Treating Open and Closed Abdominal Injuries – Treatment and Management of Abdominal Issues
Open abdominal injuries mean there is a puncture or protruding bowel or fat. Closed injuries do not have tears penetrating the abdomen. If the patient has no obvious injuries in the area, take a look at the skin color. Don’t confine your examination to the front; also look at the sides and back. Pooling blood, if present, will look like a large bruise on one side of the body. Distension, which in this case is the accumulation of gas or fluid in the abdominal cavity, causes the abdomen to expand beyond its normal girth, similar to pushing your stomach out acting like you’re pregnant. Pooling blood, distension, and rigidity are all telltale signs of an internal abdominal injury.
Open injuries require additional protective measures. When something has penetrated the body around the abdomen, do not remove it. It’s possible that object has sealed a leak in an organ. If you remove it, the organ (especially if it’s the liver or spleen) could start to hemorrhage, sending the patient into shock.
Hard as it is, even though something is sticking out of your patient’s abdomen, resist the urge to pull it out; instead, pad the area and find a way to hold the padding in place. If you’re only moving the injured person a short distance, this will work. If it’s going to take a long time, you may have to pull out the object to avoid the risk of infection. You need to watch very carefully for bleeding.
If you’re dealing with fat or bowel material that’s sticking out through an opening in the skin, you can either try to press the material back into the cavity and then dress it and put a bandage in place to secure it, or you can cover the area with a moist cloth to keep the wound from drying out. Don’t push anything into the wound (least of all your finger) and keep the area as undisturbed as possible. Keep the wound moist during transport. Don’t push the material in if it’s torn, since that could cause it to leak into the abdominal cavity, causing more damage.
The abdomen is a tricky area, one best left to medical professionals. If the patient complains of abdominal pain, evacuate her as quickly as possible. Don’t poke and pry on your own.
If you are not certain of the severity of the injury, watch the injured person over several hours. The pain may become so great the injured party wants to evacuate, or other issues, such as deteriorating vital signs, may occur, which will indicate it is time to arrange evacuation. Alternatively, the injury may not be serious, and as long as the injured person’s condition remains stable, evacuation does not need to be rushed.
If the victim has had an internal injury, there may be bleeding and even an infection. Calmly interrogate the patient to find where he’s feeling pain and discomfort. Are there external signs such as vomiting? Check the patient for dehydration, particularly in the case of vomiting and/or diarrhea. Feel his abdomen to see if it seems rigid. Is there swelling anywhere?
If yes, evacuate the injured person as soon as possible, because more serious internal injuries that cannot be treated in the field will soon manifest. Treat for shock and evacuate.
In the case of a serious injury, do not give food. The slow sipping of fluid is okay (no alcohol, milk products, or caffeine drinks), and you can give antacids, which will aid in soothing the stomach. For additional comfort, you can use a warmed canteen of water as a heat pad for the area. Be prepared for vomiting, and help the injured person find a position of comfort. Often this will be lying on his side with knees bent. Do not give solid foods or laxatives.
You’re hiking with your child on a common trail near your home when she suddenly trips and falls onto a broken stump. It lacerates her stomach, and as you roll her over you find that she has intestine protruding through a hole in her abdomen with some blood and a lot of trail debris. She’s crying and trying to hold her stomach, so she’s alert. You attempt to calm her and fail, but she allows you to treat her. Now what?
You begin by rinsing the debris off her with your water bottle, then carefully lifting her shirt to gain better access to the injury. The hole is small, but with the cool water, cool breeze, and open wound, she’s already complaining of being cold. Once rinsed for a second time, the injury isn’t bleeding much, so you apply a dampened bandanna to the wound to keep it covered and moist. Because it’s not below freezing, there’s no reason to attempt to push the protruding intestine back through the abdominal cavity. You apply a second damp bandanna to the wound followed by a used, but clean enough, sandwich bag. You hold it in place because you have no tape and instruct your daughter to hold steady pressure on the wound as you carefully lift her in a cradle carry to get her back to the house where you can call 911.