EMT Chapter 30 - Abdominal Genitourinary Injuries

Which of the following is true about injuries to the kidneys? Injuries are unusual because the kidneys are well protected. A penetrating wound that reaches the kidneys almost always involves other organs. An indication of kidney injury is bruising to the left upper quadrant. A sign of kidney damage is hematuria.

A penetrating wound that reaches the kidneys almost always involves other organs. A sign of kidney damage is hematuria.

You should suspect a kidney injury anytime the patient presents with _______. Select one: A. a hematoma in the flank region B. nausea C. abdominal distention D. dyspnea

A. a hematoma in the flank region

Difficulty breathing and a sunken appearance of the anterior abdominal wall is MOST indicative of a ruptured: Select one: A. diaphragm. B. aorta. C. stomach. D. spleen.

A. diaphragm.

In pediatric patients, the liver and spleen are _______. Select one: A. larger in proportion to the abdomen B. smaller in proportion to the abdomen C. less likely to bleed when injured D. more protected by the thorax compared to adults

A. larger in proportion to the abdomen

open abdominal injury

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 injury

An injury in which there is soft-tissue damage inside the body but the skin remains intact.

Compression injury is most likely due to which of the following? Select one: A. Hollow-organ rupture B. Improperly placed lab belt C. Stabbing D. Ejection of unrestrained driver

B. Improperly placed lab belt

Which of the following is true regarding injury to the kidneys? Select one: A. The kidneys are not well protected. B. Injury to the kidneys usually indicates injury to other organs. C. Kidney injuries are rarely caused by blunt trauma. D. Only minimal force is needed to damage the kidneys.

B. Injury to the kidneys usually indicates injury to other organs.

melena

Black tarry stool

Which of the following organs would MOST likely bleed profusely when injured? Select one: A. Bladder B. Stomach C. Liver D. Intestine

C. Liver

When should you visually inspect the external genitalia on your patient? Select one: A. Always during the secondary assessment B. Only when ordered by medical direction C. Only when there is a complaint of severe pain or other injury D. Anytime the patient agrees to treatment and transport

C. Only when there is a complaint of severe pain or other injury

When a patient stiffens the muscles of the abdomen, it is known as _______. Select one: A. distention. B. instability. C. guarding. D. crepitus.

C. guarding.

Guarding

Contracting the stomach muscles to minimize the pain of abdominal movement; a sign of peritonitis.

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. be objective and factual

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 Kidney damage Ruptured appendix Gallbladder inflammation

Dissecting abdominal aneurysm Patients with a dissecting abdominal aneurysm report tearing going from the abdomen posteriorly.

Which of the following signs would indicate that an injury to the kidney has occurred? Hemoptysis Hematuria Hematoma Hematemesis

If the kidney is injured, a common finding is hematuria, or blood in the urine.

Where is abdominal injury most likely to occur in young children? Appendix Fractured ribs Gallbladder Liver

Liver In pediatric patients, the liver and spleen are very large in proportion to the size of the abdominal cavity and are more easily injured. The soft, flexible ribs of infants and young children do not protect these two organs very well and may allow injury to underlying organs, even without fracturing the ribs.

You should have an index of suspicion that a patient with pain referred to the right shoulder has an injury to which organ? Bladder Intestine Kidney Liver

Liver Injury to the liver (or spleen) may present with referred pain to the shoulders. Unlike radiating pain, which is characterized by pain that "moves" from one area of the body to another, referred pain is characterized by pain in two separate locations.

Bruising over the right upper quadrant could indicate injury to which of the following? Liver Colon Kidney Appendix

Liver The liver is found in the right upper quadrant, along with the gallbladder, duodenum of the intestines, and a small portion of the pancreas.

Which of the following are considered solid organs? Liver and intestines Kidneys and bladder Spleen and stomach Pancreas and spleen

Pancreas and spleen

place pregnant patient on her ______ side so that:

Place patient on her left side so that the uterus will not lie on the vena cava. In the third trimester, the uterus is large and may obstruct the vena cava, leading to a decrease in the amount of blood returning to the heart if the patient is placed in a supine position (supine hypotensive syndrome).

Which of the following is an indication of a spleen injury? Referred right shoulder pain Referred left shoulder pain Radiating pain from left upper quadrant down through the flank Hematuria

Referred left shoulder pain Referred left shoulder pain is a potential indication of a splenic injury because the spleen is in the upper left quadrant.

What is the major cause of death following injury to a hollow organ in the abdomen? Evisceration Internal hemorrhage Rigidity Sepsis

Sepsis The major cause of death when hollow abdominal organs are involved is sepsis, which typically occurs later in the hospital.

solid organs

Solid masses of tissue where much of the chemical work of the body takes place (eg, the liver, spleen, pancreas, and kidneys).

hollow organs

Structures through which materials pass, such as the stomach, small intestines, large intestines, ureters, and bladder.

Evisceration

The displacement of organs outside of the body.

Which of the following statements is true? Low-velocity injuries produce extensive temporary wound channels. There are four levels of velocity. The higher the velocity of a projectile, the larger the cavity it produces. The velocity of an object is not a critical determination in your assessment.

The higher the velocity of a projectile, the larger the cavity it produces.

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.

What is the purpose of wrapping a sexual assault victim in a burn sheet? To maintain body temperature as a result of shock To preserve potential evidence To protect the patient's privacy To keep the patient calm (swaddling)

To preserve potential evidence Wrapping a sexual assault victim in a burn sheet helps preserve potential evidence (ie, hair, fluid, or fiber from the alleged offender).

A patient who has sustained a blunt abdominal injury should be log rolled to a supine position onto a backboard. TrueFalse

True Correct. A patient who has sustained a blunt abdominal injury should be log rolled to a supine position onto a backboard.

peritoneal cavity

abdominal cavity

hematuria

blood in the urine

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. closely monitor him and reassess him frequently. B. perform a comprehensive secondary assessment. C. forgo the hospital radio report because of his condition. D. begin documenting the call on the patient care form.

A. closely monitor him and reassess him frequently.

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: Select one: A. control any external bleeding, administer oxygen, and transport at once. B. visualize the vaginal area and pack the vagina with sterile dressings. C. arrange for a rape crisis center representative to speak with the patient. D. allow her to change her clothes and take a shower before you transport.

A. control any external bleeding, administer oxygen, and transport at once.

Abdominal pain, vomiting, and fever are most likely due to _______. Select one: A. infection B. hypovolemia C. hemorrhage D. evisceration

A. infection

Placing a pregnant patient in a supine position during the third trimester of pregnancy: Select one: A. may decrease the amount of blood that returns to the heart. B. often causes hypotension secondary to cardiac compression. C. is recommended if the patient has severe abdominal discomfort. D. results in spontaneous urinary incontinence if the bladder is full.

A. may decrease the amount of blood that returns to the heart.

All of the following are hollow abdominal organs, EXCEPT the: Select one: A. spleen. B. stomach. C. ureters. D. bladder.

A. spleen

Injuries to the external male genitalia _______. Select one: A. frequently lead to hypovolemic shock B. are rarely life-threatening C. are often life-threatening D. usually result in permanent damage

B. are rarely life-threatening

Because the depth of an open abdominal wound is often difficult to determine: Select one: A. the EMT must perform a thorough exam. B. prompt transport to the hospital is essential. C. vital signs should be monitored frequently. D. the abdomen must be vigorously palpated.

B. prompt transport to the hospital is essential.

Which of the following statements regarding abdominal eviscerations is correct? Select one: A. Adherent material is preferred when covering an evisceration. B. The organs should be replaced carefully to avoid heat loss. C. Most eviscerations occur to the left upper quadrant. D. The protruding organs should be kept warm and moist.

D. The protruding organs should be kept warm and moist.

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: Select one: A. covering the avulsion with moist, sterile dressings. B. requesting a paramedic to administer pain medication. C. administering 100% oxygen via a nonrebreathing mask. D. applying direct pressure with a dry, sterile dressing.

D. applying direct pressure with a dry, sterile dressing.

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. insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a BVM.

When a hollow organ is punctured during a penetrating injury to the abdomen: Select one: A. the abdomen will become instantly distended. B. it will bleed profusely and rapidly cause shock. C. it commonly protrudes through the injury site. D. peritonitis may not develop for several hours.

D. peritonitis may not develop for several hours.

A very common early sign of a significant abdominal injury is tachycardia. TrueFalse

True Correct. A very common early sign of a significant abdominal injury is tachycardia because the heart is increasing its pumping action to compensate for blood loss.

Free air in the peritoneal cavity is abnormal and indicates that a hollow organ or loop of bowel has perforated. TrueFalse

True Correct. Free air in the peritoneal cavity is abnormal and indicates that a hollow organ or loop of bowel has perforated.

You should allow patients with peritonitis to lie still with their legs drawn up. TrueFalse

True Correct. Patients with peritonitis generally prefer to lie very still with their legs drawn up to guard from pain in the abdomen. Allow a patient with a patent airway to remain in a position of comfort.