ch 35

While a​ 43-year-old man was cleaning a​ window, the glass broke and a sharp piece sliced his groin. Assessment shows him to have a large laceration to his left​ scrotum, with a testicle exposed and protruding through the sac. Blood is pouring from the​ laceration, and the patient rates the pain as an​ 8/10. What should the EMT do​ first?

Apply direct pressure to the injury to stop the hemorrhage

The EMT recognizes that the division between the thoracic and abdominal cavities lies​ approximately:

At the fifth intercostal space

You are transporting a male patient with a deep stab wound to the​ groin, with damage also noted to the genitalia following an assault by his girlfriend. The patient is alert and​ oriented, albeit restless. Vital signs on scene were​ pulse, 128​ beats/min; respirations, 20​ breaths/min; blood​ pressure, 108/64​ mmHg; and​ SpO2, 92%. Oxygen is being administered via nasal cannula. Upon​ reassessment, which sign would be most concerning to the​ EMT?

Blood pressure is now​ 106/88 mmHg

At the scene of a motor vehicle​ accident, a car has extensive​ front-end damage and a deformed steering wheel. The restrained​ driver, who was​ self-extricated, is in the care of​ EMRs, who have applied a cervical collar and continue to maintain spine motion restriction precautions. The​ patient's airway is patent and respirations adequate. His radial pulse is rapid and​ weak, and his skin is cool and diaphoretic. The EMRs report the following vital​ signs: pulse, 136​ beats/min; respirations, 20​ breaths/min; blood​ pressure, 100/68​ mmHg; and​ SpO2, 95% with supplemental O2 being administered. The right forearm is​ deformed, and the​ head, chest, and upper back are uninjured according to your assessment. Your next action would be​ to:

Check the abdomen for injury

A patient has been assaulted and sustained blunt trauma to the abdomen. As you start the primary​ assessment, you note that he is vomiting blood and you begin to suction him immediately. After the airway has been​ suctioned, you​ should:

Check the adequacy of the​ patient's breathing

You have been called for a deeply disturbed psychiatric patient who has cut off the tip of his penis with a steak knife. Assessment reveals the​ 31-year-old male to be​ crying, with blood noted to his hands and pants. The primary assessment reveals no acute life threats. At this​ time, your priority is​ to:

Control any active bleeding that may be occurring

You have been called for a male patient who was shot with a rifle. Assessment reveals an entrance wound to the left lower quadrant of the abdomen. A hemorrhaging exit wound to the left lower back is also located. What should you do​ immediately?

Cover the entrance wound with a gloved hand

Which abdominal organ or​ structure, if seriously​ injured, would cause the most rapid​ death?

Descending aorta

You have been called for a​ 42-year-old male who complains of back pain. At the​ scene, the man tells you that he was lying on the floor when his​ 5-year-old son unexpectedly jumped feet first onto his back. He gives a medical history of high blood pressure and​ asthma, for which he takes medications. As you assess the​ patient, which finding provides the greatest indication that the patient has sustained an abdominal​ injury?

Discoloration around the umbilicus

You have arrived on the scene of a stabbing. As you approach the​ patient, you note that his shirt is off and a single stab wound to the right lower quadrant of the abdomen is evident. The patient appears unresponsive as you approach. At the​ patient's side, your first action should be​ to:

Examine the​ patient's airway

On​ scene, you encounter a restless patient who has been stabbed in the right upper quadrant of the abdomen and now complains of abdominal pain and a dry mouth. Assessment reveals no immediate life threats to the airway or breathing. The radial pulse is rapid and​ weak, and the skin cool and diaphoretic. Vital signs are​ pulse, 124​ beats/min; respirations, 20​ breaths/min; blood​ pressure, 122/88​ mmHg; and​ SpO2, 90% on room air. The injury is​ isolated, with no involvement of the​ head, neck, or back. In managing the scene and the​ patient, which observation would cause you to immediately​ intervene?

Family giving the patient water to drink since he is thirsty

You are transporting a female patient who was sexually assaulted by having a foreign body inserted deep into her vagina. You are attempting to control hemorrhage by the appropriate means. As you reassess the​ patient, which finding is of most​ concern?

Heart rate increases from 116 to 140​ beats/min

A patient has referred pain to her left shoulder. What should the EMT​ suspect?

Hemorrhage from the spleen

A​ 45-year-old female was at a family reunion and fell off a trampoline. She hit a picnic table with the left side of her lower rib cage.​ Now, she is very anxious and confused. Her airway is open and her breathing adequate. Her radial pulse is rapid and​ weak, and her skin is cool and diaphoretic. Vital signs are​ pulse, 132​ beats/min; respirations, 20​ breaths/min; blood​ pressure, 102/78​ mmHg; and​ SpO2, 97% on ambient air. The patient has ecchymosis to the left lower rib area as well as tenderness and instability to the rib cage. She also has a superficial abrasion to her forehead. Given these​ findings, you would suspect and treat her for which​ condition?

Hypovolemic shock

A​ 74-year-old female complains of abdominal pain after falling down five stairs off her front porch and striking her abdomen and left hand on a mailbox at the bottom. The patient also reports pain in her left wrist and right​ ankle, both of which show obvious deformity. She is alert and​ oriented, and her abdomen is free of bruising but tender in the left upper and lower quadrants. Her vital signs are​ pulse, 132​ beats/min; respirations, 22​ breaths/min; blood​ pressure, 106/86​ mmHg; and initial​ SpO2, 93% on room air. Oxygen has been​ applied, and the patient has full spine motion restriction precautions in place. Advanced life support has been requested and is 12 minutes away from your current location. What is your next​ action?

Initiate immediate transport and intercept with the ALS unit

A patient who experienced blunt trauma to the abdomen has a lacerated liver. Given this​ information, what would represent the most immediate threat to​ life?

Internal hemorrhage

If a patient has severe retroperitoneal bleeding from an organ located within this​ cavity, she has most likely injured​ her:

Kidney

A patient has been stabbed in the right upper quadrant of the abdomen. Which solid organ should the EMT be most concerned with being​ injured?

Liver

While returning from a​ call, you are flagged down by a frantic family member of a​ 12-year-old male patient. She is standing in the​ yard, and reports that the child was shot in the abdomen and is now inside the house. She states that she has already called the​ police, who have not arrived​ yet, and that the shooter is another family member who has since left the scene. What is your best course of​ action?

Move the ambulance and wait for law enforcement to arrive

An industrial worker has sustained a laceration to his abdomen. On closer​ inspection, you note what appears to be fat tissue and a portion of intestine protruding through the wound. Which intervention is most appropriate for treating this​ injury?

Occlusive dressing applied over​ saline-soaked gauze

The​ EMT's care for an open chest wound and for an abdominal evisceration are similar in​ that:

Occlusive dressings should be placed over both wounds

You have arrived on the scene for a patient assaulted with a baseball bat. As you​ approach, which position would seemingly indicate that he has suffered an injury to the​ abdomen?

On his side with knees drawn to the chest

You have just arrived on the scene of a very serious motor vehicle collision. Emergency Medical Responders​ (EMRs) have rapidly extricated an unresponsive female from the​ driver's seat. The EMRs report that she was unrestrained and struck the steering wheel with her chest and abdomen. As you start the primary​ assessment, you note that the patient has snoring respirations and demonstrates shallow breathing at a rate of 24 breaths per minute. What should you do​ next?

Perform a​ jaw-thrust maneuver

A female patient suffered a straddle injury​ (genitalia trauma) while trying to balance on top of a​ chain-link fence, after she fell with a leg on each side of the fence. At this​ time, you​ would:

Place a moist​ compress, such as a moist sanitary​ pad, over the injury to control the bleeding

A​ 16-year-old male has been struck in the genitalia by a baseball. Assessment indicates a tremendous amount of edema as well as hematoma formation and bruising to his scrotum. The primary assessment reveals no​ life-threatening conditions;​ however, the patient is crying and rates the pain as​ 10/10. Which action is most appropriate for this​ patient?

Place cool compresses to the testicles

During a motor vehicle​ collision, a confused unrestrained male struck the steering wheel with his abdomen.​ Currently, he is confused and complains of generalized abdominal​ pain, which he rates as​ 6/10. Assessment indicates red marks across his lower abdomen caused by the steering wheel. His pulse is 140​ beats/min, respirations are 24​ breaths/min, blood pressure is​ 108/88 mmHg, and SpO2 is​ 86%. The patient looks pale and has moist skin. What is most appropriate when providing oxygen to this​ patient?

Provide 15 lpm through a nonrebreather mask

Which one of these injuries is most likely to cause​ peritonitis?

Stab wound to the small intestine

You have arrived on the scene of an assault involving a knife. Assessment of the unresponsive​ 21-year-old male patient reveals him to have sustained multiple lacerations to the arms and​ abdomen, and a section of his intestine is now protruding through a large laceration in the area around the umbilicus. He has lost a significant amount of blood. His airway is open and he is breathing poorly at a rate of 28 breaths per minute. His radial pulse is​ weak, and his skin is cool and pale. What should the EMT do​ first?

Start positive pressure ventilation

A patient has sustained a large abdominal​ evisceration, such that a large portion of intestines are now exposed. After properly managing this​ injury, you are preparing the patient for transport. You ascertain that there is no evidence of spinal injury. How should you place the patient on the stretcher for​ transport?

Supine​ position, with knees and hips flexed

A​ middle-aged male sustained blunt force trauma to the​ abdomen, resulting in an isolated tear and perforation of the large intestine. When following up on the​ patient, what would the EMT suspect​ occurred, given the organ that was​ injured?

The patient developed an infection

The EMT has fundamental understanding of abdominal trauma when he​ states:

​"Blunt trauma is especially lethal because of the large number of organs that can be​ affected."

You are assessing a young male patient who was assaulted with a baseball bat and struck once on the left upper quadrant of the abdomen. You would recognize that this patient has​ Kehr's sign when he makes which​ statement?

​"My left shoulder is killing​ me!"

You are transporting an alert and oriented male who sustained severe abdominal trauma in an assault. The primary survey indicates a patent airway with respirations of 24 breaths per minute. Breath sounds are present bilaterally. The patient has a rapid and weak radial pulse of 144 beats per​ minute, and his skin is pale and cool. The blood pressure is​ 92/64 mmHg and SpO2 is​ 92%. Best management of the respiratory and oxygenation parameters would​ include:

​High-concentration oxygen through a nonrebreather mask

A patient has been shot in the abdomen. Assessment reveals that the bullet entered the body in the right upper quadrant and exited the lower right back. Given this​ finding, the EMT should assume which solid organs may have been​ injured?

​Liver, right​ kidney, and pancreas