MASTER TEACHING NOTES







Detailed Lesson Plan
Chapter 35
Abdominal and Genitourinary Trauma
50–60 minutes
Case Study Discussion
Teaching Tips
Discussion Questions
Class Activities
Media Links
Knowledge Application
Critical Thinking Discussion
Chapter 35 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
I.
5
5
Master Teaching Notes
Introduction
Case Study Discussion
A. During this lesson, students will learn about assessment and emergency
medical care for patients suffering from abdominal and genitourinary injuries.
B. Case Study
1. Present Dispatch and Upon Arrival information from the chapter.
2. Discuss with students how they would proceed.
II. The Abdomen—Anatomy of the Abdominal Cavity
A. Types of organs and vascular structures
1. Hollow organs
a. Stomach
b. Gall bladder
c. Urinary bladder
d. Ureters
e. Internal urethra
f. Fallopian tubes
g. Small intestine
h. Large intestine
2. Solid organs
a. Liver
b. Spleen
c. Pancreas
d. Kidneys
3. Vascular structures
a. Abdominal aorta
b. Inferior vena cava
B. Additional structures
1. Diaphragm
2. Abdominal wall
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 35

What questions would you ask about the
mechanism of injury?
 Based on what you know about the
mechanism of injury, what injuries do
you suspect?
Teaching Tip
Draw a grid representing the abdominal
quadrants or regions on the white board.
Call on students to identify the organs in
each quadrant or region to fill in the grid.
PAGE 1
Chapter 35 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
10
Content Outline
Master Teaching Notes
III. The Abdomen—Abdominal Injuries
A. Blunt or penetrating trauma can cause an abdominal injury.
B. Mechanisms of injury are similar to those of chest injury.
C. Blunt trauma is especially lethal because of the large number of organs
present.
D. Open abdominal injuries result from penetrating trauma such as a gunshot
or a stabbing by a knife or other hard, sharp object.
E. In the case of a gunshot, always examine the patient for the exit wound.
F. Open wounds are easier to see, but may be less dangerous than closed
wounds.
G. Always maintain suspicion of the existence of a closed abdominal injury.
Discussion Questions


What types of injuries should you
suspect when faced with a gunshot
wound to the abdomen?
From what abdominal organ injuries
would you expect significant
hemorrhage?
Critical Thinking Discussion
Why can the early indications of blunt
abdominal trauma be subtle?
Weblink
Go to www.bradybooks.com and click on
the mykit link for Prehospital Emergency
Care, 9th edition to access a web resource
on penetrating abdominal trauma.
20
IV. The Abdomen—Assessment-Based Approach: Abdominal Trauma
A. Scene size-up
1. Take necessary Standard Precautions.
2. Scan the scene for details that might reveal the mechanism of injury.
3. Ask police or bystanders what happened, particularly if anyone heard
gunshots.
4. Attempt to determine the following in the case of a vehicle collision.
a. Type of vehicle
b. Approximate speed at which it was traveling
c. Type of collision and point(s) of impact
d. Whether the patient was driver, passenger, or pedestrian
e. Where the patient was found and in what position
f. Whether the patient was thrown from the vehicle
g. Impact marks to the windshield, steering wheel, and dashboard
h. Whether the patient was wearing a seat belt
B. Primary assessment
1. Form a general assessment of the patient’s condition.
a. Is he lying still with knees flexed up toward the chest?
b. Is he moaning and complaining of severe pain?
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 35
Discussion Questions

What information about a weapon used
to stab a patient would be helpful to
hospital personnel?
 What are the management priorities for
patients with suspected abdominal
trauma?
Knowledge Application
Students should be able to identify patients
with mechanisms of injury and assessment
findings consistent with abdominal trauma.
PAGE 2
Chapter 35 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
2. If you suspect a spine injury, establish in-line spinal stabilization.
3. Ensure an open airway and adequate breathing.
a. Inspect the airway for evidence of bloody vomitus and suction if
necessary.
b. If breathing is adequate, deliver oxygen by nonrebreather mask at
15 lpm.
c. Administer positive pressure ventilation if necessary.
4. Assess the patient’s circulation for signs of shock and abdominal injury.
a. Weak or absent radial pulse
b. Abnormally rapid heart rate
c. Moist, pale, cool skin
5. If the above signs are present, patient is a priority for immediate
transport.
C. Secondary assessment
1. Consider the patient’s complaints and the mechanism of injury.
2. Expose the entire body and perform a rapid secondary assessment:
head, neck, and chest first.
3. If you suspect a spine injury, apply a cervical spine immobilization collar.
4. Inspect the abdomen for any open wounds; determine if it appears
distended.
5. Inspect around the umbilicus (navel) and flanks for discoloration and
bruising.
6. Look for bruising of the lower abdomen.
7. Inspect and provide emergency care for any abdominal evisceration.
8. Palpate the abdomen, noting tenderness, masses, or signs of pain.
9. Assess the extremities for injuries; check and compare the pulses.
10. Assess motor and sensory function.
11. Log roll the patient and inspect back and lumbar region for trauma; log
roll him onto a backboard if you suspect a spine injury.
12. Assess baseline vital signs, especially for blood loss and shock.
13. If the patient is responsive, obtain a history from him; if he is
unresponsive, try to gather information from bystanders.
14. Be alert for the following signs and symptoms of abdominal injury.
a. Contusions, abrasions, lacerations, punctures, or other signs of
blunt or penetrating trauma
b. Pain that continues to get worse
c. Tenderness on palpation to areas besides injury site
d. Rigid abdominal muscles.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 35
Discussion Question
What is Kehr’s sign?
PAGE 3
Chapter 35 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
e.
f.
g.
h.
i.
Patient who has drawn his legs up to his chest to reduce the pain
Distended abdomen
Discoloration around the umbilicus or to the flank (late sign)
Rapid, shallow breathing
Signs of hemorrhagic shock
i. Decreasing blood pressure
ii. Narrowing pulse pressure
iii. Increasing heart rate
iv. Increasing respiratory rate
j. Nausea and vomiting (may contain blood).
k. Abdominal cramping.
l. Pain that radiates to either shoulder.
m. Weakness.
D. General emergency care—Abdominal trauma
1. Maintain an open airway and appropriate spine protection.
2. Continue oxygen therapy.
3. Reassess breathing status.
4. Treat for hemorrhagic shock if signs and symptoms are present.
5. Control any external bleeding.
6. Place the patient in a supine position with the knees flexed.
7. Stabilize any impaled objects.
8. Apply the pneumatic antishock garment (PASG) if indicated and allowed
by local protocol.
9. Transport as quickly as possible.
E. Emergency medical care—Abdominal evisceration
1. Expose the wound.
2. Position the patient on his back and flex the knees.
3. Prepare a clean, sterile dressing.
4. Cover the moist dressing with an occlusive dressing.
5. Administer high-flow, high-concentration oxygen.
6. Be prepared to treat for shock.
F. Reassessment
1. Evaluate the effectiveness of your treatment.
2. Assess for further deterioration of the patient’s condition.
3. At any sign of deterioration, repeat appropriate elements of the primary
and secondary assessments.
4. Reassess vital signs, especially for indications of blood loss or shock.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 35
PAGE 4
Chapter 35 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
V. The Abdomen—Summary: Assessment and Care—Abdominal
5
Trauma
A. Review possible assessment findings and emergency care for abdominal
trauma.
B. Review Figures 35-3 and 35-4.
10
10
Critical Thinking Discussion
How might technology allow EMTs to play a
more specific role in the future in diagnosis
of abdominal injuries?
VI. Genital Trauma
A. Injuries to male genitalia
1. Include lacerations, abrasions, avulsions, penetrations, amputations,
contusions
2. Usually produce excruciating pain and cause patient great concern
3. Penis is very vascular (can bleed excessively).
4. Treat as a soft-tissue injury; apply direct pressure and cold compress to
reduce pain and swelling.
5. Wrap any avulsed parts in sterile, moist dressing; place on ice; and
transport with patient.
6. Apply oxygen by nonrebreather mask at 15 lpm.
7. Assess for signs and symptoms of shock and transport.
B. Injuries to female genitalia
1. Include straddle injuries, sexual assault, blunt trauma, abortion attempts,
lacerations following childbirth, and foreign bodies inserted into vagina
2. Usually produce excruciating pain and cause great concern to patient
3. Area is highly vascular.
4. Apply direct pressure to any bleeding; use moist compress.
5. Never pack or place dressings inside vagina.
6. Assess for shock.
7. Provide oxygen at 15 lpm by nonrebreather mask.
8. Transport.
Knowledge Application
VII. Follow-Up
Case Study Follow-Up Discussion
A. Answer student questions.
B. Case Study Follow-Up
1. Review the case study from the beginning of the chapter.
2. Remind students of some of the answers that were given to the
discussion questions.
3. Ask students if they would respond the same way after discussing the
chapter material. Follow up with questions to determine why students
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 35
Given several scenarios, students should
be able to identify and manage patients
with injuries to the genitalia.
Weblinks
Go to www.bradybooks.com
and click on the mykit link for Prehospital
Emergency Care, 9th edition to access web
resources about genital trauma and female
genital cutting.

What is the likely explanation for Mr.
Young’s flat neck veins?
 How does pain in the upper left
quadrant fit with Mr. Young’s signs and
symptoms of shock?
Class Activity
PAGE 5
Chapter 35 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
would or would not change their answers.
C. Follow-Up Assignments
1. Review Chapter 35 Summary.
2. Complete Chapter 35 In Review questions.
3. Complete Chapter 35 Critical Thinking.
D. Assessments
1. Handouts
2. Chapter 35 quiz
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 35
Alternatively, assign each question to a
group of students and give them several
minutes to generate answers to present to
the rest of the class for discussion.
Teaching Tips

Answers to In Review and Critical
Thinking questions are in the appendix
to the Instructor’s Wraparound Edition.
Advise students to review the questions
again as they study the chapter.
 The Instructor’s Resource Package
contains handouts that assess student
learning and reinforce important
information in each chapter. This can be
found under mykit at
www.bradybooks.com.
PAGE 6