Chapter 30

Which of the following is true about injuries to the kidneys?

A sign of kidney damage is hematuria. A penetrating wound that reaches the kidneys almost involves other organs.

A 20 year old male was accidentally shot in the right upper abdominal quadrant with an arrow during an archery contest. Prior to your arrival, the patient removed the arrow. Your assesment reveals that he is conscious and alert with stable vital signs. The entrance wound is bleeding minimally and appears to be superifical. You should: A. carefully probe the wound to determine its depth B. assume that the arrow injured an internal organ C. clean the wound and apply a dry, sterile dressing D. transport only if signs of shock begin to develop.

B

A 66 year old male presents with dark red rectal bleeding and abdominal pain. He is conscious and alert, however, his skin is cool and clammy and his heart rate is elevated. Further assessment reveals that his blood pressure is 112/60 mm Hg. Which of the following questions would be MOST pertinent to ask him? A. Do you take any over-the-counter medications? B. Have you experienced recent abdominal trauma? C. Has blood soaked through your undergarments? D. What does your blood pressure normally run?

B

Blunt abdominal injuries may result from: A. a stab wound B. seat belts C. a gunshot wound D. an impaled object

B

Compression injuries to the abdomen that occur during a motor vehicle crash are typically the result of: A. air bag deployment B. a poorly placed lap belt C. failure to wear seat belts D. rapid vehicle deceleration

B

Following blunt abdominal trauma, a 30 year old male complains of referred pain to the left shoulder. This finding is called the: A. Grey Turner sign B. Kehr sign C. Brudzinski sign D. Cullen sign

B

Late signs of peritonitis may include: A. soft abdomen B. nausea C. normal bowel sounds D. diarrhea

B

The most common sign of significant abdominal injury is: A. pain B. tachycardia C. rigidity D. distention

B

Which of the following is NOT a hollow organ of the abdomen? A. Stomach B. Liver C. Bladder D. Urters

B

You respond to an 18 year old high school football player who was hit in the right flank with a helmet several hours ago. He is complaining of pain in the area. He is alert and oriented. His airway is open and his respirations are within normal limits. His pulse is regular. He has a radial pulse. He tells you that he is noticing blood in his urine. Based on this information, the patient is likely to have an injury to the: A. liver B. kidney C. gallbladder D. appendix

B

Your presence is requested by law enforcement to assess a 33 year old female who was sexually assaulted. The patient is conscious and obviously upset. As you are talking to her, you note an impressive amount of blood on her clothes in the groin area. Her blood pressure is 98/58 mm Hg, her pulse is 130 beats/min, and her respirations are 24 breaths/min. You should: A. arrange for a rape crisis center representative to speak with the patient. B. control any external bleeding, administer oxygen, and transport at once. C. visualize the vaginal area and pack the vagina with sterile dressings D. allow her to change her clothes and take a shower before you transport

B

Your primary concern when dealing with an unresponsive patient with an open abdominal injury is: A. covering the wound with a moist dressing B. maintaining the airway C. controlling the bleeding D. monitoring vital signs

B

The largest organ in the abdomen is the: A. liver B. spleen C. pancreas D. kidneys

A

open abdominal injuries

An injury in which there is a break in the surface of the skin or mucous membrane, exposing deeper tissue to potential contamination

closed abdominal injuries

An injury in which there is soft-tissue damage inside the body but the skin remains intact.

Air in the abdominal cavity can cause all of the following EXCEPT: A. pain B. diarrhea C. infection D. tissue ischemia and infarction

B

melena

Black, foul-smelling, tarry stool containing digested blood

hematuria

Blood in the urine.

_____ takes place in the solid organs. A. digestion B. Excretion C. Energy production D. Absorption

C

Low-velocity injuries

Caused by hand-held or hand-powered objects such as knives and other edged weapons

High-velocity injuries:

Caused by larger weapons such as high-powered rifles and the higher-powered handguns

Medium-velocity penetrating wounds:

Caused by smaller caliber handguns and shotguns

All of the following systems contain organs that make up the contents of the abominal cavity EXCEPT: A. the digestive system B. the urinary system C. the genitourinary system D. the limbic system

D

Which of the following signs would indicate that an injury to the kidney has occurred?

Hematuria

Bruising over the right upper quadrant could indicate injury to which of the following?

Liver

Which of the following organs would MOST likely bleed profusely when injured?

Liver

You should have an index of suspicion that a patient with pain referred to the right shoulder has an injury to which organ?

Liver

Three levels of velocity that are common in traumatic injuries:

Low-velocity injuries; Medium-velocity penetrating wounds; High-velocity injuries:

peritoneal cavity

The abdominal cavity.

peritoneum

The membrane lining the abdominal cavity (parietal peritoneum) and covering the abdominal organs (visceral peritoneum).

You should allow patients with peritonitis to lie still with their legs drawn up.

True

An unresponsive trauma patient has a large open abdominal wound with massive external bleeding. You should:

apply direct pressure to the wound.

Your documentation on a sexual assault victim should _______.

be objective and factual

The temporary wound channel caused by high-velocity weapons is called _______.

cavitation

You are transporting a patient with blunt abdominal trauma. The patient is unstable and is experiencing obvious signs and symptoms of shock. Your estimated time of arrival at the hospital is less than 10 minutes. After treating the patient appropriately, you should:

closely monitor him and reassess him frequently.

A man has a large laceration across his lower abdominal wall and a loop of bowel is protruding from the wound. He is conscious and alert and there is minimal bleeding from the wound. You should:

cover the exposed bowel with a moist sterile dressing and then secure it in place with a dry bandage.

Difficulty breathing and a sunken appearance of the anterior abdominal wall is MOST indicative of a ruptured:

diaphragm.

You are assessing a patient who reports pain that is tearing and describes it as going from the abdomen posteriorly. What should you suspect?

dissecting abdominal aneurysm

A sign of kidney damage following blunt trauma is:

hematuria.

Abdominal pain, vomiting, and fever are most likely due to _______.

infection

Abdominal rigidity and periumbilical bruising are signs of _______.

internal bleeding

In pediatric patients, the liver and spleen are _______.

larger in proportion to the abdomen

Most of the ________ system lies behind the digestive tract.

urinary

Open abdominal injuries are also known as: A. blunt injuries B. eviscerations C. penetrating injuries D. peritoneal injuries

C

The presence of tachycardia following a significant abdominal injury: A. indicates a state of decompensated shock B. should be assumed to be a sign of shock C. is most commonly caused by severe pain D. is always accompanied by hypo tension

C

The first signs of peritonitis include all of the following EXCEPT: A. severe abdominal pain B. tenderness C. muscular spasm D. nausea

D

When performing a history on a patient with abdominal trauma, which of the following questions would be appropriate regarding trauma? A. Is there any blood in your stool? B. Does your pain go anywhere? C. Do you have any nausea, vomiting or diarrhea? D. All of the above

D

Which of the following statements regarding abdominal evisceration's is correct? A. Adherent material is preferred when covering an evisceration. B. The organs should be replaced carefully to avoid heat loss. C. Most evisceration's occur to the left upper quadrant D. The protruding organs should be kept warm and moist.

D

You are called to the local bar where a fight has taken place. The police department tells you that you have a 36 year old man who has been stabbed twice in the abdomen. Upon your arrival, the patient is alert and oriented. His airway is open. His respirations are at 24 breaths/min, pulse is rapid, regular and weak. He has distal pulses. With the penetrating trauma, you should assume that the object: A. has penetrated the peritoneum B. has entered the abdominal cavity C. has possibly injured one or more organs D. all of the above

D

You are dispatched to a residence for a young female who was kicked in the abdomen by her boyfriend. While en route to the scene, you should ask the dispatcher if: A. the severity of the injury is known. B. the patient is conscious. C. there are other patients involved. D. law enforcement is at the scene.

D

What is the most common mechanism of injury in geriatric patients?

Falls

A 66-year-old male presents with dark red rectal bleeding and abdominal pain. He is conscious and alert; however, his skin is cool and clammy and his pulse is rapid. Further assessment reveals that his blood pressure is 112/60 mm Hg. Which of the following questions would be MOST pertinent to ask him?

Have you experienced recent abdominal trauma?

Compression injury is most likely due to which of the following?

Improperly placed lab belt

Which of the following is true regarding injury to the kidneys?

Injury to the kidneys usually indicates injury to other organs.

guarding

Involuntary muscle contractions (spasm) of the abdominal wall to minimize the pain of movement and protect the inflamed abdomen; a sign of peritonitis

Which of the following statements regarding rebound tenderness is correct?

It is often discovered when the patient is jarred or moved suddenly.

When should you visually inspect the external genitalia on your patient?

Only when there is a complaint of severe pain or other injury

Which of the following are considered solid organs?

Pancreas and spleen

Which of the following is an indication of a spleen injury?

Referred left shoulder pain

The genitourinary system controls:

Reproductive functions The waste discharge system

What is the major cause of death following injury to a hollow organ in the abdomen?

Sepsis

solid organs

Solid masses of tissue where much of the chemical work of the body takes place (e.g., the liver, spleen, pancreas, and kidneys).

hollow organs

Structures through which materials pass, such as the stomach, small intestines, large intestines, ureters, and urinary bladder.

evisceration

The displacement of organs outside of the body.

Left lower quadrant (LLQ)

The left lower quadrant holds both the large and small intestines, notably the descending colon and the left half of the transverse colon.

Which of the following statements regarding abdominal eviscerations is correct?

The protruding organs should be kept warm and moist.

flank

The region below the rib cage and above the hip.

Left upper quadrant (LUQ)

The stomach occupies most of the LUQ, but it shares this space with the spleen. The pancreas occupies some of this space but is mostly posterior to the region.

What is the purpose of wrapping a sexual assault victim in a burn sheet?

To preserve potential evidence

A patient who has sustained a blunt abdominal injury should be log rolled to a supine position onto a backboard.

True

A very common early sign of a significant abdominal injury is tachycardia.

True

Free air in the peritoneal cavity is abnormal and indicates that a hollow organ or loop of bowel has perforated.

True

Which of the following organs is at MOST risk for injury as the result of a pelvic fracture?

Urinary bladder

Which of the following statements regarding trauma during pregnancy is correct?

Uterine trauma is likely to cause shock in the pregnant patient.

You should suspect a kidney injury anytime the patient presents with _______.

a hematoma in the flank region

Compression injuries to the abdomen that occur during a motor vehicle crash are typically the result of:

a poorly placed lap belt.

A 54-year-old male experienced an avulsion to his penis when his foreskin got caught in the zipper of his pants. He was able to unzip his pants and remove the foreskin prior to your arrival. Your assessment reveals that he is in severe pain and that the avulsion is bleeding moderately. The MOST appropriate treatment for this patient includes:

applying direct pressure with a dry, sterile dressing.

Injuries to the external male genitalia _______.

are rarely life-threatening

A 20-year-old male was accidentally shot in the right upper abdominal quadrant with an arrow during an archery contest. Prior to your arrival, the patient removed the arrow. Your assessment reveals that he is conscious and alert with stable vital signs. The entrance wound is bleeding minimally and appears to be superficial. You should:

assume that the arrow injured an internal organ.

When documenting a call involving a female patient who was sexually assaulted, the EMT should:

avoid speculation and document only factual data.

A football player was struck by another player in the right flank area just below the posterior rib cage. He complains of severe pain and point tenderness to the area. Your assessment reveals that there is a small amount of blood in his underwear. You should be MOST suspicious for:

blunt injury to the kidney.

Your presence is requested by law enforcement to assess a 33-year-old female who was sexually assaulted. The patient is conscious and obviously upset. As you are talking to her, you note an impressive amount of blood on her clothes in the groin area. Her blood pressure is 98/58 mm Hg, her pulse is 130 beats/min, and her respirations are 24 breaths/min. You should:

control any external bleeding, administer oxygen, and transport at once.

A 40-year-old male presents with severe abdominal pain following blunt trauma. He is diaphoretic, intensely thirsty, and has a weak and rapid pulse. Appropriate treatment for this patient includes all of the following, EXCEPT:

giving him small sips of plain water.

When a patient stiffens the muscles of the abdomen, it is known as _______.

guarding.

Damage to solid organs typically leads to _______.

hemorrhage

You are transporting a 42-year-old male who experienced blunt abdominal trauma. He is receiving oxygen at 12 L/min via a nonrebreathing mask and full spinal precautions have been applied. During your reassessment, you note his level of consciousness has decreased and his respirations have become shallow. You should:

insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a BVM.

Management of evisceration injuries includes _______.

keeping the injury moist and warm

Right lower quadrant (RLQ)

large and small intestines that include the ascending colon and the right half of the transverse colon. descending colon, called the appendix

You are dispatched to a residence for a young female who was kicked in the abdomen. While en route to the scene, you should ask the dispatcher if:

law enforcement is at the scene.

While assessing a 21-year-old female who struck a tree head-on with her small passenger car, you note that her air bag deployed. You should:

lift the air bag and look for deformity to the steering wheel.

Because solid organs have a rich supply of blood, any injury can result in major: A. hemorrhaging B. damage C. pain D. guarding

A

Patients with open abdominal injures often complain of: A. pain B. nausea C. vomiting D. dyspnea

A

The major complaint of patients with abdominal injury is: A. pain B. tachycardia C. rigidity D. swelling

A

While assessing a 21 year old female who struck a tree head-on with her small passenger car, you not that her air bag deployed. You should: A. life the air bag and look for deformity to the steering wheel. B. carefully assess her upper chest for seat belt-related injuries C. perform a head-to-toe assessment while she is in the car D. extricate her immediately and transport to a trauma center

A

Right upper quadrant (RUQ) consist of?

liver, gallbladder, duodenum of the intestines, and a small portion of the pancreas

Placing a pregnant patient in a supine position during the third trimester of pregnancy:

may decrease the amount of blood that returns to the heart.

When a hollow organ is punctured during a penetrating injury to the abdomen:

peritonitis may not develop for several hours.

Because the depth of an open abdominal wound is often difficult to determine:

prompt transport to the hospital is essential.

All of the following are hollow abdominal organs, EXCEPT the:

spleen.