Chapter 35 - Abdominal and Genitourinary Trauma

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 left​ scrotum, 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? A. Call for advanced life support assistance B. Provide oxygen at 15 lpm C. Apply direct pressure to the injury to stop the hemorrhage D. Cover the exposed testicle with moist​ dressing, and dress it loosely to collect the blood that is escaping

Apply direct pressure to the injury to stop the hemorrhage

The EMT recognizes that the division between the thoracic and abdominal cavities lies​ approximately: A. At the fifth intercostal space B. Below the twelfth rib C. Above the twelfth thoracic vertebra D. At the level of the umbilicus

At the fifth intercostal space

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? A. Heart rate of 132​ beats/min B. SpO2 stabilizing at​ 96% despite O2 therapy C. Blood pressure is now​ 106/88 mmHg D. ​Patient's urge to void

Blood pressure is now​ 106/88 mmHg

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, 20​ breaths/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: 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

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: A. Check the adequacy of the​ patient's breathing B. Administer oxygen with a nonrebreather face mask C. Obtain a full set of vital signs D. Examine the abdomen for specific injuries

Check the adequacy of the​ patient's 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 be​ crying, with blood noted to his hands and pants. The primary assessment reveals no acute life threats. At this​ time, your priority is​ to: A. Prevent the patient from urinating B. Place the amputated penis in sterile water C. Control any active bleeding that may be occurring D. Determine why the patient cut himself

Control any active bleeding that may be occurring

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? A. Cover the entrance wound with a gloved hand B. Auscultate the​ patient's breath sounds C. Cover the abdominal wounds with dry sterile gauze dressings D. Place a cervical collar on the patient

Cover the entrance wound with a gloved hand

Which abdominal organ or​ structure, if seriously​ injured, would cause the most rapid​ death? A. Descending aorta B. Large intestine C. Spleen D. Stomach

Descending aorta

A penetrating abdominal injury with severe respiratory distress has MOST likely involved what​ structure? A. Large intestine B. Diaphragm C. Peritoneum D. Small intestine

Diaphragm

Which of the following structures serves as the division between the thoracic and abdominal​ cavities? A. Pleural lining B. Visceral peritoneum C. Parietal pleura D. Diaphragm

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? A. Shortness of breath B. Discoloration around the umbilicus C. Mild nausea D. Bruise to his back

Discoloration around the umbilicus

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: A. Cover the wound with a nonporous dressing B. Examine the​ patient's airway C. Quickly look for additional stab wounds D. Provide oxygen via nonrebreather face mask

Examine the​ patient's airway

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? A. An EMR placing the patient in a lateral recumbent position with the knees flexed B. An EMR placing his gloved hand over the injury to control the bleeding C. Family giving the patient water to drink since he is thirsty D. Application of supplemental oxygen

Family giving the patient water to drink since he is thirsty

Which of the following injuries is uncommon in relation to male​ genitalia? A. Blunt trauma B. Amputation C. Foreign body insertion D. Penetrations

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? A. The patient informs you she has a sexually transmitted disease B. Heart rate increases from 116 to 140​ beats/min C. Pain increases from​ 7/10 to​ 10/10 D. Large blood clots form at the vaginal entrance

Heart rate increases from 116 to 140​ beats/min

A patient has referred pain to her left shoulder. What should the EMT​ suspect? A. Trauma to the right kidney B. Rupture of the small intestine C. Damage to the gallbladder D. Hemorrhage from the spleen

Hemorrhage from the spleen

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 which​ condition? A. Hypovolemic shock B. Closed head injury C. Spinal shock D. Hypoxia

Hypovolemic shock

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? A. Monitor the patient and wait for ALS assistance B. Initiate immediate transport and intercept with the ALS unit C. Apply ice to the wrist and ankle while awaiting arrival of the ALS unit D. Secure the wrist and ankle to board​ splints, initiate​ transport, and cancel the ALS unit

Initiate immediate transport and intercept with the ALS unit

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? A. Liver infection B. Significant pain C. Internal hemorrhage D. Development of acute peritonitis

Internal hemorrhage

If a patient has severe retroperitoneal bleeding from an organ located within this​ cavity, she has most likely injured​ her: A. Large intestine B. Stomach C. Liver D. Kidney

Kidney

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? A. With an occlusive dressing B. Contact medical direction right away for advice C. With a bulky dressing D. Like a soft tissue injury and provide direct pressure

Like a soft tissue injury and provide direct pressure

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? A. Small intestine B. Stomach C. Liver D. Kidney

Liver

Which of the following is an example of a solid​ organ? A. Gallbladder B. Large intestine C. Liver D. Stomach

Liver

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? A. Move the ambulance and wait for law enforcement to arrive B. Go to the porch and have the patient brought to you C. Carefully look for scene hazards and enter once you feel safe D. Cautiously enter the house and be ready to vacate if any hazards are found

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? A. Dry sterile dressing applied over the wound B. Direct pressure using gloved palms to the injury C. Occlusive dressing applied over​ saline-soaked gauze D. One attempt at replacement of the eviscerated material in the abdomen using sterile gloves

Occlusive dressing applied over​ saline-soaked gauze

The​ EMT's care for an open chest wound and for an abdominal evisceration are similar in​ that: A. Both wounds can cause the trapping of air in the body B. Moist dressings are placed over both wounds C. Air must be periodically released from both wounds D. Occlusive dressings should be placed over both wounds

Occlusive dressings should be placed over both wounds

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? A. On his side with knees drawn to the chest B. Supine with legs extended and toes pointed C. Prone with hands on the back D. Standing with restless movement and pacing

On his side with knees drawn to the chest

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? A. Start positive pressure ventilation B. Obtain vital signs C. Secure the patient to backboard with a cervical collar placed D. Perform a​ jaw-thrust maneuver

Perform a​ jaw-thrust maneuver

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: A. Place a moist​ compress, such as a moist sanitary​ pad, over the injury to control the bleeding B. Clean the area with sterile saline and apply direct pressure with a gloved hand while monitoring for ongoing bleeding C. Gently put sterile gauze dressings into the opening of the vaginal canal to stop the bleeding D. Apply an ice pack wrapped in a towel to the genital area

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? A. Apply direct pressure to the site of injury B. Rapid transport using lights and sirens C. Application of warm packs to the scrotum D. Place cool compresses to the testicles

Place 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? A. Oxygen can be withheld due to the SpO2 reading B. Provide 2 lpm through a nasal cannula C. Provide 15 lpm through a nonrebreather mask D. Provide 8 lpm through a simple face mask

Provide 15 lpm through a nonrebreather mask

Which of the following is the correct definition of Kehr​ sign? A. Increased gastric sounds due to intraperitoneal injury B. Abdominal distention due to a ruptured diaphragm C. Referred pain to the shoulder caused by abdominal bleeding D. Bruising around the umbilicus

Referred pain to the shoulder caused by abdominal bleeding

As a review of the anatomy of the abdominal​ cavity, which of the following is​ TRUE? A. Solid organs include the pancreas and kidneys. B. The visceral peritoneum adheres to the walls of the abdominal cavity. C. The gallbladder and spleen are examples of solid organs. D. Organs that lie in the upper portion of the abdomen are called retroperitoneal.

Solid organs include the pancreas and kidneys.

Which one of these injuries is most likely to cause​ peritonitis? A. Stab wound to the small intestine B. Contusion to the pancreas C. Blunt trauma to the spleen D. Bullet injury to the liver

Stab wound to the small intestine

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? A. Start positive pressure ventilation B. Secure the patient to a long spine board C. Cover the intestine with​ saline-soaked gauze D. Check the blood pressure

Start positive pressure ventilation

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? A. ​Semi-Fowler's position, to promote adequate breathing B. Lateral recumbent position with legs extended C. Supine​ position, with knees and hips flexed D. Prone​ position, to maintain pressure on the abdomen

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? A. The​ patient's blood pressure B. The​ patient's heart rate C. The amount of pain the patient is in D. The mechanism of injury

The mechanism of injury

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? A. The patient developed severe internal bleeding B. The patient developed an infection C. The patient rapidly decompensated into shock D. The patient has profound hypoxia

The patient developed an infection

What type of abdominal organ is the vena​ cava? A. Vascular B. Solid C. Hollow D. Cutaneous

Vascular

An abdominal evisceration occurs​ when: A. the intestines are forced through the diaphragm. B. the intestines enter the chest cavity. C. a wound in the abdominal wall allows the pleura to be viewed. D. a wound through the abdominal wall allows abdominal contents to protrude.

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: A. a decreased heart rate. B. flushed skin. C. an increased heart rate. D. hypertension.

an increased heart rate.

General emergency medical care for the patient with an abdominal injury​ includes: A. covering an evisceration with a moist dressing and occlusive dressing. B. administering oxygen at 6 lpm by nasal cannula. C. applying and inflating the abdominal section of the PASG to control internal abdominal bleeding. D. placing the patient in the prone position with knees bent.

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: A. keep in mind that it takes about one liter of blood to expand the abdominal girth by 2 inches. B. palpate the​ abdomen, starting from the point closest to the pain. C. discoloration around the umbilicus indicates bleeding is occurring inside the abdomen. D. remember that the radial pulse will normally be stronger than the femoral pulse.

discoloration around the umbilicus indicates bleeding is occurring inside the abdomen.

Open wounds to the abdomen may be so large and deep that organs protrude through the wound opening. This is known as​ a/an: A. protrusion. B. avulsion. C. sucking abdominal wound. D. evisceration.

evisceration

If a woman was assaulted and has sustained deep lacerations to her​ genitals, the EMT​ should: A. treat the injury like other soft tissue injuries. B. immediately administer oxygen. C. elevate the hips. D. apply the PASG.

treat the injury like other soft tissue injuries.

Injuries to the genitalia​ are: A. often life threatening. B. usually embarrassing for the patient. C. rarely painful. D. relieved by direct pressure.

usually embarrassing for the patient.

The EMT has fundamental understanding of abdominal trauma when he​ states: A. ​"Blunt trauma is especially lethal because of the large number of organs that can be​ affected." B. ​"Injuries to hollow organs tend to be worse than injuries to solid organs because of the increased potential for blood​ loss." C. ​"Injuries to solid organs like the bladder tend to be more lethal than injuries to hollow​ organs." D. ​"Evisceration injuries can be recognized by​ dark-colored bruising over the top of the injury​ site."

​"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? A. ​"It really hurts for me to​ breathe." B. ​"My left shoulder is killing​ me!" C. ​"I am having a hard time​ breathing!" D. ​"My belly hurts really​ bad."

​"My left shoulder is killing​ me!"

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: A. Encouraging the patient to slow his respirations B. ​High-concentration oxygen through a nonrebreather mask C. Application of a nasal cannula at 4 lpm O2 D. Positive pressure ventilation with supplemental oxygen

​High-concentration oxygen through a nonrebreather mask

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 this​ finding, the EMT should assume which solid organs may have been​ injured? A. ​Liver, gallbladder, right​ kidney, and small intestine B. Liver and gallbladder C. ​Liver, right​ kidney, and pancreas D. ​Liver, gallbladder, and right kidney

​Liver, right​ kidney, and pancreas