Identify proper procedures for treating a casualty with an open abdominal wound.

Given multiple-choice items pertaining to open abdominal wounds.

Score 70 or more points on the 100-point written examination.

STP 21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.

FM 21-11, First Aid for Soldiers.

The body's abdominal cavity contains organs such as the stomach, small intestine, large intestine, liver, kidneys, and spleen. Several large arteries and veins are also located in the abdominal cavity. An object that punctures the muscular abdominal wall can injure one or more organs, cause severe bleeding, and result in infection that could spread to the organs within the cavity.

An open abdominal wound can be caused by the muscular abdominal wall being penetrated by a bullet, by a stab from a knife, by an object blown from an explosion, or by falling on a sharp object.

After evaluating the casualty and finding an open abdominal wound, position the casualty on his back with his knees up (flexed). This position helps to prevent further exposure of the abdominal organs, lessen pain, control shock, and relieve pressure on the abdominal area by allowing the abdominal muscles to relax.

FIGURE 6-1. CASUALTY IN KNEES-UP (FLEXED) POSITION

Check the casualty's abdominal region for both entry and exit wounds. Use your hand to check the casualty's back for wounds. Look for a pool of blood. If more than one open abdominal wound is found, treat the more serious wound (largest, heaviest blood loss, etc.) first.

Expose the area around the open abdominal wound by removing, cutting, or tearing the clothing covering the wound. If clothing is stuck to the wound, do not try to remove the stuck clothing as this may cause additional pain and injury. Cut or tear around the stuck clothing. Do not try to probe, clean, or remove foreign objects from the wound.

Sometimes, part of an intestine or other organ is forced out through the wound. If an organ is outside the body, do not try to push the organ back into the body. Do not touch the exposed organ with your hands. If the organ is lying on the ground, use a dressing, T-shirt, or other clean, dry material to gently pick up the organ and place the organ on top of the casualty's abdomen near the wound (not on or in the wound).

CAUTION: Do not probe, clean, or try to remove any foreign object from the abdomen. Do not touch any exposed organs with the bare hands. Do not push organs back into the body.

Open the casualty's field dressing and place the white side of the dressing over the wound and any protruding organs.

If the field dressing is too small to cover the wound and any protruding organs or if a field dressing is not available, use elastic gauze bandage or the cleanest materials available as a dressing. Clothing, part of a blanket, or similar materials may be used. Improvise bandages from strips of clothing to secure the dressing.

Hold the dressing with one hand to keep it from slipping.

Grasp one tail and slide it under the casualty.

Reach down on the other side of the casualty, grasp the tail under the casualty, and pull.

Bring the tail up the casualty's side, over the dressing, and to the other side.

Wrap the other tail in the opposite direction (down the side, under the back, and up the side to the dressing).

Tie the tails in a nonslip knot on the outer edge of the dressing closest to the casualty's side. Do not tie the knots over the wound site.

CAUTION: The bandages should be tight enough to keep the dressing from slipping, but should not be tight enough to place pressure on the wound. You should be able to insert two fingers between the knot and the dressing. The primary purpose of the dressing is to protect the wound from further contamination, not to control the bleeding through pressure. Pressure could cause additional damage to the organs of the abdominal cavity.

Elastic gauze bandages applied over exposed abdominal organs (especially intestines) should be moistened with I.V. solution using the I.V. tubing.

If other abdominal wounds are present (both entry and exit wounds are present, for example), dress and bandage the wounds.

If the situation allows and materials are available, reinforce the dressings by covering them with cravats, strips torn from a T-shirt, or other strips of cloth. The improvised bandages will provide additional support and protection. Tie the tails of the reinforcement bandages on the opposite edge side of the field dressing (not over the field dressing knot). The reinforcing material should be tight enough to help keep the dressing from slipping, but loose enough to prevent additional pressure on the wound.

CAUTION: Do not tie any knots over the wound site.

Keep the casualty in the knees-up position.

Get medical help for the casualty as soon as possible. The dressing cannot adequately control internal bleeding (blood flowing into the abdominal cavity). The risks of serious infection and damage to internal organs are also present. If possible, send someone else to get help while you treat the casualty.

CAUTION: Do not give the casualty anything to eat or drink. If the casualty complains of thirst, moisten his lips with a damp cloth.

Administer mouth-to-mouth resuscitation if the casualty stops breathing.

If you must leave the casualty, tell him to stay on his back and keep his knees up.