Page 23 - 2026 SMOG

ABDOMINAL INJURY
Signs and Symptoms
• Altered mental status • Hematuria
• Tachycardia • Pain, tenderness, distention, and asymmetry
• Absence of palpable pulses • Absent/diminished bowel sounds TRAUMA
• Pale, moist, mottled skin • Grey-Turner sign
• Poor peripheral pulses • Cullen sign
• Hypotension • Kehr’s sign
Treatment
Blunt abdominal/pelvic injury
• Serial physical exams/reassessment
˚ Pelvic binder
˚ Conduct a FAST exam, if possible*
˚
Focus on resuscitation
• Penetrating abdominal/pelvic injury
˚ Hemostatic dressing
˚ Abdominal/pressure dressing
˚ Direct pressure
˚ Pelvic binder
˚
AAJT-uncontrolled pelvic bleed
• Damage Control Resuscitation
˚ Consider implementation of DCR if indications are met (SBP <100, HR >100, penetrating
chest/abdominal injuries, amputations, pelvic injury)
*FAST exam cannot reliably exclude significant injury, but may indicate intra-abdominal injury.
Notes, Cautions, Warnings
• Pregnant patient
˚ Increased risk of aspiration and gastric acidity
˚ The patient should receive maximum O due to increased O consumption and depleted
2
2
reserves
˚ Consider warm LR before crystalloids to better restore fetal oxygenation
˚ >20 weeks gestation, tilt at least 15° to prevent Vena Cava Syndrome
˚ Determine the presence of a pregnant uterus. Some changes can mimic shock (heart rate can
increase by 20 BPM, blood volume increases by 50% during mid-pregnancy, and relative
anemia from hemodilution can occur). The risk of massive blood loss greatly increases with
trauma to the bony pelvis due to the increase in blood flow to the uterus.
• Lateral contusions (seatbelt sign) are associated with a 20% occurrence of internal injury.
Reference: TCCC Guidelines; CPG ID #09 (Blunt Abdominal Trauma, Splenectomy, and Post-Splenectomy
Vaccination); CPG ID #34 (Pelvic Fracture Care)

2026 Standard Medical Operating Guidelines (SMOG) • 15