6 Abdominal Trauma

Recognize possible injury

Abdominal injuries can cause life-threatening internal bleeding or damage to hollow organs. Early findings may be subtle, so the mechanism of injury and changes over time matter as much as the initial examination.

Consider possible injury after significant blunt or penetrating trauma, even when early symptoms are mild. A soft or minimally tender abdomen does not rule out significant injury.

Assess the abdomen and mechanism

Ask about the mechanism, including rapid deceleration, direct impact, and penetrating wounds. Assess for pain, tenderness, guarding, rigidity, distension, bruising, wounds, and evisceration. A seat-belt mark or other abdominal-wall bruising raises concern for underlying injury. Check for associated injuries and signs such as blood in the urine.

An examination may be unreliable because of altered mental status, distracting injuries, or inability to communicate. An unreliable examination does not exclude injury. Increasing abdominal distension or worsening tenderness after blunt trauma may indicate significant injury and should be reported promptly.

Prioritize assessment and resuscitation

Begin with the Primary survey: airway, breathing, circulation, disability, and exposure. Support life threats first and activate the trauma response according to local protocol.

In suspected hemorrhage, closely monitor vital signs and perfusion. Establish large-bore IV access as directed, obtain ordered blood tests and type-and-crossmatch, and prepare for blood products and definitive treatment. Keep the patient NPO while urgent evaluation is underway.

Possible Hemorrhagic shock findings include tachycardia, cool or pale skin, diaphoresis, weak pulses, delayed capillary refill, restlessness, and worsening mental status. Hypotension can be a late sign. A normal blood pressure or a single early laboratory result, including an initial hemoglobin, cannot safely exclude evolving hemorrhage. Escalate promptly when perfusion worsens and continue the primary survey and resuscitation.

Choose a diagnostic pathway

Diagnostic priorities depend on the patient's stability. FAST/E-FAST can rapidly look for free fluid at the bedside and is especially useful during evaluation of an unstable patient. It should not delay definitive intervention when the patient's condition requires it.

In a stable patient, contrast-enhanced CT is generally used to assess abdominal injury. A negative FAST examination cannot reliably exclude injury, including some solid-organ or hollow-viscus injuries. Continue reassessment and communicate ongoing concern to the trauma team, particularly when the examination is unreliable or the patient has multiple injuries. The nurse supports assessment and resuscitation; diagnostic and operative decisions are made by the trauma team.

Protect exposed organs and embedded objects

For Evisceration, cover exposed organs with a sterile dressing moistened with sterile saline. Do not push the organs back in and do not apply pressure directly to them. Summon urgent help, keep the patient NPO, and prepare for urgent surgical evaluation when indicated.

For an Impaled object, stabilize it in place and do not remove it. Follow local emergency protocols and prepare for urgent surgical evaluation when indicated.