EMT-B, Ch 30: Abdominal and Genitourinary Injuries

Compression injury is most likely due to which of the following? Select one: A. Improperly placed lab belt B. Ejection of unrestrained driver C. Stabbing D. Hollow-organ rupture

A. Improperly placed lab belt

Which of the following organs would be the MOST likely to bleed profusely if severely injured? A. Liver B. Kidney C. Stomach D. Gallbladder

A. Liver --> The liver is a highly vascular solid organ, and contains approximately 40% of the body's total blood volume at any given time. If severely injured, bleeding from the liver would be profuse and rapid. Other solid organs, such as the spleen and kidneys, may also produce severe bleeding if injured, though not as rapid as the liver. The stomach and gallbladder are hollow organs; if lacerated, they would spill their contents into the abdominal cavity, resulting in peritonitis.

While inspecting the interior of a wrecked automobile, you should be MOST suspicious that the driver experienced an abdominal injury if you find: A. a deformed steering wheel. B. that the airbags deployed. C. a crushed instrument panel. D. damage to the lower dashboard.

A. a deformed steering wheel. --> Airbags save lives when used in conjunction with properly worn seatbelts. Unfortunately, however, not all drivers wear their seatbelts. If unrestrained, the driver's abdomen may strike the steering wheel, resulting in significant trauma. Suspect this if you lift the airbag and note that the lower part of the steering wheel is deformed.

You should suspect a kidney injury anytime the patient presents with _______. Select one: A. a hematoma in the flank region B. abdominal distention C. dyspnea D. nausea

A. a hematoma in the flank region

Difficulty breathing and a sunken appearance of the anterior abdominal wall is MOST indicative of a ruptured: Select one: A. diaphragm. B. spleen. C. stomach. D. aorta.

A. diaphragm.

Abdominal pain, vomiting, and fever are most likely due to _______. Select one: A. infection B. hypovolemia C. hemorrhage D. evisceration

A. infection

Placing a pregnant patient in a supine position during the third trimester of pregnancy: Select one: A. may decrease the amount of blood that returns to the heart. B. results in spontaneous urinary incontinence if the bladder is full. C. is recommended if the patient has severe abdominal discomfort. D. often causes hypotension secondary to cardiac compression.

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

When a hollow organ is punctured during a penetrating injury to the abdomen: Select one: A. peritonitis may not develop for several hours. B. it will bleed profusely and rapidly cause shock. C. the abdomen will become instantly distended. D. it commonly protrudes through the injury site.

A. peritonitis may not develop for several hours.

When caring for a female with trauma to the external genitalia, the EMT should: A. use local pressure to control bleeding. B. carefully pack the vagina to reduce bleeding. C. remove any impaled objects from the vagina. D. cover any open wounds with moist, sterile dressings.

A. use local pressure to control bleeding. --> Bleeding from the external genitalia should be controlled by applying a dry, sterile dressing and local direct pressure. Never pack anything into the vagina to try to control bleeding; this increases the risk of infection, and anything you place into the vagina will only need to be removed at the hospital. Impaled objects in the genitalia should be carefully stabilized in place, not removed.

You are transporting a patient with possible peritonitis following trauma to the abdomen. Which position will he MOST likely prefer to assume? A. Sitting up B. Legs drawn up C. Legs outstretched D. On his right side

B. Legs drawn up --> Patients with peritonitis often lie very still and tend to have their legs drawn up into the abdomen. This relieves strain on the abdominal muscles and may provide pain relief.

The term "hematuria" is defined as: A. blood in the stool. B. blood in the urine. C. vomiting up blood. D. urinary bladder rupture.

B. blood in the urine. --> Blood in the urine is called hematuria. Following trauma, the presence of hematuria suggests injury to the urinary bladder or kidneys. Bright red blood in the stool is called hematochezia; dark, tarry stools are called melena. Vomiting up blood is called hematemesis.

Which of the following is true regarding injury to the kidneys? Select one: A. Kidney injuries are rarely caused by blunt trauma. B. Only minimal force is needed to damage the kidneys. C. Injury to the kidneys usually indicates injury to other organs. D. The kidneys are not well protected.

C. Injury to the kidneys usually indicates injury to other organs.

Which of the following organs would MOST likely bleed profusely when injured? Select one: A. Intestine B. Bladder C. Liver D. Stomach

C. Liver

Which of the following statements regarding intra-abdominal bleeding is FALSE? A. Intra-abdominal bleeding often causes abdominal distention. B. Intra-abdominal bleeding is common following blunt force trauma. C. The absence of pain and tenderness rules out intra-abdominal bleeding. D. Bruising may not occur immediately following blunt abdominal trauma.

C. The absence of pain and tenderness rules out intra-abdominal bleeding. --> Intra-abdominal bleeding is common following blunt trauma to the abdomen. Signs include abdominal distention, rigidity, bruising (may not occur immediately), and in some cases, pain to palpation. However, unlike gastric juices and bacteria, blood within the abdominal cavity does not provoke an inflammatory response; therefore, the absence of pain and tenderness does not rule out internal bleeding.

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

C. The protruding organs should be kept warm and moist.

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: Select one: A. requesting a paramedic to administer pain medication. B. covering the avulsion with moist, sterile dressings. C. applying direct pressure with a dry, sterile dressing. D. administering 100% oxygen via a nonrebreathing mask.

C. applying direct pressure with a dry, sterile dressing.

Your documentation on a sexual assault victim should _______. Select one: A. be subjective and summarize the crime B. describe the status of the suspect(s) C. be objective and factual D. include your opinion of the nature of the incident

C. be objective and factual

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: Select one: A. arrange for a rape crisis center representative to speak with the patient. B. allow her to change her clothes and take a shower before you transport. C. control any external bleeding, administer oxygen, and transport at once. D. visualize the vaginal area and pack the vagina with sterile dressings.

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

A 16-year-old boy was playing football and was struck in the left flank during a tackle. His vital signs are stable; however, he is in severe pain. You should be MOST concerned that he has injured his: A. liver. B. spleen. C. kidney. D. bladder.

C. kidney. --> The flanks are located laterally in the back and overlie the kidneys. During football, spearing injuries occur when a player is struck in the flank by another player's helmet. This can result in injury to the kidney ranging from bruising to severe bleeding. Injury to the liver, spleen, and bladder would more likely occur following blunt trauma to the anterior abdomen.

Because the depth of an open abdominal wound is often difficult to determine: Select one: A. the abdomen must be vigorously palpated. B. vital signs should be monitored frequently. C. prompt transport to the hospital is essential. D. the EMT must perform a thorough exam.

C. prompt transport to the hospital is essential.

All of the following are hollow abdominal organs, EXCEPT the: Select one: A. ureters. B. bladder. C. spleen. D. stomach.

C. spleen.

When should you visually inspect the external genitalia on your patient? Select one: A. Anytime the patient agrees to treatment and transport B. Always during the secondary assessment C. Only when ordered by medical direction D. Only when there is a complaint of severe pain or other injury

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

Other than applying a moist, sterile dressing covered with a dry dressing to treat an abdominal evisceration, an alternative form of management may include: A. placing dry towels over the open wound. B. cleaning the exposed bowel with sterile saline. C. applying the PASG to stop the associated bleeding. D. applying an occlusive dressing, secured by trauma dressings.

D. applying an occlusive dressing, secured by trauma dressings. --> Although the preferred management for an abdominal evisceration includes the application of a moist, sterile dressing covered by a dry dressing, protocols in some EMS systems call for an occlusive dressing, secured by trauma dressings. An occlusive dressing may help prevent the loss of body heat through the abdominal wound.

Injuries to the external male genitalia _______. Select one: A. frequently lead to hypovolemic shock B. usually result in permanent damage C. are often life-threatening D. are rarely life-threatening

D. are rarely life-threatening

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: Select one: A. perform a comprehensive secondary assessment. B. forgo the hospital radio report because of his condition. C. begin documenting the call on the patient care form. D. closely monitor him and reassess him frequently.

D. closely monitor him and reassess him frequently.

When a patient stiffens the muscles of the abdomen, it is known as _______. Select one: A. instability. B. crepitus. C. distention. D. guarding.

D. guarding.

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: Select one: A. perform a comprehensive secondary assessment to determine why his clinical status has changed. B. suction his oropharynx to ensure it is clear of secretions and then increase the oxygen flow rate to 15 L/min. C. reassess his vital signs and then notify the receiving hospital of the change in his clinical status. D. insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a BVM.

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

In pediatric patients, the liver and spleen are _______. Select one: A. more protected by the thorax compared to adults B. less likely to bleed when injured C. smaller in proportion to the abdomen D. larger in proportion to the abdomen

D. larger in proportion to the abdomen

Peritonitis would MOST likely result following injury to the: A. liver. B. spleen. C. kidney. D. stomach.

D. stomach. --> In general, solid organs bleed when injured and hollow organs spill their contents into the abdominal cavity, resulting in peritonitis—inflammation of the intra-abdominal lining. Of the choices listed, the stomach is the only hollow organ.

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

True

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

True

True/False: A very common early sign of a significant abdominal injury is tachycardia.

True: A very common early sign of a significant abdominal injury is tachycardia because the heart is increasing its pumping action to compensate for blood loss.

True/False: You should allow patients with peritonitis to lie still with their legs drawn up.

True: Patients with peritonitis generally prefer to lie very still with their legs drawn up to guard from pain in the abdomen. Allow a patient with a patent airway to remain in a position of comfort.

You are assessing a patient who reports pain that is tearing and describes it as going from the abdomen posteriorly. What should you suspect? a. Dissecting abdominal aneurysm b. Kidney damage c. Ruptured appendix d. Gallbladder inflammation

a. Dissecting abdominal aneurysm

Bruising over the right upper quadrant could indicate injury to which of the following? a. Liver b. Colon c. Kidney d. Appendix

a. Liver --> The liver is found in the right upper quadrant, along with the gallbladder, duodenum of the intestines, and a small portion of the pancreas.

Which of the following is true about injuries to the kidneys? (Select all that apply) a. Injuries are unusual because the kidneys are well protected. b. A penetrating wound that reaches the kidneys almost always involves other organs. c. An indication of kidney injury is bruising to the left upper quadrant. d. A sign of kidney damage is hematuria.

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

Which of the following signs would indicate that an injury to the kidney has occurred? a. Hemoptysis b. Hematuria c. Hematoma d. Hematemesis

b. Hematuria --> If the kidney is injured, a common finding is hematuria, or blood in the urine.

Which of the following is an indication of a spleen injury? a. Referred right shoulder pain b. Referred left shoulder pain c. Radiating pain from left upper quadrant down through the flank d. Hematuria

b. Referred left shoulder pain --> Referred left shoulder pain is a potential indication of a splenic injury because the spleen is in the upper left quadrant.

What is the purpose of wrapping a sexual assault victim in a burn sheet? a. To maintain body temperature as a result of shock b. To preserve potential evidence c. To protect the patient's privacy d. To keep the patient calm (swaddling)

b. To preserve potential evidence

Which of the following statements is true? a. Low-velocity injuries produce extensive temporary wound channels. b. There are four levels of velocity. c. The higher the velocity of a projectile, the larger the cavity it produces. d. The velocity of an object is not a critical determination in your assessment.

c. The higher the velocity of a projectile, the larger the cavity it produces.

Even when seatbelts are worn properly and the airbags deploy, injury may occur to the: A. chest. B. extremities. C. iliac crests. D. lower ribcage.

C. iliac crests. --> Seatbelts should be positioned over the iliac crests of the pelvis. If they are positioned higher, significant intra-abdominal injury can occur. Even when seatbelts are properly positioned and the airbags deploy, injury to the iliac crests may occur as the locking mechanism of the seatbelt engages during a motor vehicle crash that involves rapid deceleration.

Where is abdominal injury most likely to occur in young children? a. Appendix b. Fractured ribs c. Gallbladder d. Liver

d. Liver --> In pediatric patients, the liver and spleen are very large in proportion to the size of the abdominal cavity and are more easily injured. The soft, flexible ribs of infants and young children do not protect these two organs very well and may allow injury to underlying organs, even without fracturing the ribs.

You should have an index of suspicion that a patient with pain referred to the right shoulder has an injury to which organ? a. Bladder b. Intestine c. Kidney d. Liver

d. Liver --> Injury to the liver (or spleen) may present with referred pain to the shoulders. Unlike radiating pain, which is characterized by pain that "moves" from one area of the body to another, referred pain is characterized by pain in two separate locations.

Which of the following are considered solid organs? a. Liver and intestines b. Kidneys and bladder c. Spleen and stomach d. Pancreas and spleen

d. Pancreas and spleen

What is the major cause of death following injury to a hollow organ in the abdomen? a. Evisceration b. Internal hemorrhage c. Rigidity d. Sepsis

d. Sepsis --> The major cause of death when hollow abdominal organs are involved is sepsis, which typically occurs later in the hospital.