Virtual Training Director: Abdominal Trauma

The Virtual Training Director is a column for training officers that utilizes the content of CE articles in EMS Magazine to help facilitate training sessions. Use or adapt this lesson plan for your organization, its personnel and its local protocols.

ESSENTIAL INFORMATION

Abdominal trauma from blunt and penetrating mechanisms can produce injuries that are visually dramatic and potentially life-threatening to the patient. The CE article on Abdominal Trauma reviews important anatomical features of the abdominal region, types of injuries, assessment and general treatment principles.

Rather than lecturing about abdominal trauma, I have outlined an interactive training session for participants to review and practice trauma assessment skills. Before your training session, ask members to read the article so they have the necessary knowledge for a productive discussion and practice session. (Remember: You can make and distribute copies of any of our articles for education purposes.)

Time needed: 1 to 2 hours

INSTRUCTOR PREPARATION

Prepare a moulage kit with enough supplies, appliances and applicators for groups to simultaneously moulage multiple abdominal trauma patients. Gather some old clothing for patients that rescuers can cut away to expose injuries. You may also wish to prepare patient profiles for use if time is too limited for teams to prepare their own. Review your local and/or regional guidelines for triage and transport of major trauma patients to the highest level of trauma care available.

CLASSROOM TRAINING OBJECTIVES

• Understand causes of abdominal trauma
• Explain signs and symptoms of shock from abdominal trauma
• Differentiate types of organs--hollow vs. solid
• Practice abdominal trauma assessment in small group scenarios
• Review major trauma triage transport guidelines.

1. Introduce the training topic of abdominal trauma assessment by describing the team activity to prepare a patient scenario and assess all of the other patients.

2. Review the following concepts from the article (add additional content as needed, based on your group's knowledge and experience):

• Abdominal anatomy--different regions and the organs in each region
• Hollow organ types and locations
• Solid organ types and locations
• Physical exam assessments and findings
• Signs of severe abdominal injury.

TEACHING TIP: Ask participants to define these concepts and terms in their own words with concrete examples.

3. Preparation of patient assessment activity. Divide participants into 3- or 4-person teams, with one person in each team as the patient. Each team will plan and deliver a patient assessment scenario that includes:

• Selecting a specific abdominal trauma MOI--blunt or penetrating
• Using moulage to apply a simulated abdominal injury to their patient
• Preparing other vital signs and injury findings appropriate to the patient's abdominal injury and MOI.

TEACHING TIP: Each team will probably need 15 to 30 minutes to plan a scenario and apply moulage to their patient. Give a check sheet to each team so they include all needed components. Assist participants in applying moulage that is realistic for the abdominal injury type and severity.

4. Patient Assessment Rodeo. In a large classroom or outdoor space, arrange patients in a circle, about 15 feet apart. The remaining members of each team will have 5-7 minutes with each patient to:

• Determine mechanism of injury
• Expose injuries
• Identify ABC life-threats
• Check vital signs
• Gather patient history
• Perform a physical exam, including visualization, palpation, percussion and auscultation
• Outline a treatment and transport plan.

TEACHING TIP: The instructor tracks the time and calls out when it is time for teams to rotate clockwise to the next patient. If every team starts one position clockwise of their patient, the transitions will be smooth. Each team should assess all of the other patients.

5. Patient Scenario Discussion. After assessing each patient, reconvene in the classroom. You can have each team report on a single patient, or facilitate a discussion about each of the patients. Determine which patients meet major trauma triage and transport guidelines and should be transported to the highest level of trauma care available.

TEACHING TIP: Discuss interventions in the context of your local protocols and available receiving facilities.

6. Debrief. End training with a celebration of success.

• Photograph the abdominal injury moulage for future training programs.
• Award a prize for best moulage application.
• Discuss what was done well to understand assessment of abdominal trauma.
• Answer questions about abdominal trauma by asking participants, "What questions do you have about assessment and treatment of abdominal trauma?"
• Conclude the training session with a 3-5-minute reminder about the relative importance of airway management, pain management and fluid resuscitation for abdominal trauma. Remind participants about the importance of getting major trauma patients to the highest level of available trauma care, which may mean bypassing closer hospitals.

1.5 hours of CECBEMS-approved CE credit is available for the article on Abdominal Trauma. Visit RapidCE.com to complete a set of quiz questions and print a CE certificate.

Greg Friese, MS, NREMT-P, is an e-learning designer, podcaster, author, presenter and paramedic. He is also a lead instructor for Wilderness Medical Associates. Read more from him at the EverydayEMSTips.com blog. Connect with Greg at EMSUnited.com, Facebook.com/gfriese OR twitter.com/gfriese.