chapter 16. Abdominal injuries
GO Lawlor and G McEntee
INTRODUCTION
Most abdominal injury is due to blunt trauma: a punch, headbutt or kick directed at the abdomen in the form of a misdirected tackle or act of aggression. Most blunt trauma is not serious but it can sometimes require a doctor’s review.
Penetrating trauma is injury due to actions such as stabbing or shooting, or any injury caused by sharp objects. All require immediate review in a hospital.
Organs in the abdomen can be damaged after blunt or penetrating trauma (Fig. 16.1).
Deciding on the severity of an injury
• Athlete pale, sweaty, clammy
• Any penetrating trauma
• Severe, unrelenting or worsening abdominal pain with a hard belly
• (In car racing injury) seat belt rash, bruising from steering wheel
• Abdominal bruising
• Unexplained pain of a shoulder tip following injury to the belly
• Severe shortness of breath
These patients require immediate transfer to hospital.
• Mild/moderate belly pain. Athlete is otherwise ok, but winded. If pain is worse on review later, the athlete’s injuries are then in the red zone
• Vomiting on the field of play is a common occurrence. It could be due to the exercise, perhaps the player just ate, or already had gastroenteritis coming on the pitch, or a blow to the belly upset the stomach. Such injuries stay in the amber zone if symptoms improve over an hour. The player enters the red zone if they vomit blood, the vomiting worsens, they also had a blow to the head, or they exhibit any red zone symptoms
• Abdominal wall muscles can be injured by stretching, twisting or a blow to the belly – although this is not serious, it can be difficult to differentiate from serious underlying injury
The athlete should be substituted. Playing on may cause further injury. Review in a short while for any worsening in the injury.
ABDOMINAL INJURY
What should I check for?
Speak to the player
• ‘How did the injury happen?’
• ‘Where is the pain? Point to the sore area’
• ‘How bad is the pain?’ (scale of 1 to 10: 1 is no pain, 10 is extreme pain)
• ‘Does the pain spread anywhere else?’
• ‘Are there any other injuries?’
Problem identification
• A player in a lot of pain will usually not play on!
• Finding the site or cause of the pain is easy. Judging how serious it is is where the difficulty arises
Finding the site or cause of the pain is easy. Judging how serious it is, that’s the difficulty!
Observe
• Is the athlete breathing normally? Abnormal breathing may indicate serious injury to the muscles of breathing or injury to the spinal cord
• Is the patient alert? Look for signs of faintness or lightheadedness
• Does movement make the pain worse? In serious injury, the patient is unable to move because of the pain (Of course, the contrary is not true. Just because a patient can move doesn’t mean there is not a serious underlying injury)
• Vomiting – If the athlete is vomiting, it may be a serious sign of head injury that requires immediate referral to hospital
• Look for deep cuts: shallow cuts can be cleaned and covered with gauze. Deep or gaping cuts require immediate medical attention for examination of the wound
Rule out serious injury
• Observe for any of the danger signs – if symptoms or signs are in the red zone (see p. 157), refer the player directly to hospital
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