EMT chapter 23
Your medical director is providing an in-service program on abdominal pain. He notes that there are several different categories of pain and asks if anyone can describe visceral pain. Which response made by the EMT would be correct?
"A patient with visceral pain typically describes the pain as 'aching' and has a hard time identifying its exact location."
When an EMT inspects the abdomen of a patient with pain to his right upper quadrant, it appears large and possibly distended. To determine if the abdomen is indeed distended, the EMT would ask:
"Does your belly normally seem to be this size?"
You are by the side of an 80-year-old male patient whose wife called EMS because he had tearing-type abdominal pain. The patient states that he was just discharged from the hospital this morning after being treated for gastroenteritis. When questioned further, he states that he remains nauseated, but the medications for the vomiting and diarrhea seem to be working, as he is no longer experiencing either of those symptoms. Since he was just in the hospital, the patient states that he would like to refuse transport and continue his recovery at home. What is your best response?
"I don't know; your symptoms don't seem to be related to gastroenteritis."
During transport, a 27-year-old female drug addict with acute abdominal pain tells you that she is scared and starts crying. What would your best response be?
"I know that you are in pain. We are 5 minutes from the hospital and I have already called the emergency department and let them know we are coming. They will be prepared for us."
Your partner is performing the Markle test on a patient who complains of abdominal pain. Which instructions should be provided to the patient to ensure that she performs the test correctly?
"I need you to stand on the tips of your toes, then on my command drop onto your heels."
A patient who has just been raped states that she will not go with you to the hospital until she showers and cleans herself up. As an EMT, what is your best response?
"If you shower, you will destroy evidence needed to help identify the rapist."
Which of these statements indicates that the EMT correctly understands the goal of assessing a geriatric patient with abdominal pain?
"It is more important to recognize a possible abdominal emergency, as opposed to determining the exact cause, because pain perception may be distorted."
You are preparing to transport a patient with an indwelling urinary catheter. The bag is full and your partner starts to empty it. Which of these statements would be appropriate to make to your partner?
"Let's make sure that we measure the amount prior to disposing of it."
You are treating a male patient with a sickle cell crisis. Vital signs are pulse, 124; respirations, 22 breaths/min; blood pressure, 156/92 mmHg; breathing, unlabored; and SpO2, 91%. Which instruction would you provide to other EMTs in the care of this patient?
"Let's place the patient on a nasal cannula with 2 lpm of oxygen."
A 19-year-old patient with hemophilia and behavioral problems has intentionally cut his right wrist. Assessment indicates an open airway, adequate breathing, and profound bleeding from the self-inflicted laceration. Which instructions would you provide to other EMTs taking care of this patient?
"Let's use normal bleeding-control procedures and see how that works."
The primary assessment of a 27-year-old female patient who has been raped reveals no life threats to the airway, breathing, or circulation. The patient complains of pain in the vaginal area, but a focused assessment of her genitalia indicates no remarkable findings. When caring for this patient, which of these statements would be most therapeutic?
"Please be assured that you are safe from harm here in the ambulance."
You are transporting a visibly upset female patient who was raped after she let a male stranger into her house. Which of these questions would be appropriate for the EMT to ask?
"Please tell me where you are hurting."
The EMT has an accurate understanding of the solid organs contained within the abdomen when she states:
"Solid organs may receive a lot of blood flow and may bleed excessively if injured."
Upon your arrival at the scene of a patient with severe abdominal pain, an Emergency Medical Responder tells you that he is concerned because the patient's blood pressure is 146/88 mmHg and the patient has no history of high blood pressure. He states that it may be a good idea to treat the patient for hypertension as well as the abdominal pain. Your best response would be:
"Sometimes pain can naturally increase the blood pressure. I will take another reading so we can compare it with the baseline reading."
Of these statements, which best demonstrates that the EMT has an accurate understanding of acute abdominal pain?
"Sometimes the cause of abdominal pain will be obvious, but often the cause will not be that apparent."
A patient informs you that he was recently diagnosed with an abdominal aortic aneurysm (AAA). The surgeon did not want to operate on the aneurysm immediately because he felt it was stable and not worth the risks that surgery posed. Tonight, the patient states that he suddenly developed abdominal pain and wants to be evaluated in the hospital to see if the AAA has increased in size. Given this history, which of these assessment findings would cause the EMT to suspect that the AAA is the cause of the abdominal pain?
"Tearing" pain located to the lower back
The EMT understands the major function of most organs in the abdomen when he states:
"The major function of the organs in the abdominal cavity is digestion."
Which of these statements made by the patient regarding abdominal pain would lead the EMT to suspect appendicitis?
"The pain started around my belly button and slowly spread down to the right side of my belly."
A patient with a history of upper gastrointestinal bleeding is complaining of weakness and abdominal pain. He informs you that he vomited 5 minutes before you arrived. Which of these questions is most important that the EMT ask first regarding the vomit?
"Was the vomit red or did it look like coffee grounds?"
A 21-year-old female patient has called EMS for severe right-sided abdominal pain. Which of these questions should be asked before the others?
"When was your last normal period?"
A female patient, who has been sexually assaulted, has called 911 for assistance. She states that she does not know the assailant and showered immediately after the assault. The police have not yet been notified. Which of these statements would be appropriate in the care of this patient?
"Where are the clothes that you were wearing?"
Assessment of a 21-year-old female patient reveals her to have severe abdominal pain localized to the right upper quadrant. She is alert and oriented, and her vital signs are stable. After you place her supine on the stretcher, the patient quickly assumes a lateral recumbent position with her knees drawn up to her chest. Which response from the EMT would be appropriate?
"You seem more comfortable in that position. If you are, you should stay on your side."
The EMT would identify which of these patients as having an acute abdomen?
A 62-year-old male with no medical history with sudden pain to the lower abdomen
A patient with generalized weakness informs you that she has a history of iron-deficient anemia. You recognize that this patient has a history of:
A decreased amount of hemoglobin available to carry oxygen
Which of these definitions best describes the structure and function of the stomach?
A hollow organ that secretes digestive enzymes and churns food
The EMT would recognize a hematologic condition in which of these patients?
A patient with an elevated white blood cell count due to leukemia
You have been called for a patient with a sickle cell crisis. In reviewing the pathophysiology of sickle cell anemia, you understand that the underlying problem is:
Abnormal hemoglobin formation that means the blood cannot carry oxygen as efficiently
A patient informs you that he previously had a section of his small intestine removed due to cancer. You recognize that with the removal of small intestine, the patient is less able to:
Absorb nutrients
At the side of a distressed patient with active and severe esophageal varices, you realize that the priority of care will be:
Airway management
A 44-year-old female patient states that she has a history of endometritis. The EMT would recognize that this patient has:
An infection of the endometrial lining
Pelvic inflammatory disease is best described as:
An infection of the female reproductive structures
A patient complains of severe and sharp pain to the right lower abdominal quadrant. Based on location, which organ or structure is most likely involved?
Appendix
On scene, a 57-year-old female patient has profuse hemorrhage coming from the dialysis graft located on her left arm. To control the bleeding, you would immediately:
Apply direct pressure to the graft
A severely distressed patient has bright red rectal bleeding and in lethargic. His pulse is 136, respirations are 24 breaths/min, blood pressure is 72/58 mmHg, and SpO2 is 95%. His skin is moist, pale, and clammy, and his mental status is deteriorating. At this time, your priority intervention would be to:
Apply supplemental oxygen
You have completed the initial assessment on a 62-year-old male patient who complains of the sudden onset of epigastric pain. His airway is patent, his breathing is fast but still adequate, and his radial pulse is weak and barely palpable with a delayed capillary refill. His pulse is 124 beats/min and his skin is cool and moist to the touch. Your next action would be to:
Apply supplemental oxygen
A 38-year-old female patient was violently raped at a party where drugs were being abused. The patient is conscious, upset, and actively bleeding from the vaginal canal. As an EMT, your best care would involve:
Applying a bulky dressing and gentle pressure to the external genitalia
When assessing a patient with abdominal pain, you note that his abdomen feels rigid. What should you do next as part of the abdominal assessment?
Ask the patient to take a deep breath and then relax, while you repalpate the rigid area
A patient informs you that she has a dialysis fistula on her left arm. You would:
Avoid performing a blood pressure measurement on the patient's left arm
The most common cause of urinary tract infections is:
Bacterial invasion
The EMT knows that the abdomen is located:
Between the diaphragm and the top of the pelvis
Which of these assessment findings would increase the EMT's suspicion of a gastrointestinal bleed that is likely occurring slowly?
Black semi-formed stool
Hemophilia is a blood disorder in which the:
Blood is unable to form clots properly
The spleen of a patient has ruptured following a traumatic injury. Because it is a solid organ, the EMT recognizes that the primary threat to life is:
Blood loss
Which of these assessment findings is of most concern with a 46-year-old male patient who complains of severe abdominal pain?
Blood pressure of 90/64 mmHg
A 56-year-old male patient informs you that he has gastric ulcers. He has had them for several months, but recently the pain has been steadily increasing. If the cause of the abdominal pain is the gastric ulcers, how would you expect the patient to describe the pain?
Burning pain located to the left upper quadrant
Which of these complaints would raise the EMT's suspicion that a female patient has a urinary tract infection (UTI)?
Burning sensation every time she urinates
The fundamental problem associated with anemia is:
Cellular hypoxia
You have been dispatched for a patient with severe abdominal pain. On scene, the 57-year-old male patient informs you that he has a past medical history of chronic pancreatitis, which has "flared up again." Which precipitating factor would you identify as the most likely cause of the exacerbation?
Consumption of six beers this afternoon at a picnic
You are providing continuing education for a group of EMTs. The topic is acute abdominal pain. Which of these points would you stress when discussing the EMT's treatment of the patient with acute abdominal pain?
Definitive care for patients with abdominal pain is hospital evaluation and possible surgical intervention
You have been called to a local nursing home for a restless patient with a four-day history of diarrhea. The primary assessment reveals an open airway, rapid breathing, and a weak and rapid radial pulse. Vital signs are pulse, 124; respirations, 24 breaths/min; blood pressure, 100/86 mmHg; and SpO2, 95%. The patient is confused with a history of Alzheimer's dementia. For this patient, it is most important to evaluate for:
Dehydration
An EMR tells you that a patient has pain just above the umbilicus, but just below the rib cage. You would document this condition as pain in the:
Epigastric area
During a normal pregnancy process, within which structure does the sperm and egg typically meet during fertilization?
Fallopian tube
When you are obtaining information for the medical history, which of these findings would be significant for a patient with suspected cholecystitis?
Fried chicken and potato salad for dinner
A patient states that about two hours following dinner, she developed right upper quadrant abdominal pain that radiated to her shoulder. As a knowledgeable EMT, you would recognize this characteristic pain pattern as most suggestive of:
Gallbladder inflammation
Along with immunocompromised patients, which other age group(s) may have a vague presentation of an abdominal pathology due specifically to a depressed inflammatory response?
Geriatric patients
A patient with hemophilia fell backward onto his right hip and now complains of pain to that area. The primary assessment reveals no life-threatening conditions. Vital signs are pulse, 112; respirations, 18 mmHg; blood pressure, 102/84 mmHg; and SpO2, 99%. During transport, which of these findings would be of greatest concern?
Heart rate increases to and is sustained at more than 130 beats/min
What is the major threat to life for a patient with an unstable abdominal aortic aneurysm?
Hemorrhage
You have been called for a 31-year-old male patient who experienced sudden left lower quadrant pain while lifting and moving a friend's couch to an upstairs bedroom. The EMT would recognize this history as suggestive of which type of abdominal pathology?
Hernia
You have been called for a patient with abdominal pain. The patient states that he recently had his gallbladder removed. As an EMT, you realize that:
His ability to digest fats properly is impaired
A patient with lower abdominal pelvic pain, vaginal discharge, and elevated temperature has summoned EMS. In getting a medical history from this patient, which of these findings is the most important piece of information to relay to the receiving emergency department?
Internal procedure on her uterus yesterday by the gynecologist
If a patient has a retroperitoneal infection, which organ is most likely involved?
Kidney
Which of these assessment findings would help convince the EMT that a patient with abdominal pain and vaginal bleeding is experiencing a spontaneous abortion (miscarriage)?
Last menstrual period six weeks ago
A patient with abdominal pain shows you black and loosely formed stool in the toilet. You would advise the hospital that the patient has:
Melenic stool
A 26-year-old female patient has called 911 because of lower abdominal pain. Your findings are consistent with a urinary tract infection. The patient has a history of urinary tract infections as well as asthma. Her vital signs are pulse, 116; respirations, 14 breaths/min and adequate; blood pressure, 108/56 mmHg; SpO2; 99%; and temperature, 101.6°F. What is the priority of care?
Nonemergent transport
While performing the secondary assessment on a patient's abdomen, you note a pulsating mass just above the umbilicus. Your next action would be to:
Palpate the remainder of the abdomen gently
The EMT would recognize that the pain associated with a kidney stone is caused by:
Passage of the stone through the ureter
In the human body, the urethra:
Passes urine from the bladder to the outside of the body
While you are transporting a 44-year-old female patient with abdominal pain in low Fowler's position, she starts to vomit. Your immediate action would be to:
Place the patient in a left lateral recumbent position
When transporting a patient whom you suspect has a kidney stone to the hospital, in which position should the patient be placed if no contraindications exist?
Position of comfort
When transporting a patient with an indwelling catheter and bag, which of these actions is appropriate?
Position the bag below the level of the patient's bladder
A 50-year-old female states that she has gone through menopause and no longer experiences menstrual periods. Using appropriate medical terms for documentation, the EMT would describe this status as:
Post menarche
On scene, a 45-year-old female patient tells you that her current abdominal pain felt similar to a previous small bowel obstruction, so she called for EMS much earlier than the first episode. During your assessment, which signs or symptoms would agree with her assessment?
Prominent and high-pitched bowl sounds
Which of these assessment findings for a patient complaining of abdominal and back pain would raise the most concern in the EMT?
Pulsating mass above the umbilicus
A middle-aged female patient has dialed 911 for an abdominal emergency. On scene, she informs you she has a "bad gallbladder" and it has been increasingly bothering her, so she needs transport to the hospital for further care. Your assessment reveals tenderness and mild discomfort to the right upper quadrant of the abdomen. The patient also states that her right shoulder is aching. Given the patient's complaint, the EMT would recognize the shoulder pain as:
Referred pain
A patient with a history of renal failure, among other things, has an impairment in the ability to:
Regulate electrolytes
You are called to a long-term care facility for a patient with abdominal pain per staff. On scene, you find an 81-year-old female patient whom staff said complained of abdominal pain and then began to vomit several times. The patient has dementia and is occasionally confused and sometimes lethargic, which staff says is her normal status. Assessment reveals her to be confused, breathing 22 times a minute, with a pulse rate of 88 beats per minute. Her blood pressure is 118/68 mmHg and she has an SpO2 of 97% on room air. Staff states that her temperature is 100.8°F and she did not get her medication for dementia today. When treating and transporting this patient, what would most likely represent the EMT's greatest concern during transport?
Risk for vomiting
Which of these conditions would the EMT recognize as an acute abdominal emergency?
Rupture of the bladder
A patient with a kidney stone would most likely complain of:
Severe abdominal pain
A patient with sickle cell crisis will most likely complain of:
Severe pain
If a patient missed his last dialysis appointment, which complaint would you anticipate?
Shortness of breath
Assessment of a confused and lethargic patient with diabetes and renal failure reveals her to be lying in bed with notable significant edema to the face, torso, and extremities. Her respirations are extremely labored and associated with a "grunting" sound. Her airway is patent, radial pulse weak, and skin cool and diaphoretic with cyanosis noted to the fingers. Oxygen has been applied by Emergency Medical Responders (EMRs). Your next action would be to:
Sit the patient upright
A female patient has developed bacterial peritonitis after sustaining blunt trauma to the abdomen. Damage to which organ was most likely responsible for this condition?
Small intestine
When palpating the anterior portion of a patient's abdomen, you note tenderness to the left upper quadrant. As a knowledgeable EMT, you would recognize that which organ is most likely to be involved?
Spleen
A 26-year-old patient with hemophilia fell in his garage, cutting his arm on a nail protruding from a door frame. Emergency Medical Responders are on scene holding a blood-soaked towel on his right forearm that is still bleeding. The patient is alert and oriented with a pale complexion. The EMRs report a pulse of 98, respirations of 18 breaths/min, blood pressure of 142/66 mmHg, and SpO2 of 99% on room air. Your initial priority in caring for this patient is:
Stopping the bleeding
You have been dispatched for a male patient who is "sick." While you are en route, Emergency Medical Responders inform you via radio that the patient has esophageal varices, which appear to have ruptured. You would inform your partner to prepare which materials or piece of equipment?
Suction machine
The wife and primary care provider of a disabled male patient tells you that he has a suprapubic catheter in place. Upon assessment of the patient, which of these findings would you expect?
Surgical tube coming out of the pelvic area
You are by the side of a patient who thinks he has a kidney stone. After assessing the patient, which of these findings would force you to consider an alternative pathology for the patient's pain?
Tearing pain in the abdomen
An alert but confused patient called 911 with the complaint of abdominal pain. Assessment reveals her to be nauseated with pain that she localizes to the right lower quadrant of the abdomen. She states that she was not able to take her blood pressure medication this morning and wants to take it now with a small glass of juice. You would:
Tell her that she should not take her medication or drink juice
You are dispatched for a patient with an unknown medical problem at a dialysis center. When you arrive, you are directed to a patient who is sitting in a chair, with a dialysis technician holding a dressing on his arm very tight. You can see blood seeping through the dressing and on the hands of the technician. Given this limited information, what is likely the problem?
The dialysis graft is bleeding
The EMT would recognize the profession of urology as applying to:
The kidneys, ureters, bladder, and urethra
You have been called to transfer a male patient from an outpatient clinic to the hospital. The patient has been diagnosed with peritonitis and requires transport to the hospital for definitive care. As a knowledgeable EMT, you would recognize which of these statements as true?
The lining of the patient's abdominal cavity is inflamed
A patient has a tumor that has compressed and obstructed her left ureter. Which complication may result from this condition?
The urine will back up into the left kidney
Which of these statements is true concerning the functions of the vagina?
The vagina serves as a passage for the fetus during delivery as well as an outlet for blood during menstruation
In discussing patients with chlamydia and gonorrhea with a group of EMT students, you would inform them that:
These coinfections are treated with antibiotic therapy
You have been called to a local dialysis center for a patient with a bleeding fistula on her right upper arm. Despite all care at the center, the site continues to bleed. Your best choice in the initial care of the patient would be:
To place a pressure dressing over the fistula
You are treating a woman who has heavy vaginal bleeding. When estimating the blood loss, which information will be most useful to the EMT?
Total number of sanitary napkins used
Which sign or symptom would reinforce the EMT's suspicion that a patient with a history of pancreatitis is having an exacerbation of the disease?
Upper abdominal pain that radiates to the back
A patient with a history of frequent urinary tract infections (UTI) complains of lower abdominal pain and feels as though she has a UTI again. Which assessment findings would cause you to question that the problem is a UTI?
Vaginal bleeding
While assessing a patient with acute abdominal pain, you note that his abdomen is very rigid. When asked to relax his stomach muscles, he does. The EMT would recognize this patient as demonstrating:
Voluntary guarding
When EMS enters the room of a 62-year-old female patient with an unknown medical complaint, which of these clues observed during the scene size-up would increase the EMT's suspicion that the patient has an acute abdominal condition?
he patient is lying on her side, with her knees drawn to her chest
