Chapter 50 Homework
Answers
Short Answers
1. Appendix hollow, gallbladder hollow, liver solid, pancreas solid, right
kidney solid, sigmoid colon hollow, spleen solid, stomach hollow.
2. Appendix right lower, gallbladder right upper, liver right upper, pancreas
left upper and right upper, right kidney right upper, sigmoid colon left
lower, spleen left upper, stomach left upper.
3. Hollow organ trauma leads to spillage of the contents of these organs into
the abdominal cavity, resulting in peritonitis.
4. Solid organ trauma leads to hemorrhage, resulting in hypovolemic shock.
5. Collins sign is ecchymosis around the umbilicus, which is associated with
bleeding into the abdominal cavity, pancreatitis, and ectopic pregnancy.
6. Gray Turner’s sign is ecchymosis of the flanks, which is associated with
leading into the abdominal cavity and pancreatitis.
7. Kehr’s sign his abdominal pain radiating to the left shoulder.
8. Kehr’s sign suggest injury to the spleen. Bleeding from splenic damage
irritates the inferior surface of the diaphragm on the left side, resulting in
pain that radiates to the shoulder. Her sign also can occur in ectopic
pregnancy.
9. The pneumatic antishock garment is useful in managing patients with
intra-abdominal bleeding because it applies uniform pressure to the
structures within the abdomen. Bleeding occurs because the pressure
outside the opening and a blood vessel is lower than the pressure within
the vessel. The PASG raises intra-abdominal pressure, slowing or stopping
hemorrhage from injured blood vessels.
10. Yes
11. The PASG should not be applied if diaphragmatic hernia is suspected.
Pressure against you abdominal wall can displace the patient’s abdominal
contents through the tear in the diaphragm into the thoracic cavity.
12. Patients with abdominal trauma or disease process that produces a
abdominal pain frequently will have diminished bowel activity and an
increased risk of vomiting. Placing anything in the G.I. tract increases the
risk of vomiting and aspiration. Also, since these patients frequently must
go to the operating room, giving them anything by mouth increases the
risk of aspiration during induction or anesthesia
13. This patient probably has an injury to his urethra. The urethra passes
through the perineum and can be injured when force is applied to this area
by straddling an object. Bleeding from the damage urethra collects in the
scrotum, producing a hematoma, and moves down aspects of both thighs,
producing a pattern called a butterfly bruise.
14. Patients in late-term pregnancy should be transported on the left side. In
late-term pregnancy, the fundus of the uterus reaches high enough into the
abdominal cavity to lie anterior to the inferior vena cava. If a pregnant
patient is placed in a supine position, the uterus will move backwards,
compressing the inferior vena cava and decreasing venous return to the
heart. Placing the patient on her left side displaces the uterus away from
the inferior vena cava.
15. When a PASG is applied to a patient in late-term pregnancy, only the legs
of the garment should be inflated. Inflation of the abdominal segment will
this place the uterus onto the inferior vena cava, decreasing pain this
return to the heart and lowering the mothers cardiac output and blood
pressure.
16. Signs of reversal of hypovolemic shock and a woman who is in late-term
pregnancy are not an indicator of adequate fluid resuscitation. When a
pregnant patient becomes hypovolemic, the first structure to which blood
flow is reduced is the placenta. During resuscitation, the placenta is the
last structure to which adequate blood flow is restored. Although an
injured pregnant woman may be perfusing adequately, the fetus still may
not be receiving adequate blood flow.
17. Management of a pregnant patient should focus on the mother.
Supporting adequate maternal oxygenation, ventilation, and perfusion
helps ensure that the fetus is adequately oxygenated and perfused.
Multiple-Choice
1.
2.
3.
4.
5.
6.
7.
8.
9.
B
D
A
A
B
C
C
D
C
Case Study
1. The highest priority lies with the mother. Supporting the mother’s
oxygenation, ventilation, and perfusion helps ensure that the fetus is
adequately oxygenated and perfused. In the prehospital setting, no
interventions are available to directly support the fetus.
2. The abdominal section of the PASG should not be inflated. Inflation of the
abdominal section of the PASG could push the uterus onto the inferior
vena cava, decreasing being this return to the mother’s heart and dropping
her cardiac output and blood pressure. Decreasing the mother’s blood
pressure put on the fetus by decreasing placental blood flow.
3. The patient should be placed on her left side. If she is on a spine board,
padding should be placed under the right side of the board to tilt the
patient toward her left. Placing the patient on her left side displaces the
uterus away from the inferior vina cava.
4. Signs of adequate perfusion in a pregnant patient being treated for
hypovolemia do not indicate that she has been efficiently resuscitated to
ensure adequate blood flow to her fetus. The placenta is one of the last
stretchers to regain adequate perfusion following an episode of
hypovolemic shock.