How should an open abdominal injury with evisceration be managed in the field?

• A. Replace protruding viscera back inside
• B. Apply dry gauze and await surgery
• C. Cover protruding viscera with sterile moist dressings; do not replace; keep warm and transport
• D. Wrap viscera in plastic

Answer: (C)

Open abdominal injury with evisceration is managed by protecting the exposed organs while arranging rapid definitive care. The best field approach is to cover the protruding viscera with sterile moist dressings, do not replace them inside the abdomen, keep the patient warm, and transport promptly to surgery. Keeping the tissue moist helps preserve viability and reduces contamination and tissue damage; replacing the organs in the wound in the field can cause further injury and isn’t a safe prehospital step. Wrapping the viscera in plastic is inappropriate because it can trap moisture and heat and increase the risk of tissue maceration and infection. Dry gauze is not ideal because it dries the tissue and offers less protection. The focus is on maintaining moist, sterile protection and getting to definitive care quickly.