EMT- Chapter 35: Abdominal and Genitourinary Trauma

You are transporting an a/o M who sustained severe abd trauma. The primary assessment reveals a patent airway, RR 24. Breath sounds are present bilaterally. The pt has a rapid and weak pulse of 144 and BP of 29/64 and 92%. Best management of the respiratory and oxygenation would include: A. Positive pressure ventilation with supplemental oxygen B. High-concentration oxygen through a nonrebreather mask C. Application of a nasal cannula at 4 lpm O2 D. Encouraging the patient to slow his respirations

B. High-concentration oxygen through a nonrebreather mask

Kehr sign?

abdominal pain radiating to the left shoulder, due to peritoneal irritation from blood or irritants/ or from irritation of the diaphragm

Abdominal evisceration?

when an open wound thru the abd wall allows abd contents (usually the small intestine) to protrude out

The diaphragm is responsible for___-___% of the effort to breathe?

60-70%

How many liters of blood can expand the abd by 1 inch?

1.0-2.0 liters

A 45 y/o F fell off a trampoline. She his a picnic table with the left side of her lower rib cage. Now, she is very anxious and confused. Her airway is open and breathing is adequate. Her radial pulse is rapid and weak, and her skin is cool and diaphoretic. Pulse 132, RR 20, BP 102/78, 97%. The pt has ecchymosis to the left lower rib area as well as tenderness and instability of the ribs. She also has a superficial abrasion to her forehead. You would suspect and treat her for? A. Hypovolemic shock B. Hypoxia C. Spinal shock D. Closed head injury

A. Hypovolemic shock

Shoulder pain caused by blood irritating the diaphragm is called A. Kehr sign B. Babinski sign C. McRobert's sign. D. Kelly's sign.

A. Kehr sign

What is the most common cause of blunt abd trauma? A. Motor vehicle crashes B. Falls C. Gunshot wounds D. Assaults

A. Motor vehicle crashes

A pt with evisceration becomes tachycardia, cool, and hypotensive during transport. What would your next action be? A. Reevaluate the patient's priority status and expedite transport. B. Replace the dressing. C. Support the injury with the patient's arm D. Loosen one corner of the dressing.

A. Reevaluate the patient's priority status and expedite transport.

Your pt is the driver of a car that was hit head on. You find her lying on the sidewalk with her knees drawn toward her chest. She has no specific complaints. You suspect A. abdominal trauma due to the mechanism of injury and patient positioning. B. little or no injury because the patient has gotten out of the car C. cavitational injuries due to the mechanism of injury. D. paradoxical motion due to the patient positioning.

A. abdominal trauma due to the mechanism of injury and patient positioning.

Abd aortic injury may cause the pulses of the lower extremity to A. be weaker than the upper extremities. B. be stronger and bounding. C. be different on each foot. D. be easier to detect.

A. be weaker than the upper extremities. assess the popliteal or femoral pulses (they should be the same as the radial)

The damage that results from ruptured hollow abd organs is A. caused by acids and bacteria. B. not life-threatening. C. treatable in the field. D. caused by profuse bleeding.

A. caused by acids and bacteria.

Management of a F pt who has suffered a laceration to the genital area will include all of the following except A. vaginal packing. B. assessment for hypoperfusion. C. direct pressure. D. use of a sanitary pad.

A. vaginal packing.

A 74 y/o F complains of abd pain after falling down stairs off her front porch and striking her abd and left hand on the mailbox. The pt also reports pain in her left wrist and right ankle, both of which show obvious deformity. She is a/o and her abd is free of bruising and tender in the left upper and lower quadrants. Her vitals are pulse 132, RR 22, BP 106/86, 93%. O2 has been applied and the pt has full SMR. ALS have been requested and is 12 min away. What is your next action? A. Apply ice to the wrist and ankle while awaiting arrival of the ALS unit B. Initiate immediate transport and intercept with the ALS unit C. Monitor the patient and wait for ALS assistance D. Secure the wrist and ankle to board splints, initiate transport, and cancel the ALS unit

B. Initiate immediate transport and intercept with the ALS unit

You are assessing a young male pt who was assaulted with a baseball bat and struck once on the ULQ of the abd. You would recognize that this pt has Kehr's sign when he makes which statement? A. "I am having a hard time breathing!" B. "My belly hurts really bad." C. "My left shoulder is killing me!" D. "It really hurts for me to breathe."

C. "My left shoulder is killing me!"

You have been called for a male pt who was shot. Assessment reveals an entrance wound to the LLQ of the abd. A hemorrhagic exit wound to the left back is also located. What should you do immediately? A. Cover the abdominal wounds with dry sterile gauze dressings B. Auscultate the patient's breath sounds C. Cover the entrance wound with a gloved hand D. Place a cervical collar on the patient

C. Cover the entrance wound with a gloved hand

A 42 y/o M complains of back pain. The man tells you he was lying on the floor when his 5 y/o son unexpectedly jumped feet first onto his back. PMH of high BP and asthma for which he takes meds. Which finding provides the greatest indication that the pt has sustained an abd injury? A. Bruise to his back B. Mild nausea C. Discoloration around the umbilicus D. Shortness of breath

C. Discoloration around the umbilicus

You have arrived on the scene of an assault involving a knife. Assessment of the unresponsive 21 y/o M reveals him to have sustained multiple lacerations to the arms and abd, and a section of his intestine is now protruding through a laceration near the umbilicus. He has lost a sig amount of blood. HIs airway is open and breathing poor at 28. His radial pulse is weak, and his skin is cool and pale. What should the EMT do first? A. Cover the intestine with saline-soaked gauze B. Secure the patient to a long spine board C. Start positive pressure ventilation D. Check the blood pressure

C. Start positive pressure ventilation

At the scene of a vehicle accident, a car has extensive front-end damage and a deformed steering wheel. The restrained driver who was self-extricated is in the care of EMRs, who have applied a c-collar and continue SMR. The pt's airway is patent, respirations adequate. Pulse is rapid and weak, and his skin is cool and diaphoretic. the EMRs report vitals: pulse 136, RR 20, BP 100/68, 95%. The right forearm is deformed, and the head, chest and upper back are uninjured. Your next action would be A. Start positive pressure ventilation B. Repeat the vital signs C. Change the nonrebreather mask to a nasal cannula D. Check the abdomen for injury

D. Check the abdomen for injury

On scene, you encounter a restless patient who has been stabbed in the URQ of the abd and complaining of abdominal pain and a dry mouth. Assessment reveals no immediate life threats to the airway or breathing. The radial pulse is rapid and weak and the skin cool and diaphoretic. Vital signs are: pulse 124, respirations 20, blood pressure 122/88, and SpO2 97%. The injury is isolated with no involvement of the head, neck, or back. In managing the scene and patient, what observation would cause you to immediately intervene? A. An EMR placing his gloved hand over the injury to control the bleeding B. Application of supplemental oxygen C. An EMR placing the patient in a lateral recumbent position with the knees flexed D. Family giving the patient water to drink since he is thirsty

D. Family giving the patient water to drink since he is thirsty

Management of an injury caused by blunt trauma to the scrotum may include A. bleeding control. B. direct pressure. C. cold compresses. D. all of the above

D. all of the above

Apply what kind of dressing to an abd evisceration?

clear, sterile dressing soaked in saline or sterile water

Blood is not ___ to the peritoneal lining and may not cause acute severe abd pain suddenly.

irritating