Penetrating injuries are easier to detect. Emergency Nursing Principles and Management: Priority Action for Abdominal Trauma. 2. What are the signs and symptoms of bleeding that you would educate the client on upon discharge for abdominal trauma? Liver, 2. There is no place for ED thoracotomy for blunt thoracoabdominal injuries. Sitting 1. Hollow organ injuries, which can occur with blunt or penetrating trauma, most commonly involve the small bowel. accomplished in bed if pillows are used to elevate the head and legs. You also know that your trauma surgical team just took a GSW to the OR in the last hour. 1111 East Touhy Ave, Suite 540, Des Plaines, IL 60018, 2022 Society for Academic Emergency Medicine. - Conduct continuous cardiac monitoring for dysrhythmias. appetite, or malaise. 3. change dressings every 7 days or per hospital policy The abdominal space in the anterior portion of the abdomen. Cullen Sign. Penetrating abdominal trauma (PAT) is on the rise with increasing gang violence. CT scan of the abdomen has excellent sensitivity and specificity in diagnosing both solid and hollow viscus injury. o GP IIb/IIa inhibitors, such as eptifibatide. 2. What do knife wounds most commonly occur on the left side of the body? Blunt forces cause most bladder injuries. - Electrolytes: Sodium can be decreased (prerenal azotemia) or increased With rapid glucose decline, the sympathetic nervous system is affected Your patient also may need an internal examination. Blunt abdominal trauma (BAT) is frequently encountered in the form of motor vehicle crashes (MVCs) (75%), followed by falls and direct abdominal impact. 4. Spleen injury is usually associated with blunt trauma. Implement potassium, phosphate, sodium, and magnesium restrictions, if Kaiser Permanente Central Valley, Kaiser Permanente School of Medicine. the client has COPD, insert a 2L/min nasal cannula and increase the oxygen flow 4. 3. The following findings are abnormal: * Pain with light percussion suggests peritoneal inflammation. Monitor level of consciousness in a recliner with legs elevated demonstrates this position, but it can be Which will demonstrate an O-H stretch at a larger wavenumber: ethanol dissolved in carbon disulfide or an undiluted sample of ethanol? Notify the provider of fever, increased restlessness, palpitations, and chest pain. * A type and crossmatch may be needed for blood replacement. Massive transfusion protocols should be activated. o Assess level of consciousness while recognizing that older adult clients For example, a victim of an MVC can sustain a lap belt injury that deserves special attention. Abdominal trauma patients can present in a wide variety of ways ranging from frank shock to hemodynamic instability to completely stable vitals to poly-trauma. * Electrolyte, blood urea nitrogen, and creatinine levels screen for underlying renal problems and provide a baseline. Gun shot wounds What does GSW stand for? & Doty. gout: LOW PURINE DIET (reduce organ meats and shellfish), avoid starvation diets, aspirin, and diuretics alternate periods of activity with rest to improve tolerance to activities Clinical investigations of REBOA suggest potential survival benefit, particularly in patients who are hypotensive but not yet in arrest. Pancreatitis: Expected Laboratory Findings * Control the patient's pain without sedating him, so you can continue to assess his injuries and ask him questions. List commonly utilized imaging modalities in abdominal trauma. These factors include altered mental status, intoxication and distracting injuries. o Inspect skin color and capillary refill 2 demonstrates a negative RUQ eFAST exam. other symptoms of pericarditis: chest pain, coughing, swallowing difficulties, shortness of breath, relief of pain when sitting and leaning forward, Amputations: Postoperative Interventions to Prevent Complications (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 69), wrap the stump with elastic bandages (figure eight wrap) to prevent restriction of blood flow and decrease edema The Journal of Trauma, Injury, Infection, and Critical Care. ABGs HIV/AIDS: Teaching Home Care (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 86), practice good hand hygiene, avoid crowded areas, avoid raw foods, avoid cleaning pet litter boxes, Infection Control: Appropriate Room Assignment (Active Learning Template - Basic Concept, RM FUND 9.0 Ch 11), for airborne precautions: need private room, masks, negative pressure airflow, Middle and Inner Ear Disorders: Risk Factors for Hearing Loss (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 13, Disorders of the Male Reproductive System: Complication of Continuous Bladder Irrigation Following Transurethral Resection of the Prostate (TURP) (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 65), monitor for bleeding (persistent bright-red bleeding unresponsive to increase in CBI and traction on the catheter or reduced hgb levels), Burns: Findings of Hypovolemic Shock (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 75), Inflammatory Bowel Disease: Appropriate Diet Choices (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 52), recommend high protein, high calories, low fiber foods, Polycystic Kidney Disease, Acute Kidney Injury and Chronic Kidney Disease: Evaluating Teaching About Nutrition (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 59), restrict dietary sodium, potassium, phosphorous, and magnesium, Medications Affecting Blood Pressure: Client Teaching Regarding ACE Inhibitors (Active Learning Template - Medication, RM Pharm RN 7.0 Chp 20), adverse effects include hypotension, renal impairment, persistent dry cough, rash, headache, dizziness, Pulmonary Embolism: Planning Care for a Client Who Is Receiving Enoxaparin (Active Learning Template - Medication, RM AMS RN 10.0 Chp 24), educate client: tell them to call provider if they have evidence of bleeding such as spots under skin or abnormal bleeding out of gums, vagina, sudden weakness (brain bleed), coughing up blood, Blood and Blood Product Transfusion: Proper Administration Technique (Active Learning Template - Nursing Skill, RM AMS RN 10.0 Chp 40), initiate large bore IV access- 18-20 gauge needle is standard for administering blood blood products, Blood and Blood Product Transfusions: Administering Fresh Frozen Plasma (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 40), initiate large bore IV access- 18-20 gauge needle is standard for administering blood blood products perform nail care after bath Today's technology helps pinpoint the location, nature, and severity of abdominal injuries. Upon completion of this module, the student will be able to: Abdominal trauma is seen quite often in the Emergency Department and can result from blunt or penetrating mechanisms. Initial Actions and Primary Survey Abdominal trauma can present in multiple ways. Lightheadedness Clinical Assessment As with all trauma management, the priority is to identify immediately life-threatening injuries. There a numerous tutorial videos demonstrating eFAST exams. Once the appropriate depth of insertion is confirmed, the balloon is inflated using IV contrast solution in order to occlude aortic flow distal to the balloon. 2. and around the tracheostomy holder and plate. (b) Describe the hybridization of the Batoms in the molecule and the geometry around each Batom. assess psychosocial well-being of the client, Diabetes Mellitus Management: Teaching About Foot Care (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 82), inspect feet daily; wash with mild soap and warm water Video-assisted diagnostic laparoscopy has helped reduce the number of laparotomies performed to evaluate abdominal trauma. Avoid neck extension. 1. Generally, I.V. Kehr Sign DVT prophylaxis Electrolytes. What labs would you monitor for a client with abdominal trauma? A peritoneal dialysis catheter is inserted through a small incision just below the umbilicus and a liter of warmed lactated Ringer's or 0.9% sodium chloride solution is infused. The Abdominal Trauma Index (ATI) was devised to quantify the risk of complications following abdominal trauma. Abdominal computed tomography (CT) scan can reveal specific injury sites, the degree of injury and bleeding, and many retroperitoneal injuries that don't show on an ultrasound. Emergency Nursing Principles and Management: Priority Action for Abdominal Trauma; Reduction of Risk Potential Pancreatitis: Expected Laboratory Findings - Blood amylase increases within 24 hr, and remains increased for 2 to 3 days (continued elevation can indicate pancreatic abscess or pseudocyst). Notify physician. - Serum glucose: increased due to a decrease in insulin production by the The survivors of the atomic bombs that were dropped on Hiroshima and Nagasaki have been the subjects of long-term studies of the effects of ionizing radiation on cancer incidence. Bronchoscopy Following the primary survey, the secondary survey must be performed. Inspect surgical incision and dressing for drainage and bleeding, A urine toxicology screen is routine to check for substances that could mask or mimic an injury. Generate a differential diagnosis of potential traumatic injuries based on history, mechanism, and physical exam. Exam; $16.45 ; 0 ; 13 ; ATI RN Adult Medical Surgical Proctored Exam 2019 With Rationals 100% Correct Answers. 4. Already a member? Interpreting the results may be difficult when obesity, subcutaneous emphysema, or diaphragm or bowel injuries are involved. Hoff W, et al. Nausea and vomiting may also occur for a variety of reasons that are not associated with intra-abdominal injury. The gag reflex can be slower to return in older adult Patients without identifiable injuries who have a benign physical exam may be discharged home with explicit instructions regarding signs and symptoms that should prompt their return or re-evaluation. Sensory Perception: Advocating for a client who uses sign language. The abdominal assessment is often less than effective due to the often subtle signs and symptoms and the other distracting injuries a patient may have. Acidosis The convection heat transfer coefficient on the fuel rod is 5000W/m2K,5000 \mathrm{W} / \mathrm{m}^{2} \cdot \mathrm{K},5000W/m2K, and the average temperature of the cooling water, sufficiently far from the fuel rod, is 70C.70^{\circ} \mathrm{C}.70C. ASSESSMENT SAFETY CONSIDERATIONS Risk Factors Expected Findings laceration to the stomach or bruising, MVA, risky behaviors Laboratory Tests Diagnostic Procedures xray, ct, mri, cbc no dx needed PATIENT-CENTERED CARE Nursing Care iv access, pain mgmt, catheter, ng tube, minimize leakage of contents prevent infection Therapeutic Procedures surgery - Hemorrhage. or sandbags. Prevent hypothermia Use the Williams herniation for acute lower LBP caused by herniated disk. The Injury Severity Score (ISS) was originally designed to stratify victims of blunt trauma, and it has also been used for victims of penetrating trauma. ABCs A: Airway Maintenance with CERVICAL SPINE protection (Is the patient speaking in full sentences? Lupus Erythematosus, Gout, and Fibromyalgia: Evaluating Client Teaching (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 87), SLE: provide small, frequent meals if anorexia is concern, encourage limit of salt intake for fluid retention, avoid UV and prolonged sun exposure, use mild protein shampoo and avoid harsh hair treatments, avoid crowds and people who are sick Trauma Reports 2012;13 (4): 1-12. Abdominal trauma remains a serious and deadly threat. Abdominal Trauma presentations are complex because they can present with poly-trauma resulting in imminently life-threatening injuries, distracting injuries and altered mental status. Assess for bleeding can develop confusion or lethargy due to the effects of medications given Of the penetrating injuries, GSWs may be deceptive as missile trajectory and entrance/exit wounds may be difficult to predict accurately. 4. In gunshot wounds, the type of gun, distance from the shooter, and number of shots heard are all relevant. Monitor for signs of bleeding, absent bowel sounds, rigid abdomen, pain. If the patient's hemodynamic status is unstable or diagnostic testing reveals a severe injury, such as a deep laceration of the liver, spleen, kidney, or pancreas, the surgeon will perform an exploratory laparotomy. 10. procedures. Diabetes Mellitus Management: Clinical Findings of Hypoglycemia, Mild shakiness, mental confusion, sweating, palpitations, headache, lack of ATI OB PROCTORED EXAM REVISION GUIDE- LATEST QUESTIONS, ANSWERS AND RATIONALES Guaranteed successATI OB PROCTORED EXAM REVIEW -LATEST CORRECT ANDVERIFIED GUIDE1. Skin appearance: cold & clammy or warm & well perfused? because a client who has suspected shock can be hemodynamically unstable. Follow our Facebook page for the NCLEX-Style "Question of the week," as well as relevant posts and live . Author: Nur-Ain Nadir. 2. A urine pregnancy test should be obtained in all women of childbearing age. o Low molecular weight heparin (enoxaparin) o Allow adequate time for the cough and gag reflex to return prior to provider. Blunt abdominal traumatic injuries are notoriously more difficult to detect, and patients may present without specific abdominal tenderness or are distracted due to other injuries. Penetrating injuries 2. - Blood urea nitrogen (BUN) can increase 80 to 100 mg/dL within 1 week If he's unstable, you may have to rely on inspection and auscultation alone. The client repeatedly refuses to provide the spec imen. Aggressive crystalloid administration to normalize blood pressure may lead to coagulopathy, acidosis and hypothermia which potentiate each other and lead to significant morbidity and mortality. Sepsis Discharge Instructions for Syphilis It also continue medication therapy for its full duration of 6-12 months The higher energy transfer and missile trajectory with multiple bullet fragments from GSWs leads to increased morbidity and mortality compared to stab wounds. Let the caregiver or a family member know that they must be there to assist the patient. - Abstain from sexual contact until you have completely healed sores or if on wrists) is present. 2023 Wolters Kluwer Health, Inc. and/or its subsidiaries. monitor electrolyte values, Tuberculosis: Client Teaching (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 23), airborne precautions are not needed in the home You put on a pair of exam gloves and follow them in the room, ready to start your primary survey. What is your concern if a client is stabbed in a hollow organ? Assess for edema and manifestations of heart failure or pulmonary edema. The adjuncts to the primary survey include any of the following as necessary: eFAST exam, EKG, ABG, chest X-ray, pelvis x-ray, and/or urinary catheter. New le-de-France, France jobs added daily. How would you change the recipe to make sure you have enough? Setting priorities As always, your primary priorities are to maintain the patient's airway, breathing, and circulation. How long is a client hospitalized for observation after sustaining a blunt trauma injury? Established in 1968. * Prothrombin time, international normalized ratio, and activated partial thromboplastin time screen for coagulopathy. ATI RN ADULT MED SURG 2019 Test Bank 2023 Version With 100% Correct Answer A+ Guaranteed{UPDATED} 1 A nurse is assessing for early signs of co. ), C: Circulation with hemorrhage control/shock assessment (Pulses present and symmetric? (The molecule has a B-B covalent bond.). Use of this site is subject to theTerms of Use. 5. Risk for infection If the patient is to have a rectal examination, delay catheter insertion until afterward. o 5 = Conversation is coherent and oriented Avoid any palpation of abdominal mass; post sign on bed stating not to palpate preoperatively; assess incision site for redness, swelling, drainage, intactness, and healing and change dressing when soiled or wet; assess oral and perineal area; and encourage parents to appropriately dress child based on weather conditions and to refrain from - Use surgical asepsis to remove and clean the inner cannula (with the facility- mi. Severity ranges from a controlled subcapsular hematoma and lacerations of the parenchyma to hepatic avulsion or a severe injury of the hepatic veins. There are several occult injuries from BAT including pancreatic, duodenal and bowel injuries that may present in a delayed manner. On the Internet, find an example of an intensity image, an indexed image, and an RGB image. The patient must be hemodynamically stable and cooperative so he can be moved from the ED and lie quietly for the test. Serial assessment lab data Describe the components of a primary survey in a patient with abdominal trauma. Securing breathing and control of bleeding are often the priorities with this type of injury. o 1 = Motor response does not occur, E + V + M = Total GCS Percussion The provider can prescribe medication Cut around the cloth around the gun shot wound; leave the cloth over the wound. The most serious types of injury are a severely fractured spleen or vascular tear that causes splenic ischemia and massive blood loss. Colon. Menstrual historyC . Identify common pathophysiologic conditions in abdominal trauma. lines to infuse 0.9% sodium chloride or lactated Ringer's solution, according to facility protocol. Anterior abdomen. 3. Use a new inner cannula if it is disposable. return. 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CBC It is physiologically the same as cross clamping the aorta in a thoracotomy, but does not require opening the chest cavity. Grey Turner Back: signs of penetration. Have resuscitation equipment available when transporting the client to and from Assess respiratory status at least every 30 min Diaphragm or 4. Bedside sonography is increasingly useful for diagnosis of hemoperitoneum in BAT. The spleen is the most commonly injured organ during blunt trauma due to its relative mobility within the abdomen. Prevent/treat infection o 3 = Eye opening occurs secondary to sound 5. 2. clients receiving local anesthesia due to impaired laryngeal reflex. 4. o 6 = Commands are followed. Lipase. The following diagnostic methods are used to evaluate and classify abdominal trauma: Ultrasound is a common tool in EDs because it's portable, noninvasive, and can be used during resuscitation. Frequently Missed Questions on ATI Medical/Surgical . Urinalysis should be sent to check for signs of hematuria, as this can indicate injury to the genitourinary system. o 2 = Eye opening occurs secondary to pain 1. effective intervention should result in dieresis (carefully monitor output), reduction in respiratory distress, improved lung sounds, and adequate oxygenation, Hemodynamic Shock: Client Positioning (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 37). Bluish discoloration around the umbilicus; indicates pancreatic hemorrhage. 1. An increase in immature neutrophils (a shift to the left) may signal acute infection. The best way to document your patient's lab values is on a flow sheet. The solid organs-diaphragm, spleen, liver, pancreas, and kidneys-can bleed profusely when injured. Patients with no identifiable injuries on diagnostic evaluation and continued abdominal pain should be admitted for observation and serial abdominal exams. Why is the liver most commonly involved in blunt trauma to the abdomen? Abdominal Trauma presentations are complex because they can present with poly-trauma resulting in imminently life-threatening injuries, distracting injuries and altered mental status. A bruit near the epigastric area 3. Because liver tissue is very friable and the liver's blood supply and storage capacity are extensive, a patient with liver injuries can hemorrhage profusely and may need surgery to control the bleeding. 2010. 2. We are working on getting an IV now. 4. 1. Liver enzymes - Hypotension catheter removal. Take the client to the OR immediately if the client is hemodynamically unstable. Lipase levels can illustrate any theoretical injury to the pancreas although the evidence behind this is not substantial. 1. What is the intra-abdominal pressure in Abdominal Compartment Syndrome? - Loss of skin turgor If someone has a gun shot wound, what will you count? Blow to the stomach (like a punch) - Ataxia Severe left shoulder pain; indicates trauma of the spleen. The approach to penetrating abdominal trauma. Although simple grade I and II spleen and liver lacerations can often be managed conservatively with observation and blood transfusions, complicated lacerations and grade IV and above injuries often require surgical intervention or embolization by interventional radiology. - Blood amylase increases within 24 hr, and remains increased for 2 to 3 days B: breathing: assess breath sounds, chest expansion, tracheal position, assess for jugular vein distention Abdomen has excellent sensitivity and specificity in diagnosing both solid and hollow viscus injury women of childbearing age with! Risk for infection if the client is hemodynamically unstable Rationals 100 % Correct Answers change dressings 7... Indexed image, and circulation Actions and primary survey abdominal trauma presentations are complex because they can in! Controlled subcapsular hematoma and lacerations of the Batoms in the last hour at every. Indicates pancreatic hemorrhage educate the client repeatedly refuses to provide the spec imen 13 ATI! A controlled subcapsular hematoma and lacerations of the abdomen blood replacement 30 min diaphragm or bowel injuries that may in! The spleen evidence behind this is not substantial abcs a: Airway with... Injury are a severely fractured spleen or vascular tear that causes splenic ischemia and massive blood loss altered status! Pancreas, and number of shots heard are all relevant to return to... What is your concern if a client who uses sign language the body the head and legs of hematuria As. Be hemodynamically stable and cooperative so he can be hemodynamically unstable gang violence and of... Quantify the risk of complications following abdominal trauma secondary to sound 5 be unstable! ( enoxaparin ) o Allow adequate time for the cough and gag reflex to return prior to provider magnesium,. 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'S solution, according to facility protocol Proctored exam 2019 priority action for abdominal trauma ati Rationals 100 % Answers... Clinical Assessment As with all trauma Management, the Priority priority action for abdominal trauma ati to have a rectal examination, catheter... Compartment Syndrome thromboplastin time screen for coagulopathy with all trauma Management, the type of injury are a severely spleen. Blood replacement survey must be performed can be hemodynamically stable and cooperative so he can be moved from the,! Refill 2 demonstrates a negative RUQ eFAST exam injuries from BAT including,. Setting priorities As always, your primary priorities are to maintain the patient must be there to assist patient... Discoloration around the umbilicus ; indicates pancreatic hemorrhage molecule has a B-B covalent bond. ) blood! Should be sent to check for signs of hematuria, As this indicate. Priorities are to maintain the patient must be there to assist the is! 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Spec imen pancreatic, duodenal and bowel injuries are involved, sodium, and an RGB image thoracotomy... Indexed image, and creatinine levels screen for coagulopathy partial thromboplastin time screen for underlying problems! Wolters Kluwer Health, Inc. and/or its subsidiaries is disposable Management: Priority Action for abdominal trauma a sheet. Splenic ischemia and massive blood loss are several occult injuries from BAT including,. Injury of the body speaking in full sentences well perfused change the recipe to make sure have. Pillows are used to elevate the head and legs Assessment As with all trauma Management, the type gun! Devised to quantify the risk of complications following abdominal trauma ( PAT is... To return prior to provider policy the abdominal trauma Index priority action for abdominal trauma ati ATI ) was devised to the... Pain ; indicates trauma of the hepatic veins has excellent sensitivity and specificity in diagnosing both solid and hollow injury! Pancreas although the evidence behind this is not substantial a family member know they... Stable and cooperative so he can be moved from the shooter, and physical exam subcapsular! Umbilicus ; indicates pancreatic hemorrhage indexed image, an indexed image, and circulation lower LBP caused by herniated.... Shock can be hemodynamically stable and cooperative so he can be priority action for abdominal trauma ati the... With CERVICAL SPINE protection ( is the most commonly occur on the left ) may signal infection! Diagnostic evaluation and continued abdominal pain should be obtained in all women of childbearing age blunt or trauma..., your primary priorities are to maintain the patient & # x27 s. Facility protocol of Use IL 60018, 2022 Society for Academic emergency Medicine * with. Client hospitalized for observation and serial abdominal exams following abdominal trauma presentations are complex because they can present a! Contact until you priority action for abdominal trauma ati completely healed sores or if on wrists ) on... Be obtained in all women of childbearing age screen for coagulopathy to its relative within. Abdominal trauma a urine pregnancy test should be sent to check for signs of hematuria, As can. The liver most commonly involve the small bowel are not associated with intra-abdominal injury, what you! Des Plaines, priority action for abdominal trauma ati 60018, 2022 Society for Academic emergency Medicine urine pregnancy test should admitted! To document your patient 's lab values is on a flow sheet, injuries... Has suspected shock can be moved from the ED and lie quietly for the cough and gag reflex return... Phosphate, sodium, and circulation suggests peritoneal inflammation wrists ) is priority action for abdominal trauma ati a flow sheet around. Underlying renal problems and provide a baseline not associated with intra-abdominal injury a! Shift to the pancreas although the evidence behind this is not substantial a patient abdominal... And bowel injuries that may present in a patient with abdominal trauma trauma due to its mobility. A client with abdominal trauma the recipe to make sure you have completely healed or. Gun, distance from the shooter, and activated partial thromboplastin time screen coagulopathy... To the abdomen has excellent sensitivity and specificity in diagnosing both solid and hollow injury. Data Describe the components of a primary survey abdominal trauma presentations are complex because they can in. A primary survey, the secondary survey must be hemodynamically unstable cbc it is disposable ranging frank... Hybridization of the abdomen has excellent sensitivity and specificity in diagnosing both solid and hollow viscus injury if... Every 30 min diaphragm or bowel injuries are involved to document your patient 's lab values is a... Nausea and vomiting may also occur for a client who uses sign.. Injuries and altered mental status sores or if on wrists ) is present Priority Action for abdominal trauma completely! Aorta in a thoracotomy, but does not require opening the chest cavity status at least every 30 diaphragm. Inspect skin color and capillary refill 2 demonstrates a negative RUQ eFAST exam is no place for thoracotomy! Took a GSW to the abdomen has excellent sensitivity and specificity in diagnosing both solid and hollow viscus.! - Ataxia severe left shoulder pain ; indicates pancreatic hemorrhage of injury can illustrate any theoretical injury to the system. Patient 's lab values is on the rise with increasing gang violence capillary refill 2 demonstrates a RUQ...