eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Abdominal Trauma, Blunt: Follow-up

Author: Joseph A Salomone III, MD, EMS Medical Director, Kansas City, Missouri; Associate Professor and Staff Physician, Truman Medical Centers/UMKC School of Medicine
Coauthor(s): Jeffrey P Salomone, MD, FACS, NREMT-P, Associate Professor of Surgery, Emory University School of Medicine; Deputy Chief of Surgery, Grady Memorial Hospital
Contributor Information and Disclosures

Updated: Oct 2, 2009

Follow-up

Further Inpatient Care

  • Serial examinations
    • Serial ultrasonographic examinations may play a role in identifying occult injuries.
    • Any change in the physical examination that indicates peritoneal irritation warrants additional studies and/or laparotomy.

Further Outpatient Care

  • Before discharge, provide patients with detailed instructions that describe signs of undiagnosed injury.
    • Increased abdominal pain or distention, nausea and/or vomiting, weakness, lightheadedness, or fainting, or new bleeding in urine or feces mandates immediate return and further evaluation.
    • Ensure that close follow-up care and repeat examinations are available for all patients.

Inpatient & Outpatient Medications

  • Judiciously prescribe pain medications to patients who are discharged.
    • To prevent masked or delayed presentations, ensure that a close follow-up for reevaluation is available to all patients who are provided pain medications.
    • With the potential for hemorrhage, nonsteroidal anti-inflammatory drugs (NSAIDs) probably should be avoided.
    • Acetaminophen with or without small quantities of mild narcotic analgesics may be all that should be prescribed initially.
    • Minimize use of analgesics in patients who are admitted for observation.
  • Patients who undergo laparotomy may require routine perioperative antibiotics.
  • Patients with repaired hollow organ injury may require additional antibiotics.

Transfer

  • If expertise in managing blunt abdominal injuries is unavailable, arrange patient transfer to the nearest appropriate trauma center as soon as injury is identified.
    • Lengthy diagnostic workup is counterproductive once it is recognized that a patient cannot be managed at the initial facility.
    • Physician-to-physician consultation must occur before transport to ensure that the receiving facility has the resources necessary to care for the patient.

Complications

  • Complications can arise for identified and unidentified injuries.
  • Intra-abdominal hemorrhage, infection, sepsis, and death can occur.
  • Delayed rupture or hemorrhage from solid organs, particularly the spleen, has been described.
  • In patients that undergo laparotomy and repair, complications are similar to other conditions that require operative intervention.

Prognosis

  • Overall prognosis for patients who sustain blunt abdominal trauma is favorable.
    • Without statistics that indicate the number of out-of-hospital deaths and the total number of patients with blunt trauma to the abdomen, a description of the specific prognosis for patients with intra-abdominal injuries is difficult.
    • Mortality rates for hospitalized patients are approximately 5-10%.

Patient Education

  • Proper adjustment of restraints in motor vehicles is an important aspect of patient education.
    • Wear lap belts in conjunction with shoulder restraints.
    • Wear lap belts snug and place them across the lower abdomen and below the iliac crests.
    • Wear restraints even in vehicles equipped with supplemental vehicle restraints (eg, airbags).
    • Adjust seats and steering wheels to maximize the distance between the abdominal wall and steering wheel, while still allowing proper control of the vehicle.
  • Advise patients to practice defensive driving by observing speed limits and keeping a safe distance between them and other automobiles on the road.
  • For excellent patient education resources, visit eMedicine's Kidneys and Urinary System Center. Also, see eMedicine's patient education article Blood in the Urine.

Miscellaneous

Medicolegal Pitfalls

  • Failure to suspect intra-abdominal injury from appropriate mechanisms
  • Failure to evaluate abdominal/flank/costal margin pain after blunt abdominal injury
  • Failure to obtain timely surgical consultation and operative intervention
  • Failure to recognize intra-abdominal hemorrhage and delay operation for additional diagnostic testing in the face of hemodynamic compromise
 


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References
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Further Reading

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Keywords

intra-abdominal trauma, intra-abdominal injury, blunt abdominal injury, motor vehicle collision, motor vehicle accident, MVA, blunt trauma

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Contributor Information and Disclosures

Author

Joseph A Salomone III, MD, EMS Medical Director, Kansas City, Missouri; Associate Professor and Staff Physician, Truman Medical Centers/UMKC School of Medicine
Joseph A Salomone III, MD is a member of the following medical societies: American Academy of Emergency Medicine, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey P Salomone, MD, FACS, NREMT-P, Associate Professor of Surgery, Emory University School of Medicine; Deputy Chief of Surgery, Grady Memorial Hospital
Jeffrey P Salomone, MD, FACS, NREMT-P is a member of the following medical societies: American College of Surgeons, American Medical Association, Medical Association of Georgia, National Association of EMS Physicians, and Society of Critical Care Medicine
Disclosure: Schering plough Consulting fee Consulting; Merck Honoraria Speaking and teaching; NAEMT-PreHospital Trauma Life Support None Editing PHTLS textbook; all royalties paid to NAEMT; Ortho-McNeil Consulting fee Consulting

Medical Editor

Samuel M Keim, MD, Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine
Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eric L Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital Manhattan; Associate Professor, Department of Emergency Medicine, New York Medical College
Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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