ABDOMINAL INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 124

CHAPTER 10
ABDOMINAL INJURIES
Ben Eiseman, M.D.
Ernest E. Moore, M.D.
Hunter B. Moore, B.A.
Principal Contributors
The definitive treatment for a severe abdominal injury usually consists of an operation,
which is out of the question in a wilderness setting. Therefore, management of severe ab-
dominal trauma in such situations consists of recognizing potentially serious injury and de-
ciding whether immediate evacuation is required. Under no circumstances should pseudo-
heroic attempts at operative intervention be made. The results would be uniformly fatal
without proper anesthesia, sterile operating conditions, and proper instruments. Moreover,
even the most severe trauma can occasionally be successfully managed without surgery.
ASSESSMENT
Beforeanydecisioncanbemadeconcerningthecareforsomeonewithanabdominalinjury,
a systematic assessment must be done. The first step is obtaining an account of the accident.
Exact details of the mishap, including the site and direction of a blow to the abdomen, are
helpfulindiagnosinganabdominalinjury.Ablowtotheleftupperquadrantoftheabdomen
or lower part of the left chest may rupture the spleen. A blow to the corresponding area on
the right side may injure the liver. Trauma to either flank or the back may damage a kidney.
The abdomen must be examined carefully ( Chapter 20: Acute Abdominal Pain ) . In addi-
tion, close attention should also be given to signs of shock, including blood pressure, pulse
rate, respiratory rate, color of the skin and mental status (“Shock,” Chapter 3: Life-Threat-
ening Problems ). The vital signs must be recorded hourly for at least the first twelve hours
after injury. The urine should be examined for blood. Attention must not focus on the abdo-
men to the extent that other injuries are overlooked or neglected. At some time during the
individual's care, preferably early, a complete physical examination—including an examin-
ation of the back—must be performed.
If the individual is to be evacuated, as most require, a written account of the accident and
alldiagnosticfindings,alongwithadetailedrecordofsubsequentevents,shouldaccompany
the person. The exact time of the accident, all medications and the time they are admin-
istered, hourly measurements of vital signs, and observations about the individual's general
condition must be written into that record.
TREATMENT