Abdominal and Genitourinary Trauma

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? A. What does your blood pressure normally run? B. Do you take any over-the-counter medications? C. Has blood soaked through your undergarments? D. Have you experienced recent abdominal trauma?

Have you experienced recent abdominal trauma?

The mesentery is: A. the point of attachment between the small and large intestines. B. a layer of thick skeletal muscles that protects the abdominal organs. C. a complex network of blood vessels that supply blood to the liver. D. a membranous fold that attaches the intestines to the walls of the body.

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

Compression injuries to the abdomen that occur during a motor vehicle crash are typically the result of: A. air bag deployment. B. failure to wear seatbelts. C. a poorly placed lap belt. D. rapid vehicle deceleration.

a poorly placed lap belt.

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: A. transport only if signs of shock begin to develop. B. carefully probe the wound to determine its depth. C. assume that the arrow injured an internal organ. D. clean the wound and apply a dry, sterile dressing.

assume that the arrow injured an internal organ.

When worn properly, a seatbelt should lie: A. below the anterior superior iliac spines of the pelvis and against the hip joints. B. across the abdominal wall at the level of the diaphragm and below the hip joints. C. above the anterior posterior iliac spines of the pelvis and below the hip joints. D. across the abdominal wall at the level of the umbilicus and against the hip joints.

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

A football player was struck by another player in the right flank area just below the posterior rib cage. He complains of severe pain and point tenderness to the area. Your assessment reveals that there is a small amount of blood in his underwear. You should be MOST suspicious for: A. external genitalia injury. B. a lacerated liver or spleen. C. blunt injury to the kidney. D. a ruptured urinary bladder.

blunt injury to the kidney.

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

closely monitor him and reassess him frequently.

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

diaphragm.

A sign of kidney damage following blunt trauma is: A. hematuria. B. hemoptysis. C. hematemesis. D. hematochezia.

hematuria.

During your assessment of a patient who experienced blunt trauma to the abdomen, you notice bruising around the umbilicus. This is a sign of: A. a ruptured spleen. B. a severe liver laceration. C. intra-abdominal bleeding. D. rupture of a hollow organ.

intra-abdominal bleeding.

Which of the following organs would MOST likely bleed profusely when injured? A. bladder B. liver C. stomach D. intestine

liver

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

peritonitis may not develop for several hours.

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

prompt transport to the hospital is essential.

Early bruising following abdominal trauma often manifests as: A. localized pain. B. red areas of skin. C. gross distention. D. dark purple marks.

red areas of skin.

Which of the following statements regarding abdominal trauma is correct? A. Most of the vital abdominal organs lie within the retroperitoneal space. B. The absence of abdominal pain does not rule out intra-abdominal bleeding. C. The liver is well protected and is rarely injured during a traumatic event. D. Hollow abdominal organs are vascular and bleed profusely when injured.

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

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

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

applying direct pressure with a dry, sterile dressing.

When documenting a call involving a female patient who was sexually assaulted, the EMT should: A. theorize as to why the sexual assault occurred. B. include the results of his or her internal vaginal exam. C. include a description of the suspected perpetrator. D. avoid speculation and document only factual data.

avoid speculation and document only factual data.

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

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

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: A. covering him with a warm blanket. B. giving him small sips of plain water. C. promptly transporting to the hospital. D. administering supplemental oxygen.

giving him small sips of plain water.

Contraction or tensing of the abdominal muscles in an effort to ease pain is called: A. flexing. B. referring. C. guarding. D. withdrawing.

guarding.

Air bags, in conjunction with properly worn seatbelts, are MOST beneficial when a person is involved in a: A. rollover crash. B. lateral collision. C. head-on crash. D. rear-end collision.

head-on crash.

All of the following are hollow abdominal organs, EXCEPT for the: A. liver. B. bladder. C. ureters. D. stomach.

liver.

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 blood pressure 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: A. apply full spinal motion restriction precautions. B. keep him on his side but gently straighten his legs. C. place him supine but allow him to keep his knees bent. D. transport him in the position in which you found him.

transport him in the position in which you found him.

Which of the following organs is at MOST risk for injury as the result of a pelvic fracture? A. pancreas B. fallopian tubes C. urinary bladder D. liver or spleen

urinary bladder