Battlefield advanced trauma life support (BATLS). Chapter 7. Abdominal injuries.

Recognise the possibility of abdominal injury. Two major types of abdominal injury may be present in war, blunt and penetrating. In either case, early surgery is essential. With blunt injuries, a high index of suspicion is required. Diagnosis in the early stages may be very difficult. Serial examination is required; even then, evacuate early. Aids to diagnosis include: DPL, FAST, CT Casualties with penetrating injuries must be given the highest priority for evacuation and surgical evaluation. Penetrating injury to the loin, back, buttocks, lower chest and thighs, should raise suspicion of intra-abdominal injury. Management of abdominal injury follows normal BATLS protocol and includes: Primary survey: Remember the A B C D E routine. Resuscitation: This involves: Continued oxygenation Appropriate therapy for hypovolaemic shock (refer to Chapter 5) Continued monitoring of response by assessment of vital signs, aided by additional parameters such as pulse oxymetry and blood gas analysis, when available. Placement of nasogastric tube and bladder catheter. Secondary survey: Following stabilization, but not before, you may proceed to full assessment of the mechanism and location of injury. This demands a full secondary survey and continued monitoring of the casualty.