Last week a pediatric abdominal trauma was managed well by the patrol
managing. A diagnosis (as reported on social media) was a liver
laceration. This issue can be life threatening. I was asked to review the
case and I thought I would share the abdominal assessment with you.
1 MOI: the MOI for abdominal trauma is not necessarily direct impact or
penetration to the abdomen. Any trauma with energy traversing the abdomen
can cause an injury. My favorite example of this principle is a 6 year old
girl at a local elementary school coming off the slide appropriately and
landing on her butt. Typically this is how the slide is designed to be
used. In her case the energy traveled up from her buttocks into her
abdomen causing a grade II splenic laceration.
2. any post trauma (even minor trauma) the abdomen should be assessed.
3. any complaint of abdominal pain should be directed to the emergency
4. An increase in pain with palpation over 1 of the 4 quadrants of the
abdomen should be considered an organ injury and handled by EMS activation.
5. Rebound tenderness or + Kehr's sign (pain radiating to the left
shoulder) should be an indication of active bleeding into the abdominal
See the graphic display of this decision tree.
Please let me know if you have question or would like to do a hands on
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