Chapter 36

Periumbilical ecchymosis is: Select one: A. commonly observed in the prehospital setting following blunt force trauma to the abdomen. B. referred to as Cullen sign and may take several hours to develop following abdominal trauma. C. usually seen in conjunction with flank bruising and is highly suggestive of injury to the liver or spleen. D. also called Grey Turner sign and manifests almost immediately following blunt abdominal trauma.

referred to as Cullen sign and may take several hours to develop following abdominal trauma.

You are dispatched to the parking lot of a shopping mall for a person who was kicked in the abdomen numerous times. While en route to the scene, it is MOST important for you to: Select one: A. request law enforcement assistance. B. alert the trauma center of the situation. C. take appropriate standard precautions. D. place air medical transport on standby.

request law enforcement assistance.

Fournier gangrene is a potential complication associated with: Select one: A. scrotal lacerations. B. ovarian rupture. C. urethral injuries. D. urinary bladder rupture.

scrotal lacerations.

Referred pain to the left shoulder following blunt abdominal trauma should lead you to suspect injury to the: Select one: A. spleen. B. stomach. C. intestines. D. diaphragm.

spleen.

Intraabdominal bleeding may produce few signs and symptoms of trauma because: Select one: A. the intraabdominal cavity can accommodate large amounts of blood. B. blood in the peritoneum can compress the aorta and maintain perfusion. C. it takes approximately 4 L of blood loss before signs of shock manifest. D. the abdominal musculature can sustain massive blunt force without bruising.

the intraabdominal cavity can accommodate large amounts of blood.

The diaphragm curves from its point of attachment at the _______ rib and peaks in the center at the _______ intercostal space. Select one: A. ninth, third B. tenth, seventh C. twelfth, fourth D. eighth, seventh

twelfth, fourth

What do the spleen and liver have in common? Select one: A. They are both highly vascular and bleed profusely when injured. B. The liver and spleen are well protected by the abdominal muscles. C. They are less likely to be crushed by blunt trauma than other organs. D. The liver and spleen are the only solid organs in the abdominal cavity.

They are both highly vascular and bleed profusely when injured.

What type of motor vehicle crash poses the LEAST threat for abdominal trauma if the patient is properly restrained? Select one: A. Frontal crash B. Rear-end crash C. Lateral crash D. Rollover crash

Rear-end crash

What organs are the primary sources of exsanguination during abdominal trauma? Select one: A. Stomach and liver B. Liver and spleen C. Spleen and kidneys D. Kidneys and liver

Liver and spleen

In the absence of a traumatic brain injury, the goal of fluid replacement in a patient with abdominal trauma is to maintain a systolic BP of: Select one: A. 70 to 80 mm Hg B. 80 to 90 mm Hg C. 90 to 100 mm Hg D. 100 to 110 mm Hg

80 to 90 mm Hg

You are caring for a patient who experienced blunt abdominal trauma. The patient is conscious, but restless. Her respirations are rapid and shallow and her pulse is rapid and weak. What will maximize this patient's chances of survival? Select one: A. Basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluid boluses as needed en route B. Administering supplemental oxygen, administering crystalloid IV fluids at the scene, and rapidly transporting to a trauma center C. Orotracheal intubation, ventilation assistance, 2 to 3 L of IV fluid at the scene, and rapid transport to a trauma center D. Aggressive airway support, a detailed physical exam at the scene, transport to the closest hospital, and IV therapy performed en route

Basic airway and circulation support at the scene, prompt transport to a trauma center, and IV fluid boluses as needed en route

The MOST frequent presentation of blunt renal trauma is: Select one: A. low back pain and anuria. B. pelvic pain and tachycardia. C. pelvic pain and oliguria. D. flank pain and hematuria.

flank pain and hematuria.

What membranous tissue functions as the point of attachment for the various abdominal organs? Select one: A. Pleura B. Mesentery C. Peritoneum D. Ligamentum arteriosum

Mesentery

Which of the following is NOT a function of the pancreas? Select one: A. Enzyme secretion B. Secretion of insulin C. Glucagon secretion D. Reservoir for bile

Reservoir for bile

Which of the following statements regarding stomach injuries is correct? Select one: A. Rupture of the stomach following blunt trauma is usually associated with a recent meal or inappropriate seat belt use. B. The vast majority of injuries to the stomach are caused by blunt force trauma and result in severe peritoneal hemorrhage. C. Patients taking antacid medications usually experience immediate signs of peritoneal irritation following an injury to the stomach. D. Penetrating mechanisms are a rare cause of in jury to the stomach because the stomach is well protected by the abdominal musculature.

Rupture of the stomach following blunt trauma is usually associated with a recent meal or inappropriate seat belt use.

Which of the following injuries is the patient with mononucleosis prone to following relatively minor blunt abdominal trauma? Select one: A. Ruptured spleen B. Lacerated liver C. Aortic dissection D. Ruptured urinary bladder

Ruptured spleen

Which of the following assessment findings is MOST suggestive of intra-abdominal hemorrhage? Select one: A. Signs of shock B. Palpable pain C. Diffuse tenderness D. Nausea and vomiting

Signs of shock

Which of the following factors does NOT contribute to the extent of injury from a gunshot wound to the abdomen? Select one: A. Size of the patient B. Profile of the bullet C. Trajectory of the bullet D. Distance the bullet traveled

Size of the patient

Grey Turner sign is defined as ecchymosis to the _________ and is indicative of _________. Select one: A. umbilicus, peritoneal bleeding B. epigastrium, stomach rupture C. flank, retroperitoneal bleeding D. back, traumatic aortic dissection

flank, retroperitoneal bleeding

Injuries to the vascular structures in the intraperitoneal space: Select one: A. commonly involve the inferior vena cava and phrenic artery. B. are most often associated with penetrating injury mechanisms. C. are generally associated with flank or periumbilical bruising. D. are often caused by shearing forces secondary to blunt trauma.

are often caused by shearing forces secondary to blunt trauma.

The LEAST practical technique when assessing the patient with abdominal trauma in the field is: Select one: A. palpation. B. percussion. C. inspection. D. auscultation.

auscultation.

Most abdominal injuries: Select one: A. result in death. B. are caused by falls. C. involve blunt trauma D. involve penetrating trauma.

blunt trauma

The abdomen extends superiorly to the level of the: Select one: A. xiphoid process. B. second intercostal space. C. fourth intercostal space. D. two pairs of floating ribs.

fourth intercostal space.

A 59-year-old construction worker collapsed on the job and fell into a pile of steel rods. Your assessment reveals that he is pulseless and apneic, and has a 12-inch steel rod impaled in his epigastrium. As your partner and an emergency medical responder begin CPR, you should: Select one: A. trim the steel rod to 6 inches, stabilize it in place with bulky dressing, apply firm direct pressure around the rod, and initiate IV therapy en route to a trauma center. B. carefully remove the steel rod, apply direct pressure to the wound, assess his cardiac rhythm, start a large-bore IV line and give 2 L of normal saline, and transport. C. remove the rod so you can perform effective CPR, control any external bleeding, start two large-bore IV lines, and assess his cardiac rhythm en route to the hospital. D. control any external bleeding, stabilize the rod in place with bulky dressings, apply the cardiac monitor, and start at least one large-bore IV line en route to the hospital.

control any external bleeding, stabilize the rod in place with bulky dressings, apply the cardiac monitor, and start at least one large-bore IV line en route to the hospital.

A 36-year-old female was sexually assaulted and is experiencing intense pain. Your assessment reveals several open lacerations to her vaginal area and a painful distended abdomen. Her blood pressure is 86/50 mm Hg and her heart rate is 120 beats/min and weak. In addition to administering supplemental oxygen, you should: Select one: A. control any bleeding from her open wounds, establish two large-bore IV lines, and give 1 µg/kg of fentanyl. B. apply pressure dressings to her open injuries, cover the dressings with an ice pack, and transport rapidly. C. cover her open wounds with sterile dressings, establish at least one large-bore IV, and administer IV fluid. D. insert a sterile dressing into her vagina to control any internal bleeding, establish a large-bore IV, and set it at a KVO rate.

cover her open wounds with sterile dressings, establish at least one large-bore IV, and administer IV fluid.

Anatomically, the abdominal cavity extends from the: Select one: A. fifth rib to the pelvis. B. umbilicus to the pelvis. C. diaphragm to the pelvis. D. nipple line to the diaphragm.

diaphragm to the pelvis.

Generalized abdominal pain following rupture of a hollow organ is MOST suggestive of: Select one: A. severe intraabdominal bleeding. B. gas accumulation in the peritoneum. C. diffuse peritoneal contamination. D. inflammation of deep nerve endings.

diffuse peritoneal contamination.

Following blunt force trauma to the lower right rib cage, a 40-year-old woman presents with restlessness, tachycardia, and unlabored tachypnea. You should be MOST concerned that she has a: Select one: A. pyloric injury. B. liver injury. C. splenic rupture. D. pneumothorax.

injury.

Fractures of the lower rib cage should make you MOST suspicious for injuries to the: Select one: A. liver or spleen. B. urinary bladder. C. ascending aorta. D. kidneys or pancreas.

liver or spleen.

Penetrating abdominal trauma MOST commonly results from: Select one: A. flying debris following an explosion. B. high-powered rifles or military weapons. C. low-velocity gunshot or stab wounds. D. crush forces that separate the abdominal wall.

low-velocity gunshot or stab wounds.

When blood is released into the peritoneal cavity: Select one: A. the abdomen almost immediately becomes grossly distended. B. it is most often the result of blunt force trauma to the pancreas. C. blood pressure falls with as little as 500 mL of internal blood loss. D. nonspecific signs such as tachycardia and hypotension may occur.

nonspecific signs such as tachycardia and hypotension may occur.

You should suspect a ruptured kidney if a patient presents with flank pain, gross hematuria, and: Select one: A. left shoulder pain. B. pain with inhalation. C. right shoulder pain. D. pain with exhalation.

pain with inhalation.

The upper peritoneal cavity includes all of the following organs, EXCEPT the: Select one: A. pancreas. B. stomach. C. spleen. D. gallbladder.

pancreas.

The major complication associated with hollow organ injury is: Select one: A. massive internal hemorrhage and profound shock. B. peritonitis caused by rupture and spillage of toxins. C. immediate death secondary to a massive infection. D. delayed treatment due to the absence of external signs.

peritonitis caused by rupture and spillage of toxins.

EMS providers can have the MOST positive impact on mortality and morbidity from abdominal trauma by: Select one: A. recognizing the need for rapid transport. B. initiating fluid resuscitation in the field. C. contacting medical control immediately. D. performing a careful abdominal assessment.

recognizing the need for rapid transport.