Chapter 36

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

Anatomic Regions

Know

Anatomic Regions

Know which organs are located in each region

Orthostatic Vital signs

BP or PR that changes with body positions. May indicate hypovolemia, a common result of GI bleeding.

Grey Turners Sign

Indicates blood collecting in the abdomen from retroperitoneal hemorrhage. To assess for Grey Turners sign, assess the back. If Patient has discoloration in the flanks, a positive Grey Turners sign is present Grey Turners sign indicates abdominal bleeding, retroperitoneal bleeding from the pancreas, duodenum, kidneys, vena cava, or aorta

Fournier gangrene is a potential complication associated with

scrotal lacerations.

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

Size of the patient

To measure Orthostatic Vital signs

Take pt's BP and PR while patient is supine Then take BP and PR while patient is sitting and last, take BP and PR while standing.* WAIT at least 1 minute in between each position>Consider a decrease in systolic pressure of 20 mmHg or more, or a pulse rate increase of 10 beats per minute or more, as positive for hypovolemia

What do the spleen and liver have in common

They are both highly vascular and bleed profusely when injured.

What are the two layers that cover the testicles

Tunica albuginea and tunica vaginalis

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.

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

auscultation

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.

Cullen's Sign

Look for bluish discoloration of the skin around the umbilicus, sometimes associated with intraperitoneal hemorrhage, especially following rupture of fallopian tube in ectopic pregnancy. Cullen's sign may also indicate acute hemorrhagic pancreatitis

"referred Pain"

Patient will complain of pain in left shoulder, which is caused by irritation of the diaphragm due to bleeding. This sign indicates a ruptured spleen

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.

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.

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.

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

flank, retroperitoneal bleeding

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.

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

bladder

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

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

intoxicated

At least two thirds of all abdominal injuries

involve blunt trauma.