Clinical Practice Guidelines:

Trauma/Abdominal trauma
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Date October, 2015

Purpose To ensure a consistent approach to the management of patients with Abdominal trauma.
Scope Applies to all QAS clinical staff.
Author Clinical Quality & Patient Safety Unit, QAS
Review date October, 2017
URL https://ambulance.qld.gov.au/clinical.html

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 Abdominal trauma
October, 2015

Penetrating and blunt trauma to the abdomen can produce significant 


Clinical features
and life-threatening injuries. Many serious abdominal injuries may

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appear insignificant, making it extremely difficult to predict severity.
The close proximity of organs within the torso makes distinguishing
between abdomen, chest and pelvic injuries difficult. Associated
injuries outside that cavity should be considered in all patients.[1]
Blunt abdominal trauma
Blunt trauma results in compression and shearing force injuries.
Features may be obvious but in some presentations
unexplained shock may be the only sign of severe
abdominal trauma.[2] Signs and symptoms include:
• ALOC
• Dyspnoea
• Abdominal pain/discomfort, guarding 


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Compression forces are those that result in abdominal organs and 
 and tenderness on palpation
blood vessels being crushed between solid objects. Shearing 
 • Hypovolaemic shock
forces cause tearing and rupture of solid organs and blood vessels 

• Abdominal bruising (e.g. Cullen’s sign, 

at multiple sites. Grey Turner sign) and distension can be 

Penetrating trauma a late sign and difficult to determine.

The extent of vessel and organ damage, including haemmorhage, 
 • Shoulder tip pain (Kehr’s sign)
due to penetrating trauma is dependent on the mechanism 


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(e.g. stab wound vs gunshot wound). Many of these patients will
require formal surgical exploration and repair. Small entry wounds 
 Complications
may mask significant internal injury.[2] Regardless of the mechanism,
catastrophic deterioration can develop quickly and unexpectedly. 
 • Significant abdominal injuries may present 

All penetrating injuries despite the assessed level of penetration, 
 with little external evidence of trauma or a 

or actual size of the wound, should be treated as serious and trivial pattern of injury and or mechanism.[1]
potentially life threatening. • Fluid resuscitation. Use minimal fluid therapy 


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Children
Due to their physique, children are particularly susceptible to
abdominal trauma. In comparison to adults, their relatively large
to achieve a systolic BP 90 mmHg or perfusion 

of vital organs.[4]
• Refer to specific CPG for abdominal trauma 

in head-injured or pregnant patients.
abdomen is poorly protected by lower ribs and pelvis and children 

may present with few external signs of trauma.[3]
Figure 2.83
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 e

Additional information CPG: Paramedic Safety Consider:

CPG: Standard Cares
• IV access
• Pattern bruising such as Cullen’s and 

• Analgesia
Grey Turner’s sign may take hours or 
 Antiemetic

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•
days to develop. • FAST
• Maintain normothermia
• Trauma that presents with eviscerated Shocked? N
• Manage any other injuries
bowel should be covered with moist 

sterile pads or cling wrap.
Y Consider:
• Focused assessment with sonography

in trauma (FAST) assists responders to


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• IV access
identify internal complications present 

• IV fluid (maintain a radial pulse)
in the trauma patient. Shocked with TBI? N
• Pelvic binder
• FAST
• Blood
Y

Consider:

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IMPORTANT:
Pregnant patient: 

•
•
•
IV access
IV fluid
Pelvic binder
Manage as per CPG: • FAST
Trauma in pregnancy • Blood

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Note: Officers are only to 

perform procedures for 

which they have received 
 Transport to hospital
specific training and 
 Pre-notify as appropriate
authorisation by the QAS.

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