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JOURNAL ARTICLE REVIEW #2

Journal Article Review #2 Short title

“Introduction” is not

required by APA, but it may 2 be used. Because it is a

scored element in this

paper, please include it as a goes here Introduction heading.

‘Penetrating and blunt abdominal trauma’ is an article published in Critical Care Nursing

Quarterly in the January to March, 2005 issue, written by Kristine L. Eckert. In this article,

Kristine Eckert provides an overview of abdominal trauma related to penetrating and blunt

mechanisms of injury. There are different case studies provided to illustrate interventions and

treatments of different types of trauma. This article also provides an overview of the anatomy

and physiology of the different organ systems, with complications being briefly discussed.

Summary of Article

The abdomen is divided anatomically into the peritoneal space, the retroperitoneal space,

and the pelvis. There are both solid and hollow organs in these areas. Trauma to any of these

areas in the abdomen can lead to complications including hemorrhage, shock, peritonitis, and

sepsis. ”Before considering a bowel injury, the patient’s respiratory, hemodynamic, and

neurologic status should be evaluated because of a much greater immediate threat to life from

these systems rather than a delay in bowel injury” (Eckert, 2005, p. 50). The differences between

penetrating and blunt abdominal trauma and their threat to life are further illustrated in the four

case studies discussed in this article.

The first two case studies considered penetrating abdominal traumas. In the first case

study, a male patient sustains gunshot wounds to his chest, back, and leg. With the gunshot

wound, he suffers hemothorax, injuries to his lungs, bilateral kidney, diaphragm, liver and small

bowel, laceration of spleen, and tear to the distal end of his esophagus. The second case involves

a male victim of a drive-by shooting with two gunshots wound to the right buttock and left

lateral thigh. This type of gunshot wound is considered of the transabdominal nature, and the JOURNAL ARTICLE REVIEW #2 3

patient is a candidate for immediate surgery; computed tomography (CT) scanning was not

completed prior to entry to the Operating Room (OR). With these gunshot wounds, he suffers

bladder lacerations, perforation, retroperitoneal hematoma in the right pelvic area, and a gunshot

wound to his thigh, which left him with a femur fracture.

It is important to keep in mind that the external appearance of the wound does not

determine the extent of internal injury. By just looking at the external location of a gunshot

wound, certain organs or cavities may appear not to be involved. However, the trajectory of the

bullet plays an important role in the extent of internal injury. The trajectory of the bullet depends

on the caliber of the bullet, along with the angle and distance from which the gun was fired. The

bullet can change its path and refract off of bony surfaces. Therefore, the assessment should

include distinguishing the entrance and exit wounds and their locations, to assist in determining

the trajectory of the bullet and what organs may be involved. It is necessary to have an

exploratory laparotomy surgery for most gunshot wounds to the abdomen for damage control,

even though the wound may appear to be superficial. The principles of damage control surgery

are to: control hemorrhage, prevent contamination from the bowel, and to avoid further injury. In

conjunction with clinical findings and patient symptoms, CT scan of the chest, abdomen, and

pelvis with contrast, most commonly diagnose spleen and liver injuries. CT scan is the most

sensitive diagnostic tool for most abdominal trauma injuries. A FAST scan is an inexpensive and

rapid, noninvasive ultrasound that can be performed at the bedside to quickly evaluate intra-

abdominal hemorrhage (Eckert, 2005).

Examples of blunt abdominal traumas are presented in the last two case studies. In the

third case study, a restrained elderly female driver was involved in a motor vehicle crash without

airbag deployment. The female patient presents with unilateral weakness and complaints of chest JOURNAL ARTICLE REVIEW #2 4

pain. She has no visible trauma but her CT scan revealed liver laceration, multiple right rib

fractures, and a grade I pancreatic contusion. Later, diagnosis includes right calcaneus fracture

and a right proximal ulnar process fracture. The last case study is of a young female teenage

passenger involved in a motor vehicle collision. Her main complaint is primarily abdominal pain.

Assessment reveals an abrasion across the lower abdomen from iliac crest to iliac crest with mild

tenderness to palpation. Initial complete blood count is normal. However, within three hours, her

white count doubled, showing signs and symptoms of peritonitis. During surgery, a small bowel

and a large bowel laceration, and a minor spleen laceration were noted. Undetected abdominal

trauma can rapidly lead to death due to hemorrhage, shock, and sepsis. Common injuries due to

blunt abdominal trauma can include: tears to the liver, rupture spleen, pancreatic tear, duodenum

rupture, and kidney injuries.

Evaluation of Article

This is an interesting article, presenting an overview of both penetrating and blunt abdominal

trauma. After reading this article, a deeper insight into understanding of both penetrating and

blunt abdominal trauma is developed. The case studies are written in such a way to provide a

step-by-step occurrence to the scenarios, making one feel part of the experience. The case studies

help by providing a clearer picture and understanding of how each different injury led to a

different outcome. This writer especially likes the breakdown of different organs and systems,

and the significance they presented to each injury. The journal author provides a review of the

systems, which was refreshing to one’s memory while reading about each organ and system, thus

lending to the article being easily read. The injury grading scales of organs, such as the: liver,

spleen, kidney, and pancreas, were clearly graded. This breakdown helps one develop a better JOURNAL ARTICLE REVIEW #2

understanding of the different injury levels. The abdominal assessment signs are an interesting

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tool to have, although they are not conclusive in diagnosis.

This writer does not personally work with trauma patients. However, this valuable

knowledge can come in handy when exposed to the chance to work with trauma patients. It helps

by looking at gunshot injuries and motor vehicle accident injuries from a different perspective.

One must look at a bigger picture and use critical thinking skills, as with all other injuries.

However, it is interesting to know that in both penetrating and blunt abdominal trauma that the

genitourinary system has the most common injuries.

This article also includes an assessment of trauma patients with: observation,

auscultation, perineum, rectal, and vaginal examinations. This assessment is clearly outlined, and

easily followed. The knowledge from this article can be relevant to both nurses and practitioners

because it provides a clear outline of the assessment process.

The only section found to be slightly irrelevant is the detail about the surgical procedure

in the first case study. However, it is not redundant. Actually, the information regarding the

surgical procedure is found to be interesting, as it allows one to know the detail of the procedure

so that the whole process can be understood.

Conclusion

This article provides a practical overview of abdominal trauma, with incidence of abdominal

injuries being discussed and illustrated through case studies. Significant complications of

intestinal injury include wound dehiscence, wound infection, intra-abdominal abscess, short

bowel syndrome, and intestinal obstruction. The treatments and interventions discussed are

applicable to nursing assessment, clinical practice, and prevent of complications. In addition to

the anatomy and physiology of the different organ systems overviewed, the complications are JOURNAL ARTICLE REVIEW #2 6

discussed, and the differences between solid and hollow organs are reviewed, all valuable

knowledge to develop.