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EMT > Ch 30 Abdominal and Genitourinary Injuries > Flashcards

Ch 30 Abdominal and Genitourinary Injuries Flashcards

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1
Q

Closed abdominal injuey

A

Injury in which there is soft-tissue damage inside the body but the skin remains in tact

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2
Q

Evisceration

A

The displacement of organs outside of the body

Never try to replace an organ; Keep the organ moist and warm, cover the injury site with a large, sterile, moist, bulky dressing (and an occlusive dressing if specified by local protocol)

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3
Q

Flank

A

The region below the rib cade and above the hip

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4
Q

Guarding

A

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

Can make it difficult to locate pain in patient with voluntary/involuntary guarding

Most often the rectus abdominis muscles are held tight

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5
Q

Hematuria

A

Blood in the urine

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6
Q

Hollow organs

A

Structures through which materials pass, such as the stomach, small intestines, large intestines, ureters and the bladder
Injuries may have delayed signs and symptoms

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7
Q

Melena

A

Black, tarry stools

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8
Q

Open abdominal injury

A

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

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9
Q

Peritoneal cavity

A

The abdominal cavity

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10
Q

Peritoneum

A

The membrane lining of the abdominal cavity (parietal peritoneum) and covering the abdominal organs (visceral peritoneum)

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11
Q

Solid organs

A

Solid masses of tissue where much of the chemical work of the body takes place, such as the liver, spleen pancreas and kidneys

Can bleed significantly and cause rapid blood loss that can be hard to identify

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12
Q

Abdominal injuries are categorized as either _____ or _____

A

Open (penetrating trauma) or closed (blunt force trauma)

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13
Q

What type of abdominal injury(s) can injury solid or hollow organs and cause life threatening bleeding?

A

Open and/or closed

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14
Q

Blunt force trauma that causes closed injuries results from _____

A

An object striking the body without breaking the skin

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15
Q

Penetrating trauma is _____

A

The result of a GSW or stab wound

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16
Q

Injury to solid organs often causes _____

A

significant internal bleeding that can be life threatening

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17
Q

Injury to hollow organs of the abdomen may cause _____

A

Irritation and inflammation to the peritoneum as caustic digestive juices leak into the peritoneum; Serious infection may occur hours later

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18
Q

Always maintain an index of suspicion for serious intra-abdominal injuries in ____

A

trauma patients who exhibit signs of shock

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19
Q

Impaled objects in the abdominal region

A

Never remove; secure it in place with a large, bulky dressing and provide rapid transport

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20
Q

Treatment for shock

A

Always be prepared to treat

Place the patient supine, keep them warm, and provide high-flow O2

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21
Q

Injuries to the kidneys

A

May be difficult to detect because they are located in a well-protected region; be alert for bruising or a hematoma in the flank region

Common funding is hematuria

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22
Q

Injury to external M or F genetalia

A

Very painful but usually not life-threatening

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23
Q

Treatment for sexual assault or rape

A

Treat for shock if necessary and record all facts in detail; follow any crime scene policy established in your system to protect the scene and evidence; advise the patient not to wash, bathe, shower, douche or void until a physician has examined them

Do not examine the genitalia of the victim unless obvious bleeding must be controlled

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24
Q

Organs of the Right Upper Quadrant (RUQ)

A

Liver, gallbladder, duodenum of the intestines and a small portion of the pancreas

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25
Q

Organs of the Left Upper Quadrant (LUQ)

A

Spleen and stomach, pancreas (mostly posterior region)

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26
Q

Organs of the Left Lower Quadrant (LLQ)

A

Large and small intestines, notably the descending colon and L half of the transverse colon

27
Q

Organs of the Right Lower Quadrant (RLQ)

A

Appendix, large and small intestines, notably the ascending colon and R half of the transverse colon

28
Q

Appendix rupture

A

Severe infection and septic shock may occur

29
Q

Peritonitis

A

Caused by the leaking of stomach and/or intestinal fluids to the peritoneal cavity. May become life threatening

First signs are severe abdominal pain, tenderness and muscular spasm; Later signs are diminished bowel sounds or function; nausea, vomiting, abdomen may be become distended

30
Q

Small intestines

A

Duodenum, jejunum, ileum

31
Q

Large intestines

A

Cecum, colon, rectum

32
Q

Mesentery

A

Supplies blood to the intestines; a fold of tissue containing vessels, nerves and lymphatic tissues; it connects the small intestine to the posterior of abd. wall

33
Q

Retroperitoneal region

A

Where many solid organs, great vessels, abdominal aorta, inferior vena cava, kidneys, ureters, pancreas and bladder are housed

34
Q

Compression injuries

A

Typically caused by a poorly placed seatbelt; creates a pattern called a clasp-knife injury, an exaggerated resistance of muscles, resembling the opening of a penknife or clasp knife

Can also be caused when a person is run over or rolled over

35
Q

Deceleration injuries

A

Commonly occur when a person or vehicle the person is in strike a large immovable mass

36
Q

Injury to the liver and spleen, and bleeding into the peritoneal space can result in pain that is

A

Pain is often referred (transferred) to the shoulder and can easily be overlooked

37
Q

An abdominal aneurysm that is dissecting can result in pain that is

A

Tearing pain and describes it as going from the abdomen posteriorly

38
Q

Damage to the kidneys or ureters can result in pain that is

A

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

39
Q

An inflamed or ruptured appendix can result in pain that is

A

Pain primarily located in the RLQ

40
Q

Direct injury or inflammation of the gallbladder can result in pain that is

A

Pain that can be found just under the margin of the ribs on the right side or between the shoulder blades

41
Q

Acute pain in the entire abdomen is

A

A common response to blood and fluid from damaged organs flowing into the peritoneal cavity; rebound tenderness may occur if exposed to any jarring motion

42
Q

Abdominal distention or swelling between the xiphoid process and groin is often the result of

A

Free fluid, blood or organ contents spilling into the peritoneal cavity

May also be the result of air or gases in the bowel or from infection

43
Q

Lower rib fractures

A

If trauma was forceful enough to break ribs, it may have damaged internal organs

44
Q

Because it make take several minutes to hours for contusion or hematoma to become present

A

Do not rule out serious abdominal injury based on the absence of bruising or discoloration

45
Q

When worn properly, the seatbelt sits

A

Below the anterior superior iliac spines of the pelvis and against the hip joints

46
Q

If a seatbelt is too high

A

It can squeeze abdominal organs or great vessels against the spine when the vehicle suddenly decelerates; occasionally fractures to the lumbar spine may occur

47
Q

This anatomic change allows the normally protected bladder to become more susceptible to injuries from impacts and the seat belt

A

Later stages of pregnancy where the gravid uterus displaces the bladder to the anterior

Pregnant patients who adjust the lap belt for comfort can sustain further injuries

48
Q

When a patient sustains a penetrating injury to the abdomen, it is important to

A

Attempt to determine the velocity of the object because it can predict the amount of damage to tissue

49
Q

Low-velocity injuries

A

Caused by hand-held or hand powered objects such as knives

Bleeding at the entrance wound may hide how far the the object went into the body, which is especially important to remember when an injury occurs in the region of the diaphragm

50
Q

Medium velocity injuries penetrating wounds

A

Caused by smaller caliber handguns and shotguns; has temporary wound channels (caused by cavitation) in addition to the exit and entrance wounds

51
Q

High velocity injuries

A

Caused by larger weapons such as rifles and higher-power handguns; has temporary wound channels (caused by cavitation) in addition to the exit and entrance wounds

52
Q

Cavitation

A

When a cavity forms as the pressure wave from a projectile is transferred to the tissues causing microscopic tears to blood vessels and nerves, expanding the width and length of the wound

Can produce significant bleeding

Higher velocity = larger amount of cavitation and tissue damage

53
Q

Any time there is an injury at or below the xiphoid process

A

Assume both thoracic and peritoneal cavities have been affected

54
Q

Signs of abdominal injury

A

Early sign - tachycardia

Later signs - signs of shock, decreased BP, pale, cool and moist skin, and changes to the abdomen

55
Q

Free air in the peritoneal cavity

A

Abnormal and typically indicates that a hollow organ or loop of the bowel has been perforated; very painful

56
Q

The liver

A

The largest organ in the abdomen and very vascular; Can contribute to hypoperfusion of injured

Pain is commonly referred to the shoulder

57
Q

Pancreas and spleen

A

Bleed heavily when affected by blunt or penetrating trauma

Spleen often injured in MVA, especially with improper seatbelt placement, steering wheel impact, bike crashes; Pain may refer to shoulder

58
Q

If the diaphragm is penetrated

A

The bowel may herniate into the thoracic cavity and patients will exhibit dyspnea; may be worsened when patients are placed in a supine position

59
Q

In pediatric patients in MVA or car v. bike accidents

A

The chest and abdomen are less protected and may experience significant transfer of energy

The ribcage is flexible and can lead to extreme compression in the chest and abdomen but very few outward signs of injury

60
Q

Falls in geriatric patients may lead to

A

Risk of injury to the aorta, liver, spleen because the abdominal organs have lost some elasticity

61
Q

Rectal bleeding

A

May occur after sexual assault, colitis, ulcers, etc.

Significant rectal bleeding can occur after hemorrhoid surgery and can lead to significant blood loss and shock

62
Q 
The first signs of peritonitis include all of the following EXCEPT:
Severe abdominal pain
Tenderness
Muscular spasms
Nausea
A

Nausea

63
Q 
Late signs of abdominal injury include all of the following EXCEPT
Distention
Increased BP
Change in mental status
Pale, cool, moist skin
A

Increased BP

EMT (25 decks)

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