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Blunt Trauma

April 19, 2015

Physical Blunt Trauma

Introduction

Blunt trauma (blunt force trauma, blunt force injury, non-penetrating trauma) refers to a type of physical trauma caused to a body part, either by impact, injury or physical attack. The term itself is used to refer to the precursory trauma, from which there is further development of more specific types of trauma, such as concussions, abrasions, lacerations, and/or bone fracturing.

Blunt trauma is contrasted with penetrating trauma, in which an object such as a bullet enters the body.

Blunt Abdominal Trauma (BAT)

Blunt abdominal trauma is often referred to as the most common type of trauma. The majority of BAT is often attributed to car-to-car collisions, in which rapid deceleration often propels the driver forwards into the steering wheel or dashboard, causing contusions in less serious cases or rupturing of internal organs due to briefly increased intraluminal pressure in more serious cases where speed or forward force is greater.

Care

The care of the trauma patients is demanding and requires speed and efficiency. Evaluating patients who have sustained blunt abdominal trauma remains one of the most challenging and resource-intensive aspects of acute trauma care. Physical examination findings are notoriously unreliable for several reasons; a few examples are the presence of distracting injuries, an altered mental state, and drug and alcohol intoxication in the patient.

Missed intra-abdominal injuries and concealed hemorrhage are frequent causes of increased morbidity and mortality, especially in patients who survive the initial phase after an injury. Coordinating a trauma resuscitation demands a thorough understanding of the pathophysiology of trauma and shock, clinical and diagnostic acumen, skill with complex procedures, compassion, and the ability to think rationally in a chaotic milieu.

Blunt abdominal trauma usually results from motor vehicle collisions, assaults, recreational accidents, or falls. The most commonly injured organs are the spleen, liver, retroperitoneum, small bowel, kidneys, bladder, colorectum, diaphragm, and pancreas.

Splenic flexure syndrome may result in BAT. Splenic flexure syndrome is used to describe the bloating, muscle spasms of the colon, and upper abdominal discomfort thought to be caused by trapped gas at the splenic (as opposed to hepatic) flexure in the colon; the pain caused can be excruciating and debilitating, and may mimic that of a heart attack (because of the proximity of the splenic flexure to the heart).

Abdominal trauma caused by deceleration and impact shows a similar effect to trauma to any other part of the body; namely the rupturing or damage of free and relatively fixed objects, a classic example of such an injury would be a hepatic tear along the ligamentum teres followed with injuries to the renal arteries.

As with most trauma, blunt abdominal trauma is often the cause of further injury, depending upon the severity of the accident. In the majority of cases, the liver and spleen are most severely affected, followed by damage to the small intestine. Recent studies utilizing CT scanning have suggested that hepatic and other concomitant injuries may develop from blunt abdominal trauma. In rare cases, BAT has been attributed to several medical techniques such as the Heimlich Maneuver, attempts at cardiopulmonary resuscitation, and manual thrusts to clear an airway. Although these are rare causes of blunt abdominal trauma, it is often thought that they are caused by applying unnecessary pressure when administering such techniques.

Among equestrians with BAT, common causes include kicks from the horse and the horse falling on top of its rider.

Diagnosis

Although blunt trauma is a condition in itself, the main emphasis on the diagnosis of blunt trauma is to ascertain the cause of the accident, any further injury and its correlation with the medical, dietary, and physiological history of the patient gathered from various sources, such as family and friends, or previous physicians, in order to establish the most swift path to recovery. This method is given the mnemonic “SAMPLE”; [5]

SIGNS AND SYMPTOMS
ALLERGIES
MEDICATIONS
PAST MEDICAL HISTORY
LAST ORAL INTAKE
EVENTS LEADING UP TO

Usually, in the case of examination, areas such as the head or those linked with the respiratory system have a higher priority, and are examined before the abdomen, so as to administer, if necessary, medical treatments which will immediately limit the amount of progressive damage which could be caused from such injuries. The amount of time spent on diagnosing abdominal injury should be minimal, and expedited by using relatively quick methods of determining the extent of such injury, such as by identifying free intra-abdominal fluid through diagnostic peritoneal lavage (DPL) before recommending a laparotomy if the situation requires one.

Whenever any blunt trauma is sustained to the body, it is normal to ensure first that there is no bleeding, internal or back injury, or breathing problems before administering any type of rehabilitative care to the patient. In cases of car accidents, or where a patient has had some form of accelerated impact, the likelihood is that there will be progressive damage to internal organs.

Pathophysiology

Vehicular trauma is by far the leading cause of blunt abdominal trauma in the civilian population. Auto-to-auto and auto-to-pedestrian collisions have been cited as causes in 50-75% of cases. Rare causes of blunt abdominal injuries include iatrogenic trauma during cardiopulmonary resuscitation, manual thrusts to clear an airway, and the Heimlich maneuver.

Intra-abdominal injuries secondary to blunt force are attributed to collisions between the injured person and the external environment and to acceleration or deceleration forces acting on the person’s internal organs.

Blunt force injuries to the abdomen can generally be explained by 3 mechanisms.

The first is when rapid deceleration causes differential movement among adjacent structures. As a result, shear forces are created and cause hollow, solid, visceral organs and vascular pedicles to tear, especially at relatively fixed points of attachment. For example, the distal aorta is attached to the thoracic spine and decelerates much more quickly than the relatively mobile aortic arch. As a result, shear forces in the aorta may cause it to rupture. Similar situations can occur at the renal pedicles and at the cervicothoracic junction of the spinal cord.

The second is when intra-abdominal contents are crushed between the anterior abdominal wall and the vertebral column or posterior thoracic cage. This produces a crushing effect, to which solid viscera (eg, spleen, liver, kidneys) are especially vulnerable.

The third is external compression forces that result in a sudden and dramatic rise in intra-abdominal pressure and culminate in rupture of a hollow viscous organ (ie, in accordance with the principles of Boyle law).

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From → Blood, Body, Health, Injury, Pain

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