AEMT Chapter 39

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You are caring for a patient who you suspect has severe peritonitis. If this field impression is​ correct, what type of organ has likely​ perforated, causing the​ problem? A. vascular B. hollow C. solid D. retroperitoneal

B. hollow Hollow organs are not as vascular as solid organs.​ Therefore, they do not produce as much risk of internal bleeding when injured.​ However, they do contain digestive enzymes and waste that can cause inflammation and infection of the peritoneum called peritonitis. When acidic digestive enzymes are released into the peritoneal​ cavity, it typically results in immediate pain.

What is the large solid organ located primarily in the upper right quadrant of the abdominal​ cavity? A. spleen B. liver C. ascending colon D. right kidney

B. liver The liver is the solid organ that is located primarily in the upper right quadrant of the abdomen. The spleen is in the upper left​ quadrant, and the right kidney is a lower​ situated, retroperitoneal structure. The ascending colon is partly in the upper right​ quadrant, but it is a hollow organ.

Which of the following injuries that occurs to the abdomen would most likely create a​ life-threatening intra-abdominal​ bleed? A. stomach laceration B. liver fracture C. tear to the jejunum D. rupture of the urinary bladder

B. liver fracture The liver is a solid organ that receives a large amount of cardiac​ output, owing to its vascularity. When it is injured​ (the term used for a damaged liver is​ "fractured"), it can bleed profusely into the fascia capsule that encases it. If that capsule​ ruptures, the bleeding can occur freely into the abdominal cavity. Hollow organs​ however, do not bleed to the same extent as solid organs​ do; therefore, injuries to hollow organs are not as life threatening.

The patient you are caring for is complaining of intense abdominal pain. During your physical​ assessment, you start to palpate the abdomen but notice that every time you do​ so, the patient tenses up his abdominal muscles. This is known​ as: A. active abdominal spasms. B. voluntary guarding. C. autonomic muscle guarding. D. purposeful contraction.

B. voluntary guarding. When a tender area of the abdomen is being​ palpated, the abdomen may tense up in anticipation of palpation. This is called voluntary guarding and is a natural response to reduce pain associated with palpation.

Why would a patient with significant​ intra-abdominal injury and a suspected​ intra-abdominal bleed, who is found unresponsive and​ hypotensive, most likely have an airway​ occlusion? A. The hypoperfusion from the blood loss can cause brainstem​ failure, causing the patient to be unable to manage her own airway B. As the patient becomes​ unresponsive, the weight of the abdominal cavity pushes up on the diaphragm and causes the airway to close off. C. Many​ times, abdominal trauma​ co-occurs with neck trauma that can occlude the airway. D. Because the patient is supine and probably on a​ backboard, the neck muscles relax and occlude the airway.

A. The hypoperfusion from the blood loss can cause brainstem​ failure, causing the patient to be unable to manage her own airway During a hypoperfusive​ state, the brainstem does not receive adequate blood flow​ and, as a​ result, is unable to provide appropriate neural stimulation to the muscles of the airway to keep it patent.

An injury to the abdomen that results in an overlying​ contusion, abdominal​ pain, and guarding but no open​ soft-tissue trauma would most likely be from what​ mechanism? A. getting hit in the abdomen by a baseball bat B. puncture wound from a knife C. injury with external bleeding from an explosion D. primary blast injury

A. getting hit in the abdomen by a baseball bat Blunt trauma is the type of mechanism by which energy is transmitted to the abdomen by an object that strikes the abdomen​ (in this​ instance, the​ bat). The internal structures of the body can become​ damaged, resulting in pain and guarding.​ However, there is no open​ soft-tissue injury from blunt trauma mechanisms.

A patient with​ Kehr's sign would display what​ finding? A. pain in the left shoulder B. premature contraction of the ventricles C. difficulty in swallowing D. RLQ pain on palpation

A. pain in the left shoulder Kehr's sign is referred pain to the left shoulder caused by diaphragmatic​ irritation, which is caused by the presence of blood and may indicate splenic injury.

What is the superior border of the abdominal​ cavity? A. inferior mesenteric fold B. diaphragm C. rectus abdominus muscle D. parietal peritoneum

B. diaphragm The upper border of the abdominal cavity is the diaphragm. The anterior and lateral borders are the abdominal​ musculature, and the inferior border is the pelvis.

During your reassessment of the patient with abdominal​ trauma, you note that the​ patient's pulse pressure is continuing to​ narrow, even though his systolic pressure is still​ >90 mmHg. The heart rate has gone from​ 112/min initially to​ 124/min currently. What does this reassessment information tell​ you? A. The patient should have been flown from the scene by an aeromedical service. B. The patient is remaining clinically stable. C. The patient is continuing to deteriorate. D. The patient is improving with treatment.

C. The patient is continuing to deteriorate The narrowing of the pulse pressure and the elevating heart rate are both indicative of ongoing shock syndrome. The patient should receive ongoing management for the injuries and expedient transport to the hospital. If the patient was previously categorized as​ stable, this new information should be considered as demonstrating instability.

What should you suspect if a patient is complaining of pain to the left shoulder even though is traumatic injury occurred to the anterior abdominal​ wall? A. A fractured scapula is also likely present. B. It results from referred pain due to liver injury. C. The patient may have a splenic injury. D. It is referred pain from an anterior clavicular injury.

C. The patient may have a splenic injury. ​Kehr's sign is referred pain to the left shoulder caused by diaphragmatic​ irritation, which is caused by the presence of blood and may indicate splenic injury. You need to maintain a high index of suspicion for abdominal injuries whenever there is atypical presentation.

A patient is found unresponsive in an alley and is suspected to be the victim of a robbery. The patient is found unresponsive and hypotensive. The only outward sign of injury is a puncture to the abdomen near the​ umbilicus, and the abdomen is markedly distended. Given this​ information, what would be the most likely mechanism of​ injury? A. disruption of the spinal cord from a traumatic fall B. blunt trauma to the abdomen from getting punched C. penetration from a knife wound D. brain injury from a skull fracture

C. penetration from a knife wound Penetration injuries to the abdomen are a common mechanism that results in vascular structure damage. This would result in an obvious​ soft-tissue injury on the abdominal wall​ (the knife​ wound), and with the heavy bleeding that would accompany the injured vascular​ structure, the abdomen would become distended.

You arrive on scene to a female patient who is in cardiac arrest secondary to a MVC. The patient is seemingly uninjured except for a large abdominal contusion and significant abdominal distention. If the patient went into arrest due to an​ intra-abdominal bleed and severe​ hemorrhage, what organ was most likely​ damaged? A. duodenum B. transverse colon C. spleen D. uterus

C. spleen The spleen is a solid organ that is highly vascular​ and, if damaged due to​ trauma, can bleed significantly into the abdominal​ cavity, causing abdominal distention. The blood loss can be severe enough to cause the patient to go into cardiac arrest. The other organs listed are hollow and do not characteristically bleed significantly with damage.

You are managing a patient with a suspected abdominal injury. The patient is found unresponsive with rapid​ breathing, tachycardia, and hypotension. Capillary refill is​ delayed, the pulse ox is​ diminishing, and you see a large contusion to the upper and lower left quadrants of the abdomen. What type of injury has most likely​ occurred? A. solid organ damage B. hollow organ damage C. vascular organ damage D. skeletal structure damage

C. vascular organ damage There are essentially three types of abdominal​ organs: solid organs such as the​ liver, spleen,​ pancreas, and​ kidneys; hollow organs such as the GI​ structures; and vascular organs such as the descending aorta and inferior vena cava. Of​ these, injury to the vascular organs would result in the most severe hemorrhage.

You are managing a patient who has a grossly distended abdomen following a MVC in which he was ejected from a car. Given the mechanism of injury and the concurrent​ findings, you believe that the patient is suffering from a significant​ intra-abdominal bleed. During your​ management, you are attempting to ventilate the patient with a​ BVM, but you notice that there is poor lung compliance with each delivered breath. Why would a large bleed into the abdomen make it more difficult to ventilate the​ patient? A. The blood that you think is going into the abdominal compartment is actually going into the thoracic compartment. B. Bleeding in the abdomen causes​ hypotension, which causes the brainstem to​ fail, resulting in poor lung compliance. C. It is normal for a hemorrhage into the abdomen to leak into the thoracic​ cavity, causing a hemothorax. D. A large amount of blood in the free abdomen makes it harder for the diaphragm to drop lower during ventilations.

D. A large amount of blood in the free abdomen makes it harder for the diaphragm to drop lower during ventilations. During​ breathing, the diaphragm has to descend lower into the abdominal cavity to allow space for lung inflation.​ However, if the abdominal cavity is distended with​ blood, it will be harder for the diaphragm to displace itself into the abdominal​ cavity, thereby making it harder to ventilate the lungs.

A patient with blunt abdominal trauma presents as hypotensive and tachycardic and responds only to pain. You notice that the patient has an extremely distended abdomen that is firm to palpation. Given these​ findings, which of the following is most​ correct? A. The patient has early indications of abdominal trauma. B. The patient will also display​ Kehr's sign from the abdominal trauma. C. The hypotension and tachycardia are not related to the distended abdomen. D. He has likely lost more than 1.5 liters of blood in the abdomen.

D. He has likely lost more than 1.5 liters of blood in the abdomen. The abdominal cavity can hold 1.5 or more liters of blood before distention occurs.​ Therefore, distention is a late sign of hemorrhagic abdominal injury. Loss of this much blood can easily cause the​ patient's orientation to​ diminish, blood pressure to​ drop, and heart rate to increase.​ However, patients can also have very significant​ intra-abdominal injury without the presence of distention.

A​ 17-year-old boy was stabbed once in the abdomen in an altercation. He presents with several loops of bowel protruding from a​ 4-inch laceration of the​ abdomen, just below the umbilicus. Bleeding is​ minimal, but the patient is very distraught. He is alert and​ oriented, but gaining cooperation is difficult because of his emotional state. His skin is warm and moist. Vital​ signs: HR​ 92, BP​ 118/84, RR​ 20, SpO2​ 100% on room air. What treatment plan is best for this​ patient? A. complete a rapid trauma​ exam, cover the eviscerated organs with a sterile dressing wetted with normal​ saline, cover the wet dressing with an occlusive​ dressing, position the patient in a position of​ comfort, transport, start two​ large-bore IVs and rapidly infuse isotonic crystalloids B. complete a rapid trauma exam and a detailed​ head-to-toe exam, cover the eviscerated organs with an occlusive dressing that is sealed on three​ sides, position the patient in a position of​ comfort, start two​ large-bore IVs at a​ keep-open rate, transport C. immediately cover the open wound with an occlusive​ dressing, perform a detailed​ head-to-toe examination, immobilize the patient to a​ long-backboard, transport D. complete a rapid trauma​ exam, cover the eviscerated organs with a sterile dressing wetted with normal​ saline, cover the wet dressing with an occlusive​ dressing, position the patient in a position of​ comfort, transport, start two​ large-bore IVs at a​ keep-open rate

D. complete a rapid trauma​ exam, cover the eviscerated organs with a sterile dressing wetted with normal​ saline, cover the wet dressing with an occlusive​ dressing, position the patient in a position of​ comfort, transport, start two​ large-bore IVs at a​ keep-open rate Even though the​ patient's vital signs are​ normal, he has a significant mechanism of injury​ (penetrating trauma to the​ torso). He requires a rapid trauma assessment and basic stabilization on the​ scene, transport without undue​ delay, and further assessment and management en route to the emergency department. Penetrating injury to the torso carries a high risk of​ hemorrhage, so the patient should have two IVs in​ place, although fluid infusion is not warranted at this point. The mechanism of injury is not consistent with the potential for spinal cord​ injury, and spinal immobilization is not necessary.​ Therefore, the patient should be transported in a position of​ comfort, which is most likely to be supine with the hips and knees flexed. The specific management of evisceration is to use a​ wet, sterile dressing to prevent the exposed organs from drying out and protect them from​ contamination; and to cover the wet dressing with an occlusive dressing to prevent the wet dressing from drying​ out, prevent contamination of the wet​ dressing, and to help maintain the temperature of the exposed organs.

A​ 52-year-old man was the restrained driver of a midsized sedan that struck a bridge abutment at about 55 miles per hour. He is alert and​ anxious, with​ cool, dry, slightly pale skin. His chief complaints are pain across his sternum and abdominal pain. Your examination reveals minor abrasions to the face that are consistent with front airbag​ deployment, a developing contusion from the left shoulder to the right upper​ abdomen, consistent with his shoulder​ harness, and a developing contusion across the​ abdomen, just below the​ umbilicus, consistent with wearing the lap belt incorrectly. The patient states that he has pain with inspiration. You find no deformity or instability of the chest wall or​ sternum, and breath sounds are clear. The abdomen is diffusely tender to palpation with voluntary guarding. Vital​ signs: HR​ 92, BP​ 132/90, RR​ 24, SpO2​ 93% on room air. The best way to prioritize management of this patient​ is: A. oxygen by nasal​ cannula, spinal​ immobilization, transport, two​ large-bore IVs at a keep open​ rate, nitrous oxide by​ self-administration B. oxygen by nonrebreather​ mask, transport the patient in a position of​ comfort, start two​ large-bore IVs and rapidly infuse isotonic crystalloid fluids C. transport in a position of​ comfort, start an IV en route as a precautionary measure D. oxygen by nasal​ cannula, spinal​ immobilization, transport, two​ large-bore IVs at a​ keep-open rate

D. oxygen by nasal​ cannula, spinal​ immobilization, transport, two​ large-bore IVs at a​ keep-open rate The patient has a critical mechanism of injury​ (impact at 55​ mph) with evidence of chest and abdominal injury. The mechanism is significant for not only cervical spine​ injury, but lumbar spine injury as well​ (the misplaced lap belt can result in forcing the lumbar spine beyond its range of​ motion). Spinal immobilization is necessary. The vital signs are currently​ normal, except for a slightly low SpO2 of​ 93%, but the potential for deterioration must be taken​ seriously, given the mechanism of injury and evidence of chest and abdominal injury. You should treat the mild hypoxia with oxygen by NRB​ mask, immobilize, and begin transport to minimize scene time. Start two​ large-bore IVs en route to the emergency​ department, but the​ patient's perfusion status does not currently call for aggressive fluid resuscitation. Nitrous oxide is contraindicated in patients who may have injuries to the bowel or potential for pneumothorax.

On which patient should the Advanced EMT plan to complete a reassessment every 5 minutes during transport to the​ hospital? A. responsive male with an open fracture to his left forearm B. responsive female with​ tachycardia, normotension, and adequate respirations C. unresponsive male found pinned beneath a​ car, with an open skull fracture with brain matter​ showing, a distended​ abdomen, and currently no pulse or breathing. D. unresponsive female with a distended abdomen after a MVC

D. unresponsive female with a distended abdomen after a MVC An unresponsive patient with a distended abdomen has likely been bleeding into the abdominal​ cavity, which results in distention.​ Also, the drop in blood pressure will cause a diminishment in the cerebral perfusion​ pressure, contributing to the disorientation or unresponsiveness.


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