Intra-abdominal Injuries
Intra-abdominal injuries may have been caused by penetrating or blunt mechanisms
Penetrating Injuries
Treatment
1. Immediately make plans to evacuate the patient.
2. Anticipate and treat for shock (see Chapter 13).
3. If violation of the peritoneum is suspected, administer a broad-spectrum antibiotic (e.g., ciprofloxacin 500–750 mg PO bid) until emergent delivery to definitive care.
4. Do not push extruded bowel back into the abdomen. Keep the exteriorized bowel moist and covered at all times (apply sterile dressing and moisten every 2 hours ideally with sterile saline, alternatively with potable water, then cover with thin, clingy plastic wrap).
5. Keep patient NPO except for sips of water with antibiotic.
Stab Wound
Treatment
1. If the wound extends into subcutaneous tissue and deeper penetration is in question, the evacuation decision may rest on results of local wound exploration. This procedure is simple to perform, even in the wilderness environment, but can be done safely only for wounds that lie between the costal margin and the inguinal ligament. Infiltrate skin and subcutaneous tissue with lidocaine 1% with epinephrine, and extend the laceration several centimeters to clearly visualize the underlying anterior fascia. The wound should never be probed with any instruments, particularly if overlying the ribs.
3. Anticipate and treat for shock (see Chapter 13).
4. Administer a broad-spectrum antibiotic (e.g., ciprofloxacin 500–750 mg PO bid) if the wound extends deeper than the subcutaneous tissue.
5. Do not push extruded bowel back into the abdomen. Keep the exteriorized bowel moist and covered at all times (apply sterile dressing, and moisten every 2 hours ideally with sterile saline, alternatively with potable water, then cover with thin, clingy plastic wrap).
6. If anticipating evacuation, keep patient NPO except for sips of water with antibiotic.
