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