*3.2.6 Lack of equipments and infrastructure to use while managing traumatic abdominal patients*

The evidence is clear management of any traumatic abdominal patient should be done at standard trauma center which should have adequate equipments and good infrastructures. Lack of standard trauma care is a major factor leading to the occurrence of complications. Evidence has confirmed that, findings of history and physical examination are unreliable for deciding management approach. Many studies have shown that, CT, FAST, and laparoscopy support to make correct decision regarding the management approach to utilize for traumatic abdominal patients. Due to shortage of equipments and infrastructures many traumatic abdominal patients continue to undergo non-therapeutic laparotomy which is ever associated with numerous complications. Markedly, unacceptable shortage of equipments and infrastructures is found in developing countries where most trauma incidence, mortality and morbidity happen.

#### **3.3 Mechanisms of abdominal trauma related risk factors**

All mechanisms leading to abdominal trauma have the potential to associate with a certain complications which may occur during the trajectory of management.

However, the variability in terms of how dangerous they provoke complications exist. For instance Gunshot as one of the mechanisms of penetrating abdominal injury is associated with many complications [1]. If the bullet of high velocity and large mass was used, many complications develop because of the damage of multiple abdominal organs. Classically, penetrating abdominal trauma is associated with many complications and deaths compared to blunt abdominal trauma. However, in terms of making diagnosis, blunt abdominal trauma poses more challenges to diagnose compared to penetrating abdominal injuries. As such, astute clinician should thoroughly assess all traumatic patients and perform certain investigations in order to remove such confusions, make appropriate diagnosis and institute timely treatment interventions.

#### **3.4 Abdominal trauma with concurrent and multiple injuries related risk factors**

Concurrent and multiple injuries profoundly increase the occurrence of complications associated with the management of traumatic abdominal patient. Shown in **Table 7** are possible injuries which increase complications associated with management abdominal trauma. In fact evidences have shown that these injuries are the leading cause of deaths among traumatic abdominal patients. The way these injuries cause complications vary from one another. For instance, patient with abdominal trauma together with traumatic brain injury and who are unconscious are at higher risk of aspiration and asphyxia. Unconsciousness impairs the contraction of pharyngeal muscles and muscles of the tongue, thus the tongue fall back when the patient is in supine position, causing airway obstruction that culminate into aspiration and asphyxia. Moreover, injuries to the central respiratory centers may be present and are among the cause of impaired breathing.


#### **Table 7.**

*Possible injuries which increase complications associated with management abdominal trauma.*

#### **3.5 Treatment approach related risk factors**

Classically, in order to lessen complications and burden associated with the management of abdominal trauma, astute clinician should manage any traumatic abdominal patient using principles of medical management. There are five principles of medical management namely: (1) identify and treat the cause, (2) identify and treat complications which have occurred or as they occur, (3) communication, (4) consultation, and (5) continuous management. The causes of abdominal trauma include road traffic accident, assaults, wars etc. It is impossible for the clinician to directly stop the causes of abdominal trauma. However, in the hospital clinician should teach patients, attendants, and community measures designed to stop the occurrence of injuries all the time, but also clinician should teach them other health promotion and preventive measures.

There are numerous complications such as airway obstruction, hypoxia, hemorrhage, infections, and multiple organs failure which are likely to occur during management of traumatic abdominal patient. It is necessary for practitioners caring

traumatic abdominal patient to have optimal understanding factors which favor the development of these complications at any stage of management. In broadly speaking three factors can contribute to the occurrence of complications to the hospitalized traumatic abdominal patient. These factors are: (1) Lack of information, incorrect information or confusion in data regarding to choosing, and planning management approach, (2) Incorrect judgment in choosing and planning management approach, and (3) incorrect execution of management approach. Shown in **Table 8** are factors and examples of conditions which are likely to increase the occurrence of complications.

Furthermore, treatment of abdominal trauma should be comprehensive and should be done via multidisplinary approach. Appropriate communication (between the patient and clinician, and between clinicians), consultation and continuous management are highly crucial in terms of mitigating the burden associated with the management of abdominal trauma.


#### **Table 8.**

*Factors and examples of conditions leading to complications associated with the management of abdominal trauma within the hospital.*
