Operational Medicine 2001
Field Medical Service School
Student Handbook

ABDOMINAL INJURIES

FMST 0408

16 Dec 99

TERMINAL LEARNING OBJECTIVES:

1.      Given an abdominal injury in a combat environment and standard Field Medical Service Technician supplies and equipment, manage abdominal injuries, per the references. (FMST. 04.09)

ENABLING LEARNING OBJECTIVES:

1.      Without the aid of reference materials and given a list, identify the locations of major organs within the abdomen, per the student handbook.  (FMST.04.09a)

2.      Without the aid of reference materials and given a list of signs and symptoms, select the signs which identify traumatic abdominal injuries, per the student handbook.  (FMST.04.09b)

3.      Without the aid of reference materials and given a list of treatments and a list of abdominal injuries, select the appropriate treatment for each injury, per the student handbook.(FMST.04.09c)

4.      Without the aid of reference materials and given the FMST MOLLE Medic bag and a simulated casualty with an abdominal injury, identify, treat and monitor the casualty, per the student handbook.  (FMST.04.09d)

OUTLINE:

A.     GENRAL ANATOMY

1. The abdomen contains the major organs of digestion and excretion.

2. The diaphragm separates the thorax from the abdomen.  Anteriorly and posteriorly, thick muscular abdominal walls create the boundaries of this space.  Inferiorly, the abdomen is separated from the pelvis by an imaginary plane that extends from the symphysis pubis through the sacrum.  Many organs lie in both the abdomen and the pelvis.

3. The simplest and most common method of describing the portions of the abdomen is by quadrants.  In this system, the abdomen is divided into four equal parts by two imaginary lines that intersect at right angles at the umbilicus.

a.       Right Upper Quadrant (# 1 in Fig - 1)

Contains the liver, right kidney, colon, pancreas, and the gallbladder.

b.      Right Lower Quadrant (# 2 in Fig - 1)

Contains the colon, small intestines, major artery and vein for the right leg, the right ureter, and the appendix.

c.       Left Upper Quadrant (# 3 in Fig - 1)

Contains the spleen, left kidney, stomach, colon, and the pancreas.

d.      Left Lower Quadrant (# 4 in Fig -1)

Contains the colon, small intestines, major artery and vein for the left leg, and the

left ureter.

4.      The abdominal organs can be classified as either "Hollow" or "Solid" organs, depending on their functions.

a.       Hollow - tubes through which materials pass (stomach, intestines, ureters and bladder)

1.      food that is in the process of being digested

2.      urine that is being passed to the bladder for release

3.      bile

b.      Solid - solid masses of tissue (liver, spleen, pancreas and kidneys)

1.      much of the chemical work of the body takes place

2.      highly vascular

Figure 1 - Diagram of the Four Quadrants of the Abdomen

B.     TYPES OF INJURIES

1. Closed Injuries - where a severe blow damages the abdomen without breaking the skin

2. Open Injuries - a foreign object enters the abdomen and opens the peritoneal cavity to the outside

C.     SIGNS AND SYMPTOMS

1. Closed / Blunt Trauma

a.       Pain to the area

b.      Guarding from pain

c.       Elevated heart rate

d.      Signs of shock

e.       Distended abdomen

f.        Obvious bruising

g.       Abdomen firm or rigid on palpation

h.       Hypoactive or absent bowel sounds

i.         Hypotension

2. Open / Penetrating

a.       Obvious entry wound

b.      Bleeding

c.       Bowel evisceration (a portion of the bowel extrudes from the abdominal cavity)

d.      Guarding

e.       Signs of shock

f.        Pain to the area

g.       Distended abdomen

h.       Abdomen may be distended or rigid on palpation

i.         Hypotension

D.     TREATMENT

1. Closed / Blunt Trauma

a.       Maintain the patient’s ABC's

b.      Establish baseline vital signs

c.       Place in the supine position with knees slightly flexed

d.      Determine history

e.       Keep calm

f.        Treat for shock

g.       Do not strongly palpate abdomen

h.       CASEVAC immediately

2. Open / Penetrating

a.       Maintain the patient’s ABC's

b.      Inspect sides and back for entry / exit wounds

c.       Apply dry, sterile dressing to open wounds

d.      Eviscerated bowels should be covered with sterile dressings soaked in normal saline

e.       Gently secure eviscerated bowel to avoid further damage

f.        Assume penetrations have reached peritoneum

g.       Treat for shock

h.       Do not probe for objects

i.         Penetrating objects still embedded should be left in place and protected with dressing

j.        CASEVAC immediately

REFERENCE (S):

1.  Emergency Care and Transportation of the Sick and Injured; Seventh Edition, 1998

Field Medical Service School
Camp Pendleton, California

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Operational Medicine 2001
Health Care in Military Settings

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