EMT Chapter 35
The EMT has fundamental understanding of abdominal trauma when he states:
"Blunt trauma is especially lethal because of the large number of organs that can be affected."
You are assessing a young male patient who was assaulted with a baseball bat and struck once on the left upper quadrant of the abdomen. You would recognize that this patient has Kehr's sign when he makes which statement?
"My left shoulder is killing me!"
Why is blunt abdominal trauma considered lethal?
A large number of organs may be injured
An abdominal evisceration occurs when:
A wound through the abdominal wall allows abdominal contents to protrude
Severe abdominal trauma and blood loss may cause signs and symptoms of shock, which include:
An increased heart rate
Which of the following is the proper treatment of an amputated penis?
Apply direct pressure to control bleeding
While a 43-year-old man was cleaning a window, the glass broke and a sharp piece sliced his groin. Assessment shows him to have a large laceration to his leftscrotum, with a testicle exposed and protruding through the sac. Blood is pouring from the laceration, and the patient rates the pain as an 8/10. What should the EMT do first?
Apply direct pressure to the injury to stop the hemorrhage
Peritoneal space is potential space
Between the peritoneal layers
You are transporting a male patient with a deep stab wound to the groin, with damage also noted to the genitalia following an assault by his girlfriend. The patient is alert and oriented, albeit restless. Vital signs on scene were pulse, 128 beats/min; respirations, 20 breaths/min; blood pressure, 108/64 mmHg; and SpO2, 92%. Oxygen is being administered via nasal cannula. Upon reassessment, which sign would be most concerning to the EMT?
Blood pressure is now 106/88 mmHg
You have been called for a male patient who was shot with a rifle. Assessment reveals an entrance wound to the left lower quadrant of the abdomen. A hemorrhaging exit wound to the left lower back is also located. What should you do immediately?
Cover the entrance wound with a gloved hand.
General emergency medical care for the patient with an abdominal injury includes:
Covering an evisceration with a moist dressing and occlusive dressing
During your focused history and physical exam of a patient with a suspected abdominal injury:
Discoloration around the umbilicus indicates bleeding is occurring inside the abdomen.
On scene, you encounter a restless patient who has been stabbed in the right upper quadrant of the abdomen and now complains 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 beats/min; respirations, 20 breaths/min; blood pressure, 122/88 mmHg; and SpO2, 90% on room air. The injury is isolated, with no involvement of the head, neck, or back. In managing the scene and the patient, which observation would cause you to immediately intervene?
Family giving the patient water to drink
Palpation of abdominal pain should begin:
Farthest from the quadrant that hurts
Which of the following injuries is uncommon in relation to male genitalia?
Foreign body insertion
You are transporting a female patient who was sexually assaulted by having a foreign body inserted deep into her vagina. You are attempting to control hemorrhage by the appropriate means. As you reassess the patient, which finding is of most concern?
Heart rate increases from 116 to 140 beats/min
A patient has referred pain to her left shoulder. What should the EMT suspect?
Hemorrhage from the spleen
If a male patient is kicked in the testicles during a fight, after determining there is NO bleeding, the EMT should consider:
Ice and a position of comfort
A 74-year-old female complains of abdominal pain after falling down five stairs off her front porch and striking her abdomen and left hand on a mailbox at the bottom. The patient also reports pain in her left wrist and right ankle, both of which show obvious deformity. She is alert and oriented, and her abdomen is free of bruising but tender in the left upper and lower quadrants. Her vital signs are pulse, 132 beats/min; respirations, 22 breaths/min; blood pressure, 106/86 mmHg; and initial SpO2, 93% on room air. Oxygen has been applied, and the patient has full spine motion restriction precautions in place. Advanced life support has been requested and is 12 minutes away from your current location. What is your next action?
Initiate immediate transport and intercept with the ALS unit
You are treating a male 22-year-old who is embarrassed because he has a serious bleeding injury to his penis. How should you treat this?
Like a soft tissue injury and provide direct pressure
While returning from a call, you are flagged down by a frantic family member of a 12-year-old male patient. She is standing in the yard, and reports that the child was shot in the abdomen and is now inside the house. She states that she has already called the police, who have not arrived yet, and that the shooter is another family member who has since left the scene. What is your best course of action?
Move the ambulance and wait for law enforcement to arrive
An industrial worker has sustained a laceration to his abdomen. On closer inspection, you note what appears to be fat tissue and a portion of intestine protruding through the wound. Which intervention is most appropriate for treating this injury?
Occlusive dressing applied over saline-soaked gauze.
You have arrived on the scene for a patient assaulted with a baseball bat. As you approach, which position would seemingly indicate that he has suffered an injury to the abdomen?
On his side with knees drawn to the chest
A female patient suffered a straddle injury (genitalia trauma) while trying to balance on top of a chain-link fence, after she fell with a leg on each side of the fence. At this time, you would:
Place a moist compress, such as a moist sanitary pad, over the injury to control the bleeding
A 16-year-old male has been struck in the genitalia by a baseball. Assessment indicates a tremendous amount of edema as well as hematoma formation and bruising to his scrotum. The primary assessment reveals no life-threatening conditions; however, the patient is crying and rates the pain as 10/10. Which action is most appropriate for this patient?
Placing cool compresses to the testicles.
During a motor vehicle collision, a confused unrestrained male struck the steering wheel with his abdomen. Currently, he is confused and complains of generalized abdominal pain, which he rates as 6/10. Assessment indicates red marks across his lower abdomen caused by the steering wheel. His pulse is 140 beats/min, respirations are 24 breaths/min, blood pressure is 108/88 mmHg, and SpO2 is 86%. The patient looks pale and has moist skin. What is most appropriate when providing oxygen to this patient?
Provide 15 lpm through a nonrebreather mask
Which of the following is the correct definition of Kehr sign?
Referred pain to the shoulder caused by abdominal bleeding
Organs that lie dorsal to the peritoneum are called:
Retroperitoneal
As a review of the anatomy of the abdominal cavity, which of the following is TRUE?
Solid organs include the pancreas and the kidneys
Which one of these injuries is most likely to cause peritonitis?
Stab wound to the small intestine.
You are getting ready to move a patient with an evisceration to the wheeled cot. The EMR on scene asks you what position you want the patient placed into after he is moved. What would be the BEST response?
Supine with hips and knees flexed
A middle-aged male sustained blunt force trauma to the abdomen, resulting in an isolated tear and perforation of the large intestine. When following up on the patient, what would the EMT suspect occurred, given the organ that was injured?
The patient developed an infection
If a woman was assaulted and has sustained deep lacerations to her genitals, the EMT should:
Treat the injury like other soft tissue injuries
Injuries to the genitalia are:
Usually embarrassing for the patient
Which of the following injuries or mechanisms of injury is specific to female genitalia?
abortion attempts
Which of the following abdominal injuries would be considered the most dangerous?
assault with a club
The EMT recognizes that the division between the thoracic and abdominal cavities lies approximately:
at the fifth intercostal space.
At the scene of a motor 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 cervical collar and continue to maintain spine motion restriction precautions. The patient's airway is patent and respirations adequate. His radial pulse is rapid and weak, and his skin is cool and diaphoretic. The EMRs report the following vital signs: pulse, 136 beats/min; respirations, 20breaths/min; blood pressure, 100/68 mmHg; and SpO2, 95% with supplemental O2 being administered. The right forearm is deformed, and the head, chest, and upper back are uninjured according to your assessment. Your next action would be to:
check the abdomen for injury
A patient has been assaulted and sustained blunt trauma to the abdomen. As you start the primary assessment, you note that he is vomiting blood and you begin to suction him immediately. After the airway has been suctioned, you should:
check the adequacy of the patients breathing
You have been called for a deeply disturbed psychiatric patient who has cut off the tip of his penis with a steak knife. Assessment reveals the 31-year-old male to becrying, with blood noted to his hands and pants. The primary assessment reveals no acute life threats. At this time, your priority is to:
control any active bleeding that may be occurring
Which abdominal organ or structure, if seriously injured, would cause the most rapid death?
descending aorta
A penetrating abdominal injury with severe respiratory distress has MOST likely involved what structure?
diaphragm
Which of the following structures serves as the division between the thoracic and abdominal cavities?
diaphragm
You have been called for a 42-year-old male who complains of back pain. At the scene, the man tells you that he was lying on the floor when his 5-year-old son unexpectedly jumped feet first onto his back. He gives a medical history of high blood pressure and asthma, for which he takes medications. As you assess the patient, which finding provides the greatest indication that the patient has sustained an abdominal injury?
discoloration around the umbilicus
Open wounds to the abdomen may be so large and deep that organs protrude through the wound opening. This is known as a/an:
evisceration
You have arrived on the scene of a stabbing. As you approach the patient, you note that his shirt is off and a single stab wound to the right lower quadrant of the abdomen is evident. The patient appears unresponsive as you approach. At the patient's side, your first action should be to:
examine the patients airway
A 45-year-old female was at a family reunion and fell off a trampoline. She hit a picnic table with the left side of her lower rib cage. Now, she is very anxious and confused. Her airway is open and her breathing adequate. Her radial pulse is rapid and weak, and her skin is cool and diaphoretic. Vital signs are pulse, 132 beats/min; respirations, 20 breaths/min; blood pressure, 102/78 mmHg; and SpO2, 97% on ambient air. The patient has ecchymosis to the left lower rib area as well as tenderness and instability to the rib cage. She also has a superficial abrasion to her forehead. Given these findings, you would suspect and treat her for whichcondition?
hypovolemic shock
A patient who experienced blunt trauma to the abdomen has a lacerated liver. Given this information, what would represent the most immediate threat to life?
internal hemorrhage
If a patient has severe retroperitoneal bleeding from an organ located within this cavity, she has most likely injured her:
kidney
A patient has been stabbed in the right upper quadrant of the abdomen. Which solid organ should the EMT be most concerned with being injured?
liver
Which of the following abdominal organs would be characterized as being solid despite containing a large amount of blood?
liver
Which of the following is an example of a solid organ?
liver
An abdominal evisceration should be covered with a moist sterile dressing, followed by:
occlusive dressing
The EMT's care for an open chest wound and for an abdominal evisceration are similar in that:
occlusive dressings should be placed over both wounds.
Which is the inferior border of the abdominal cavity?
pelvic ring
You have just arrived on the scene of a very serious motor vehicle collision. Emergency Medical Responders (EMRs) have rapidly extricated an unresponsive female from the driver's seat. The EMRs report that she was unrestrained and struck the steering wheel with her chest and abdomen. As you start the primary assessment, you note that the patient has snoring respirations and demonstrates shallow breathing at a rate of 24 breaths per minute. What should you do next?
perform a jaw thrust maneuver
Which of the following organs, if injured, would be MOST likely to cause peritonitis?
small intestine
The liver, spleen, and pancreas are examples of what type of abdominal organs?
solid
You have arrived on the scene of an assault involving a knife. Assessment of the unresponsive 21-year-old male patient reveals him to have sustained multiple lacerations to the arms and abdomen, and a section of his intestine is now protruding through a large laceration in the area around the umbilicus. He has lost a significant amount of blood. His airway is open and he is breathing poorly at a rate of 28 breaths per minute. His radial pulse is weak, and his skin is cool and pale. What should the EMT do first?
start positive pressure ventilation
Which of the following is a common mechanism of female genitalia injury?
straddle injury
A patient has sustained a large abdominal evisceration, such that a large portion of intestines are now exposed. After properly managing this injury, you are preparing the patient for transport. You ascertain that there is no evidence of spinal injury. How should you place the patient on the stretcher for transport?
supine position, with knees and hips flexed
What bit of information gathered during the scene size-up will be extremely important in determining the severity of abdominal injuries?
the mechanism of injury
Why should the EMT complete a full assessment of all areas of the body on any patient with abdominal pain?
to find any other injuries
What type of abdominal organ is the vena cava?
vascular
A patient has been shot in the abdomen. Assessment reveals that the bullet entered the body in the right upper quadrant and exited the lower right back. Given thisfinding, the EMT should assume which solid organs may have been injured?
Liver, right kidney, pancreas
You are transporting an alert and oriented male who sustained severe abdominal trauma in an assault. The primary survey indicates a patent airway with respirations of 24 breaths per minute. Breath sounds are present bilaterally. The patient has a rapid and weak radial pulse of 144 beats per minute, and his skin is pale and cool. The blood pressure is 92/64 mmHg and SpO2 is 92%. Best management of the respiratory and oxygenation parameters would include:
high-concentration oxygen through a nonrebreather mask
