EMT: Abdominal and Genitourinary Trauma

Questions and Answers

If the abdomen appears larger than normal, this is called:

Guarding

Crepitation

Rigidity

Distension (correct)

Organs that lie dorsal to the peritoneum are called:

Anteroperitoneal

Retroperitoneal (correct)

Supraperitoneal

Infraperitoneal

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

Lymphatic

Solid (correct)

Vascular

Hollow

What is the danger of penetrating trauma to the lower quadrants in a male patient?

A full urinary bladder will leak bacteria and waste products. Signup and view all the answers

Blunt abdominal trauma that causes the perforation of a vascular structure in the abdomen may cause:

Significant blood loss. Signup and view all the answers

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 Signup and view all the answers

Why should the EMT complete a full assessment on any patient with abdominal pain?

To find any other injuries Signup and view all the answers

You notice a bluish discoloration around the belly button. What does this finding mean?

It is a late sign of intra-abdominal bleeding. Signup and view all the answers

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

Diaphragm Signup and view all the answers

You note that the abdomen is slightly distended, rigid to the touch, with an ecchymotic area surrounding the umbilicus. What does this finding imply?

An abdominal injury that is likely several hours old Signup and view all the answers

An object impaled in the abdomen should be:

Stabilized in place. Signup and view all the answers

In addition to the traditional management of a patient with abdominal trauma, what additional consideration should be made for an eight-month-pregnant female with abdominal trauma?

Place the pregnant female in a position to alleviate pressure of the uterus on the vena cava Signup and view all the answers

If the patient has sustained an abdominal evisceration, the EMT should:

Cover the wound with a moist dressing followed by an occlusive dressing. Signup and view all the answers

In the treatment of an abdominal evisceration, the EMT should NOT:

Attempt to return the loop of bowel to its original location. Signup and view all the answers

Injuries to the genitalia are:

Usually embarrassing for the patient. Signup and view all the answers

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:

Ruptured uterus. Signup and view all the answers

Which of the following structures serves as the division of the thoracic and abdominal cavities? (Select all that apply)

Diaphragm Signup and view all the answers

What should you suspect in a construction worker bleeding from the abdomen with a screwdriver nearby? (Select all that apply)

Penetration injury Signup and view all the answers

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

An increased heart rate Signup and view all the answers

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

Solid organs include the pancreas and kidneys Signup and view all the answers

If a patient has an impaled object in his upper left abdominal quadrant, which organ is likely to have been injured?

The small intestine Signup and view all the answers

Which of the following solid organs is offered the BEST protection from blunt trauma?

Spleen Signup and view all the answers

How should you treat a patient with a serious bleeding injury to his penis?

Like a soft tissue injury and provide direct pressure Signup and view all the answers

A patient with an abdominal injury will likely want to keep his legs in what position to reduce pain?

Bent Signup and view all the answers

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

Occlusive dressing Signup and view all the answers

An abdominal evisceration occurs when:

A wound through the abdominal wall allows abdominal contents to protrude Signup and view all the answers

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:

Shock Signup and view all the answers

Which of the following is TRUE regarding abdominal injury assessment?

Assessment of the patient with a suspected abdominal injury is very similar to that for a patient with a suspected chest injury Signup and view all the answers

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

Covering an evisceration with a moist dressing and occlusive dressing Signup and view all the answers

Palpation of abdominal pain should begin:

Farthest from the quadrant that hurts Signup and view all the answers

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

Referred pain to the shoulder caused by abdominal bleeding Signup and view all the answers

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 Signup and view all the answers

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

Ice and position of comfort Signup and view all the answers

Peritoneal space is potential space:

Between the peritoneal layers Signup and view all the answers

What type of abdominal organ is the vena cava?

Vascular Signup and view all the answers

Your patient sustained abdominal trauma a day earlier from a dirt bike accident. Given this presentation, what type of abdominal injury has the patient likely sustained?

Hollow organ damage to the colon Signup and view all the answers

You are caring for a patient who sustained a GSW injury to the abdomen. Injury to which of the following structures would MOST likely result in acute deterioration and death?

Vascular Signup and view all the answers

When a patient has a knife impaled in his abdomen, the MOST likely condition to develop will be:

Shock Signup and view all the answers

Why should the EMT complete a full assessment on any patient with abdominal pain?

To find any other injuries Signup and view all the answers

Your patient has an abdominal wound that resulted in an evisceration of bowel. How should this be managed?

Cover the exposed bowel with a saline-soaked trauma pad Signup and view all the answers

Injuries to the genitalia are:

Usually embarrassing for the patient Signup and view all the answers

You have a patient who was trapped beneath a truck along the freeway. What should be your FIRST priority of management?

Establish an open airway Signup and view all the answers

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

Pancreas Signup and view all the answers

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

Small intestine Signup and view all the answers

During a fight with a knife, your teenage patient was stabbed in the lower left abdominal quadrant. What structure is MOST likely injured from the stabbing?

Large bowel Signup and view all the answers

What would be the preferred position in which to place a patient who has an abdominal evisceration?

Supine Signup and view all the answers

If your patient has vaginal bleeding from an assault, the EMT should do all of the following, EXCEPT:

Instruct the patient to take a shower Signup and view all the answers

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

Liver Signup and view all the answers

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

Treat the injury like other soft tissue injuries Signup and view all the answers

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 Signup and view all the answers

You are caring for a patient who was injured while riding his bike and was struck by a car. Where should the EMT start their assessment?

With the airway Signup and view all the answers

What age bracket of patients is MOST likely to suffer injury to the liver and spleen from blunt abdominal trauma?

Pediatric Signup and view all the answers

When assessing a patient with a large piece of glass sticking out of his abdomen, what should you do?

Stabilize it and administer oxygen Signup and view all the answers

What is the target pulse oximeter reading when providing oxygen to a patient with abdominal trauma?

Greater than or equals 94 percent Signup and view all the answers

Which of the following causes immediate, excruciating pain?

Peritonitis Signup and view all the answers

Internal abdominal injuries can be severe because:

There are several major organs and blood vessels in the abdomen Signup and view all the answers

Study Notes

Abdominal Anatomy and Trauma Basics

The diaphragm separates the thoracic and abdominal cavities, acting as a crucial structural division.
The abdominal cavity houses vital organs of digestion, urinary, and endocrine systems, protected by muscles, the rib cage, and the pelvic ring.
The peritoneum and pleura serve as linings but provide minimal structural support to separate the cavities.

Penetrating and Blunt Trauma

A screwdriver found with a construction worker bleeding from the abdomen suggests a penetration injury.
Signs of shock from abdominal trauma include increased heart rate and cold, pale skin; these are critical indicators of blood loss.

Anatomy Review

Solid organs in the abdomen, such as the liver, spleen, pancreas, and kidneys, are highly vascularized and susceptible to severe injury.
Injury to the small intestine is often suspected if a penetrating object is impaled in the abdomen, specifically in the upper left quadrant.

Treatment Considerations

Injuries to genitalia should be treated as soft tissue injuries, providing direct pressure for bleeding control and emotional support for the patient.
An abdominal evisceration requires a moist sterile dressing followed by an occlusive dressing to retain warmth and moisture.

Positioning and Assessment

Patients with abdominal injuries often find relief in a bent position, which relaxes abdominal muscles and reduces pain.
In cases of evisceration, place the patient in a supine position with knees flexed unless lower extremity injuries are suspected.

Signs and Symptoms of Internal Injury

Hypoperfusion signs, including weak pulses and cool skin, are alarming signs of shock that could indicate internal bleeding.
Discoloration around the umbilicus often indicates internal bleeding; it is a late sign suggesting prolonged hemorrhage.

Unique Injuries and Their Management

Hollow organ injuries, such as those to the colon, can cause internal spillage and subsequent severe infections.
The liver is a solid organ with a significant blood supply and is susceptible to rupture from blunt abdominal trauma.

Safety Precautions and Protocols

Never remove objects embedded in a wound; stabilize them and prioritize airway management in trauma cases.
Always start patient assessments from the airway, especially in unresponsive patients, before checking specific injuries.

Risks and Complications

Pediatric patients are more at risk for severe liver or spleen injuries due to their anatomical placement and vulnerability in blunt traumas.
Penetrating injuries to the penis or lower abdomen in males pose risks of serious complications, including urinary tract infections from bladder damage.

Key Terms

Evisceration: Protrusion of abdominal contents through an open wound.
Kehr's Sign: Referred shoulder pain caused by abdominal bleeding, particularly from irritations affecting the diaphragm.
Distension: Enlargement or swelling of the abdomen, indicating underlying complications.

Emergency Care Protocols

General treatment involves covering eviscerated tissues with moist dressings and closely monitoring vital signs.
Patients with significant abdominal trauma should not be placed in prone or lateral positions; supine is preferred.

Protective Structures

The spleen is one of the best-protected solid organs while the urinary bladder is less protected and at risk in penetrating injuries.

Conclusion

Understanding the complexities of abdominal and genitourinary trauma equips medical personnel to react swiftly and effectively in emergency situations. Proper assessments, positioning, and treatment protocols are vital for patient survival and recovery.### Mechanism of Injury
The mechanism of injury is crucial for assessing the severity of abdominal injuries.
Signs include blunt or penetrating trauma, hemorrhagic shock, rapid shallow respirations, and abdominal pain or rigidity.
Patients complaining of abdominal pain require thorough examination due to potential serious injuries.

Full Assessment Necessity

Completing a full assessment on patients with abdominal pain is vital for identifying any additional injuries.
Patients may overlook other injuries due to severe abdominal pain, risking missing life-threatening conditions.

Bruising Indicators

Bluish discoloration around the belly button indicates a late sign of intra-abdominal bleeding.
Inspecting the umbilicus and flank areas for bruising is essential, as it may signify internal bleeding over time.

Respiratory Distress and Diaphragm Injury

Severe respiratory distress from a penetrating abdominal injury likely indicates diaphragm involvement.
The diaphragm accounts for 60-70% of breathing effort, making its injury critical.

Abdominal Injury Timeline

Rigid and distended abdomen with ecchymosis around the umbilicus suggests an abdominal injury that is likely several hours old.
Cullen's sign is a specific indicator of periumbilical ecchymosis associated with abdominal trauma.

Management of Impaled Objects

Any object impaled in the abdomen must be stabilized in place rather than removed.
Removal could exacerbate internal injuries, potentially leading to fatal consequences.

Special Considerations for Pregnant Patients

Pregnant women with abdominal trauma should be positioned to relieve pressure on the vena cava to avoid hypotension.
The left lateral recumbent position is recommended to alleviate stress from the uterus.

Evisceration Treatment

In cases of abdominal evisceration, cover the wound with a moist dressing followed by an occlusive dressing to maintain moisture and warmth.
Avoid using aluminum foil as it may damage protruding organs.

Handling Evisceration

Never attempt to return bowel to its original location in cases of abdominal evisceration; this is managed surgically later.

Genitalia Injuries

Injuries to the genitalia, while often painful and embarrassing, are typically not life-threatening and are primarily soft tissue injuries.

Vaginal Bleeding in Non-Pregnant Women

In non-pregnant women experiencing serious vaginal bleeding after trauma, a ruptured uterus is unlikely.
Possible causes include genital trauma, pelvic fractures, and significant internal injuries.

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Description

Test your knowledge on abdominal and genitourinary trauma with these flashcards. This quiz covers key anatomical structures and their functions in the thoracic and abdominal cavities, helping you prepare for EMT scenarios effectively.