Module 8

Shortness of breath or difficulty breathing.

Dyspnea

The displacement of organs outside of the body.

Evisceration

The region of the lower rib cage.

Flank

The vomiting of blood

Hematemesis

A sign of kidney damage following blunt trauma is:

Hematuria

Presence of blood in the urine

Hematuria

A bruise of the heart muscle. Myocardial contusion Dressing made of Vaseline gauze, aluminum foil, or plastic that prevents air and liquids from entering or exiting a wound.

Occlusive dressing

An injury of the abdomen caused by a penetrating or piercing instrument or force, in which the skin is lacerated or perforated and the cavity is opened to the atmosphere; also called penetrating injury.

Open abdominal injury

Compression of the heart due to a buildup of blood or other fluid in the pericardial sac.

Pericardial tamponade

The abdominal cavity.

Peritoneal cavity

Inflammation of the peritoneum.

Peritonitis

A partial or complete accumulation of air in the pleural space.

Pneumothorax

A bruise of the lung.

Pulmonary contusion

A pneumothorax that occurs when a weak area on the lung ruptures in the absence of major injury, allowing air to leak into the pleural space.

Spontaneous pneumothorax

An open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound

Sucking chest wound

Rapid respirations.

Tachypnea

An accumulation of air or gas in the pleural cavity that progressively increases the pressure in the chest with potentially fatal results.

Tension pneumothorax

A 33-year-old male was stabbed in the left anterior chest. He is conscious, but is experiencing signs of shock. Further assessment reveals that his jugular veins are distended and his breath sounds are bilaterally equal and clear. This patient is MOST likely experiencing:

a pericardial tamponade.

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

a poorly placed lap belt.

A flail chest occurs when:

a segment of the chest wall is detached from the thoracic cage.

Pneumothorax is MOST accurately defined as:

accumulation of air in the pleural space

an open pneumothorax occur when:

air enters the pleural space from outside the body.

Subcutaneous emphysema is an indication that:

air is escaping into the chest wall from a damaged lung

A 30-year old male was rescued after being lost in the woods for app. 18 hour. The outside temp is 30 F. He is immediately placed in a awarded ambulance. He is unconscious and pale. You should:

assess a carotid pulse for up to 45 seconds

When worn properly, a seatbelt should lie

below the anterior superior iliac spines of the pelvis and against the hip joints.

Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT:

collapsed jugular veins.

Hemoptysis is defined as:

coughing up blood.

Pleural fluid is contained between the:

visceral and parietal pleurae.

The phrenic nerves control the diaphragm and exit the spinal cord at:

C3, C4, and C5.

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

Hollow organs

Following blunt abdominal trauma, a 30-year-old male complains of referred pain to the left shoulder. This finding is called the:

Kehr sign.

An injury to the chest in which the chest wall itself is penetrated, by a fractured rib or, more frequently, by an external object such as a bullet or knife.

Open chest injury

The motion of the chest wall section that is detached in a flail chest; the motion is exactly the opposite of normal motion during breathing (ie, in during inhalation, out during exhalation).

Paradoxical motion

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

Solid organs

Which of the following statements regarding abdominal trauma is correct?

The absence of abdominal pain does not rule out intra-abdominal bleeding.

The mesentery is

a membranous fold that attaches the intestines to the walls of the body

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.

Patients with rib fractures will commonly:

breathe rapidly and shallowly.

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

You are transporting a stable patient with a possible pneumothorax. The patient is receiving 100% oxygen and has an oxygen saturation of 95%. During your reassessment, you find that the patient is now confused, hypotensive, and profusely diaphoretic. What is MOST likely causing this patient's deterioration?

compression of the aorta and vena cava

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 BP is 98/58 mm Hg, pulse is 130 beats/min, and respirations are 24 breaths/min. You should:

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

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

diaphragm.

The thoracic cavity is separated from the abdominal cavity by the

diaphragm.

A spontaneous pneumothorax would MOST likely occur as the result of:

exertion of a person with a congenital lung defect

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 water

Airbags, in conjunction with properly worn seatbelts, are of MOST benefit when a person is involved in a:

head-on crash

Common signs and symptoms of a chest injury include all of the following, EXCEPT:

hematemesis.

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 bag-mask device.

Definitive care for a tension pneumothorax involves:

inserting a needle through the rib cage into the pleural space.

During your assessment of a patient who experienced blunt trauma to the abdomen, you notice bruising around the umbilicus. This is a sign of

intra-abdominal bleeding.

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:

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 airbag deployed. You should:

lift the airbag and look for deformity to the steering wheel.

Bruising to the right upper quadrant of the abdomen following blunt trauma is MOST suggestive of injury to the:

liver

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

liver

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

liver.

Which of the following organs or structures does NOT reside within the mediastinum?

lungs

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

If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she:

must increase his or her respiratory rate to maintain adequate minute volume.

You have sealed an open chest wound on a 40-year-old male who was stabbed in the anterior chest. Your reassessment reveals that he is experiencing increasing respiratory distress and tachycardia, and is developing cyanosis. You should:

partially remove the dressing.

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

peritonitis may not develop for several hours

The ________ nerves control the diaphragm.

phrenic

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

prompt transport to the hospital is essential.

A 20-year-old male was pulled from cold water by his friends. The length of his submersion is not known and was not witnessed. You perform a primary assessment and determine that the patient is apneic and has a slow, weak pulse. You should:

provide rescue breathing, remove wet clothes, immobilize spine,keep warm, transport carefully

Early bruising following abdominal trauma is often indicated by:

red areas of skin

When assessing a patient with a hemothorax, you would MOST likely find:

signs and symptoms of shock

A 31-year old male fell and landed on his left elbow. Your assessment reveals that the elbow is grossly deformed, his forearm is cool and pale, and the distal pulse on the side of the injury is barely palpable. His vital signs are stable. You transport him to the hospital. You should:

splint the elbow in the position found and transport

A 22-year old female was ejected from her car after striking a tree head-on. As you approach her, you not closed deformities to both femurs. She is not moving and in not conscious. You should:

stabilize her head and perform a primary assessment

A drop in blood pressure caused when the heavy uterus of a supine patient in the third trimester of pregnancy obstructs the vena cava, decreasing blood return to the heart.

supine hypotensive syndrome

A 22-year old male was punched in the abdomen several times. You find him lying on his left side with his knees drawn up. He is conscious and alert and complains of increased pain and nausea when he tries to straighten his legs. His bp is 142/82 mm Hg, his pulse rate is 110 beats/min and strong, and his respirations are 22 breaths/min and regular. In addition to administering high-flow oxygen, you should:

transport him in the position in which you found him

Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of:

traumatic aortic rupture

Any injury of the abdomen caused by a nonpenetrating instrument or force, in which the skin remains intact; also called blunt abdominal injury.

Closed abdominal injury

An injury to the chest in which the skin is not broken, usually due to blunt trauma.

Closed chest injury

A condition in which two or more ribs are fractured in two or more places or in association with a fracture of the sternum so that a segment of chest wall is effectively detached from the rest of the thoracic cage.

Flail chest

A one-way valve that allows air to leave the chest cavity but not return; formed by taping three sides of an occlusive dressing to the chest wall, leaving the fourth side open as a valve.

Flutter valve

Involuntary muscle contractions (spasm) of the abdominal wall in an effort to protect the inflamed abdomen; a sign of peritonitis.

Guarding

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?

Have you experienced recent abdominal trauma?

The spitting or coughing up of blood.

Hemoptysis

A collection of blood in the pleural cavity.

Hemothorax

Which of the following statements regarding abdominal eviscerations is correct?

The protruding organs should be kept warm and moist.

A 37-year old male was pinned between a flatbed truck and a loading dock. On exam, you find bruising to the chest, distended neck veins, bilaterally diminished breath sounds, and bilateral scleral hemorrhaging. You should:

aggressively manage his airway

Accumulation of blood in the abdominal cavity will MOST likely cause:

distention

Contraction or tensing of the abdominal muscles in an effort to ease pain is called:

guarding

Peritonitis, an intense inflammatory reaction of the abdominal cavity, usually occurs when:

hollow abdominal organs are damaged and spill their contents.

The MOST critical treatment for a tension pneumothorax involves:

inserting a needle through the rib cage into the pleural space.

When a person is lying supine at the end of exhalation, the diaphragm

may rise as high as the nipple line.

If a person's tidal volume decreases, but his or her respiratory rate remains unchanged:

minute volume will decrease.

A rapid, irregular pulse following blunt trauma to the chest is MOST suggestive of a:

myocardial contusion.

Asymmetry of the chest wall occurs when:

one side of the chest wall does not expand during inhalation.

It can be difficult to assess the severity of injuries to the genitourinary system following sexual assault because:

patients may be hesitant to allow you to examine them

Irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called:

pleurisy

In order to avoid exacerbating a patient's injury, it is especially important to use extreme caution when providing positive-pressure ventilation to patients with a:

pneumothorax.

A 28-year-old male was struck in the chest with a baseball bat during an altercation. He is conscious and alert and complains of severe chest pain. Your assessment reveals a large area of ecchymosis over the sternum and a rapid, irregular pulse. In addition to applying 100% oxygen, you should

prepare for immediate transport.

A 30-year-old male has a large laceration to his right lower abdominal quadrant with a loop of bowel protruding through the wound. When treating this patient, the EMT-B should recall that the:

protruding bowel should be kept warm and moist.

Following blunt trauma to the chest, an 18-year-old female presents with respiratory distress, reduced tidal volume, and cyanosis. Her blood pressure is 80/50 mm Hg and her pulse is 130 beats/min and thready. You should:

provide some form of positive-pressure ventilation

A patient who presents with profound cyanosis following a chest injury:

requires prompt ventilation and oxygenation.

The presence of tachycardia following a significant abdominal injury:

should be assumed to be a sign of shock.

Elevation of the rib cage during inhalation occurs when:

the intercostal muscles contract.

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

urinary bladder

A 19-year-old male is unresponsive, apneic, and pulseless after being struck in the center of the chest with a softball. Based on the mechanism of injury, what MOST likely occurred?

ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle