Chapter 30

Question 1

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

Answer 1

organs; RLQ

Question 2

(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

Answer 2

stomach; intestines; ureters; bladder

Question 3

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

Answer 3

mesentery; peritoneal cavity

Question 4

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

Answer 4

liver; spleen; pancreas; kidneys

Question 5

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

Answer 5

compression; deceleration

Question 6

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 …

Answer 6

diffuse; referred; entire abdomen

Question 7

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

Answer 7

guarding; abdominal distension

Question 8

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

Answer 8

blunt injuries; bladder

Question 9

(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 …

Answer 9

velocity; edged; handguns; shotguns; rifles; handguns

Question 10

(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

Answer 10

wound; cavitation; thoracic; peritoneal

Question 11

...: 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

Answer 11

evisceration; push down

Question 12

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

Answer 12

tachycardia; shock; mental status; distended abdomen

Question 13

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

Answer 13

infection; pop; infection; septic shock

Question 14

(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

Answer 14

blood loss; liver; hypoperfusion

Question 15

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

Answer 15

spleen; pancreas; diaphragm

Question 16

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

Answer 16

blood in urine

Question 17

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

Answer 17

nausea; vomiting; diarrhea; bowel movements; urinary output

Question 18

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.

Answer 18

exhibiting signs of injury and pain; kidney

Question 19

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.

Answer 19

supine; backboard

Question 20

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.

Answer 20

exit wounds; dry, sterile

Question 21

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

Answer 21

replace; moist; warm; bandage

Question 22

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.

Answer 22

reproductive; waste discharge

Question 23

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

Answer 23

flank; flank; upper abdomen; hematoma

Question 24

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.

Answer 24

rupture; rupture; urethra

Question 25

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 ...

Answer 25

Rarely; severe bleeding

Question 26

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.

Answer 26

pregnant uterus; pelvis

Question 27

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.

Answer 27

Vulva; clitoris; labia; sterile absorbent sanitary pad

Question 28

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

Answer 28

Diarrhea;
urine; emesis
bowel; bladder

Question 29

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.

Answer 29

output; Last intake of food and fluids

Question 30

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

Answer 30

blood in urine

Question 31

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.

Answer 31

urethral;

Question 32

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.

Answer 32

sterile, moist compresses

Question 33

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

Answer 33

blood loss; fractured; angled

Question 34

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.

Answer 34

heavy bleeding; local pressure; cut

Question 35

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.

Answer 35

Straddle; pelvic; urinate

Question 36

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.

Answer 36

scrotal contents; moist, sterile; testicle

Question 37

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.

Answer 37

moist, sterile compresses; diaper

Question 38

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.

Answer 38

stabilizing; associated injuries; hemorrhage

Question 39

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

Answer 39

sexual assault; hemorrhoids; colitis; ulcers; hemorrhoid surgery

Question 40

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 ….

Answer 40

compassion; transport; shock

Question 41

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.

Answer 41

dressing

Question 42

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.

Answer 42

wash; bathe; shower; douche; urinate; defecate