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General Trauma

Abdominal Injury

Your kid, BMX hero, is making some jumps on the construction site next door. Now he comes in holding his stomach. He landed on his bike as he crashed.

There's a lot of squishy stuff in your tummy. But the squishy stuff isn't likely to be injured. Most often, it's the harder stuff: the spleen, liver, and sometimes the pancreas. Although it's rare, you can injure the bowel or bladder. But let's cover the basics first.

Bikers don't die from broken fingers. But they DO die from ruptured spleens. If there seems to be a significant abdominal injury, don't mess around. Get to an ER.

See the doctor if:
    - pain is severe
    - pain prevents normal activity
    - pain is spreading
    - pain doesn't improve with time
    - there's repeated vomiting
    - there's blood in vomit or bowel movements

Spleen Injury:
The spleen is the most commonly injured organ in blunt abdominal trauma. It sits under the lower left ribs, straight down from your armpit. When hit, the spleen can rupture and bleed. The most common cause is a blunt hit on the lower left ribs. Pain begins to spread from the left upper abdomen downward. Sometimes there's pain over the left shoulder (caused by blood under the diaphragm). Lightheadedness may develop as blood is lost. It may take an hour or two before the classical "peritoneal signs" of rigid abdomen and sensitivity to jiggling develop.

Liver Injury:
The liver is "squishier" than the spleen, so it's not as easily ruptured. But it's bigger, so a severe blow to the right lower anterior chest can cause a tear. The internal bleeding usually isn't as heavy as a ruptured spleen. Pain spreads down from the right upper abdomen and over into the pit of the stomach. Blood on the top of the liver can cause pain over the right shoulder or shoulder blade. Lightheadedness may occur as bleeding continues. It may take an hour or two before the classical "peritoneal signs" of rigid abdomen and sensitivity to jiggling develop.

Pancreas Injury:
The pancreas sits behind the intestines, directly in front of the spine in the middle of the abdomen. It can be injured by a blow that penetrates sharply into the belly-button area, such as landing on the end of the handlebars. Typically, there's deep pain in the middle to upper stomach that radiates through to the middle of the back. Vomiting is common. The pain often spreads as the pancreas enzymes begin to inflame nearby tissues.

Bowel Injury:
Rarely, the bowel itself may be seriously injured when it's "pinched" against the spine by a sharp blow to the abdomen. Examples would be landing directly on a large broken branch or the end of your handlebar. After the initial dull pain, there may be improvement for a while. If the bowel is ruptured, pain spreads and becomes more intense. Sensitivity to jiggling develops. There may be fever. If the bowel has a hematoma (a collection of blood within the bowel wall, most commonly in the duodenum), the only symptoms may be vague pain, cramps, and vomiting.

Bladder Injury:
Rarely, a blow to a full bladder can rupture it. Examples would be landing directly on a large broken branch or the end of your handlebar. This is very rare in mountain biking, possibly because there are plenty of bushes to pee behind -- so the bladder isn't full enough to rupture. After the injury, there would be severe lower abdominal pain and bloody urine.

Immediate care:
If the injury doesn't seem all that serious, lie down and rest. Don't eat or drink anything just yet. Put a cold pack on the bumped area. If things seem to be improving, gently get back home and rest some more.

If there are signs of significant abdominal injury (see above), just get back to civilization. If possible, lie down and rest during the trip. Don't eat or drink anything. Head for the ER.

Kidney Injury

After coming back from Slickrock, you're hanging around the motel parking lot practicing wheelies and curb jumping. As you pop a wheelie, you tip back. You hit the curb with the side of your back, right at your waistline. It hurts. An hour later, the toilet water goes pink when you pee.

The kidney can be injured by a blow to the side of your back, in the space between the lower ribs and the top of the pelvic bone. Most bruises and internal tears of the kidney heal by themselves. Big ruptures, or damage to the kidney's blood vessels, can be serious.

After a hit to the kidney, see the doctor if:
    - the urine is obviously bloody
    - pain remains severe
    - pain is spreading
    - you become lightheaded

Immediate care:
Cold-pack the injured area and rest.

Rib Injury

Deer Valley. Oops. Slide through the turn. Body-slam against the aspen. Ouch. Hurts to breathe.

A rib injury typically causes sharp pain with motion of the chest or shoulders and while taking a deep breath. Unless a broken rib has punctured the lung, causes severe internal bleeding, or prevents adequate breathing, it's not serious -- just painful.

Lean close to your monitor. Stare at this x-ray and scowl. Put your hand on your chin; thumb on one side, fingers on the other. Rub your beard stubble while saying "Hmmm" without opening your lips. See? Isn't it fun to play doctor?

xrayches.jpg (7012 bytes)

Even without a broken rib, a slam to the chest can cause a ruptured lung (pneumothorax). There can be bruising of underlying lung or internal bleeding from torn blood vessels. Under your lower ribs, there's a kidney (in back), a spleen (on the left), and a liver (on the right) that can be ruptured.

See the doctor if:
    - you're short of breath
    - you become lightheaded
    - there's deep or severe pain
    - the surface of the chest "crunches" when pressed
    - there's deformity or swelling
    - pain involves the abdomen
    - there's blood in the urine

Immediate care:
Ice pack the painful area and rest a minute. If it hurts to breath or move, try wrapping an elastic dressing ("Ace wrap") around the chest, compressing the injured rib. Sometimes it helps to hug your shirt or backpack against the area. Of course, you can't ride your bike like that. You may need to hike. See the doctor if it's an injury that will interfere with usual activities -- the ability to do your usual activities is a pretty reliable indication that a rib injury isn't serious.

Binder for a broken rib, constructed from a large elastic wrap.

bf-ribb.jpg (11950 bytes)

Ongoing care:
Keep an elastic wrap around the area when you're doing activities that cause pain (such as breathing), but loosen it at least once an hour to take a few deep breaths. Apply cold packs 30 minutes every two hours, for two days. Avoid vigorous physical activity until the pain is improving. In general: if it hurts, don't do it. Expect about 4 weeks to heal.

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