Injuries — abdomen and pelvis

Abdomen includes from nipples to tops of thighs at front and sides, on the back from tips of the shoulder blades to buttock creases

If pregnant — see Injuries in pregnancy

• Can be serious abdominal injuries without external evidence of trauma
• Penetrating injuries to chest or buttocks can involve abdominal organs
• Injuries to liver, spleen, pelvis can quickly cause life-threatening blood loss — see Injuries — bleeding
• If fractured lower ribs — consider injury to liver or spleen
• Pain and tenderness can
• Be masked by other serious injuries or impaired level of consciousness
• Be absent if spinal cord injury
• Develop slowly over hours (eg peritonitis due to bowel or vessel damage)

Do not

• Do not let person eat or drink anything — may need operation — consider IV fluids
• Do not remove any object sticking into abdomen
• Do not probe (poke or feel about inside wound)
• Do not replace exposed bowel or gut contents
• Do not spring pelvis
• Do not put in indwelling urinary catheter if signs of urethral or bladder injury (eg blood in urethra, bruised scrotum) — medical consult

Do first

• Put in 2 IV cannula, largest possible or intraosseous if unable to get IV access
• Give pain relief — person will be more relaxed and assessment more accurate

Ask

• Mechanism of injury
• Blunt, penetrating, multi-trauma (more than 1 area injured)
• Amount of force — takes a lot of force to fracture pelvis, consider if side-impact car accident, motorbike accident, pedestrian hit by car
• Other injuries
• Pain
• Abdominal pain 
• Back pain
• At shoulder tip — may mean bleeding inside abdomen
• On lower limb movement — consider pelvic fracture
• On weight bearing or walking — consider pelvic fracture

• Allergies, medicines, medical history, time they last ate

Check

Remember: Log-roll if concerned about spinal injury, or if possible penetrating injury to back causing circulation or breathing problems. Wherever possible person should be moved with a scoop stretcher and rolling minimised

Do

• Medical consult, send to hospital straight away
• If in shock — give boluses — adult 250mL, child 20mL/kg and assess response
• Use blood if available or Hartmann's solution or normal saline
• If head injury or not alert — target systolic BP of more than 90mmHg
• Otherwise target systolic BP of 80–90mmHg

• If evidence of shock — low BP and/or high pulse AND suspicion of uncontrolled (internal) haemorrhage AND less than 3 hours from time of injury — medical consult for tranexamic acid 
• Adult — tranexamic acid IV — 1g (in 100mL compatible fluid) over 10 minutes THEN 1g (in 1000mL of a compatible fluid) over 8 hours — doses
• Child — tranexamic acid IV — 15mg/kg up to 1g over 10 minutes THEN 2mg/kg/h for 8 hours, dilution 500mg in 500mL of compatible fluid and infuse at 2mL/kg/h (maximum dose 125mg per hour) — doses
• Give pain relief
• Put in indwelling urinary catheter if needed and no sign of urethral or bladder damage — female, male

Splinting

Do — if pelvic fracture

• As soon as you suspect pelvic fracture — put on pelvic binder following the manufacturer's instructions or apply pelvic sheeting 
• Pelvic binders should be placed over the greater trochanters — Figure 2.17 and whenever possible should not be placed over clothing

Do — if deep or open wound

• Cover wounds with sterile dressing soaked in normal saline then cling wrap

• Lay cling wrap lengthways. If wrapped around body it can become too tight, reducing breathing and circulation

• Give cefazolin IV — adult 2g, child 50mg/kg/dose up to 2g — doses — 8-hourly
• For heavily contaminated or severe wounds add metronidazole IV — adult 500mg, child 12.5mg/kg up to 500mg, 12-hourly
• If allergy — medical consult