Chapter 30 Flashcards by Gail I

abdomen divided into 4 quadrants
quadrant of bruising/pain can delineate which … are involved
… is a common location for swelling and inflammation

organs; RLQ

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(hollow organs) …, …, …, …
most contain digested food, urine, or bile
when ruptured/lacerated, contents spill into peritoneal cavity–> can cause intense inflammatory rxn and infection, such as in the case of peritonitis

stomach; intestines; ureters; bladder

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(hollow organs) intestinal blood supply comes from …–> connects the small intestine to the …
patients with injuries to this can bleed into the peritoneal cavity

mesentery; peritoneal cavity

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solid organs:
…, …, …, … –> perform chemical work of the body: enzyme production, blood cleansing, energy production
because of rich blood supply, hemorrhage can be severe

liver; spleen; pancreas; kidneys

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blunt trauma to abdomen without breaking skin:
…: poorly placed lap belt; being run over by a vehicle
…: fast-moving vehicle strikes an immoveable object

compression; deceleration

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closed abdominal injuries:
signs and symptoms:
pain can be deceiving–> often … in nature, may be … to another body location
blood in peritoneal cavity produces acute pain in …

diffuse; referred; entire abdomen

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closed abdominal injuries:
signs and symptoms: CONTD:
difficult to determine location of pain
…: stiffening of abdominal muscles
.. is result of free fluid, blood, or organ contents spilling into peritoneal cavity
abdominal bruising and discoloration–> may appear as abrasions initially

guarding; abdominal distension

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seatbelts:
prevent many injuries and save lives
may cause … of abdominal organs particularly when belt lies too high
can cause … injuries to pregnant injuries

blunt injuries; bladder

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(open abdominal injuries) damage depends on ,.. of object
low-velocity injuries: knives, other … weapons
medium-velocity injuries: smaller caliber … and …
high-velocity injuries: high-powered … and …

velocity; edged; handguns; shotguns; rifles; handguns

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(open abdominal injuries) high- and medium- velocity injuries:
have temporary … channels
caused by …
low-velocity injuries: internal injury may not be apparent; injury at or below xiphoid process may affect … and … cavities

wound; cavitation; thoracic; peritoneal

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...: bowel protrudes from peritoneum 
can be painful and visually shocking
do not ... on abdomen
only perform visual assessment
cut clothing close twound
never pull on clothing stuck to or in the wound channel

evisceration; push down

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(open abdominal injuries) signs and symptoms:
…–> heart increases pumping action to compensate for blood loss
later signs include:
evidence of …
changes in ..
…

tachycardia; shock; mental status; distended abdomen

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hollow organ injuries:
often have delayed signs and symptoms
spill contents into abdomen–> … develops, which can take hours/days; stomach and intestines can leak highly toxic and acidic liquids into peritoneal cavity
blunt trauma causes organ to … where penetrating trauma causes direct injury
air in peritoneal cavity causes pain–> severe … and … may develop

infection; pop; infection; septic shock

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(solid organ injuries) can bleed significantly and cause rapid …–> can be hard to identify from physical exam
slowly ooze blood into perito cavity
the … is the largest organ in the abdomen–> very vascular and can lead to …. often injured by fractured lower right rib/penetrating trauma

blood loss; liver; hypoperfusion

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(solid organ injuries) … and …: vascular and prone to heavy bleeding
…: when penetrated or ruptured, loops of bowels invade thoracic cavity. patient may exhibit dyspnea

spleen; pancreas; diaphragm

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(solid organ injuries) kidneys: can cause significant blood loss
common finding is …
blood visible on urinary meatus indicates significant trauma to genitourinary system

blood in urine

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patient asses–> sample:
ask if there is …, …, or …
ask about appearance of any … and …–> esp blood in urine/ black, tarry stools

nausea; vomiting; diarrhea; bowel movements; urinary output

secondary assess:
Physical examinations (cont’d)
Palpate quadrant farthest away from quadrant ….
Perform full-body scan to identify injuries.
If you find life threat, stop and treat it.
Inspect and palpate … area for tenderness, bruising, swelling, or other trauma signs.

exhibiting signs of injury and pain; kidney

Closed abdominal injuries (cont’d)
Patient with blunt abdominal injury should be log rolled to a …position on a …
Protect the spine.
Monitor vital signs.

supine; backboard

Open abdominal injuries
Patients with penetrating injuries
Maintain high index of suspicion for unseen blood loss
Inspect patient’s back and sides for …
Apply … dressing to all open wounds.
If penetrating object is still in place, apply stabilizing bandage around it.

exit wounds; dry, sterile

Evisceration (cont’d)
Never try to ... a protruding organ.
Keep the organs ... and ...
Cover with moistened, sterile dressings.
Secure dressing with ...and tape.

replace; moist; warm; bandage

genitourinary system:
Controls … functions and ..
Genitourinary organs are located in the abdomen
Kidneys, ureters, bladder, urethra
Male genitalia lie outside pelvic cavity.
Female genitalia lie within pelvic cavity.

reproductive; waste discharge

Suspect kidney damage if patient has a evidence of any of the following:
Abrasion, laceration, contusion on the …
Penetrating wound in region of … or ….
Fractures on either side of lower rib cage or of lower thoracic or upper lumbar vertebrae
A .. in the flank region

flank; flank; upper abdomen; hematoma

Urinary bladder injuries
May result in …–> Urine spills into surrounding tissues.
Blunt injuries to lower abdomen or pelvis can … urinary bladder.
In males, sudden deceleration can shear the bladder from the ….
In later trimesters of pregnancy, bladder injuries increase.

rupture; rupture; urethra

``` External male genitalia injuries Soft-tissue wounds Painful and of great concern for patient ... life threatening Should not be given priority over more severe wounds unless there is ... ```

Rarely; severe bleeding

Female genitalia injuries Internal female genitalia: Uterus, ovaries, fallopian tubes are rarely damaged. Exception is … Uterus enlarges substantially and rises out of ... Injuries can be serious. Also keep the fetus in mind.

pregnant uterus; pelvis

Female genitalia injuries (cont’d) External female genitalia .., ..., major and minor ..Very rich nerve supply Consider sexual assault and pregnancy. If external bleeding, a ... may be applied to the labia. Do not insert anything into the vagina.

Vulva; clitoris; labia; sterile absorbent sanitary pad

``` Investigate chief complaint. Common associated complaints with genitourinary injuries are: Nausea and vomiting ... Blood in ... or … Abnormal … and … habits ```

Diarrhea; urine; emesis bowel; bladder

Obtain SAMPLE history Ask patient about ...from the genitourinary system. Especially blood in the urine ... is important because it can predict the genitourinary system’s contents.

output; Last intake of food and fluids

Kidney injuries Injuries may not be obvious. You will see signs of shock and .... Treat for shock, transport promptly, monitor vital signs en route.

blood in urine

Urinary bladder injury Suspect if you see: Blood at ..opening Signs of trauma to lower abdomen, pelvis, perineum In presence of shock or associated injuries: Transport promptly. Monitor vital signs en route.

urethral;

External male genitalia Make patient comfortable. Use... to cover areas stripped of skin. Apply direct pressure with dry, sterile gauze dressings to control bleeding. Never move or manipulate foreign objects in urethra. Identify and take avulsed parts in a bag to the hospital with the patient.

sterile, moist compresses

External male genitalia (cont’d) Amputation of penile shaft Managing ... is top priority. If connective tissue surrounding erectile tissue is damaged, shaft can be ...or ... Associated with intense pain, bleeding, and fear

blood loss; fractured; angled

External male genitalia (cont’d) Laceration of head of penis Associated with ... Apply .. with sterile dressing. Skin of shaft or foreskin caught in zipper If small segment of zipper is involved, try to unzip. If long segment of zipper is involved, ...the zipper out of the pants with heavy scissors.

heavy bleeding; local pressure; cut

External male genitalia (cont’d) Urethral injuries are not uncommon ...injuries, … fractures, and penetrating wounds of the perineum Important to know if patient can ...and if there is blood in urine Foreign bodies protruding from urethra will have to be surgically removed.

Straddle; pelvic; urinate

External male genitalia (cont’d) Avulsion of the skin of the scrotum may damage ... Preserve avulsed skin in a ... dressing. Wrap scrotal contents or perineal area with a sterile moist compress. Direct blows to scrotum can result in rupture of a ...or accumulation of blood around testes. Apply ice to scrotal area.

scrotal contents; moist, sterile; testicle

``` Female genitalia Treat lacerations and avulsions with... Use local pressure to control bleeding. Hold dressings in place with ...-type bandage. Do not pack dressings into the vagina. ```

moist, sterile compresses; diaper

Female genitalia (cont’d) Leave any foreign bodies in place after ... with bandages. Injuries are painful but not life threatening. In-hospital evaluation required. Transport urgency determined by ..., amount of ..., presence of shock.

stabilizing; associated injuries; hemorrhage

Rectal bleeding Common complaint Possible causes include ... rectal foreign bodies, ..., ..., ..., or ...surgery.

sexual assault; hemorrhoids; colitis; ulcers; hemorrhoid surgery

Sexual assault and rape are common. Victims are generally women. Sometimes men and children Often little you can do beyond providing ... and .. Patient may have sustained multisystem trauma and need treatment for ....

compassion; transport; shock

sex assault: Do not examine genitalia unless obvious bleeding requires application of .... Follow appropriate procedures and protocol. Shield patient from curious onlookers. Document patient’s history, assessment, treatment, and response to treatment.

dressing

Follow crime scene policy of your EMS system. Advise patient not to ..., ..., ..., ..., ..., or ...until after examination. Handle patient’s clothes as little as possible. Treat medical injuries and provide privacy, support, reassurance.

wash; bathe; shower; douche; urinate; defecate