal vascular injury 5-10% of the time. Injury occurs primarily by deceleration, producing shear injuries, or by crushing, often times seen in MVA's.

just to add:

most common organs injured in blunt trauma: liver and spleen
most common organs injured in penetrating trauma: liver and small bowel...

25-35% of stab wounds to the anterior abdomen do not penetrate the abdominal cavity; of those that do 50% do not injure any intra-abdominal organs (at least in civilian life!)

[NousDefionsDoc]

Sources for the numbers I quoted if anybody is interested.

Feliciano DV, Burch JM, Graham JM. Abdominal vascular injury. In: Moore EE, Mattox RL, Feliciano DV, eds. Trauma. 2nd ed. East Norwalk, CT: Appleton & Lange, 1991:553-552.

Feliciano DV, Burch JM, Spjut-Patrinely V, et al. Abdominal gunshot wounds: an urban trauma center's experience with 300 consecutive patients. Ann Surg 1988; 208:362.


Similar numbers came from the Detroit Receiving Hospital (DRH) series:
810 abd stab wound patients - 6.5% suffered vascular injury.
1358 abd GSW patients - 18.9% suffered vascular injury.
573 abd blunt trauma patients - 4.0% suffered vascular injury.

Welcome aboard Doc T!