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Blunt abdominal trauma is common following major traumatic injury but may not be recognised quickly enough and is therefore a cause of preventable death in trauma patients. Emergency department nurses have a major role to play in reducing the incidence of unrecognised abdominal trauma by enhancing their knowledge and skills. They can do this by attending trauma-related courses, taking on more expanded roles, carrying out full and comprehensive physical assessments, and ensuring that members of the multidisciplinary team use the wide range of diagnostic adjuncts available to them. This article reviews the anatomy and physiology of the abdominal cavity, explains abdominal trauma, gives an overview of advanced abdominal assessment techniques and diagnostic adjuncts, and reviews some management strategies for uncontrolled haemorrhage that have been adopted in the UK.

The purpose of this review is to examine existing research on oral contrast administrating as it pertains to the computed tomographic (CT) evaluation of blunt abdominal trauma, as well as to determine the necessity of oral contrast as part of a CT scanning universal protocol. Many hospitals routinely administer both oral and intravenous contrast prior to abdominal CT scan. There have been found to be numerous disadvantages and risks associated with oral contrast administration prior to CT scan. There has been a shift in many hospitals over the years from traditional CT scanners to multidetector row helical scanners, which allow for thinner collimation and higher spatial resolution. With the advances in technology, from single detector row to multidetector row helical CT scanners, the question whether oral contrast is necessary, useful, or dangerous presents itself. There is a significant lack of research on this topic over the past 10 years. All of the studies referenced support no longer administering oral contrast for the initial evaluation of the patient with blunt abdominal trauma. However, the findings of the studies cited in this article are based on small sample sizes and low incidences of solid organ, bowel, or mesenteric injuries. The current level of available research has significant limitations to support a recommendation to eliminate the administration of oral contrast before obtaining the initial CT scanning for blunt abdominal trauma. Further research is necessary before any conclusion or practice change can be made.

Trauma is the leading cause of death for people younger than age 45 in the United States. To help prevent death or disability, critically injured trauma patients must reach definitive care within the "golden hour."Often, the perioperative team has no more than 10 minutes to prepare the room before a patient who has suffered multiple, critical, traumatic injuries is rushed into the OR. For the trauma patient's safety, the perioperative team must be diligent and use creative measures to efficiently ensure that all surgical counts are completed. Foregoing surgical counts places the trauma patient at an increased risk for unintentionally retained foreign objects.

The management of large cavity wounds has always posed particular challenges for nurses and clinicians. The National Institute for Clinical Excellence (NICE, 2001) suggests that the number of difficult-to-heal surgical wounds may increase in the future and that increased knowledge and expertise should be available across primary and secondary care. Recent research into wound healing has tended to focus on the biology of wound healing and manipulation of the healing processes with new dressings technology and other clinical and cost-effective treatments. Vacuum-assisted closure (VAC) is an innovation that is being given increasing attention. In Northampton, one patient nursed in the community setting has recently benefited from the technology to accelerate healing of a deep abdominal cavity. This article considers the historical management of cavity wounds and presents a case study. The feelings of the patient and the experiences of the district nurses in overcoming management problems are discussed. The case has proved to be the catalyst for a collaborative initiative across primary and secondary care services to ensure that all patients requiring the treatment are able to receive it in the community setting as well as in the hospital, when they are ready for discharge. It is recognized in Northampton that there are several applications for VAC in wound management and that the treatment has many benefits for patients and for those managing finite NHS resources.

Patients with severe abdominal trauma injuries can have improved outcomes if a priority-oriented approach is taken to surgical intervention. This includes temporary abdominal closure and planned reoperation to complete complex, lengthy procedures when the patient is stabilized. Temporary abdominal closure can be achieved safely and cost-effectively by using a presterilized 3-liter cystoscopy fluid i.v. bag. This article discusses the rationale for temporary abdominal closure and planned reoperation, physiologic considerations in abdominal compartment syndrome (ACS), abdominal injuries or conditions leading to ACS, and manifestations of ACS. It compares and contrasts various materials used for temporary abdominal closure, illustrates bag preparation and silo application and removal, and analyzes complex intraoperative and postoperative nursing activities.

To review the use of ultrasound for assessment of abdominal trauma during the secondary assessment. Three current methods for evaluation of abdominal trauma will be outlined. The use of ultrasound in evaluation of patients with blunt abdominal trauma will be highlighted, including performance of test, time to test completion, strengths, and limitations. The use of serial examination utilizing focused abdominal sonography for blunt trauma (FAST) to evaluate hemoperitoneum will be presented.

Topic: Abdominal compartment syndrome (ACS) in blunt and penetrating abdominal trauma., Purpose: To review the clinical manifestations, pathophysiology, and nursing management of patients with ACS., Sources: Published literature, case study., Conclusions: Trauma nurses play a key role in early identification and management of ACS. Priorities include knowledge of signs and symptoms, methods of measurement of ACS; specifics of wound care, psychosocial interventions, and key factors in discharge planning.

Laparoscopy has been shown to be an effective diagnostic and therapeutic modality for trauma patients. The benefits of laparoscopic intervention include the avoidance of negative laparotomy procedures, decreased patient morbidity rates, shorter hospital stays, and lower costs. Laparoscopic limitations are discussed in this article as well as the perioperative nursing considerations in all phases of trauma patients' care. Five case studies in which patients' care was enhanced by the use of laparoscopy are presented.

Retrohepatic inferior vena caval injuries resulting from blunt or penetrating abdominal trauma are rare but devastating events that remain formidable challenges to even the most experienced Level I trauma center team members. Prepackaged atrial caval shunts have improved emergency medical treatments, and prior planning and coordination by perioperative nurses allow for rapid response by surgical team members. These efforts provide an optimal level of care required to increase patient survival. This article provides a general overview of abdominal trauma and retrohepatic inferior vena caval injuries and a proactive plan to meet the needs of patients with these injuries.

Solid organ injuries of the upper abdomen consist primarily of injuries to the spleen and liver. Several years ago, these injuries were fairly straightforward to manage. Recently, however, combinations of new diagnostic modalities and the advent of nonsurgical treatments have added complexity to the management of splenic and hepatic injuries. Splenic injuries that require surgical repairs are managed by splenic salvage when feasible and by splenectomy procedures when the injuries are complicated. Hepatic injuries may require a variety of therapeutic modalities, depending on their complexity. This article reviews some of these treatment options for the management of upper abdominal solid organ injuries.

Patients with significant abdominal trauma and polytrauma patients with less severe abdominal injuries require critical care management. The diagnostic skills used for the initial evaluation of the injured abdomen are used to determine whether celiotomy is required and to evaluate the postoperative abdomen for missed injury or early detection for complications. The critical care nurse must identify life-threatening abdominal injuries immediately and all abdominal injuries in a timely fashion through consideration of the mechanism of injury and a combination of history, physical examination, and diagnostic tests. All facets of the critical care management of abdominal trauma must be familiar to the critical care nurse in order to recognize abdominal injuries and lower the frequency of preventable death after trauma.

Traumatic injuries are the primary cause of death in children. Nursing care that the critically injured child receives during the acute phases of resuscitation and stabilization and critical care have direct impact on potential for good long-term outcome. The nurse works in concert with other members of the trauma team to provide comprehensive assessment and interventions during both the primary and secondary surveys. Knowledge of mechanisms of injury in the pediatric population, patterns of injury unique to children, physiologic differences between adults and children and their impact on care, and developmental needs of children and families guide the trauma nurse in providing expert clinical care and caring psychosocial support to traumatized patients and families.

This paper describes the assessment, investigation and management of patients suffering blunt abdominal trauma. Many of the structures within the abdominal cavity are highly vascular and damage following trauma can lead to life-threatening hypovolaemia. Initial assessment of the patient must follow the usual trauma protocols with identification and management of life-threatening conditions; specific procedures related to the abdomen are described. Although formal examination of the patient has traditionally been a medical responsibility, nurses are assuming more responsibility by working in triage or as nurse practitioners. Nurses working both in triage and within the Accident and Emergency department must be able to rapidly assess these patients and assist in their management.

1. Epidemiology may affect admission. It is essential to know what types of trauma patients are typically admitted, at what time of day, and on which day of the week. Within trauma systems, one of the major determinants of patient survival is the adequacy of surgical personnel and equipment resources. 2. Assessment of the abdominal and thoracic trauma patient is an active process, requiring constant curious attention. Due to the time-critical nature of these injuries, effective communication is paramount. There may be little or no documentation, and minimal verbal report, consisting of mechanism of injury and vital signs. A stable patient may rapidly deteriorate. 3. Injury severity and location are key in patients' mortality and morbidity. Outcomes for vascular injury surgeries depend on time lag, differences in surgeons' experience, associated injury, site of wounds, type of arterial lesions, and infection.

Children, especially multitrauma victims, are at significant risk for abdominal and GU trauma. Frequently, external indicators of trauma to these systems may be subtle or nonspecific. Expert assessment skills and a knowledge of potential injuries are required. Nonoperative management of these injuries is frequently the treatment of choice, requiring the nurse to understand the type of injury sustained, as well as potential complications of the injury. The nurse is often the first to detect subtle signs of deterioration in the child's condition and must be able to intervene appropriately to promote optimal outcomes for the child. The families of children who sustain abdominal or GU trauma have special teaching needs related to inhospital or home management, as well as long-term outcomes of the injury. It is the responsibility of the nurse to identify and address these needs in a timely fashion to promote optimal outcomes as well as appropriate development for the child.

Pediatric multitrauma causes more deaths and injuries each year in children than any other cause of death. Most of the multitrauma cases involve a motor vehicle accident. Blunt trauma and head injuries constitute the majority of injuries in pediatric multitrauma. Blunt trauma leaves minimal evidence of the underlying injury and is difficult to assess in the unconscious child. The initial assessment in children is in some ways more complex than in an adult. The airway is a more critical concern in the child. Airway obstruction is a more frequent cause of ventilatory insufficiency in pediatric trauma. Hypothermia is a vital concern because children lack the ability to maintain their temperature when they are compromised. Assessment of circulation and shock in children is complicated because the signs of shock are subtle in the child. The plan of care and the approach to the child must incorporate the child's fears and coping mechanisms based on the child's age and developmental level. Nursing diagnoses should reflect the plan of care not only for the child, but for his or her family. The proper approach to the child can positively influence the quality of the assessment, the level of cooperation, and the long-term outcome of care.

Pathology of blunt and penetrating abdominal trauma is presented in specific sections. Samples of a focused cue search, nursing diagnostic statements, and defining characteristics are included. Utilization of the aforementioned items are discussed within the context of a case involving victims of an accident resulting from a high-speed chase.

Abdominal trauma should always be suspected with major pelvic fractures until proven otherwise. Thorough assessment and diagnostic evaluation will determine whether surgical management is necessary. Nursing care continues to the postinjury period, which needs close observation because further complications are common.

Blunt trauma to the abdomen presents a diagnostic challenge for even the most experienced emergency nurse. Isolated injury to the esophagus, diaphragm, duodenum, or pancreas is indeed rare and, more important, seemingly minor trauma to this region can increase the risk of severe morbidity if these injuries remain undetected. A high index of suspicion and continuous, systematic assessment of the abdomen offer the most effective means of preventing the consequences of delay in diagnosis to any of these organs.