EMT CH 35

The EMT has fundamental understanding of abdominal trauma when he states:

"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

"My left shoulder is killing me!"

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 8/1 O. What should the EMT do first?

Apply direct pressure to the injury to stop the hemorrhage

The EMT recognizes that the division between the thoracic and abdominal cavities lies approximately:

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?

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 02 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:

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

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

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

Cover the entrance wound with a gloved hand

Which abdominal organ or structure, if seriously injured, would cause the most rapid death?

Descending aorta

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

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

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

Family giving the patient water to drink since he is thirsty

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

Heart rate increases from 116 to 140 beats/min

A patient has referred pain to her left shoulder. What should the EMT suspect?

Hemorrhage from the spleen

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

High-concentration oxygen through a nonrebreather mask

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 diaphoretlc. 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?

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 mm Hg; 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?

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

Internal hemorrhage

If a patient has severe retroperitoneal bleeding from an organ located within this cavity, she has most likely injured her

Kidney

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?

Liver

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?

Liver, right kidney, and pancreas

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

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?

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:

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

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?

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:

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 10/1 0. Which action is most appropriate for this patient

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

Provide 15 lpm through a nonrebreather mask

Which one of these injuries is most likely to cause peritonitis?

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?

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?

Supine position, with knees and hips flexed

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

The patient developed an infection