Basic EMT Ch 28-30

Crepitus

A grating or grinding sensation caused by fractured bone ends or joints rubbing together; also air bubbles under the skin that produce a crackling sound or crinkly feeling.

A sign of kidney damage following blunt trauma is: a) hemoptysis. b) hematemesis. c) hematochezia. d) hematuria.

A hematuria aka blood in urine

articular cartilage

A pearly white layer of specialized cartilage covering the articular surfaces (contact surfaces on the ends) of bones in synovial joints.

Cavitation

A phenomenon in which speed causes a bullet to generate pressure waves, which cause damage distant from the bullet's path. Higher the velocity of the penetrating object, the larger the cavity it produces.

joint

A place in the body where two bones come together

nondisplaced fracture

A simple crack in the bone that has not caused the bone to move from its normal anatomic position; also called a hairline fracture.

acromioclavicular j(AC) Joint

A simple joint where the bony projections of the scapula and the clavicle meet at the top of the shoulder.

Signs of a Ruptured Diaphragm

Abdomen with sunken anterior wall and difficulty breathing because of bowel contents in the chest cavity which causes bowel sounds during auscultation of the lungs

scaphoid abdomen

An abdomen that dips in towards the patient when lying supine. The opposite of a distended abdomen.

compartment syndrome

An elevation of pressure within a closed fascial compartment, characterized by extreme pain, decreased pain sensation, pain on stretching of affected muscles, and decreased power; frequently seen in fractures below the elbow or knee in children. Develops in 6-12 hours after injury. Result of excessive bleeding.

open abdominal injury

An injury in which there is a break in the surface of the skin or mucous membrane, exposing deeper tissue to potential contamination.

closed abdominal injury

An injury in which there is soft-tissue damage inside the body but the skin remains intact.

intestinal mesentery

Any of the several folds of the peritoneum tissue that connect the intestines to the dorsal/posterior abdominal wall, especially found around the jejunum and ileum.

A 20-year-old male was accidentally shot in the right upper abdominal quadrant with an arrow during an archery contest. Prior to your arrival, the patient removed the arrow. Your assessment reveals that he is conscious and alert with stable vital signs. The entrance wound is bleeding minimally and appears to be superficial. You should: Select one: A. transport only if signs of shock begin to develop. B. assume that the arrow injured an internal organ. C. carefully probe the wound to determine its depth. D. clean the wound and apply a dry, sterile dressing.

B

Because the depth of an open abdominal wound is often difficult to determine: Select one: A. vital signs should be monitored frequently. B. prompt transport to the hospital is essential. C. the abdomen must be vigorously palpated. D. the EMT must perform a thorough exam.

B

The presence of tachycardia following a significant abdominal injury: Select one: A. is most commonly caused by severe pain. B. should be assumed to be a sign of shock. C. indicates a state of decompensated shock. D. is always accompanied by hypotension.

B

When documenting a call involving a female patient who was sexually assaulted, the EMT should: Select one: A. include a description of the suspected perpetrator. B. avoid speculation and document only factual data. C. include the results of his or her internal vaginal exam. D. theorize as to why the sexual assault occurred.

B

While assessing a 21-year-old female who struck a tree head-on with her small passenger car, you note that her air bag deployed. You should: Select one: A. carefully assess her upper chest for seatbelt-related injuries. B. lift the air bag and look for deformity to the steering wheel. C. perform a head-to-toe assessment while she is in the car. D. extricate her immediately and transport to a trauma center.

B. lift the air bag and look for deformity to the steering wheel.

Grey.Turner sign

Bruises in RUQ (liver), LUQ (Spleen), flank (kidney) indicating injury to underlying organs

Signs of abdominal injury

Bruising and discoloration (Not always as may take a while for the bruising to develop) Abdominal distention (Blood or contents of hollow organs) Abdominal firmness on palpation Swelling (Blood, fluid, gas) Tenderness, particularly localized tenderness Difficulty moving because of pain

A 66-year-old male presents with dark red rectal bleeding and abdominal pain. He is conscious and alert; however, his skin is cool and clammy and his heart rate is elevated. Further assessment reveals that his blood pressure is 112/60 mm Hg. Which of the following questions would be MOST pertinent to ask him? Select one: A. Has blood soaked through your undergarments? B. Do you take any over-the-counter medications? C. Have you experienced recent abdominal trauma? D. What does your blood pressure normally run?

C

A football player was struck by another player in the right flank area just below the posterior rib cage. He complains of severe pain and point tenderness to the area. Your assessment reveals that there is a small amount of blood in his underwear. You should be MOST suspicious for: Select one: A. a ruptured urinary bladder. B. external genitalia injury. C. blunt injury to the kidney. D. a lacerated liver or spleen.

C

The mesentery is: Select one: A. a complex network of blood vessels that supply blood to the liver. B. a layer of thick skeletal muscles that protects the abdominal organs. C. a membranous fold that attaches the intestines to the walls of the body. D. the point of attachment between the small and large intestines.

C

Low velocity injuries

Caused by handheld or hand-powered objects, such as knives and other edged weapons

High-Velocity Injuries

Caused by larger weapons such as high-powered rifles and the higher-powered handguns

Medium-Velocity Injuries

Caused by smaller caliber handguns and shotguns

Guarding

Contracting the stomach muscles to minimize the pain of abdominal movement; a sign of peritonitis.

Accumulation of blood in the abdominal cavity will MOST likely cause: Select one: A. referred pain. B. diffuse bruising. C. nausea or vomiting. D. distention.

D

Difficulty breathing and a sunken appearance of the anterior abdominal wall is MOST indicative of a ruptured: Select one: A. spleen. B. stomach. C. aorta. D. diaphragm.

D

During your assessment of a patient who experienced blunt trauma to the abdomen, you notice bruising around the umbilicus. This is a sign of: Select one: A. a ruptured spleen. B. rupture of a hollow organ. C. a severe liver laceration. D. intra-abdominal bleeding.

D

You are transporting a 42-year-old male who experienced blunt abdominal trauma. He is receiving oxygen at 12 L/min via a nonrebreathing mask, and full spinal precautions have been applied. During your reassessment, you note his level of consciousness has decreased and his respirations have become shallow. You should: Select one: A. suction his oropharynx to ensure it is clear of secretions and then increase the oxygen flow rate to 15 L/min. B. reassess his vital signs and then notify the receiving hospital of the change in his clinical status. C. perform a comprehensive secondary assessment to determine why his clinical status has changed. D. insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a bag-mask device.

D

Which of the following organs would MOST likely bleed profusely when injured? Select one: A. bladder B. intestine C. stomach D. liver

D Liver

Which of the following organs is at MOST risk for injury as the result of a pelvic fracture? Select one: A. liver or spleen B. fallopian tubes C. pancreas D. urinary bladder

D. Urinary Bladder Particularly when the bladder is full and distended. blunt or penetrating injury to bladder may result in its rupture.

Dislocation

Disruption of a joint in which ligaments are damaged and the bone ends are completely displaced.

symptoms of appendicitis/ruptured appendix

Dull periumbilical pain that radiates to the LRQ Fever Nausea Vomiting Anorexia

Special Populations: Elderly

Falls are most common MOI. Abdominal organs have lost elasticity over time = greater exposure to forces. Brittle bones that break and sharp edges that puncture organs

Causes of Traumatic Liver Injuries

Fractured lower right rib Penetrating trauma such as a knife wound Only Diagonal seatbelt used

Seat belt injuries: Lap Belt

If seat belt worn too high can lead to abdominal organs or great vessels being squeezed against the spine.

Causes of Traumatic Spleen Injuries

Improperly placed seatbelt Impact with steering wheel falls either from heights or onto sharp objects Impact to handlebars of bicycles/motorcycles

Seat belt injuries: Diagonal Belt only used

Injuries to upper part of the trunk, bruised chest, fractured ribs, lacerated liver or even decapitation.

Symptoms of liver and spleen injury

Injury to spleen Kehr Sign

Kehr Sign

Left shoulder pain caused by blood in the peritoneal cavity.

Auscultation

Listening with a stethoscope

Velocity that causes cavitation

Medium- and High-Velocity

abdominal distention

Occurs when substances, such as air (gas) or fluid, accumulate in the abdomen causing its outward expansion beyond the normal girth of the stomach and waist

Symptoms of Kidney or ureters injury

Pain following the angle from the lateral hip to the midline of the groin

Symptoms of gallbladder injury/Inflammation of gallbladder

Pain found just under the margin of the ribs on the right side or between the shoulder blades.

Reliable Indicator of Underlying Fracture

Point Tenderness

Symptoms of a Dissecting Abdominal Aneurysm:

Pt reports pain that is tearing and going from the abdomen posteriorly.

femoral pulse

Pulse felt on either side of the groin; Femoral artery

Special Populations: Pediatric

Soft Flexible ribs that compress when force acted upon them but then regains shape so no outward sign of force of injury. Do not offer much protection to organs. Liver and spleen are very large in proportion to size of child.

solid organs

Solid masses of tissue where much of the chemical work of the body takes place. They have a rich blood supply so injury can cause severe and unseen hemorrhage.

hollow organs

Structures through which materials pass, such as the stomach, small intestines, large intestines, ureters, and bladder.

Later signs of abdominal injury

Tachycardia (Heart pumping to compensate for blood loss) Tachypnea Decreased Blood Pressure Shallow Respirations

Evisceration

The displacement of organs outside of the body.

Blumberg's sign

The experience of sharp, stabbing pain as the compressed area returns to a noncompressed state. Often discovered as move patient onto the stretcher or into ambulance

glenoid fossa

The part of the scapula that joins with the humeral head to form the glenohumeral joint.

flank

The posterior region below the margin of the lower rib cage.

fracture

a break in the continuity of a bone

peritoneal cavity

abdominal cavity

open fracture/compound fracture

any fracture in which the bone breaks through the overlying skin

Organs in the RLQ/Right lower quadrant

appendix colon small intestine ureter major vein and artery to right leg

iliac artery

artery that carries oxygenated blood to the hip and groin area

Popliteal

back of knee

Sign of significant trauma to genitourinary system

blood on opening of the urethra on the glans penis or in vulva

digestive system/gastrointestinal system

body system the breaks down food and absorbs nutrients.

Components of the Large Intestine

cecum, colon, rectum

deceleration injury

collision between a rapidly moving body part and a stationary object. Example: car hitting a large immovable mass such as a larger vehicle, a bridge abutment or the ground.

clasp-knife injury

compression Injury pattern caused by a poorly placed lap belt.

Components of the Small Intestine

duodenum, jejunum, ileum

Chemical Work of Solid Organs

enzyme production, blood cleansing and energy production.

calcaneus

heel bone

peritonitis

inflammation of the peritoneum (membrane lining the abdominal cavity and surrounding the organs within it). It is serious and may become life threatening.

retroperitoneal organs

kidneys, adrenal glands, pancreas, etc organs positioned behind the parietal peritoneum but still within the abdominopelvic cavity

abdomen

large, oval cavity extending from the diaphragm down to the brim of the pelvis that contains organs that make up the digestive, urinary and genitourinary systems. Second major body cavity

Pregnant Patient Possible Seat Beat Injuries

later stages of pregnancy causes the bladder to move to the anterior and allows for greater chance of bladder injury.

MOI to suspect Kidney Injury

-Abrasion, laceration, or contusion to the flank -Penetrating wound in the region of the lower rib cage (the flank) or the upper abdomen -Fractures on either side of the lower rib cage or of the lower thoracic or upper lumbar vertebrae -Hematoma in flank region

Later Signs of Peritonitis

-Diminished or absent bowel sounds -Patient may feel nauseous or vomit -Abdomen becomes distended and firm to touch -Infection may occur

Treatment for a Ruptured Diaphragm

-PPV with Bag Valve Mask and transport

Signs of Bleeding in the abdomen

-Rigidity, with almost a boardlike feeling to the abdomen -Cullen Sign, occasionally

organs in the LLQ/Left Lower Quadrant

-Stomach -Spleen -Left Lobe of Liver -Body of pancreas -Left Kidney and adrenal gland -Splenic flexure of colon -Parts of transverse and descending colon

Components of the intestinal mesentery

-a web of vessels (arteries and veins) -nerves -lymphatic tissues

Component of digestive system

-gastrointestinal tract (stomach and intestines) -mouth -salivary glands -Pharynx -esophagus -liver -gallbladder -pacreas -rectum -anus

Compartment Syndrome S/S

5 P -Pain out of proportion -Pain with Passive stretch(w/hyperextension), -Pallor, -Pulsenessless or diminished pulses -Power, Decreased Late Sign Paresthesia (Burning or prickling sensation)

Bruising to the right upper quadrant of the abdomen following blunt trauma is MOST suggestive of injury to the: Select one: A. liver. B. spleen. C. stomach. D. kidney.

A

Following blunt abdominal trauma, a 30-year-old male complains of referred pain to the left shoulder. This finding is called the: Select one: A. Kehr sign. B. Brudzinski sign. C. Grey Turner sign. D. Cullen sign.

A

Placing a pregnant patient in a supine position during the third trimester of pregnancy: Select one: A. may decrease the amount of blood that returns to the heart. B. results in spontaneous urinary incontinence if the bladder is full. C. often causes hypotension secondary to cardiac compression. D. is recommended if the patient has severe abdominal discomfort.

A

When worn properly, a seatbelt should lie: Select one: A. below the anterior superior iliac spines of the pelvis and against the hip joints. B. across the abdominal wall at the level of the umbilicus and against the hip joints. C. above the anterior posterior iliac spines of the pelvis and below the hip joints. D. across the abdominal wall at the level of the diaphragm and below the hip joints.

A

displaced fracture

A fracture in which bone fragments are separated from one another and not in anatomic alignment.

closed fracture

A fracture in which the skin is not broken.

Organs in the RUQ/Right Upper Quadrant

liver, gallbladder, pancreas duodenum of the intestine (1st part of the small intestine immediately beyond the stomach) colon Right Kidney

Four solid organs

liver, spleen, pancreas, and kidneys.

retroperitoneal space

located above the level of the umbilicus, extend from the 11th rib to the 3rd lumbar vertebra. between the abdominal cavity and the posterior abdominal wall. containing the kidneys, certain great vessels and parts of the gastrointestinal tract.

Function of the intestinal mesentery

provides the intestinal blood supply

First signs of peritonitis

severe abdominal pain Rebound tenderness aka Blumberg sign muscular spasm

Organs in the LUQ/Left Upper Quadrant

stomach, left kidney, spleen, colon, pancreasst

Cullen sign

superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus. sign of bleeding in abdomen.

Fibula

the outer and thinner of the two bones of the human leg between the knee and ankle. Not part of knee joint but is outer knob of ankle joint.

Dorsal pedis (pulse site)

top of foot

What is a traumatic cause of peritonitis?

when a hollow organ (stomach, intestines, ureters and bladder) is ruptured or lacerated, these organs spill their contents (food being digested, stomach acid or urine that is being passed to bladder) into the peritoneal cavity, causing an intense inflammatory response and possible infection.