CHAPTER 36 ABDOMINAL & GENITOURINARY TRAUMA

38. You are caring for a patient who experienced blunt abdominal trauma. The patient is conscious, but restless. His respirations are rapid and shallow and his pulse is rapid and weak. What will maximize this patient's chances of survival? A) Basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluid boluses as needed en route B) Administering supplemental oxygen, administering crystalloid IV fluids at the scene, and rapidly transporting to a trauma center C) Application and inflation of the PASG, ventilation assistance, 2 to 3 L of IV fluid at the scene, and rapid transport to a trauma center D) Aggressive airway support, a detailed physical exam at the scene, transport to the closest hospital, and IV therapy performed en route

A) Basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluid boluses as needed en route

26. Which of the following statements regarding stomach injuries is correct? A) Rupture of the stomach following blunt trauma is usually associated with a recent meal or inappropriate seat belt use. B) The vast majority of injuries to the stomach are caused by blunt force trauma and result in severe peritoneal hemorrhage. C) Patients taking antacid medications usually experience immediate signs of peritoneal irritation following an injury to the stomach. D) Penetrating mechanisms are a rare cause of injury to the stomach because the stomach is well protected by the abdominal musculature.

A) Rupture of the stomach following blunt trauma is usually associated with a recent meal or inappropriate seat belt use.

31. Which of the following assessment findings is MOST suggestive of intraabdominal hemorrhage? A) Signs of shock B) Palpable pain C) Diffuse tenderness D) Nausea and vomiting

A) Signs of shock

19. Which of the following factors does NOT contribute to the extent of injury from a gunshot wound to the abdomen? A) Size of the patient B) Profile of the bullet C) Trajectory of the bullet D) Distance the bullet traveled

A) Size of the patient

14. What do the spleen and liver have in common? A) They are both highly vascular and bleed profusely when injured. B) The liver and spleen are well protected by the abdominal muscles. C) They are less likely to be crushed by blunt trauma than other organs. D) The liver and spleen are the only solid organs in the abdominal cavity.

A) They are both highly vascular and bleed profusely when injured.

21. Fractures of the lower rib cage should make you MOST suspicious for injuries to the: A) liver or spleen. B) urinary bladder. C) ascending aorta. D) kidneys or pancreas.

A) liver or spleen.

7. Intraperitoneal organs include all of the following, EXCEPT the: A) pancreas. B) stomach. C) small bowel. D) gallbladder.

A) pancreas.

11. As contents exit the stomach, they FIRST pass through the: A) pylorus. B) duodenum. C) gallbladder. D) cardiac sphincter.

A) pylorus.

3. EMS providers can have the MOST positive impact on mortality and morbidity from abdominal trauma by: A) recognizing the need for rapid transport. B) initiating fluid resuscitation in the field. C) contacting medical control immediately. D) performing a careful abdominal assessment.

A) recognizing the need for rapid transport.

36. You are dispatched to the parking lot of a shopping mall for an injured person. While en route to the scene, it is MOST important for you to: A) request law enforcement assistance. B) alert the trauma center of the situation. C) take appropriate standard precautions. D) place air medical transport on standby.

A) request law enforcement assistance.

43. Fournier gangrene is a potential complication associated with: A) scrotal lacerations. B) ovarian rupture. C) urethral injuries. D) urinary bladder rupture.

A) scrotal lacerations.

13. Intraabdominal bleeding may produce few signs and symptoms of trauma because: A) the intraabdominal cavity can accommodate large amounts of blood. B) blood in the peritoneum can compress the aorta and maintain perfusion. C) it takes approximately 4 L of blood loss before signs of shock manifest. D) the abdominal musculature can sustain massive blunt force without bruising.

A) the intraabdominal cavity can accommodate large amounts of blood.

8. Which of the following organs lies within the retroperitoneal space? A) Liver B) Kidneys C) Spleen D) Ovaries

B) Kidneys

6. What membranous tissue functions as the point of attachment for the various abdominal organs? A) Pleura B) Mesentery C) Peritoneum D) Ligamentum arteriosum

B) Mesentery

20. What type of motor vehicle crash poses the LEAST threat for abdominal trauma if the patient is properly restrained? A) Frontal crash B) Rear-end crash C) Lateral crash D) Rollover crash

B) Rear-end crash

2. Which of the following factors can decrease the potential damage caused by trauma to the abdomen? A) A seat belt that is worn above the iliac crests B) Toned abdominal muscles and an empty bladder C) Abdominal muscle tensing at the time of impact D) Air bags and being younger than 44 years old

B) Toned abdominal muscles and an empty bladder

39. A 39-year-old man sustained an abdominal evisceration after he was cut in the abdomen with a machete. The patient is semiconscious and is breathing shallowly. You should: A) administer oxygen via nonrebreathing mask; cover the exposed bowel with dry, sterile dressings; start an IV and give a 500-mL fluid bolus; and transport to a trauma center. B) assist ventilations with a bag-mask device; cover the exposed bowel with moist, sterile dressings and protect them from injury; transport at once; and initiate IV therapy en route. C) insert an oral airway, provide ventilatory assistance, cover the exposed bowel with aluminum foil, begin transport, and start two large-bore IV lines with normal saline en route. D) consider intubation to protect his airway; cover the exposed bowel with moist, sterile dressings; start an IV and give analgesia; and transport to a trauma center with fluid boluses en route.

B) assist ventilations with a bag-mask device; cover the exposed bowel with moist, sterile dressings and protect them from injury; transport at once; and initiate IV therapy en route.

34. Following blunt force trauma to the lower right rib cage, a 40-year-old man presents with restlessness, tachycardia, and unlabored tachypnea. You should be MOST concerned that he has a: A) pyloric injury. B) liver injury. C) splenic rupture. D) pneumothorax.

B) liver injury.

41. You should suspect a ruptured kidney if a patient presents with flank pain, gross hematuria, and: A) left shoulder pain. B) pain with inhalation. C) right shoulder pain. D) pain with exhalation.

B) pain with inhalation.

15. The major complication associated with hollow organ injury is: A) massive internal hemorrhage and profound shock. B) peritonitis caused by rupture and spillage of toxins. C) immediate death secondary to a massive infection. D) delayed treatment due to the absence of external signs.

B) peritonitis caused by rupture and spillage of toxins.

29. Periumbilical ecchymosis is: A) commonly observed in the prehospital setting following blunt force trauma to the abdomen. B) referred to as Cullen sign and may take hours or days to develop following abdominal trauma. C) usually seen in conjunction with flank bruising and is highly suggestive of injury to the liver or spleen. D) also called Grey Turner sign and manifests almost immediately following blunt abdominal trauma.

B) referred to as Cullen sign and may take hours or days to develop following abdominal trauma.

44. A 24-year-old male intentionally placed a commercially manufactured constricting object around the base of his penis. He complains of moderate pain, and assessment of his penis reveals that it is cyanotic. You should: A) make one attempt to cut the constricting object away from his penis. B) transport him to the hospital and provide emotional support en route. C) apply ice to the area to reduce any swelling and then remove the object. D) administer a narcotic analgesic prior to removing the constricting object.

B) transport him to the hospital and provide emotional support en route.

24. Left shoulder pain following injury to the spleen: A) typically precedes hypotension and other signs of shock. B) usually does not occur until 1 to 2 hours after the injury. C) is a sign of associated injury to a hollow abdominal organ. D) is called Cullen sign and indicates intraabdominal bleeding.

B) usually does not occur until 1 to 2 hours after the injury.

You are caring for a patient who experienced blunt abdominal trauma. The patient is conscious, but restless. His respirations are rapid and shallow and his pulse is rapid and weak. What will maximize this patient's chances of survival?

Basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluid boluses as needed en route

9. Which of the following statements regarding the liver is correct? A) The liver is the largest hollow organ in the abdomen and is responsible for producing and storing bile. B) The liver is a relatively avascular organ that is uncommonly injured during blunt abdominal trauma. C) The liver is a solid organ that lies in the right upper abdominal quadrant and detoxifies the blood. D) The liver is partially protected by the left lower rib cage and serves the function of filtering bacteria from the blood.

C) The liver is a solid organ that lies in the right upper abdominal quadrant and detoxifies the blood.

40. What are the two layers that cover the testicles? A) Tunica vaginalis and tunica intima B) Tunica media and tunica albuginea C) Tunica albuginea and tunica vaginalis D) Tunica intima and tunica adventitia

C) Tunica albuginea and tunica vaginalis

33. When assessing a patient with abdominal trauma for distention, you must recall that: A) a distended abdomen is one of the earliest clinical findings in patients with abdominal trauma. B) abdominal distention is usually caused by muscle tensing rather than intraabdominal bleeding. C) a significant amount of blood volume in the abdominal cavity is required to produce distention. D) because distention is a late sign of intraabdominal bleeding, it should not be assessed for in the field.

C) a significant amount of blood volume in the abdominal cavity is required to produce distention.

35. A 17-year-old high school football player was struck in the abdomen by another player during a tackle. Your assessment reveals signs of shock and pain to the patient's left shoulder, which is unremarkable for trauma. Examination of the patient's abdomen is also unremarkable for obvious injury. Based on your assessment findings and the patient's clinical presentation, you should be MOST suspicious of: A) a lacerated liver. B) acute peritonitis. C) an injury to the spleen. D) retroperitoneal bleeding.

C) an injury to the spleen.

27. Gross hematuria and suprapubic pain following a pelvic injury is MOST indicative of injury to the: A) ureters. B) urethra. C) bladder. D) kidney.

C) bladder.

45. A 36-year-old female was sexually assaulted and is experiencing intense pain. Your assessment reveals several open lacerations to her vaginal area and a painful distended abdomen. Her blood pressure is 86/50 mm Hg and her heart rate is 120 beats/min and weak. In addition to administering supplemental oxygen, you should: A) control any bleeding from her open wounds, establish two large-bore IV lines, and give 1 µg/kg of fentanyl. B) apply pressure dressings to her open injuries, cover the dressings with an ice pack, and transport rapidly. C) cover her open wounds with sterile dressings, establish at least one large-bore IV, and give a 20-mL/kg fluid bolus. D) insert a sterile dressing into her vagina to control any internal bleeding, establish a large-bore IV, and set it at a KVO rate.

C) cover her open wounds with sterile dressings, establish at least one large-bore IV, and give a 20-mL/kg fluid bolus.

1. Anatomically, the abdominal cavity extends from the: A) fifth rib to the pelvis. B) umbilicus to the pelvis. C) diaphragm to the pelvis. D) nipple line to the diaphragm

C) diaphragm to the pelvis.

22. Generalized abdominal pain following rupture of a hollow organ is MOST suggestive of: A) severe intraabdominal bleeding. B) gas accumulation in the peritoneum. C) diffuse peritoneal contamination. D) inflammation of deep nerve endings

C) diffuse peritoneal contamination.

28. Grey Turner sign is defined as ecchymosis to the _________ and is indicative of _________. A) umbilicus, peritoneal bleeding B) epigastrium, stomach rupture C) flank, retroperitoneal bleeding D) back, traumatic aortic dissection

C) flank, retroperitoneal bleeding

4. The abdomen extends superiorly to the level of the: A) xiphoid process. B) second intercostal space. C) fourth intercostal space. D) two pairs of floating ribs.

C) fourth intercostal space.

18. Penetrating abdominal trauma MOST commonly results from: A) flying debris following an explosion. B) high-powered rifles or military weapons. C) low-velocity gunshot or stab wounds. D) crush forces that separate the abdominal wall.

C) low-velocity gunshot or stab wounds.

12. The diaphragm curves from its point of attachment at the _______ rib and peaks in the center at the _______ intercostal space. A) ninth, third B) tenth, seventh C) twelfth, fourth D) eighth, seventh

C) twelfth, fourth

10. Which of the following is NOT a function of the pancreas? A) Enzyme secretion B) Secretion of insulin C) Glucagon secretion D) Reservoir for bile

D) Reservoir for bile

17. During the third collision in a motor vehicle crash: A) hollow abdominal organs rupture upon impact. B) the person's abdomen collides with the steering wheel. C) rapid deceleration propels an unrestrained person forward. D) abdominal organs shear from their points of attachment.

D) abdominal organs shear from their points of attachment.

30. Injuries to the vascular structures in the intraperitoneal space: A) commonly involve the inferior vena cava and phrenic artery. B) are most often associated with penetrating injury mechanisms. C) are generally associated with flank or periumbilical bruising. D) are often caused by shearing forces secondary to blunt trauma.

D) are often caused by shearing forces secondary to blunt trauma.

5. The periumbilical area refers to the: A) space behind the navel. B) external umbilical orifice. C) area lateral to the umbilicus. D) area around the umbilicus.

D) area around the umbilicus.

32. The LEAST helpful technique when assessing the patient with abdominal trauma is: A) palpation. B) percussion. C) inspection. D) auscultation.

D) auscultation.

37. A 59-year-old construction worker collapsed on the job and fell into a pile of steel rods. Your assessment reveals that he is pulseless and apneic, and has a 12-inch steel rod impaled in his epigastrium. As your partner and an emergency medical responder begin CPR, you should: A) trim the steel rod to 6 inches, stabilize it in place with bulky dressing, apply firm direct pressure around the rod, and initiate IV therapy en route to a trauma center. B) carefully remove the steel rod, apply direct pressure to the wound, assess his cardiac rhythm, start a large-bore IV line and give 2 L of normal saline, and transport. C) remove the rod so you can perform effective CPR, control any external bleeding, start two large-bore IV lines, and assess his cardiac rhythm en route to the hospital. D) control any external bleeding, stabilize the rod in place with bulky dressings, apply the cardiac monitor, and start at least one large-bore IV line en route to the hospital.

D) control any external bleeding, stabilize the rod in place with bulky dressings, apply the cardiac monitor, and start at least one large-bore IV line en route to the hospital.

42. Traumatic urinary bladder rupture is seen MOST frequently in patients who are: A) diabetic. B) short and obese. C) tall and thin. D) intoxicated.

D) intoxicated.

16. At least two thirds of all abdominal injuries: A) result in death. B) are caused by falls. C) are penetrating injuries. D) involve blunt trauma.

D) involve blunt trauma.

23. When blood is released into the peritoneal cavity: A) the abdomen almost immediately becomes grossly distended. B) it is most often the result of blunt force trauma to the pancreas. C) blood pressure falls with as little as 500 mL of internal blood loss. D) nonspecific signs such as tachycardia and hypotension may occur.

D) nonspecific signs such as tachycardia and hypotension may occur.

25. Because of its anatomic position in the retroperitoneum, it typically takes high-energy force to damage the: A) liver. B) spleen. C) stomach. D) pancreas.

D) pancreas.

Which of the following organs lies within the retroperitoneal space?

Kidneys

What membranous tissue functions as the point of attachment for the various abdominal organs?

Mesentery

What type of motor vehicle crash poses the LEAST threat for abdominal trauma if the patient is properly restrained?

Rear-end crash

Which of the following is NOT a function of the pancreas?

Reservoir for bile

Which of the following statements regarding stomach injuries is correct?

Rupture of the stomach following blunt trauma is usually associated with a recent meal or inappropriate seat belt use.

Which of the following assessment findings is MOST suggestive of intraabdominal hemorrhage?

Signs of shock

Which of the following factors does NOT contribute to the extent of injury from a gunshot wound to the abdomen?

Size of the patient

Which of the following statements regarding the liver is correct?

The liver is a solid organ that lies in the right upper abdominal quadrant and detoxifies the blood.

What do the spleen and liver have in common?

They are both highly vascular and bleed profusely when injured.

Which of the following factors can decrease the potential damage caused by trauma to the abdomen?

Toned abdominal muscles and an empty bladder

What are the two layers that cover the testicles?

Tunica albuginea and tunica vaginalis

When assessing a patient with abdominal trauma for distention, you must recall that:

a significant amount of blood volume in the abdominal cavity is required to produce distention.

During the third collision in a motor vehicle crash:

abdominal organs shear from their points of attachment.

A 17-year-old high school football player was struck in the abdomen by another player during a tackle. Your assessment reveals signs of shock and pain to the patient's left shoulder, which is unremarkable for trauma. Examination of the patient's abdomen is also unremarkable for obvious injury. Based on your assessment findings and the patient's clinical presentation, you should be MOST suspicious of:

an injury to the spleen.

Injuries to the vascular structures in the intraperitoneal space:

are often caused by shearing forces secondary to blunt trauma.

The periumbilical area refers to the:

area around the umbilicus.

A 39-year-old man sustained an abdominal evisceration after he was cut in the abdomen with a machete. The patient is semiconscious and is breathing shallowly. You should:

assist ventilations with a bag-mask device; cover the exposed bowel with moist, sterile dressings and protect them from injury; transport at once; and initiate IV therapy en route

The LEAST helpful technique when assessing the patient with abdominal trauma is

auscultation.

Gross hematuria and suprapubic pain following a pelvic injury is MOST indicative of injury to the:

bladder.

A 59-year-old construction worker collapsed on the job and fell into a pile of steel rods. Your assessment reveals that he is pulseless and apneic, and has a 12-inch steel rod impaled in his epigastrium. As your partner and an emergency medical responder begin CPR, you should:

control any external bleeding, stabilize the rod in place with bulky dressings, apply the cardiac monitor, and start at least one large-bore IV line en route to the hospital

A 36-year-old female was sexually assaulted and is experiencing intense pain. Your assessment reveals several open lacerations to her vaginal area and a painful distended abdomen. Her blood pressure is 86/50 mm Hg and her heart rate is 120 beats/min and weak. In addition to administering supplemental oxygen, you should

cover her open wounds with sterile dressings, establish at least one large-bore IV, and give a 20-mL/kg fluid bolus

Anatomically, the abdominal cavity extends from the:

diaphragm to the pelvis

Generalized abdominal pain following rupture of a hollow organ is MOST suggestive of:

diffuse peritoneal contamination

Grey Turner sign is defined as ecchymosis to the _________ and is indicative of _________

flank, retroperitoneal bleeding

The abdomen extends superiorly to the level of the:

fourth intercostal space.

Traumatic urinary bladder rupture is seen MOST frequently in patients who are

intoxicated

At least two thirds of all abdominal injuries

involve blunt trauma.

Following blunt force trauma to the lower right rib cage, a 40-year-old man presents with restlessness, tachycardia, and unlabored tachypnea. You should be MOST concerned that he has a:

liver injury.

Fractures of the lower rib cage should make you MOST suspicious for injuries to the:

liver or spleen.

Penetrating abdominal trauma MOST commonly results from:

low-velocity gunshot or stab wounds.

When blood is released into the peritoneal cavity:

nonspecific signs such as tachycardia and hypotension may occur.

You should suspect a ruptured kidney if a patient presents with flank pain, gross hematuria, and:

pain with inhalation.

Because of its anatomic position in the retroperitoneum, it typically takes high-energy force to damage the:

pancreas.

Intraperitoneal organs include all of the following, EXCEPT the:

pancreas.

The major complication associated with hollow organ injury is:

peritonitis caused by rupture and spillage of toxins.

As contents exit the stomach, they FIRST pass through the:

pylorus.

EMS providers can have the MOST positive impact on mortality and morbidity from abdominal trauma by:

recognizing the need for rapid transport.

Periumbilical ecchymosis is:

referred to as Cullen sign and may take hours or days to develop following abdominal trauma.

You are dispatched to the parking lot of a shopping mall for an injured person. While en route to the scene, it is MOST important for you to:

request law enforcement assistance.

Fournier gangrene is a potential complication associated with

scrotal lacerations

Intraabdominal bleeding may produce few signs and symptoms of trauma because:

the intraabdominal cavity can accommodate large amounts of blood.

A 24-year-old male intentionally placed a commercially manufactured constricting object around the base of his penis. He complains of moderate pain, and assessment of his penis reveals that it is cyanotic. You should:

transport him to the hospital and provide emotional support en route

The diaphragm curves from its point of attachment at the _______ rib and peaks in the center at the _______ intercostal space.

twelfth, fourth

Left shoulder pain following injury to the spleen

usually does not occur until 1 to 2 hours after the injury