Anthony McGrath and Dean Whiting discuss the anatomy and physiology of the abdominal cavity , and the management of patients who have sustained major traumatic injuries RECOGNISING AND ASSESSING BLUNT ABDOMINAL TRAUMA

UNRECOGNISED ABDOMINAL trauma is one of the main causes of preventable death in severely injured patients throughout the world (American College of Surgeons Committee on Trauma (ACSCT) 2012). About one fifth of all major trauma fatalities involve trauma to organs in the abdominal cavity (Brooks et al 2004) and blunt abdominal trauma is the third most common problem encountered in trauma patients. Yet it is often missed or its diagnosis delayed because patients’ clinical signs and symptoms are not immediately recognised. Diagnosis can be complicated if the patients concerned have ingested alcohol or taken drugs, mortality and morbidity rates among trauma patients tend to be higher among those who have consumed alcohol (Small et al 2006). Diagnosis can also be complicated if patients have sustained distracting injuries, such as long bone or pelvic fractures (Michetti et al 2010, Diercks et al 2011). It is therefore essential that abdominal injuries are prioritised and managed in the context of concomitant injuries. Abdominal trauma is classified as penetrating or blunt. Penetrating abdominal trauma is usually easy to diagnose due to the cause of the injury: gunshot or stabbing for example. Blunt abdominal trauma can be less obvious, however, even though it can produce life-threatening injuries (Blank-Reid 2004). Most preventable deaths following blunt abdominal trauma are due to failures in identifying the injuries involved (ACSCT 2012), often because the signs and symptoms of abdominal injury take more than eight hours to appear or to be experienced, that is after patient arrival in hospital (Jones et al 2014). Most abdominal injuries are secondary to highspeed road traffic accidents (Isenhour and Mark 2007, Fleming et al 2012) so emergency department (ED) nurses should always look for abdominal injuries in patients who have been in such accidents. Nurses must also understand fully the anatomy and physiology of the abdominal cavity, and the problems that can arise there due to trauma. The organ in the abdominal cavity that is most commonly injured is the spleen, followed by the Abstract