Fullness and doughy consistency on palpation may indicate intra-abdominal hemorrhage. Peritonitis due to intra-abdominal hemorrhage may take several hours to develop. Such signs appearing soon after an injury suggest leakage of intestinal content. Palpation may reveal local or generalized tenderness, guarding, rigidity, or rebound tenderness, which suggests peritoneal injury. Abdominal bruit may indicate underlying vascular disease or traumatic arteriovenous fistula. Auscultation of bowel sounds in the thorax may indicate the presence of a diaphragmatic injury. Visual inspection for abdominal distention, which may be due to pneumoperitoneum, gastric dilatation secondary to assisted ventilation or swallowing of air, or ileus produced by peritoneal irritation, is important. Ecchymosis involving the flanks (Grey Turner sign) or the umbilicus (Cullen sign) indicates retroperitoneal hemorrhage, but this is usually delayed for several hours to days. In most studies, lap belt marks have been correlated with rupture of the small intestine and an increased incidence of other intra-abdominal injuries. Particular attention should be paid to injury patterns that predict the potential for intra-abdominal trauma (eg, lap belt abrasions, steering wheel–shaped contusions). The abdomen is inspected for abrasions or ecchymosis. The abdominal examination must be systematic.Shearing: inappropriate location of the lap belt contributing to bowel injury.07/20/12 Temple College EMS Professions.

Seat belt sign trauma ppt