CHAPTER 36 - NANCY EMERGENCIES III

EMS providers can have the MOST positive impact on mortality and morbidity from abdominal trauma by: a) recognizing the need for rapid transport b) initiating fluid resuscitation in the field c) contacting medical control immediately d) performing a careful abdominal assessment

a

external compression results in ________ a) rupture of the hollow organs b) perforation of the bladder c) shearing in the aorta d) crushing of the solid organs

a

how should you treat a pregnant woman who you suspect has internal bleeding a) place her on her left side secured to a back board lifted 15 degrees b) place her in semi fowler position c) place her on her right side secured to a back board lifted 15 degrees d) place her supine on a short backboard

a

referred pain to the left shoulder following blunt abdominal trauma should lead you to suspect injury to the: a) spleen b) stomach c) intestines d) diaphragm

a

what do the spleen and liver have in common? a) they are both highly vascular and bleed profusely when injured b) the liver and spleen are well protected by the abdominal muscles c) they are less likely to be crushed by blunt trauma than other organs d) the liver and spleen are the only solid organs in the abdominal cavity

a

which of the following assessment findings is MOST suggestive of intra-abdominal hemorrhage? a) signs of shock b) palpable pain c) diffuse tenderness d) nausea and vomiting

a

which of the following injuries is the patient with mononucleosis prone to following relatively minor blunt abdominal trauma? a) ruptured spleen b) lacerated liver c) aortic dissection d) ruptured urinary bladder

a

which of the following statements regarding stomach injuries is correct? a) rupture of the stomach following blunt trauma is usually associated with a recent meal or inappropriate seat belt use b) the vast majority of injuries to the stomach are caused by blunt force trauma and results in severe peritoneal hemorrhage c) patients taking antacid medications usually experience immediate signs of peritoneal irritation following an injury to the stomach d) penetrating mechanisms are a rare cause of injury to the stomach because the stomach is well protected by the abdominal musculature

a

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 patient's chances of survival? a) basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluid boluses as needed en route b) administering supplemental oxygen, administering crystalloid IV fluids at the scene, and rapidly transporting to a trauma center c) orotracheal intubation, ventilation assistance, 2 to 3 L of IV fluid at the scene, and rapid transport to a trauma center d) aggressive airway support, a detailed physical exam at the scene, transport to the closet hospital, and IV therapy performed en route

a

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: a) request law enforcement assistance b) alert the trauma center of the situation c) take appropriate standard precautions d) place air medical transport on standby

a

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 side walk. a police officer at the scene is holding pressure to the patients right upper abdomen with a blood soaked gym towel. you observe no obvious trauma injuries. based on the location of the patients wound you should suspect injury to which of the following a) liver and possibly the gall bladder b) urinary bladder c) appendix d) stomach and possibly the spleen

a

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? a) kidney b) urinary bladder c) liver d) gallbladder

a

following blunt force trauma to the lower right rib cage, a 40 year old woman presents with restlessness, tachycardia, and unlabored tachypnea. you should be MOST concerned that she has a: a) pyloric injury b) liver injury c) splenic rupture d) pneumothorax

b

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: a) 70 to 80 mm Hg b) 80 to 90 mm Hg c) 90 to 100 mm Hg d) 100 to 110 mm Hg

b

periumbilical ecchymosis is: a) commonly observed in the prehospital setting following blunt force trauma to the abdomen. b) referred to as cullen sign and may take several hours to develop following abdominal trauma c) usually seen in conjunction with flank bruising and is highly suggestive of injury to the liver or spleen d) also called grey turner sign and manifests almost immediately following blunt abdominal trauma

b

what is hemoperitoneum? a) blunt trauma to the liver b) a collection of blood in the abdominal cavity c) a diaphragmatic injury d) a collection of blood in the retroperitoneal space

b

what organs are the primary sources of exsanguination during abdominal trauma? a) stomach and liver b) liver and spleen c) spleen and kidneys d) kidneys and liver

b

what type of motor vehicle crash poses the LEAST threat for abdominal trauma if the patient is properly restrained? a) frontal crash b) rear-end crash c) lateral crash d) rollover crash

b

which of the following is characterized by ecchymosis in the umbilical region caused by peritoneal bleeding a) grey turners sign b) cullen sign c) becks triad d) kehr sign

b

which of the following is indicative of a diaphragmatic rupture a) cullen sign b) abdominal sounds in the chest c) peritonitis d) distended abdomen

b

you should suspect a ruptured kidney if a patient presents with flank pain, gross hematuria, and: a) left shoulder pain b) pain with inhalation c) right shoulder pain d) pain with exhalation

b

grey turner sign is defined as ecchymosis to the ______ and is indicative of______. a) umbilicus, peritoneal bleeding b) epigastrium, stomach rupture c) flank, retroperitoneal bleeding d) back, traumatic aortic dissection

c

penetrating abdominal trauma MOST commonly results fromL a) flying debris following an explosion b) high-powered rifles or military weapons c) low-velocity gunshot or stab wounds d) crush forces that separate the abdominal wall

c

the diaphragm curves from its point of attachment at the _____ rib and peaks in the center at the ______ intercostal space a) ninth, third b) tenth, seventh c) twelfth, fourth d) eighth, seventh

c

what are the most commonly injured abdominal organs a) kidney and pancreas b) large and small intestines c) liver and spleen d) appendix and colon

c

which of the following signs are consistent with abdominal hemorrhage a) tender abdomen, hypertension and bradycardia b) tachycardia, hypertension and distention c) periumbilical ecchymosis, distention, bradycardia and shock d) distention, hypotension, tachycardia, shock

c

Injuries to the vascular structures in the intraperitoneal space: a) commonly involve the inferior vena cava and phrenic artery b) are most often associated with penetrating injury mechanisms c) are generally associated with flank or periumbilical bruiusing d) are often caused by shearing forces secondary to blunt trauma

d

_____ is an uncontrollable abdominal wall muscle contraction resulting from inflammation of the peritoneum a) ecchymosis b) guarding c) rebound tenderness d) rigidity

d

_____ pain results from stretching, oxygen deprivation, and swelling a) superficial b) referred c) somatic d) visceral

d

the LEAST practical technique when assessing the patient with abdominal trauma in the field is: a) palpation b) percussion c) inspection d) auscultation

d

the MOST frequent presentation of blunt renal trauma is: a) low back pain and anuria b) pelvic pain and tachycardia c) pelvic pain and oliguria d) flank pain and hematuria

d

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 mechanism of injury

d