EMT A1: Chapter 30, Abdominal and Genitourinary Injuries Knowledge Objectives

Explain the emergency medical care of a patient who has sustained a genitourinary injury to the kidneys

Damage may not be obvious but watch for shock and hematuria

Explain assessment of a patient who has experienced a genitourinary injury; include special considerations related to patient privacy and determining the MOI. (pp 1075-1077)

Don't insert anything into the vagina and always consider sexual assault

Discuss the types of traumatic injuries sustained by the internal and external genitalia

Rarely life threatening and shouldn't be prioritized over other severe wounds except for bleeding Internal damage is rare except for pregnant uterus Consider sexual assault when it comes to external female genitalia damage

Define open abdominal injuries; include the three common velocity levels that distinguish these injuries, provide examples of the MOI that would cause each, and common signs and symptoms exhibited by patients who have experienced this type of injury. (pp 1061-1062)

Low velocity: knives. internal injuries may not be apparent during physical exam due to bleeding Medium: Smaller handguns and shotguns High: Produces *cavitation* problems along w entrance/exit wound

Discuss the types of traumatic injuries sustained by the urinary bladder

May result in rupture, in which *urine spills into surrounding tissue* Suspect if *blunt injury to lower abs or pelvis*, particularly when bladder is full or *pregnancy*

Define closed abdominal injuries; provide examples of the mechanisms of injury (MOI) likely to cause this type of trauma, and common signs and symptoms exhibited by patients who have experienced this type of injury. (pp 1059-1060)

Blunt trauma from *compression due to seatbelt or deceleration* Signs and symptoms: *Pain*: liver and spleen injuries refer pain to the shoulder! blood/fluid in peritoneal cavity causes acute pain in entire abdomen *Guarding* (flexing abs) makes it hard to locate pain

Explain the emergency medical care of a patient who has sustained a closed abdominal injury, including blunt trauma caused by a seatbelt or air bag. (pp 1069-1070)

*Biggest concern* is that you can't tell true extent of closed abdominal injury *Position* for comfort *Blunt injury* PT should be log rolled to supine position on a backboard

Explain the emergency medical care of a patient who has sustained an open abdominal injury, including penetrating injuries and abdominal evisceration. (pp 1070-1072)

*Maintain high index of suspciion* for unseen blood loss Already know how to manage evisceration

Explain assessment of a patient who has experienced an abdominal injury; include common indicators that help determine the MOI and whether it is a significant or insignificant MOI. (pp 1064-1069)

*Reassessment* critical because some abdominal injuries develop and worsen over time. *Secondary* Palpate distant quadrant first to avoid guarding. If MOI suggests isolated injury to abdomen, focus exam there. *IF YOU FIND ENTRY WOUND, MUST LOOK FOR EXIT WOUND* *DON'T REMOVE KNIFE*

Describe the different ways hollow and solid organs of the abdomen can be injured, and include the common signs and symptoms exhibited by patients depending on the organ(s) involved. (pp 1062-1064)

Hollow organ injuries: delayed signs and symptoms, contents spill into peritoneum and *cause infection* *Gallbladder and bladder* can cause irritation due to infection/corrosion *Free air* causes pain and indicates hollow organ has perforated Solid organs can *bleed significantly*. Penetrated diaphragm can cause bowel loops to herniate into thoracic cavity. PTs present dyspnea. *Penetrated kidney* can cause hematuria.

Discuss the types of traumatic injuries sustained by the kidneys

Kidneys: Can result from an indirect blow or even *football tackle* Suspect if abrasion/laceration/contusion on *the flank*

Describe the anatomy and physiology of the female and male genitourinary systems; include the differences between hollow and solid organs. (pp 1072-1073)

Solid organs: Kidneys Hollow: Ureters, bladder and urethra Except for *prostate gland and seminal vessicles*, male genitalia are exterior Female genitalia are completely interior except for *vulva, clitoris and labia*

Explain the emergency medical care of a patient who has sustained a genitourinary injury to the bladder

Suspect if blood at urethral opening, signs of trauma to lower abs/pelvis/perineum

Describe some special considerations related to the care of pediatric patients and geriatric patients who have experienced abdominal trauma. (pp 1058-1059, 1065)

The *aorta, liver, and spleen are at risk* of injury from falls. Fractured geriatric bones can create sharp edges that might puncture organs

Explain special considerations related to a patient who has experienced a genitourinary injury caused by a sexual assault, including patient treatment, criminal implications, and evidence management. (p 1079)

Treat PT like crime scene, Document, advoice PT not to do anything to get rid of evidence

Describe the anatomy and physiology of the abdomen; include an explanation of abdominal quadrants and boundaries and the difference between hollow and solid organs. (pp 1057-1059)

URQ: liver, gallbladder, duodenum, part of the pancreas ULQ: mostly stomach, some spleen, some pancreas LLQ: Large and small intestines LRQ Large and small intestines, appendix Hollow organs: stomach, intestines, ureters, bladder. Contain food being processed, urine passed to bladder, or bile. When ruptured, *spill contents into peritoneal cavity* Solid organs: Liver, spleen, pancreas, kidneys. Enzyme production, blood cleansing, energy prdxn When ruptured, *severe unseen hemorrhage*

Explain the emergency medical care of a patient who has sustained a genitourinary injury to the rectum

Usuallly from hemorrhoids, but can be from sexual assault, colitis and ulcers. Post-hemorrhoids surgery can lead to significant blood loss and shock!