Ch. 36 - Abdominal and Genitourinary Trauma

A priority assessment of the patient with abdominal trauma should be to auscultate for bowel sounds. A) true B) false

B) false

GSWs to the abdomen typically involve a more predictable injury pattern than stab wounds. A) true B) false

B) false

The major cause or mortality and morbidity in abdominal trauma is infection and peritonitis. A) true B) false

B) false

The primary consequence of hollow organ injury is hemorrhage. A) true B) false

B) false

Most abdominal injuries: A) involve penetrating trauma B) involve blunt trauma C) are caused by falls D) result in death

B) involve blunt trauma

You are responding to a 20 y/o male who was assaulted a day ago. He is complaining of right flank pain. There is bruising on his right lateral abdomen and lower right back. He reports blood in his urine. Which organ do you suspect has been affected? A) gallbladder B) kidney C) liver D) urinary bladder

B) kidney

Which of the following is indicative of a diaphragmatic rupture? A) Cullen sign B) peritonitis C) distended abdomen D) abdominal sounds in the chest

D) abdominal sounds in the chest

Because of its anatomic position in the retroperitoneum, it usually takes high-energy force to damage the: A) liver B) spleen C) stomach D) pancreas

D) pancreas

You are providing care for a 16 y/o male complaining of lower back pain. He was playing football and was tackled from behind, and has been complaining of pain ever since. On closer inspection, the patient has some bruising in his right flank. Based on this information, the patient is demonstrating: A) Grey Turner sign, and you should maintain a high index of suspicion for retroperitoneal injury B) Grey Turner sign, and you should maintain a high index of suspicion for abdominal injury C) Cullen sign, and you should maintain a high index of suspicion for retroperitoneal injury D) Cullen sign, and you should maintain a high index of suspicion for abdominal injury

A) Grey Turner sign, and you should maintain a high index of suspicion for retroperitoneal injury

What membranous tissue functions as the point of attachment for the various abdominal organs? A) mesentery B) ligamentum arteriousm C) pleura D) peritoneum

A) mesentery

The upper peritoneal cavity includes all of the following organs EXCEPT the: A) pancreas B) gallbladder C) stomach D) spleen

A) pancreas

You are providing care for a 47 y/o male patient who was the front seat passenger of a car involved in an MVC. The patient was wearing his seatbelt and the airbag did deploy. At this time he is slightly confused, and complaining of diffuse abdominal pain and tenderness. His vital signs appear within normal limits, but his pulse is a little fast. Based on this information, your MOST appropriate action should be to: A) perform any primary interventions then rapid transport to the highest level of trauma center available B) perform more in-depth assessment to determine the nature of organs involved, then transport to the closest hospital C) transport immediately to the closest appropriate receiving facility D) provide rapid transport to the highest level of trauma center available

A) perform any primary interventions then rapid transport to the highest level of trauma center available

Which of the following is NOT a function of the pancreas? A) reservoir for bile B) secretion of insulin C) secretion of glucagon D) secretion of enzymes

A) reservoir for bile

Intra-abdominal bleeding may produce few signs and symptoms of trauma because: A) the intra-abdominal cavity can accommodate large amounts of blood B) it takes approximately 4 L of blood loss before signs of shock manifest C) the abdominal musculature can sustain massive blunt force without bruising D) blood in the peritoneum can compress the aorta and maintain perfusion

A) the intra-abdominal cavity can accommodate large amounts of blood

Every injured patient should be assumed to have a full stomach and bladder. A) true B) false

A) true

Penile trauma is often the result of abuse, and evaluation for other injuries is warranted. A) true B) false

A) true

A 39 y/o woman sustained an abdominal evisceration after she was cut in the abdomen with a machete. The patient is semiconscious and breathing shallowly. You should: A) administer oxygen via NRB, cover the exposed bowel with dry sterile dressings, start an IV and give 500 mL bolus, and transport to a trauma center B) assist ventilations with a BVM, cover the exposed bowel with moist sterile dressings and protect it from injury, transport at once, and initiate IV therapy en route C) insert an OPA, provide ventilatory assistance, cover the exposed bowel with aluminum foil, begin transport, and start two large-bore IVs with NS en route D) perform intubation to protect the airway, cover the exposed bowel with moist sterile dressings, start an IV and give analgesia, and transport to a trauma center with fluid boluses en route

B) assist ventilations with a BVM, cover the exposed bowel with moist sterile dressings and protect it from injury, transport at once, and initiate IV therapy en route

With respect to penetrating injury, the most frequently injured organ is the: A) spleen B) liver C) diaphragm D) small intestine

B) liver

You are dispatched to the scene of a 19 y/o male who has been assaulted. When you arrive, you find the patient sitting on the sidewalk. A police officer at the scene is holding pressure to the patient's RUQ with a blood-soaked gym towel. You observe no other obvious traumatic injuries. Based on the location of the patient's wound, you should suspect injury to which of the following? A) appendix B) liver and possibly gallbladder C) urinary bladder D) stomach and possibly spleen

B) liver and possibly gallbladder

Which of the following organs or structures lies in the retroperitoneal space? A) spleen B) pancreas C) ascending colon D) transverse colon

B) pancreas

Which of the following signs are consistent with abdominal hemorrhage? A) distension, hypotension, tachycardia, and shock B) periumbilical ecchymosis, distension, bradycardia, and shock C) tachycardia, hypertension, and distension D) tender abdomen, hypertension, and bradycardia

B) periumbilical ecchymosis, distension, bradycardia, and shock

You are providing care for a 22 y/o female who was assaulted with a knife. The patient has sustained an evisceration with a small amount of bowel exposed. The patient has sustained no other injuries and is alert. Based on this information, your MOST appropriate action should be to: A) irrigate with normal saline and gently place the organs back into the body, bandage, and transport to the closest hospital B) place saline-soaked dressings on the wound and cover loosely, then transport to the closest receiving facility C) apply a clean adhesive dressing and transport to the closest appropriate hospital D) irrigate the wound with normal saline and transport to the closest appropriate hospital

B) place saline-soaked dressings on the wound and cover loosely, then transport to the closest receiving facility

Fournier gangrene is a potential complication associated with: A) ovarian rupture B) scrotal lacerations C) urethral injuries D) bladder rupture

B) scrotal lacerations

Which of the following factors can decrease the potential damage caused by trauma to the abdomen? A) a seatbelt that is worn above the iliac crests B) toned abdominal muscles and an empty bladder C) abdominal muscle tensing at the time of impact D) airbags and being younger than 44 y/o

B) toned abdominal muscles and an empty bladder

A 24 y/o male intentionally placed a commercially manufactured constricting object around the base of his penis. He complains of moderate pain, and assessment of his penis reveals that it is cyanotic. You should: A) make one attempt to cut the constricting object away from the penis B) transport him to the hospital and provide emotional support en route C) apply ice to the area to reduce any swelling, then remove the object D) administer a narcotic analgesic prior to removing the constricting object

B) transport him to the hospital and provide emotional support en route

The periumbilical area refers to the: A) space behind the navel B) external umbilical orifice C) area lateral to the umbilicus D) area around the umbilicus

D) area around the umbilicus

When assessing a patient with abdominal trauma for distension, you should recall that: A) a distended abdomen is one of the earliest clinical findings in patients with abdominal trauma B) abdominal distension is usually caused by muscle tensing rather than intra-abdominal bleeding C) a significant amount of blood volume in the abdominal cavity is required to produce distension D) because distension is a late sign of intra-abdominal bleeding, it should not be assessed for in the field

C) a significant amount of blood volume in the abdominal cavity is required to produce distension

A 17 y/o high school football player was struck in the abdomen by another player during a tackle. Your assessment reveals signs of shock and pain to the patient's left shoulder, which is unremarkable for trauma. Examination of the patient's abdomen is also unremarkable for obvious injury. Based on your assessment and the patient's clinical presentation, you should suspect: A) a lacerated liver B) acute peritonitis C) an injury to the spleen D) retroperitoneal bleeding

C) an injury to the spleen

Gross hematuria and suprapubic pain following a pelvic injury is MOST indicative of injury to the: A) ureters B) urethra C) bladder D) kidney

C) bladder

Anatomically, the abdominal cavity extends from the: A) fifth rib to the pelvis B) nipple line to the diaphragm C) diaphragm to the pelvis D) umbilicus to the pelvis

C) diaphragm to the pelvis

Generalized abdominal pain following rupture of a hollow organ is MOST suggestive of: A) inflammation of deep nerve endings B) gas accumulation in the peritoneum C) diffuse peritoneal contamination D) severe intra-abdominal bleeding

C) diffuse peritoneal contamination

Fractures of the lower rib cage should make you MOST suspicious for injuries to the: A) urinary bladder B) ascending aorta C) liver or spleen D) kidneys or pancreas

C) liver or spleen

The major complication associated with hollow organ injury is: A) immediate death secondary to a massive infection B) delayed treatment due to the absence of external signs C) peritonitis caused by rupture and spillage of toxins D) massive internal hemorrhage and profound shock

C) peritonitis caused by rupture and spillage of toxins

How should you treat a pregnant woman who you suspect has internal bleeding? A) place her supine on a short backboard B) place her on her right side secured to a backboard lifted 15 degrees C) place her on her left side secured to a backboard lifted 15 degrees D) place her in semi-Fowler position

C) place her on her left side secured to a backboard lifted 15 degrees

Which of the following is characterized by ecchymosis in the umbilical region caused by peritoneal bleeding? A) Beck's triad B) Grey Turner sign C) Kehr sign D) Cullen sign

D) Cullen sign

What is hemoperitoneum? A) a collection of blood in the retroperitoneal space B) blunt trauma to the liver C) a diaphragmatic injury D) a collection of blood in the abdominal cavity

D) a collection of blood in the abdominal cavity

During the third collision in an MVC: A) hollow abdominal organs rupture upon impact B) the person's abdomen collides with the steering wheel C) rapid deceleration propels an unrestrained person forward D) abdominal organs shear from their points of attachment

D) abdominal organs shear from their points of attachment

A 59 y/o construction worker collapsed on the job and fell into a pile of steel rods. Your assessment reveals that he is pulseless and apneic, and has a 12-inch steel rod impaled in his epigastrium. As your partner and an EMR begin CPR, you should: A) remove the rod so you can perform effective CPR, control any external bleeding, start two large-bore IV lines, and assess his cardiac rhythm en route to the hospital B) carefully remove the steel rod, apply direct pressure to the wound, assess his cardiac rhythm, start a large-bore IV line and give 2 L of NS, and transport C) trim the steel rod 6 inches, stabilize it in place with a bulky dressing, apply firm direct pressure around the rod, and initiate IV therapy en route to a trauma center D) control any external bleeding, stabilize the rod in place with bulky dressings, apply the cardiac monitor, and start at least one large-bore IV line en route to the hospital

D) control any external bleeding, stabilize the rod in place with bulky dressings, apply the cardiac monitor, and start at least one large-bore IV line en route to the hospital

A 36 y/o female was sexually assaulted and is experiencing intense pain. Your assessment reveals several open lacerations to her vaginal area and a painful distended abdomen. Her BP is 86/50 and her HR is 120 bpm and weak. In addition to administering supplemental oxygen, you should: A) control any bleeding from her open wounds, establish two large-bore IVs, and give 1 mcg/kg of Fentanyl B) apply pressure dressings to her open injuries, cover the dressings with an ice pack, and transport rapidly C) insert a sterile dressing into her vagina to control any internal bleeding, establish a large-bore IV, and set it at a KVO rate D) cover her open wounds with sterile dressings, establish at least one large-bore IV, and administer IV fluid

D) cover her open wounds with sterile dressings, establish at least one large-bore IV, and administer IV fluid

The abdomen extends superiorly to the level of the: A) xiphoid process B) two pairs of floating ribs C) second intercostal space D) fourth intercostal space

D) fourth intercostal space

You are providing care for a 46 y/o female patient who was the driver of a car involved in an MVC. The patient is awake and was wearing her seatbelt. At this time, she is complaining of pain in her right lower chest and there is bruising to her right lower ribs. Based on this information, you should also maintain a high index of suspicion for injuries to the: A) urinary bladder and intra-abdominal trauma B) small intestine and peritonitis C) kidneys and retroperitoneal organs D) liver

D) liver

What are the most commonly injured abdominal organs? A) appendix and colon B) large and small intestines C) kidney and pancreas D) liver and spleen

D) liver and spleen

When blood is released into the peritoneal cavity: A) it is most often the result of blunt force trauma to the pancreas B) blood pressure falls with as little as 500 mL of internal blood loss C) the abdomen almost immediately becomes grossly distended D) nonspecific signs such as tachycardia and hypotension may occur

D) nonspecific signs such as tachycardia and hypotension may occur

____ is uncontrollable abdominal wall muscle contraction resulting from inflammation of the peritoneum. A) guarding B) rebound tenderness C) ecchymosis D) rigidity

D) rigidity

External compression results in ____. A) shearing in the aorta B) perforation of the bladder C) crushing of the solid organs D) rupture of the hollow organs

D) rupture of the hollow organs External compression forces result in a sudden and dramatic rise in intra-abdominal pressure and culminate in rupture of a hollow organ.

Which of the following factors does NOT contribute to the extent of injury from a GSW to the abdomen? A) profile of the bullet B) trajectory of the bullet C) distance the bullet traveled D) size of the patient

D) size of the patient

You should base your suspicion of blunt abdominal trauma on ____. A) rigidity of the abdomen on palpation B) the location and amount of abdominal pain C) physical signs such as ecchymosis or abrasions D) the MOI

D) the MOI

You are providing care to a 26 y/o male who sustained a laceration to his scrotum after a fall from some gym equipment. The laceration has moderate bleeding and the scrotal area feels spongy, and you can hear crepitus when the patient moves. Based on this information, which of the following statements is correct? A) the hemorrhage is minor; you should apply a clean dressing and ice pack to the wound, and then transport to the closest appropriate facility B) the hemorrhage is severe; you should apply a clean dressing and ice pack to the wound, and then transport promptly to the closest appropriate facility C) the injury is minor, and you should complete your assessment and then make transport decision D) there are signs of pressure necrosis and the patient should be transported promptly to the closest hospital

D) there are signs of pressure necrosis and the patient should be transported promptly to the closest hospital

____ pain results from stretching, oxygen deprivation, and swelling. A) superficial B) referred C) somatic D) visceral

D) visceral