**1. General evaluation**

Initial management of patients with abdominal trauma is the same as for all other trauma patients. Begin with a rapid primary survey, including evaluation of the airway, breathing, circulation, disability, and exposure.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

If the abdomen is the probable source of exsanguinating hemorrhage, the patient should be transferred to the operating room for immediate laparotomy. The hemodynamically stable patient can be more meticulously assessed within the framework of the secondary survey. Evaluation always includes comprehensive physical examination with pelvic and rectal examinations and may require specific laboratory and radiologic tests.

or across the abdomen. The classic "seat belt sign" or linear bruising across the lower abdo-

Abdominal Trauma

77

http://dx.doi.org/10.5772/intechopen.76474

Evaluate the pelvis for anteroposterior or lateral instability with gentle pressure; this does not require much force and should not be repeatedly performed. Examine the genitalia and look for blood at the urethral meatus, especially in males. Perform digital rectal examination in any patient with abdominal trauma. Look for gross blood, assess sphincter tone, and note any other evidence of trauma. If blood at the urethral meatus or a high riding prostate is present, placement of a urinary catheter is contraindicated, and a retrograde urethrogram is required

Initial laboratory evaluation should include hemoglobin and hematocrit and platelet count to establish a baseline, and a blood type and screen in case transfusion of packed red cells are needed. A lactate level may be obtained and, if elevated, is an excellent indicator of shock. Base deficit is another indicator of shock. The role of amylase in abdominal trauma is uncertain. Examination of the urine may reveal gross hematuria, which suggests significant injury to the urogenital tract.

Almost all major trauma patients require plain X-rays of the chest, pelvis, and cervical spine. Although rarely used today because of the ubiquity of computed tomography (CT) scanning, a one-shot intravenous pyelogram may be useful in patients with flank wounds or gross hematuria who are unable to undergo further diagnostic testing prior to operative intervention.

Ultrasonography has emerged as the primary initial diagnostic examination of the abdomen in multisystem injured blunt trauma patients. Emergency ultrasonography has been studied extensively and is rapid and accurate in the identification of intraperitoneal free fluid. Also, it is safe in special patient populations (e.g., pediatrics, obstetrics). Focused assessment with sonography for trauma (FAST) examination is a bedside test that has demonstrated good accuracy with relatively minimal operator experience. In the standard FAST examination, four areas are scanned: the right upper quadrant, the subxiphoid area, the left upper quadrant, and the pelvis. Unstable patients with a positive FAST examination should undergo urgent exploratory laparotomy [1]. Unlike CT, a FAST examination is rapid, can be performed

bedside in the emergency department, and is easily repeatable [2] (**Figure 1**).

Examine the abdomen for tenderness, distention, rigidity, or guarding.

men is a marker for intra-abdominal injury.

to evaluate for potential urethral injury.

**2.1. Laboratory evaluation**

**2.2. Plain radiography**

**2.3. Ultrasonography**

**2. General examination**
