EMT Chapter 35

The EMT has fundamental understanding of abdominal trauma when he​ states:

"Blunt trauma is especially lethal because of the large number of organs that can be affected."

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!"

Why is blunt abdominal trauma considered​ lethal?

A large number of organs may be injured

An abdominal evisceration occurs​ when:

A wound through the abdominal wall allows abdominal contents to protrude

Severe abdominal trauma and blood loss may cause signs and symptoms of​ shock, which​ include:

An increased heart rate

Which of the following is the proper treatment of an amputated​ penis?

Apply direct pressure to control bleeding

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 and protruding through the sac. 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

Peritoneal space is potential space

Between the peritoneal layers

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 106/88 mmHg

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 entrance wound with a gloved hand.

General emergency medical care for the patient with an abdominal injury​ includes:

Covering an evisceration with a moist dressing and occlusive dressing

During your focused history and physical exam of a patient with a suspected abdominal​ injury:

Discoloration around the umbilicus indicates bleeding is occurring inside the abdomen.

On​ scene, you encounter a restless 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

Palpation of abdominal pain should​ begin:

Farthest from the quadrant that hurts

Which of the following injuries is uncommon in relation to male​ genitalia?

Foreign body insertion

You are transporting a female patient who was sexually assaulted by having a foreign body inserted deep into her vagina. You are attempting to control hemorrhage by the appropriate means. As you reassess the​ patient, which finding is of most​ concern?

Heart rate increases from 116 to 140 beats/min

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

Hemorrhage from the spleen

If a male patient is kicked in the testicles during a​ fight, after determining there is NO​ bleeding, the EMT should​ consider:

Ice and a position of comfort

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

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?

Like a soft tissue injury and provide direct 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.

You have arrived on the scene for a patient assaulted with a baseball bat. As you​ approach, which position would seemingly indicate that he has suffered an injury to the​ abdomen?

On his side with knees drawn to the chest

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. 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?

Placing cool compresses to the testicles.

During a motor vehicle​ collision, a confused unrestrained male struck the steering wheel with his abdomen.​ Currently, he is confused and complains of generalized abdominal​ pain, which he rates as​ 6/10. Assessment indicates red marks across his lower abdomen caused by the steering wheel. His pulse is 140​ beats/min, respirations are 24​ breaths/min, blood pressure is​ 108/88 mmHg, and SpO2 is​ 86%. The patient looks pale and has moist skin. What is most appropriate when providing oxygen to this​ patient?

Provide 15 lpm through a nonrebreather mask

Which of the following is the correct definition of Kehr​ sign?

Referred pain to the shoulder caused by abdominal bleeding

Organs that lie dorsal to the peritoneum are​ called:

Retroperitoneal

As a review of the anatomy of the abdominal​ cavity, which of the following is​ TRUE?

Solid organs include the pancreas and the kidneys

Which one of these injuries is most likely to cause​ peritonitis?

Stab wound to the small intestine.

You are getting ready to move a patient with an evisceration to the wheeled cot. The EMR on scene asks you what position you want the patient placed into after he is moved. What would be the BEST​ response?

Supine with hips and knees flexed

A​ middle-aged male sustained blunt force trauma to the​ abdomen, resulting in an isolated tear and perforation of the large intestine. When following up on the​ patient, what would the EMT suspect​ occurred, given the organ that was​ injured?

The patient developed an infection

If a woman was assaulted and has sustained deep lacerations to her​ genitals, the EMT​ should:

Treat the injury like other soft tissue injuries

Injuries to the genitalia​ are:

Usually embarrassing for the patient

Which of the following injuries or mechanisms of injury is specific to female​ genitalia?

abortion attempts

Which of the following abdominal injuries would be considered the most​ dangerous?

assault with a club

The EMT recognizes that the division between the thoracic and abdominal cavities lies​ approximately:

at the fifth intercostal space.

At the scene of a motor vehicle​ accident, a car has extensive​ front-end damage and a deformed steering wheel. The restrained​ driver, who was​ self-extricated, is in the care of​ EMRs, who have applied a cervical collar and continue to maintain spine motion restriction precautions. The​ patient's airway is patent and respirations adequate. His radial pulse is rapid and​ weak, and his skin is cool and diaphoretic. The EMRs report the following vital​ signs: pulse, 136​ beats/min; respirations, 20​breaths/min; blood​ pressure, 100/68​ mmHg; and​ SpO2, 95% with supplemental O2 being administered. The right forearm is​ deformed, and the​ head, chest, and upper back are uninjured according to your assessment. Your next action would be​ to:

check the abdomen for injury

A patient has been assaulted and sustained blunt trauma to the abdomen. As you start the primary​ assessment, you note that he is vomiting blood and you begin to suction him immediately. After the airway has been​ suctioned, you​ should:

check the adequacy of the patients breathing

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

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

descending aorta

A penetrating abdominal injury with severe respiratory distress has MOST likely involved what​ structure?

diaphragm

Which of the following structures serves as the division between the thoracic and abdominal​ cavities?

diaphragm

You have been called for a​ 42-year-old male who complains of back pain. At the​ scene, the man tells you that he was lying on the floor when his​ 5-year-old son unexpectedly jumped feet first onto his back. He gives a medical history of high blood pressure and​ asthma, for which he takes medications. As you assess the​ patient, which finding provides the greatest indication that the patient has sustained an abdominal​ injury?

discoloration around the umbilicus

Open wounds to the abdomen may be so large and deep that organs protrude through the wound opening. This is known as​ a/an:

evisceration

You have arrived on the scene of a stabbing. As you approach the​ patient, you note that his shirt is off and a single stab wound to the right lower quadrant of the abdomen is evident. The patient appears unresponsive as you approach. At the​ patient's side, your first action should be​ to:

examine the patients airway

A​ 45-year-old female was at a family reunion and fell off a trampoline. She hit a picnic table with the left side of her lower rib cage.​ Now, she is very anxious and confused. Her airway is open and her breathing adequate. Her radial pulse is rapid and​ weak, and her skin is cool and diaphoretic. Vital signs are​ pulse, 132​ beats/min; respirations, 20​ breaths/min; blood​ pressure, 102/78​ mmHg; and​ SpO2, 97% on ambient air. The patient has ecchymosis to the left lower rib area as well as tenderness and instability to the rib cage. She also has a superficial abrasion to her forehead. Given these​ findings, you would suspect and treat her for which​condition?

hypovolemic shock

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

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

Which of the following abdominal organs would be characterized as being solid despite containing a large amount of​ blood?

liver

Which of the following is an example of a solid​ organ?

liver

An abdominal evisceration should be covered with a moist sterile​ dressing, followed​ by:

occlusive dressing

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.

Which is the inferior border of the abdominal​ cavity?

pelvic ring

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

Which of the following​ organs, if​ injured, would be MOST likely to cause​ peritonitis?

small intestine

The​ liver, spleen, and pancreas are examples of what type of abdominal​ organs?

solid

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

Which of the following is a common mechanism of female genitalia​ injury?

straddle injury

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

What bit of information gathered during the scene​ size-up will be extremely important in determining the severity of abdominal​ injuries?

the mechanism of injury

Why should the EMT complete a full assessment of all areas of the body on any patient with abdominal​ pain?

to find any other injuries

What type of abdominal organ is the vena​ cava?

vascular

A patient has been shot in the abdomen. Assessment reveals that the bullet entered the body in the right upper quadrant and exited the lower right back. Given this​finding, the EMT should assume which solid organs may have been​ injured?

​Liver, right​ kidney, pancreas

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