Chapter 30
hematuria
Blood in the urine.
Open abdominal injuries are also known as: A. blunt injuries B. eviscerations C. penetrating injuries D. peritoneal injuries
C
The presence of tachycardia following a significant abdominal injury: A. indicates a state of decompensated shock B. should be assumed to be a sign of shock C. is most commonly caused by severe pain D. is always accompanied by hypo tension
C
Low-velocity injuries
Caused by hand-held or hand-powered objects such as knives and other edged weapons
The first signs of peritonitis include all of the following EXCEPT: A. severe abdominal pain B. tenderness C. muscular spasm D. nausea
D
Which of the following statements regarding rebound tenderness is correct?
It is often discovered when the patient is jarred or moved suddenly.
You should have an index of suspicion that a patient with pain referred to the right shoulder has an injury to which organ?
Liver
Which of the following statements regarding abdominal eviscerations is correct?
The protruding organs should be kept warm and moist.
An unresponsive trauma patient has a large open abdominal wound with massive external bleeding. You should:
apply direct pressure to the wound.
The temporary wound channel caused by high-velocity weapons is called _______.
cavitation
In pediatric patients, the liver and spleen are _______.
larger in proportion to the abdomen
You are dispatched to a residence for a young female who was kicked in the abdomen. While en route to the scene, you should ask the dispatcher if:
law enforcement is at the scene.
Because the depth of an open abdominal wound is often difficult to determine:
prompt transport to the hospital is essential.
All of the following are hollow abdominal organs, EXCEPT the:
spleen.
Most of the ________ system lies behind the digestive tract.
urinary
A 21-year-old male was working in an auto repair shop and sustained radiator burns to the anterior aspect of both arms and to his anterior chest. According to the rule of nines, this patient has burns that cover _____ of his BSA.
18%
A patient with a head injury presents with abnormal flexion of his extremities. What numeric value should you assign to him for motor response?
3
Abdominal pain, vomiting, and fever are most likely due to _______. Select one: A. infection B. hemorrhage C. evisceration D. hypovolemia
A
Because solid organs have a rich supply of blood, any injury can result in major: A. hemorrhaging B. damage C. pain D. guarding
A
Patients with open abdominal injures often complain of: A. pain B. nausea C. vomiting D. dyspnea
A
Suspect a possible injury of the urinary bladder in all of the following findings EXCEPT: A. bruising to the left upper quadrant B. blood at the urethral opening C. blood at the tip of the penis or a stain on the patient's underwear D. physical signs of trauma on the lower abdomen, pelvis or perineum
A
The largest organ in the abdomen is the: A. liver B. spleen C. pancreas D. kidneys
A
The major complaint of patients with abdominal injury is: A. pain B. tachycardia C. rigidity D. swelling
A
The solid organs of the urinary system include the: A. kidneys B. ureters C. bladder D. urethra
A
Which of the following is true regarding injury to the kidneys? Select one: A. Injury to the kidneys usually indicates injury to other organs. B. Only minimal force is needed to damage the kidneys. C. The kidneys are not well protected. D. Kidney injuries are rarely caused by blunt trauma.
A
While assessing a 21 year old female who struck a tree head-on with her small passenger car, you not that her air bag deployed. You should: A. life the air bag and look for deformity to the steering wheel. B. carefully assess her upper chest for seat belt-related injuries C. perform a head-to-toe assessment while she is in the car D. extricate her immediately and transport to a trauma center
A
Which of the following is true about injuries to the kidneys?
A sign of kidney damage is hematuria. A penetrating wound that reaches the kidneys almost involves other organs.
If applying a dressing to control the bleeding of a patient's arm, the EMT should ________.
A. apply direct pressure first B. use large or small gauze pads or dressings depending upon the size of the wound C. cover the entire wound, above and below, with the dressing D. All of these answers are correct. Correct
open abdominal injuries
An injury in which there is a break in the surface of the skin or mucous membrane, exposing deeper tissue to potential contamination
closed abdominal injuries
An injury in which there is soft-tissue damage inside the body but the skin remains intact.
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 assesment reveals that he is conscious and alert with stable vital signs. The entrance wound is bleeding minimally and appears to be superifical. You should: A. carefully probe the wound to determine its depth B. assume that the arrow injured an internal organ C. clean the wound and apply a dry, sterile dressing D. transport only if signs of shock begin to develop.
B
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. Do you take any over-the-counter medications? B. Have you experienced recent abdominal trauma? C. Has blood soaked through your undergarments? D. What does your blood pressure normally run?
B
Air in the abdominal cavity can cause all of the following EXCEPT: A. pain B. diarrhea C. infection D. tissue ischemia and infarction
B
Because the depth of an open abdominal wound is often difficult to determine: Select one: A. the abdomen must be vigorously palpated. B. prompt transport to the hospital is essential. C. vital signs should be monitored frequently. D. the EMT must perform a thorough exam.
B
Blunt abdominal injuries may result from: A. a stab wound B. seat belts C. a gunshot wound D. an impaled object
B
Compression injuries to the abdomen that occur during a motor vehicle crash are typically the result of: A. air bag deployment B. a poorly placed lap belt C. failure to wear seat belts D. rapid vehicle deceleration
B
Following blunt abdominal trauma, a 30 year old male complains of referred pain to the left shoulder. This finding is called the: A. Grey Turner sign B. Kehr sign C. Brudzinski sign D. Cullen sign
B
In any case of trauma to a female patient, you should always determine if the patient: A. is on birth control B. is pregnant C. is currently menstruating D. has a history of ovarian cysts
B
In cases of sexual assault, which of the following is true? A. You should always examine the genitalia for any sign of injury B. Advise the patient not to wash, urinate or defecate C. In addition to recording the facts, it is important to include your personal thoughts D. You should use plastic bags when collecting items such as clothes
B
Late signs of peritonitis may include: A. soft abdomen B. nausea C. normal bowel sounds D. diarrhea
B
The most common sign of significant abdominal injury is: A. pain B. tachycardia C. rigidity D. distention
B
When treating a patient with an amputation of the penile shaft, your top priority is: A. locating the amputated part B. controlling bleeding C. keeping the remaining tissue dry D. delaying transport until bleeding is controlled
B
Which of the following is NOT a hollow organ of the abdomen? A. Stomach B. Liver C. Bladder D. Urters
B
You respond to an 18 year old high school football player who was hit in the right flank with a helmet several hours ago. He is complaining of pain in the area. He is alert and oriented. His airway is open and his respirations are within normal limits. His pulse is regular. He has a radial pulse. He tells you that he is noticing blood in his urine. Based on this information, the patient is likely to have an injury to the: A. liver B. kidney C. gallbladder D. appendix
B
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. arrange for a rape crisis center representative to speak with the patient. B. control any external bleeding, administer oxygen, and transport at once. C. visualize the vaginal area and pack the vagina with sterile dressings D. allow her to change her clothes and take a shower before you transport
B
Your primary concern when dealing with an unresponsive patient with an open abdominal injury is: A. covering the wound with a moist dressing B. maintaining the airway C. controlling the bleeding D. monitoring vital signs
B
melena
Black, foul-smelling, tarry stool containing digested blood
All of the following male genitalia lie outside the pelvis cavity EXCEPT the: A. urethra B. penis C. seminal vesicles D. testes
C
Signs of injury to the kidney may include any of the following EXCEPT: A. bruises or lacerations on the overlying skin B. shock C. increased urgency of urination D. hematuria
C
When treating a patient with an evisceration, you should: A. attempt to replace the abdominal contents B. cover the protruding organs with a dry, sterile dressing C. cover the protruding contents with moist, sterile gauze compresses
C
_____ takes place in the solid organs. A. digestion B. Excretion C. Energy production D. Absorption
C
High-velocity injuries:
Caused by larger weapons such as high-powered rifles and the higher-powered handguns
Medium-velocity penetrating wounds:
Caused by smaller caliber handguns and shotguns
All of the following systems contain organs that make up the contents of the abominal cavity EXCEPT: A. the digestive system B. the urinary system C. the genitourinary system D. the limbic system
D
Difficulty breathing and a sunken appearance of the anterior abdominal wall is MOST indicative of a ruptured: Select one: A. stomach. B. aorta. C. spleen. D. diaphragm.
D
In pediatric patients, the liver and spleen are _______. Select one: A. more protected by the thorax compared to adults B. smaller in proportion to the abdomen C. less likely to bleed when injured D. larger in proportion to the abdomen
D
Injuries to the external male genitalia _______. Select one: A. usually result in permanent damage B. are often life-threatening C. frequently lead to hypovolemic shock D. are rarely life-threatening
D
Suspect kidney damage if the patient has a history or physical evidence of all of the following EXCEPT: A. an abrasion, laceration, or contusion in the flank B. a penetrating wound in the lower rib cage or the upper abdomen C. fractures on either side of the lower rib cage D. a hematoma in the umbilical region
D
When a patient stiffens the muscles of the abdomen, it is known as _______. Select one: A. crepitus. B. distention. C. instability. D. guarding.
D
When performing a history on a patient with abdominal trauma, which of the following questions would be appropriate regarding trauma? A. Is there any blood in your stool? B. Does your pain go anywhere? C. Do you have any nausea, vomiting or diarrhea? D. All of the above
D
Which of the following statements regarding abdominal evisceration's is correct? A. Adherent material is preferred when covering an evisceration. B. The organs should be replaced carefully to avoid heat loss. C. Most evisceration's occur to the left upper quadrant D. The protruding organs should be kept warm and moist.
D
You are called to the local bar where a fight has taken place. The police department tells you that you have a 36 year old man who has been stabbed twice in the abdomen. Upon your arrival, the patient is alert and oriented. His airway is open. His respirations are at 24 breaths/min, pulse is rapid, regular and weak. He has distal pulses. With the penetrating trauma, you should assume that the object: A. has penetrated the peritoneum B. has entered the abdominal cavity C. has possibly injured one or more organs D. all of the above
D
You are dispatched to a residence for a young female who was kicked in the abdomen by her boyfriend. While en route to the scene, you should ask the dispatcher if: A. the severity of the injury is known. B. the patient is conscious. C. there are other patients involved. D. law enforcement is at the scene.
D
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. reassess his vital signs and then notify the receiving hospital of the change in his clinical status. C. suction his oropharynx to ensure it is clear of secretions and then increase the oxygen flow rate to 15 L/min. D. insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a BVM.
D
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. begin documenting the call on the patient care form. B. perform a comprehensive secondary assessment. C. forgo the hospital radio report because of his condition. D. closely monitor him and reassess him frequently.
D
Your documentation on a sexual assault victim should _______. Select one: A. include your opinion of the nature of the incident B. describe the status of the suspect(s) C. be subjective and summarize the crime D. be objective and factual
D
A 12-year-old male jumped approximately 12 feet from a tree and landed on his feet. He complains of pain to his lower back. What injury mechanism is MOST likely responsible for his back pain?
Energy transmission to the spine
What is the most common mechanism of injury in geriatric patients?
Falls
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 pulse is rapid. Further assessment reveals that his blood pressure is 112/60 mm Hg. Which of the following questions would be MOST pertinent to ask him?
Have you experienced recent abdominal trauma?
Which of the following signs would indicate that an injury to the kidney has occurred?
Hematuria
Compression injury is most likely due to which of the following?
Improperly placed lab belt
Which of the following is true regarding injury to the kidneys?
Injury to the kidneys usually indicates injury to other organs.
guarding
Involuntary muscle contractions (spasm) of the abdominal wall to minimize the pain of movement and protect the inflamed abdomen; a sign of peritonitis
Bruising over the right upper quadrant could indicate injury to which of the following?
Liver
Which of the following organs would MOST likely bleed profusely when injured?
Liver
Three levels of velocity that are common in traumatic injuries:
Low-velocity injuries; Medium-velocity penetrating wounds; High-velocity injuries:
When should you visually inspect the external genitalia on your patient?
Only when there is a complaint of severe pain or other injury
Which of the following are considered solid organs?
Pancreas and spleen
Which of the following is an indication of a spleen injury?
Referred left shoulder pain
The genitourinary system controls:
Reproductive functions The waste discharge system
What is the major cause of death following injury to a hollow organ in the abdomen?
Sepsis
solid organs
Solid masses of tissue where much of the chemical work of the body takes place (e.g., the liver, spleen, pancreas, and kidneys).
hollow organs
Structures through which materials pass, such as the stomach, small intestines, large intestines, ureters, and urinary bladder.
peritoneal cavity
The abdominal cavity.
evisceration
The displacement of organs outside of the body.
Left lower quadrant (LLQ)
The left lower quadrant holds both the large and small intestines, notably the descending colon and the left half of the transverse colon.
peritoneum
The membrane lining the abdominal cavity (parietal peritoneum) and covering the abdominal organs (visceral peritoneum).
flank
The region below the rib cage and above the hip.
Left upper quadrant (LUQ)
The stomach occupies most of the LUQ, but it shares this space with the spleen. The pancreas occupies some of this space but is mostly posterior to the region.
What is the purpose of wrapping a sexual assault victim in a burn sheet?
To preserve potential evidence
A patient who has sustained a blunt abdominal injury should be log rolled to a supine position onto a backboard.
True
A very common early sign of a significant abdominal injury is tachycardia.
True
Free air in the peritoneal cavity is abnormal and indicates that a hollow organ or loop of bowel has perforated.
True
You should allow patients with peritonitis to lie still with their legs drawn up.
True
Which of the following organs is at MOST risk for injury as the result of a pelvic fracture?
Urinary bladder
Which of the following statements regarding trauma during pregnancy is correct?
Uterine trauma is likely to cause shock in the pregnant patient.
Following blunt trauma to the face, a 21-year-old male complains of a severe headache and decreased ability to move his eyes. This patient's clinical presentation is MOST consistent with:
a blowout fracture.
You should suspect a kidney injury anytime the patient presents with _______.
a hematoma in the flank region
Compression injuries to the abdomen that occur during a motor vehicle crash are typically the result of:
a poorly placed lap belt.
An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is:
a rapid deterioration of neurologic signs.
Common signs and symptoms of a serious head injury include all of the following, EXCEPT:
a rapid, thready pulse.
A flail chest occurs when:
a segment of the chest wall is detached from the thoracic cage.
An open pneumothorax occurs when:
air enters the pleural space from outside the body.
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:
applying direct pressure with a dry, sterile dressing.
Injuries to the external male genitalia _______.
are rarely life-threatening
A young male sustained a gunshot wound to the abdomen during an altercation. As your partner is assessing and managing his airway, you should control the obvious bleeding and then:
assess for an exit wound.
A young male was shot in the abdomen by an unknown type of gun. He is semiconscious, has shallow breathing, and is bleeding externally from the wound. As you control the external bleeding, your partner should:
assist the patient's ventilations.
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:
assume that the arrow injured an internal organ.
When documenting a call involving a female patient who was sexually assaulted, the EMT should:
avoid speculation and document only factual data.
A man jumped from the roof of his house and landed on his feet. He complains of pain to his heels, knees, and lower back. This mechanism of injury is an example of:
axial loading.
Your documentation on a sexual assault victim should _______.
be objective and factual
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:
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:
closely monitor him and reassess him frequently.
A 30-year-old female presents with redness, inflammation, and pain to her left eye. During your assessment, you note that she is having difficulty keeping her eyes open. You should suspect that she is experiencing:
conjunctivitis.
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:
control any external bleeding, administer oxygen, and transport at once.
A closed soft-tissue injury characterized by swelling and ecchymosis is called a(n):
contusion.
A man has a large laceration across his lower abdominal wall and a loop of bowel is protruding from the wound. He is conscious and alert and there is minimal bleeding from the wound. You should:
cover the exposed bowel with a moist sterile dressing and then secure it in place with a dry bandage.
Difficulty breathing and a sunken appearance of the anterior abdominal wall is MOST indicative of a ruptured:
diaphragm.
Bleeding from soft-tissue injuries to the face is MOST effectively controlled with:
direct pressure using dry, sterile dressings
You are assessing a patient who reports pain that is tearing and describes it as going from the abdomen posteriorly. What should you suspect?
dissecting abdominal aneurysm
A 67-year-old male presents with weakness, dizziness, and melena that began approximately 2 days ago. He denies a history of trauma. His blood pressure is 90/50 mm Hg and his pulse is 120 beats/min and thready. You should be MOST suspicious that this patient is experiencing:
gastrointestinal bleeding.
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:
giving him small sips of plain water.
When a patient stiffens the muscles of the abdomen, it is known as _______.
guarding.
Hyperextension injuries of the spine are MOST commonly the result of:
hangings.
According to the American College of Surgeons Committee on Trauma (ACS-COT), an adult trauma patient should be transported to the highest level of trauma center if he or she:
has a GCS score of less than or equal to 13 with a mechanism attributed to trauma
A sign of kidney damage following blunt trauma is:
hematuria.
Damage to solid organs typically leads to _______.
hemorrhage
Abdominal pain, vomiting, and fever are most likely due to _______.
infection
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:
insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a BVM.
Abdominal rigidity and periumbilical bruising are signs of _______.
internal bleeding
Following a blunt injury to the head, a 22-year-old female is confused and complains of a severe headache and nausea. On the basis of these signs and symptoms, you should be MOST concerned with the possibility of:
intracranial bleeding.
In contrast to a cerebral concussion, a cerebral contusion:
involves physical injury to the brain tissue.
A factory worker was splashed in the eyes with a strong acid chemical. He complains of intense pain and blurred vision. Your ambulance does not carry bottles of sterile saline or water. You should:
irrigate both eyes continuously for 20 minutes with plain water.
A simple pneumothorax:
is commonly caused by blunt chest trauma
A tight-fitting motorcycle helmet should be left in place unless:
it interferes with your assessment of the airway.
Management of evisceration injuries includes _______.
keeping the injury moist and warm
Right lower quadrant (RLQ)
large and small intestines that include the ascending colon and the right half of the transverse colon. descending colon, called the appendix
Approximately 25% of severe injuries to the aorta occur during:
lateral collisions.
While assessing a 21-year-old female who struck a tree head-on with her small passenger car, you note that her air bag deployed. You should:
lift the air bag and look for deformity to the steering wheel.
Right upper quadrant (RUQ) consist of?
liver, gallbladder, duodenum of the intestines, and a small portion of the pancreas
Placing a pregnant patient in a supine position during the third trimester of pregnancy:
may decrease the amount of blood that returns to the heart.
As you approach a young male who was involved in an industrial accident, you note that his eyes are closed and that he is not moving. You can see several large contusions to his arms, a laceration to his forehead with minimal bleeding, and a closed deformity to his right leg. You should:
open his airway and assess his breathing status.
A spinal cord injury at the level of C7 would MOST likely result in:
paralysis of the intercostal muscles.
Burns to pediatric patients are generally considered more serious than burns to adults because:
pediatric patients have more surface area relative to total body mass.
Circulation of blood within an organ or tissue in adequate amounts to meet the cells' oxygen, nutritional, and waste-removal needs is termed _______.
perfusion
When a hollow organ is punctured during a penetrating injury to the abdomen:
peritonitis may not develop for several hours.
A 43-year-old man is experiencing a severe nosebleed. His blood pressure is 190/110 mm Hg and his heart rate is 90 beats/min and bounding. Preferred treatment for this patient includes:
pinching the patient's nostrils and having him lean forward.
A 28-year-old male was struck in the chest with a baseball bat during an altercation. He is conscious and alert and complains of severe chest pain. Your assessment reveals a large area of ecchymosis over the sternum and a rapid, irregular pulse. In addition to providing supplemental oxygen, you should:
prepare for immediate transport.
A man called EMS 12 hours after injuring his chest. Your assessment reveals a flail segment to the right side of the chest. The patient is experiencing respiratory distress and his oxygen saturation is 78%. His breath sounds are equal bilaterally and his jugular veins are normal. You should suspect:
pulmonary contusion.
A 6-year-old female was riding her bicycle and struck a clothesline with her throat. She is breathing, but with obvious difficulty. Your assessment reveals a crackling sensation in the soft tissues of her neck and facial cyanosis. In addition to the appropriate airway management, the intervention that will MOST likely improve her chance of survival is:
rapidly transporting her to the hospital
An 8-year-old male was bitten by a stray dog. He has a large laceration to the back of his left hand, which your partner covered with a sterile dressing and bandage. In addition to transporting the child to the hospital, you should:
report the incident to the appropriate authorities.
Following blunt trauma to the abdomen, a 21-year-old female complains of diffuse abdominal pain and pain to the left shoulder. Your assessment reveals that her abdomen is distended and tender to palpation. On the basis of these findings, you should be MOST suspicious of injury to the:
spleen.
A 15-year-old female was struck by a small car while riding her bicycle. She was wearing a helmet and was thrown to the ground, striking her head. In addition to managing problems associated with airway, breathing, and circulation, it is MOST important for you to:
stabilize her entire spine.
During your primary assessment of a 19-year-old unconscious male who experienced severe head trauma, you note that his respirations are rapid, irregular, and shallow. He has bloody secretions draining from his mouth and nose. You should:
suction his oropharynx for up to 15 seconds
A burn that is characterized by redness and pain is classified as a:
superficial burn.
Hypovolemic shock occurs when:
the body cannot compensate for rapid blood loss.
According to the Association of Air Medical Services, you should consider air medical transport of a trauma patient if:
traffic conditions hamper the ability to get the patient to a trauma center by ground within the ideal time frame for the best clinical outcome.
If your patient swallows blood following facial trauma, there is an increased risk of ________.
vomiting