Chapter 36 Abdominal and Genitourinary Trauma

In the absence of a traumatic brain injury, the goal of fluid replacement in a patient with abdominal trauma is to maintain a systolic BP of:

80-90 mm Hg

What is hemoperitoneum?

A collection of blood in the abdominal cavity.

You are providing care for a 22-year-old female patient 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:

Place saline-soaked dressings on the wound and cover loosely, then transport to the closest receiving facility.

You are providing care for a 47-year-old male patient who was the front seat passenger of a car involved motor vehicle collision. 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 although his pulse is a little fast. Based on this information, your most appropriate action should be to:

Perform any primary interventions then rapid transport to the highest level of trauma center available.

Which of the following signs are consistent with abdominal hemorrhage?

Periumbillical ecchymosis, distention, bradycardia, and shock.

How should you treat a pregnant woman who you suspect has internal bleeding?

Place her on her left side secured to a backboard lifted 15º

Most abdominal injuries:

involve blunt trauma.

A 24-year-old 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:

transport him to the hospital and provide emotional support en route

What type of motor vehicle crash poses the LEAST threat for abdominal trauma if the patient is properly restrained?

Rear-end crash

External compression results in ________.

Rupture of the hollow organs.

Which of the following assessment findings is MOST suggestive of intra-abdominal hemorrhage?

Signs of shock

During the third collision in a motor vehicle crash:

abdominal organs shear from their points of attachment.

Which of the following is indicative of a diaphragmatic rupture?

abdominal sounds in the chest

True or False: The major cause of mortality and morbidity in abdominal trauma is infection and peritonitis.

Fasle

A 17-year-old 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 findings and the patient's clinical presentation, you should suspect:

An injury to the spleen.

You are caring for a patient who experienced blunt abdominal trauma. The patient is conscious, but restless. Her respirations are rapid and shallow and her pulse is rapid and weak. What will maximize this patients chances of survival?

Basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluid boluses as needed en route

True or False: A priority assessment of the patient with abdominal trauma should be to auscultate for bowel sounds.

False

Which of the following is characterized by ecchymosis in the umbilical region caused by peritoneal bleeding?

Cullen sign

True or False: Gunshot wounds to the abdomen involve a more predictable injury pattern than stab wounds.

False

True or False: The primary consequence of hollow organ injury is hemorrhage.

False

You are providing care for a 16-year-old male patient complaining of lower back pain. The patient 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:

Grey Turner sign and you should maintain a high index of suspicion for retroperitoneal injury.

You are responding to a 20-year-old male patient 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?

Kidney

With respect to penetrating injury, the most frequently injured organ is the:

Liver

You are providing care for a 46-year-old female patient who was the driver of a car involved motor vehicle collision. 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 for her right lower ribs. Based on this information, you should also maintain a high index of suspicion for injuries to the:

Liver

You are dispatched to the scene of a 19-year-old man 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 right upper abdomen with a blood-soaked gym towel. You observe no other obvious trauma injuries. Based on the location of the patient's wound, you should suspect injury to which of the following?

Liver and possibly the gallbladder.

You are providing care to a 26-year-old male patient 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 whenever the patient moves. Based on this information, which of the following statements is correct?

There are signs of pressure necrosis and the patient should be transported promptly to the closes appropriate hospital.

Which of the following factors can decrease the potential damage caused by trauma to the abdomen?

Toned abdominal muscles and an empty bladder

True or False: Every injured patient should be assumed to have a full stomach and bladder.

True

True or False: Penile trauma is often the result of abuse and evaluation for other injuries is warranted.

True

True or False: Vaginal trauma may result from blunt or penetrating trauma.

True

When assessing a patient with abdominal trauma for distention, you should recall that:

a significant amount of blood volume in the abdominal cavity is required to produce distention.

The periumbilical area refers to the:

area around umbilicus

A 39-year-old woman sustained an abdominal evisceration after she was cut in the abdomen with a machete. The patient is semiconscious and is breathing shallowly. You should:

assist ventilations with a bag-mask device; cover the exposed bowel with moist, sterile dressings and protect them from injury; transport at once; and initiate IV therapy en route.

Gross hematuria and suprapubic pain following pelvic injury is MOST indicative of injury to the:

bladder

Anatomically, the abdominal cavity extends from the:

diaphragm to pelvis

The MOST frequent presentation of blunt renal trauma is:

flank pain and hematuria

Grey Turner sign is defined as ecchymosis to the _________ and is indicative of _________.

flank, retroperitoneal bleeding

The abdomen extends superiorly to the level of the:

fourth intercostal space

What are the most commonly injured abdominal organs?

liver and spleen

Fractures of the lower rib cage should make you MOST suspicious for injuries to the:

liver or spleen

When blood is released into the peritoneal cavity:

nonspecific signs such as tachycardia and hypotension may occur.

You are dispatched to the parking lot of a shopping mall for a person who was kicked in the abdomen numerous times. While en route to the scene, it is MOST important for you to:

request law enforcement assistance.

Which of the following is NOT a function of the pancreas?

reservoir for bile

_____________ is an uncontrollable abdominal wall muscle contraction resulting from inflammation of the peritoneum.

rigidity

You should suspect a ruptured kidney if a patient presents with flank pain, gross hematuria, and:

pain with inhalation.

Because of its anatomic position in the retroperitoneum, it typically takes high-energy force to damage the:

pancreas

The upper peritoneal cavity includes all of the following organs, EXCEPT the:

pancreas

Which of the following organs or structures lies in the retroperitoneal space?

pancreas

The major complication associated with hollow organ injury is:

peritonitis caused by rupture and spillage of toxins.

Periumbilical ecchymosis is:

referred to as Cullen sign and may take hours or days to develop following abdominal trauma.

Referred pain to the left shoulder following blunt abdominal trauma should lead you to suspect injury to the:

spleen

Intraabdominal bleeding may produce few signs and symptoms of trauma because:

the intraabdominal cavity can accommodate large amounts of blood.