abdominal trauma
Introduction
Introduction to abdominal trauma The key problem of abdominal trauma is the presence or absence of internal organ damage. The hair is only a simple abdominal wall injury, which does not pose much threat to the life of the wounded. What is important is the hemorrhage and shock caused by visceral injury, infection and peritonitis, and the condition is more critical. If you do not treat it in time, it will endanger the lives of the wounded. The mortality rate can be as high as 10-20%. Therefore, the wounded person with abdominal trauma should be diagnosed and treated promptly. Abdominal trauma can be divided into open and closed. Openness is easier to diagnose than closure; closed injury often involves abdominal organ injury. The symptoms of injury may be different in the morning and evening, which may lead to missed diagnosis and misdiagnosis, resulting in untimely treatment, poor prognosis and high mortality. Because abdominal trauma is common in both normal and wartime, how to diagnose the abdominal trauma patients early, reasonable treatment is the key to reducing mortality. Discussions on early correct diagnosis in clinical work are now available. basic knowledge The proportion of illness: 0.01%-0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: peritonitis
Cause
Abdominal traumatic cause
Cause of disease
Abdominal trauma is a common and serious trauma in both normal and wartime. Its incidence rate is about 0.4% to 1.8% of all kinds of injuries in normal times; it accounts for 5% to 8% in wartime. In the war it was 4%.
Pathophysiology
Abdominal trauma can be divided into open and closed. Openness is easier to diagnose than closed. Closed injury often combined with abdominal organ injury. The symptoms of injury are different, which may lead to missed diagnosis and misdiagnosis, resulting in untimely treatment and poor prognosis. The mortality rate is high. Because abdominal trauma is common in both normal and wartime, how to diagnose the abdominal trauma patients early, reasonable treatment is the key to reducing mortality. The early diagnosis of clinical diagnosis is now discussed.
Prevention
Abdominal wound prevention
Abdominal trauma patients are mostly emergency patients. They are not psychologically prepared for sudden blows. They are panicked, fearful, and even irritated when they are hospitalized. Some even refuse treatment. The nurses should respond to the patient's initiative and enthusiasm, so that patients and their families have a sense of security. Dependence, reduce panic, actively cooperate with the examination and treatment, postoperatively get out of bed according to the condition, enhance physical fitness.
Complication
Abdominal trauma complications Complications peritonitis
The mortality rate of abdominal trauma is closely related to the time of injury to the time of definite surgery. 90% of patients who receive correct treatment within two hours after injury are expected to be cured. With the delay of time, the mortality rate increases significantly, so the mortality rate should be reduced. First of all, we must try our best to shorten the time from injury to definite surgery, and at the same time improve the rescue and diagnosis techniques to prevent missed diagnosis.
Symptom
Abdominal trauma symptoms Common symptoms Abdominal pain Intestinal palsy Abdominal tenderness Abdominal "flexibility" signs Wound healing Itching leukocytosis Duodenal hypertonic liver dullness shrinks or disappears Abdominal tension bowel
1, nausea, vomiting, blood in the stool, hematuria.
2, physical examination: pay attention to blood pressure, pulse, breathing, with or without signs of shock, abdominal skin with or without bleeding, ecchymosis, closed injury or open injury, check whether there is visceral prolapse in the wound or the flow of organs, with or without belly Respiratory movement limitation, abdominal distension, abdominal muscle tension, tenderness, mobile dullness, weakened or disappeared bowel sounds, and signs of visceral injury and signs of intra-abdominal hemorrhage. There is no tenderness or lumps in the rectal examination, and there is no blood on the finger. All abdominal penetrating injuries (open injuries that penetrate the peritoneum) should be considered to have the possibility of visceral injury. All chest, lumbosacral, buttocks and perineal injuries (especially firearm injuries) must be carefully examined.
Examine
Abdominal wound examination
1, physical examination
Pay attention to blood pressure, pulse, breathing, signs of shock, abdominal skin with or without bleeding, ecchymosis, closed injury or open injury. Check whether there is visceral prolapse or organ content in the wound, whether there is abdominal respiratory movement Limitations, abdominal distension, abdominal muscle tension, tenderness, mobility of dull voices, weakened or disappeared bowel sounds, and signs of visceral injury and signs of intra-abdominal hemorrhage. There is no tenderness or lumps in the rectal examination, and there is no blood on the finger. All abdominal penetrating injuries (open injuries that penetrate the peritoneum) should be considered to have the possibility of visceral injury. All chest, lumbosacral, buttocks and perineal injuries (especially firearm injuries) must be carefully examined.
2, inspection
Blood, urine routine, if there is hematuria, it indicates urinary tract injury. Injuries, indwelling catheters to observe urine volume and its traits are more important for people with traumatic shock. When suspected pancreatic injury, blood and urine amylase should be checked, and the disease should be reviewed and observed. Those suspected of internal bleeding should be tested for hematocrit and blood type and prepared for blood.
3. Auxiliary inspection
If the injury allows, X-ray examination, such as abdominal fluoroscopy or radiography, can be observed whether there is pneumoperitoneum, diaphragm position and its range of motion, with or without metal foreign bodies and their location, can also show the presence of spine and pelvic fractures. Low rib fractures should be noted whether there is liver or spleen rupture. Suspected of substantial organ injury and intra-abdominal hemorrhage, when the condition permits, can be used for ultrasound, CT or selective celiac angiography to help diagnose. Diagnostic abdominal puncture and lavage
(1) Diagnostic abdominal puncture: the bladder should be emptied before puncture. The puncture point is in the four quadrants of the upper left, upper right, lower left and lower right of the abdomen. Generally, the lower left or lower right quadrant is used for puncture. Take the middle and outer 1/3 junction of the umbilical cord and the anterior superior iliac spine as the puncture site. When the upper abdomen is punctured, the needle point is selected along the outer edge of the rectus abdominis. The patient is placed supine or laterally on the injured side. The needle is pierced with a needle with a short beveled tip (the tip of the needle is facing outward). When the resistance of the needle is reduced, it indicates that the abdominal cavity has been inserted, and the needle can be aspirated. A positive or non-clotting fluid or turbid liquid is aspirated. If the puncture technique is correct, the intra-abdominal hemorrhage or the perforation of the hollow organ can be clearly diagnosed. From the injury side puncture to prevent mis-prone to the side of the retroperitoneal hematoma and false positive results, the wrong operation. When a puncture is negative, it can be puncture in the other three quadrants. Diagnostic peritoneal lavage was feasible in patients with stun, cranial and chest injuries who were negative for multiple punctures but were suspected of abdominal organ injury.
(2) Diagnostic peritoneal lavage: the patient is placed in the supine position, emptying the bladder, and the local anesthesia is taken up in the middle line of the 3cm water under the umbilicus. The 14th needle of the syringe is used to puncture the abdominal cavity at a 30° angle. After the abdominal cavity is inserted, the needle is removed. The tube is inserted into the pelvic cavity through a silicone tube with a side hole (usually inserted 20 to 25 cm), and then the needle is removed. The outer end of the tube was connected to a saline bottle and slowly injected into the abdominal cavity according to the amount of physiological saline of 20 ml/kg. After the liquid has drained, the infusion bottle is lowered to allow the peritoneal lavage fluid to flow back into the bottle by siphoning. After the operation, the silicone tube was removed and the puncture site was covered with sterile gauze. The effluent was taken for microscopic examination (cell count exceeded 0.01×l012/L, white blood cell count exceeded 0.5×109/L, at the time of diagnosis) and amylase assay. Even if there is less hemorrhage or exudate, this procedure can often get a positive result.
Diagnosis
Diagnostic diagnosis of abdominal trauma
diagnosis
Inquire about the time of injury, the location of the injury, the nature of the violence, the direction of violence, the position at the time, the location, extent and nature of abdominal pain after injury, whether there is nausea, vomiting, blood in the stool, hematuria, and how to treat and effect.
Differential diagnosis
The disease has a history of external trauma and does not need to be differentiated from other diseases.
