Chapter 35

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. Blood is pouring from the​ laceration, and the patient rates the pain as an​ 8/10. What should the EMT do​ first?

Apply direct pressure to the injury to stop the hemorrhage

A​ "chance" fracture in a pediatric patient is most likely due​ to?

The lap belt in a MVC

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!"

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

In the geriatric​ population, what is the minimally acceptable pulse oximeter reading that you want to​ maintain?

0.95

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​ 104/88 mmHg

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 hemorrhaging wound with a gloved hand

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

Descending aorta

You have arrived on the scene of a stabbing. As you approach the male​ patient, you note that his shirt is off and a single stab wound to the right lower quadrant of the abdomen is​ evident, without external hemorrhaging. 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 male 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

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

Hemorrhage from the spleen

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​ mmHg; 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

You are caring for a pediatric patient that was stuck by a car. The patient is complaining of generalized abdominal​ pain, and is unable to really localize it when you ask them to. This is concerning​ because?

It could indicate a liver or splenic injury.

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

Because of the different anatomy of a pediatric​ patient, what organs are not as well protected by the body in situations of blunt abdominal​ trauma?

Liver and spleen

A pediatric patient has sustained blunt abdominal trauma and has significant internal bleeding. Which finding is likely one of the last ones to present​ itself?

Low blood pressure

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 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 and was not wearing a protective cup as he should have been. 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​ 10/10. Which action is most appropriate for this​ patient?

Place cool compresses to the testicles

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