The chief cause of blunt abdominal trauma in the United States is motor vehicle accidents. Other rare causes include falls from heights, bicycle injuries, injuries sustained during sporting activities, and industrial accidents. In children, the most common causes are due to motor vehicle injuries and bicycle accidents.
Because the presentation is often not straightforward, the diagnosis can be difficult and often time-consuming. Besides pain, the patient may present with bleeding per rectum, unstable vital signs, and the presence of peritonitis. The physical exam may reveal marks from a lap belt, ecchymosis, abdominal distention, absent bowel sounds and tenderness to palpation. If peritonitis is present, abdominal rigidity, guarding and rebound tenderness may be present. The mechanism of injury, motor vehicle speed, associated deaths at the scene, uses of alcohol or other substance of abuse must be taken into account so as not to miss an injury.
The evaluation of any trauma patient begins with evaluating the airway, accessing the breathing, and managing the circulation. The diagnosis of intra-abdominal injury following blunt trauma depends primarily on the hemodynamic status of the patient. If the patient is hemodynamically stable, CT scan is the ideal test to look for solid organ injury in the abdomen and pelvis. For unstable patients, one may perform an ultrasound (Extended Focused Assessment with Sonography for Trauma (EFAST)) or diagnostic peritoneal lavage, both of which are associated with a high rate of false negatives and false positives.
All indications for trauma ultrasound include blunt or penetrating trauma to the torso where there is a suspicion of intraperitoneal hemorrhage, pericardial tamponade, and hemothorax.
The Extended Focused Assessment with Sonography for Trauma (EFAST) exam includes the following views:
1. RUQ (right upper quadrant)
2. Perisplenic space LUQ (left upper quadrant)
3. Pelvis (bladder)
4. Cardiac view: Subcostal or any other cardiac view. See below
5. Normal Lung: Lung sliding back and forth is normally secondary to the normal anatomy of the parietal and visceral pleural movement. As well, the pleura moves with respect to the ribs+Comet tail artifacts.
Pneumothorax: With a pneumothorax, there is NO lung sliding back and forth. you will note the pleura and ribs move together. There will be NO comet tail artifacts.
Both the anterior and posterior pericardium should be visualized for anterior or posterior fluid in the pericardium.
Parasternal long axis (PSLA)
Parasternal short axis (PSSA)
Treatment of patients with blunt abdominal injury requires the routine ABCs (Airway, Breathing, and Circulation). Once the airway is protected, it is mandatory to protect the cervical spine. After the primary survey is complete, patients who are hypotensive require aggressive fluid resuscitation. If hemodynamic instability persists, blood should be typed and crossed, but in the meantime, immediate transfusion with O negative blood can be done (O+ for males and women past childbearing years). All patients with blunt abdominal trauma who have signs of peritonitis, frank bleeding, or worsening of clinical signs require an immediate laparotomy. Non-surgical treatment in patients with blunt abdominal injury depends on the clinical features, hemodynamic stability and results of the CT scan. Advances in angiography can now help control hemorrhage with the use of embolization therapy, which is more cost effective than laparotomy. In general, the prognosis of patients with blunt abdominal trauma is good. 
Mortality rates have substantially decreased in the last two decades as trauma centers have streamlined the approach to diagnosis and management. Mortality rates do vary from 2% to 10% and are most common in people with multiple organ injuries who present with shock and frank hemorrhage.
According to the Centers for Disease Control, traumatic injury is the leading cause of death in people younger than the age of 44. Many traumatic injuries can be prevented, beginning with awareness and education. Blunt abdominal trauma is in the top three categories of preventable injuries. These include older adults falls and preventable motor vehicle accidents in teens.
Blunt abdominal trauma results in thousands of admission each year, resulting in great costs to the healthcare system. while the actual injury is managed by a team of healthcare professionals, there is also focus on preventing such injuries. The nurses not only are responsible for monitoring these patients but they also have an important role in patient education. To prevent blunt abdominal trauma, the public has to be educated on wearing a safety belt. These safety devices have to be worn even if the motor vehicle comes fitted with airbags. More important, the public has to be educated about defensive driving and maintaining a safe distance from other automobiles on the road. Plus, the public should be told about the consequences of drinking and driving. Finally, the nurse and the pharmacist should educate the public on avoiding distractions in the car like eating, texting or using a mobile phone. (Level V)
In the past two decades, the outcomes of blunt abdominal trauma have improved. However, there are very few papers published on long-term data and hence the eventual outcome of these patients remains unknown. For patients with minor blunt trauma, the outcomes are good but for those who suffer multiple organ injuries, the in-hospital mortality can vary from 3-10%. The ready availability of CT scans has also allowed physicians to closely monitor these patients without performing unnecessary surgeries. (Level II)
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