35: EMT: Abdominal and Genitourinary Trauma: Homework

What is the danger of penetrating trauma to the lower quadrants in a male​ patient? A. The patient may become constipated and get obstructed. B. A full urinary bladder will leak bacteria and waste products. C. The stomach may be injured. D. The liver could get injured.

A full urinary bladder will leak bacteria and waste products. The urinary bladder contains urine which will leak out if the patient has a bullet wound or hole in his bladder.

You are assessing a patient with blunt abdominal trauma. You note that the abdomen is slightly​ distended, rigid to the​ touch, with an ecchymotic area surrounding the umbilicus. What does this finding​ imply? A. Penetrating trauma somewhere in the flank area B. The patient just sustained blunt abdominal trauma C. An abdominal injury that is likely several hours old D. A pelvic ring fracture at the symphysis pubis

An abdominal injury that is likely several hours old Often when​ injured, abdominal skin and underlying muscle may only show erythema during the first hour or so. The more visible discoloration of ecchymosis and any noticeable swelling require several hours to develop.​ Specifically, Cullen's sign is used to describe periumbilical ecchymosis seen with abdominal trauma.

Which of the following is TRUE regarding abdominal injury​ assessment? A. Assessment of the patient with a suspected abdominal injury is very similar to that for a patient with a suspected chest injury. B. A severe form of abdominal wound is an​ evisceration, in which the injury site is extremely swollen and discolored. C. Closed wounds are as easy to find as open wounds. D. Alcohol​ intoxication, head​ injury, and the influence of other drugs may increase the​ patient's response to pain.

Assessment of the patient with a suspected abdominal injury is very similar to that for a patient with a suspected chest injury. Assessment of the abdominal injury is similar to the chest assessment as it utilizes the modalities of​ inspection, palpation, and auscultation.

A patient with an abdominal injury will likely want to keep his legs in what position to reduce​ pain? A. Flat B. Bent C. Elevated D. Straight

Bent When the legs and hips are in a flexed​ position, it fully relaxes the abdominal musculature which in turn reduces pressure on the abdominal​ contents, and thus decreases pain. 968

Your patient has an abdominal wound that resulted in an evisceration of bowel. How should this be​ managed? A. Cover the exposed bowel with a​ saline-soaked trauma pad. B. Gently tuck the bowel back into the abdominal cavity without rinsing it with saline. C. Cover the exposed bowel with an occlusive dressing. D. Wash off the bowel with saline and tuck it gently back into the abdominal cavity.

Cover the exposed bowel with a​ saline-soaked trauma pad.

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

Diaphragm The abdominal cavity contains the major organs of the​ digestive, urinary, and endocrine systems. The abdomen is separated from the chest cavity superiorly by the diaphragm. The inferior border is the​ heavy, bony pelvic ring.​ Tough, thick, flat muscles form the bulk of the anterior​ border, along with the lower portion of the rib cage.​ Posteriorly, the spinal column and strong muscles provide protection. The peritoneum and pleura are thin linings of the abdominal and thoracic​ cavities, respectively. Although they both course along the​ diaphragm, they do not provide enough strength to keep the two cavities separate.

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

Diaphragm The diaphragm could be injured from a penetrating injury or from a severe blunt force applied to the abdomen. The diaphragm is responsible for approximately 60 to 70 percent of the effort to​ breathe; therefore, injury to the diaphragm will likely cause respiratory distress.pg 967

You have a patient who was trapped beneath a truck along the freeway when he was trying to repair the brakes. By the time you​ arrive, the local fire department has already extricated the patient from underneath the​ truck, and he is currently immobilized. They advise you that the patient has a crushed​ pelvis, an open fracture to the left​ femur, a distended​ abdomen, and vomit in the airway. The patient suddenly became unresponsive when the weight of the truck was lifted from him. What should be your FIRST priority of​ management? A. Remove the cervical collar and palpate the posterior vertebrae of the neck. B. Apply the AED and wait for it to analyze the rhythm. C. Establish an open airway. D. Immobilize the fractured femur.

Establish an open airway.

Your patient sustained abdominal trauma a day earlier from a dirt bike accident. The patient now presents with lower abdominal pain and guarding that had a slow onset. The patient is very warm to the touch. Given this​ presentation, what type of abdominal injury has the patient likely​ sustained? A. Vascular organ damage to the inferior vena cava B. Hollow organ damage to the colon C. Solid organ damage to the liver D. Hollow organ damage to a vascular structure

Hollow organ damage to the colon Hollow organ damage results in hemorrhage and in content spillage into the​ retroperitoneal, peritoneal, or pelvic spaces. The​ jejunum, ileum,​ colon, and rectum contain increasingly higher bacterial​ concentrations, and their rupture and the subsequent leakage into the abdomen will likely induce severe but delayed infection.

You are assessing the abdomen of a​ 16-year-old female that was kicked by a horse earlier in the day. You notice a bluish discoloration around the belly button. What does this finding​ mean? A. It is a late sign of intraabdominal bleeding. B. They are a victim of child abuse. C. The female is probably pregnant. D. They are starting to bleed into the abdominal cavity now.

It is a late sign of intraabdominal bleeding Inspect around the umbilicus​ (navel) and the flank areas for discoloration and​ bruising, which also indicate that bleeding is occurring inside the abdomen. This is a late sign and may be an indication that the patient had been bleeding for some time before contacting EMS. pg 969

During a fight with a​ knife, your teenage patient was stabbed in the lower left abdominal​ quadrant, at roughly the 5​ o'clock position. Bleeding is​ minimal, and the patient is conscious and in extreme pain. Given this​ injury, what structure is MOST likely injured from the​ stabbing? A. Inferior vena cava B. Large bowel C. Gallbladder D. Small bowel

Large bowel

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

Like a soft tissue injury and provide direct pressure An injury to the penis is generally treated like all other soft tissue injuries.

Which of the following abdominal organs would be characterized as being solid despite containing a large amount of​ blood? A. Uterus B. Colon C. Liver D. Abdominal aorta

Liver

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

Pancreas

What age bracket of patients is MOST likely to suffer injury to the liver and spleen from blunt abdominal​ trauma? A. ​Middle-age adult B. Young adult C. Elderly D. Pediatric

Pediatric

You arrive on scene at a construction​ site, and are directed to a worker who at first glance is bleeding from the abdomen as his box of tools lay​ nearby, next to a screwdriver with blood on it. What should you​ suspect? A. Hemothorax B. Penetration injury C. Blunt trauma D. Thoracic injury

Penetration injury Given the scene​ size-up findings of a construction worker with an abdominal injury and blood on the​ screwdriver, a logical assumption would be that he accidently penetrated his abdomen with the tool.

In addition to the traditional management of a patient with abdominal​ trauma, what additional consideration should be made for an​ eight-months-pregnant female with abdominal​ trauma? A. Never immobilize a pregnant female B. Use of low flow oxygen only to avoid fetal hyperoxia C. Place the pregnant female in a position to alleviate pressure of the uterus on the vena cava D. Use a cold compress or ice pack on the abdomen to relieve pain

Place the pregnant female in a position to alleviate pressure of the uterus on the vena cava Special care is offered to the pregnant patient because of the anatomical and physiological changes induced by pregnancy. Place the​ late-term mother, when​ possible, in the left lateral recumbent position. This ensures that the weight of the uterus does not compress the vena​ cava, reduce blood return to the​ heart, and cause hypotension.

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

Referred pain to the shoulder caused by abdominal bleeding. Blood that irritates the diaphragm and causes referred pain to the shoulder is is called Kehr sign. pg 967

If a woman who does NOT believe she is pregnant starts having serious vaginal bleeding after being involved in a​ high-speed collision, it is MOST likely NOT due to​ a/an: A. ruptured uterus. B. internal bleeding in the abdomen. C. pelvic fracture. D. genital trauma.

Ruptured uterus The uterus of a​ non-pregnant woman is small and rarely injured with abdominal trauma.​ However, genital​ trauma, a pelvic​ fracture, and significant intraabdominal injuries may result in blood loss through the vagina.

Which of the following​ organs, if​ injured, would be MOST likely to cause​ peritonitis? A. Spleen B. Lung C. Ovary D. Small intestine

Small intestine

The​ liver, spleen, and pancreas are examples of what type of abdominal​ organs? A. Lymphatic B. Hollow C. Solid D. Vascular

Solid Solid organs within the abdominal cavity include the​ following: liver,​ spleen, pancreas and kidneys. Solid organs usually contain a rich blood supply. pg966

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

Solid organs include the pancreas and kidneys. Solid organs within the abdominal cavity include the​ following: ​liver, spleen, pancreas and kidneys. Solid organs usually contain a rich blood supply. pg 966

Which of the following solid organs is offered the BEST protection from blunt​ trauma? A. Descending aorta B. Urinary bladder C. Gavid uterus D. Spleen

Spleen The spleen is a solid organ located in the upper left abdominal quadrant that is especially well protected from blunt trauma by the lower​ ribs, back and flank​ muscles, and spinal column. The​ aorta, uterus, and urinary bladder are in the abdominal​ cavity, but they are not solid type organs.

When you are assessing the abdomen of a​ 25-year-old male you note that he has a large piece of glass sticking out of his right upper quadrant. What should you do about​ this? A. Monitor vitals and transport right away. B. Stabilize it and administer oxygen. C. Remove it and apply the PASG. D. Place the patient in the prone position.

Stabilize it and administer oxygen.

An object impaled in the abdomen should​ be: A. twisted while being pulled out. B. immediately removed. C. stabilized in place. D. slowly removed.

Stabilized in place Just as any other impaled object in the trunk of the​ body, the item should be stabilized in place and not removed by the EMT. The concern is that the amount of damage that could be caused from pulling it out is​ unknown, and may be fatal.

What would be the preferred position in which to place a patient who has an abdominal​ evisceration? A. ​Semi-Fowler's B. Prone C. Lateral D. Supine

Supine After treating the abdominal​ evisceration, place the patient in a position that would be used with abdominal trauma in general. Place the patient in a supine position with legs flexed at the knees​ (legs brought up toward the​ chest) if no injury to the lower​ extremities, hips,​ pelvis, or spine is suspected. When the legs and hips are in a flexed​ position, it fully relaxes the abdominal​ musculature, which in turn reduces pressure on the abdominal contents and thus decreases pain. Do not place the patient in a​ prone, lateral or​ semi-Fowler's position.

What bit of information gathered during the scene​ size-up will be extremely important in determining the severity of abdominal​ injuries? A. The amount of pain the patient is in B. The​ patient's heart rate C. The mechanism of injury D. The​ patient's blood pressure

The mechanism of injury A mechanism of injury involving either blunt or penetrating​ trauma, early signs and symptoms of hemorrhagic​ shock, shallow and rapid​ respirations, and abdominal pain and rigidity are all significant and early signs of a serious abdominal injury. Any patient who complains of abdominal pain should be taken seriously and assessed carefully. pg 969

If a patient has an impaled object in his upper left abdominal​ quadrant, which organ is likely to have been​ injured? A. The bladder B. The liver C. The prostate D. The small intestine

The small intestine The small intestine is found in each of the four abdominal quadrants. The liver is in the URQ while the bladder and prostate are in the lower quadrants.

Why should the EMT complete a full assessment on any patient with abdominal​ pain? A. To see if the patient can be distracted away from the pain B. In order to assure transport is necessary C. So you can complete the PCR D. To find any other injuries

To find any other injuries

Why should the EMT complete a full assessment on any patient with abdominal​ pain? A. To find any other injuries B. To see if the patient can be distracted away from the pain C. So you can complete the PCR D. In order to assure transport is necessary

To find any other injuries Since abdominal injuries can produce severe​ pain, the patient may not complain of any other injuries. If you allow yourself to develop tunnel vision and not inspect other areas of the​ body, you can easily miss​ life-threatening injuries.

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

Vascular

You are caring for a patient who sustained a GSW injury to the abdomen. Injury to which of the following structures from this mechanism would MOST likely result in acute deterioration and​ death? A. Solid B. Hollow C. Vascular D. Muscular

Vascular Vascular injury in the​ peritoneal, retroperitoneal, and pelvic spaces can be serious for several reasons. These spaces expand​ easily, and do not progressively resist continuing hemorrhage that would occur with vascular injury within a muscle mass elsewhere in the body. Without this​ pressure, both the rate and volume of blood loss do not diminish and the resultant blood loss can be​ severe, if not fatal.

You are caring for a patient who was injured while riding his bike and was struck by a car. The patient is found lying in a fetal position on the​ ground, holding his stomach. You see a deformed left ankle and multiple abrasions to his face and arms. Given​ this, where should the EMT start their​ assessment? A. With the abdomen B. With the angulated ankle C. With the airway D. With the abrasions to the face and arms

With the airway

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

a wound through the abdominal wall allows abdominal contents to protrude. An abdominal evisceration occurs when an open wound through the abdominal wall allows abdominal​ contents, usually the small​ intestine, to protrude and be exposed.

Severe abdominal trauma and blood loss may cause signs and symptoms of​ shock, which​ include: A. a decreased heart rate. B. an increased heart rate. C. hypertension. D. flushed skin.

an increased heart rate. An elevation of the heart rate in trauma is a common​ finding, but is still an important finding as the heart rate will increase when there is blood loss and the heart is trying to maintain blood pressure by increasing cardiac output.

In the treatment of an abdominal evisceration the EMT should​ NOT: A. pour cold saline onto the injury site. B. allow the patient to lie with his hips flexed. C. administer​ high-concentration oxygen. D. attempt to return the loop of bowel to its original location.

attempt to return the loop of bowel to its original location. If the patient has sustained an abdominal evisceration do not attempt to replace the organs into the​ patient's body cavity. This is done in surgery after the organs have been assessed for additional injuries and the abdominal cavity and bowel have been properly cleaned.

Peritoneal space is potential space A. below the peritoneum. B. behind the peritoneal layers. C. between the peritoneal layers. D. above the peritoneum.

between the peritoneal layers. The potential space between the visceral and parietal peritonea is called the peritoneal space.

If the patient has sustained an abdominal evisceration the EMT​ should: A. cover the wound with a moist dressing followed by an occlusive dressing. B. administer oxygen with a nasal cannula. C. administer four baby aspirins. D. have the patient lie flat.

cover the wound with a moist dressing followed by an occlusive dressing. Cover the evisceration with a moist dressing followed by an occlusive dressing to retain moisture and warmth. Plastic wrap will do. Avoid the use of aluminum​ foil, if​ possible, since it may lacerate the protruding organs. Secure the dressing in place with​ tape, cravats, or a bandage.

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

covering an evisceration with a moist dressing and occlusive dressing. The EMT should cover any eviscerated tissue with a moist sterile dressing. The EMT should not attempt to replace the tissue back into the abdominal cavity. pg 967

During your focused history and physical exam of a patient with a suspected abdominal​ injury: A. palpate the​ abdomen, starting from the point closest to the pain. B. remember that the radial pulse will normally be stronger than the femoral pulse. C. discoloration around the umbilicus indicates bleeding is occurring inside the abdomen. D. keep in mind that it takes about one liter of blood to expand the abdominal girth by two inches.

discoloration around the umbilicus indicates bleeding is occurring inside the abdomen. The EMT should inspect around the umbilicus​ (navel) and the flank areas for discoloration and​ bruising, which also indicate that bleeding is occurring inside the abdomen. This is a late sign and may be an indication that the patient had been bleeding for some time before contacting EMS. pg 969

If the abdomen appears larger than​ normal, this is​ called: A. guarding. B. rigidity. C. distension. D. crepitation.

distension.

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. avulsion. B. evisceration. C. protrusion. D. sucking abdominal wound.

evisceration.

Palpation of abdominal pain should​ begin: A. in the left upper quadrant. B. immediately. C. in the quadrant that hurts. D. farthest from the quadrant that hurts.

farthest from the quadrant that hurts. When palpating the​ abdomen, always start in a position furthest away from the area of pain and work towards the quadrant of concern. This will help with patient comfort. pg 969

If a male patient is kicked in the testicles during a​ fight, after determining there is NO bleeding the EMT should​ consider: A. prone position and an occlusive dressing. B. direct pressure and elevation. C. ice and position of comfort. D. heat packs and supine position.

ice and position of comfort. If the patient has been kicked during a​ fight, you should consider transporting in the position of comfort and apply some ice.

If your patient has vaginal bleeding from an​ assault, the EMT should do all of the​ following, EXCEPT: A. provide emotional support of the patient. B. instruct the patient to take a shower. C. stop bleeding with direct pressure. D. notify the police.

instruct the patient to take a shower.

An abdominal evisceration should be covered with a moist sterile​ dressing, followed​ by: A. a dry bandage. B. a sterile trauma pad. C. ​non-sterile bandage. D. occlusive dressing.

occlusive dressing. Cover the moist dressing with an occlusive dressing to retain moisture and warmth. Plastic wrap will do. Avoid the use of aluminum​ foil, if​ possible, since it may lacerate the protruding organs. Secure the dressing in place with​ tape, cravats, or a bandage.

Which of the following causes​ immediate, excruciating​ pain? A. bleeding into the peritoneal space. B. peritonitis. C. bowel inflammation. D. bleeding into a solid organ.

peritonitis.

Organs that lie dorsal to the peritoneum are called A. retroperitoneal. B. supraperitoneal. C. infraperitoneal. D. anteroperitoneal.

retroperitoneal. Some organs in the posterior abdominal cavity lie partially or completely behind the peritoneum. They are said to be retroperitoneal. pg 966

A weak or absent radial​ pulse, pale,​ moist, cool​ skin, and an increased heart rate in a patient with an abdominal injury are signs​ of: A. shock. B. open chest wound. C. closed chest wound. D. pneumothorax.

shock. These findings are consistent with hypoperfusion from blood loss. It is important for the EMT to understand that the findings of hypovolemia will be largely the same whether or not the bleeding is occurring externally or internally.

When a patient has a knife impaled in his abdomen the MOST likely condition to develop will​ be: A. hyperthermia. B. hypoglycemia. C. shock. D. respiratory depression.

shock. Patients with an object impaled in their abdomen are more than likely to go into shock due to blood loss into the abdomen​ (or even​ externally).

Blunt abdominal trauma that causes the perforation of a vascular structure in the abdomen may​ cause: A. rupture of the urinary bladder with resultant chemical inflammation. B. loss of function to lower extremities. C. significant blood loss. D. spinal cord damage to motor nerve roots.

significant blood loss. A vascular structure injury represents a serious and often​ life-threatening hemorrhage. There is often heavy blood loss into the abdominal compartment that may go unrecognized for a period of time. pg 966- 967

Internal abdominal injuries can be severe​ because: A. air might leak into the abdominal cavity through an open wound. B. there are several major organs and blood vessels in the abdomen. C. they are more prone to infection. D. they are very painful.

there are several major organs and blood vessels in the abdomen.

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. elevate the hips. C. immediately administer oxygen. D. apply the PASG.

treat the injury like other soft tissue injuries.

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

usually embarrassing for the patient.

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

usually embarrassing for the patient. Injuries to the genitals are rarely life threatening as really its nothing more than soft tissue trauma.​ However, they are typically very painful and embarrassing for the patient.

What is the target pulse oximeter reading when providing oxygen to a patient with abdominal​ trauma? A. greater than or equals≥94 percent B. ​>90 percent C. 98 to 100 percent D. ​>96 percent

≥94 percent