Primary Assessment Study Guide for the EMT Test

Page 5

Chief Complaint and Life Threats: Part 2

Abdominal Injuries

Abdominal injuries can be categorized as closed or open. The closed trauma is typically related to a direct blow or impact to the abdominal area with no open wound. Signs and symptoms that help identify the impact on an organ must be considered. Some signs and symptoms are tenderness, distention, inflammation, bruising, rebound tenderness, and, in some cases, referred pain. During open trauma, there is visual trauma caused by a penetrating injury. This includes exposure of the peritoneal cavity. Some related signs and symptoms include pain, bleeding, and evisceration, depending on the quadrant affected.

Here are some terms and concepts to know:

  • closed abdominal trauma—caused by blunt force; skin is unbroken but internal organs may be injured; bleeding may be present; signs include bruising, tenderness, pain, and rigidity

  • open abdominal trauma—caused by a penetrating injury (knife wound, bullet hole, impaled object); the skin and underlying tissues are broken; organs may be damaged; signs include visible wounds, bleeding, or protruding organs (evisceration)

  • guarding—involuntary or voluntary tensing of the abdominal muscles in response to pain or injury

  • flank—area on the side of the body between the lower ribs and the top of the hip

  • evisceration—abdominal contents protruding outside of the abdominal cavity

  • levels of velocity—In terms of trauma, levels of velocity describe how much energy a force or object has when it hits the body. These three levels include low, medium, and high velocity.

    • Low velocity is limited to the direct path of the object; commonly caused by knives, sticks, or other sharp impaled objects.

    • Medium velocity can cause more tissue damage due to the projectile carrying more energy creating a temporary cavity inside the tissue; caused by handguns, shotguns and other projectile objects.

    • High velocity produces massive tissue destruction and deep cavitation due to high energy transfer; commonly caused by rifles or high-powered firearms

Abdomen Anatomy and Physiology

The abdomen is the second major body cavity and contains both solid and hollow organs. The solid organs are solid masses of tissue where the chemical work of the body takes place. The hollow organs are a part of the digestive system and, if injured, may contain food that can abnormally leak into the peritoneal cavity.

The abdomen is made up of four quadrants: right, left, upper, and lower quadrants, based on the patient’s viewpoint. Important points for the EMT to understand include the location of organs within quadrants and where specific organs overlap with these quadrants. To triage the degree and impact of injuries, knowing the function of such organs is also essential.

Here are some concepts and terms to know:

  • hollow and solid organs and function—Hollow organs contain fluids or other contents; these organs include the stomach (breaks down food), small and large intestines (absorb nutrients and water), bladder (stores urine), gallbladder (stores bile), and uterus (houses developing fetus). Solid organs are dense and highly vascular. These organs include the liver (filters blood, stores energy, produces bile), spleen (filters blood and fights infection), pancreas (produces insulin and digestive enzymes), and kidneys (filter waste).

  • peritoneal cavity—space within the abdomen that lies between the abdominal wall and the organs it contains

  • peritonitis—inflammation of the peritoneum, typically caused by bacteria, digestive juices, or other irritants that may have leaked into the peritoneal cavity

Facial and Neck Injuries

Injuries to the face and neck area may often seem benign, especially if there are no open wounds or penetrating injuries. Understanding how injuries occur and present in these areas will help to identify potential concerns and promote prompt identification and treatment.

The patient assessment of facial and neck injuries involves thorough knowledge of the face and neck areas of the body, including the eyes, ears, nose, neck/throat, mouth, and dental areas. These parts of the body have special concerns that are related to potential airway obstruction, bleeding, and disfiguring scars. Special attention should be given to the airway, depending on the location of bleeding and the anatomical location of the face/neck injury.

Here are some concepts to know:

  • major facial bones—mandible (lower jaw), maxilla (upper jaw), nasal bones (bridge of the nose), zygomatic bone (cheekbones)

Anatomy and Physiology

Understanding the anatomy and physiology of the face and neck area is crucial for identifying potential life-threatening injuries in this region. Since this area includes the airway, it is critical to understand the connections between the ear, nose, and throat. Additionally, knowledge of the structure of the facial and skull bones will help you understand the impacts on these areas when bleeding, bruising, or a penetrating wound is present.

The Eyes

The eyes serve as one of the five senses. The eye is approximately 1 inch in diameter and is surrounded by bones, muscles, and nerves. Considering how small the eyes are, it is amazing that they play such a significant role in how human beings obtain information.

Eye injuries can be as minor as an irritated contact lens or as catastrophic as the penetration of a sharp foreign object. High-risk injuries may potentially cause blindness or loss of the eye. The important thing to remember with emergency eye problems or injuries is that time is important for positive patient outcomes.

Here are some terms to know:

  • orbital socket and bones—eyesocket; the bony cavity that holds and protects the eye; the bones forming the orbital socket which include the frontal bone, zygomatic bone, maxilla, sphenoid, ethmoid, lacrimal, and palatine

  • extraocular muscles—the six muscles that control eye movement (superior rectus, inferior rectus, lateral rectus, medial rectus, superior oblique, and inferior oblique)

  • lens—transparent, flexible structure inside the eye behind the iris and pupil; responsible for creating a clear image

  • optic nerve—carries visual information from the retina to the brain

  • retina—thin, light-sensitive layer of tissue at the back of the eye; detects light and color; sends signals to the brain

  • cornea—clear, dome-shaped outer layer at the front of the eye; protects the eye from dust, germs, and injury

  • iris—colored part of the eye surrounding the pupil

  • pupil—black circular opening in the center of the eye; controls the amount of light entering the eye by dilating (getting bigger) and constricting (getting smaller)

  • sclera—white, tough outer layer of the eye that surrounds most of the eyeball

  • conjunctiva—thin, transparent membrane that covers the front of the eye and lines the inside of the eyelid; produces mucus and tears to protect the eye and keep it moist

  • globe—the eyeball, which houses the structures needed for vision

  • vitreous and aqueous humor—two main fluids contained by the eye that help maintain its shape and function

  • major components of the eye—Major external structures include: sclera, cornea, conjunctiva, iris, pupil. Major internal structures include: lens, retina, optic nerve, vitreous humor, aqueous humor, and globe.

  • symptoms of retinal detachment—Retinal detachment occurs when the retina pulls away from its normal position in the back of the eye. Common signs and symptoms typically associated with retinal detachment include sudden visual flashes of light, floaters, a shadow or curtain, blurred or decreased vision, or in severe cases, loss of vision.

  • anisocoria—a condition in which the pupils of the eyes are unequal in size

Nose

Nose injuries may present with varied symptoms. A basic and common symptom of a nose injury is bleeding. Other symptoms of nose injuries may be bruising around the eyes, difficulty breathing through the nose, blunt or penetrating injuries, and even swelling of, or around, the nose.

Ear

Ear injuries may present with chief complaints related to the inner, middle, or outer areas. Understanding the anatomy and physiology of the ear is crucial for recognizing signs and symptoms that can indicate hearing loss or high-acuity injuries.

Dental

Dental injuries can range from a broken/cracked tooth to lip, gum, tongue, frenulum, or cheek laceration. In some instances, foreign objects can cause injury. An example is that caused by broken braces or other sharp objects.

Here are some terms to know:

  • avulsion—soft tissue injury where a portion of skin is torn loose or completely off the body

  • hematoma—collection of blood beneath the skin or tissue, caused by damage to blood vessels, resulting in a large bump or bruise

Emergency care for injury to dentition and surrounding areas requires knowledge of first aid treatment for pain, bleeding, and broken, loose, or dislodged teeth. Be aware of these potential injuries to provide a time-sensitive response. The mucous membrane, gums, and bones of the mouth are all at risk for injury.

Fractures

Fractures can be very serious. The facial bone structure is multifaceted, as it supports and involves the nose, eyes, ears, teeth, cheeks, jaw, dental, and even part of the skull. Fractures of facial bones can present various emergency conditions, including bleeding and difficulty breathing.

Cheek

Several bones make up the cheeks. Injury to them may present with pain caused by swelling, muscle, and/or nerve involvement. Some injuries may cause indentation or misalignment of the cheekbones. In some cases, these injuries will prevent the patient from being able to open the mouth or jaw.

Soft Tissue

Due to the abundance of veins in the facial area, soft tissue injuries here commonly cause bleeding. Skin that has been broken by penetration or abrasion may emit copious amounts of blood. Injury where the skin is intact may present in the formation of a hematoma, or bruise.

Laryngeal

Injury to the larynx may present with symptoms of hematoma, bleeding, edema, and subcutaneous emphysema. These injury types can be caused by a crushing, blunt, or penetrating trauma. Injury to the larynx can put a patient at risk for respiratory and airway difficulties.

Neck

Injury of the neck can occur at a superficial, venous, or arterial level. There may also be impacts to the upper airway or bones. Injuries to this area can affect function and be life-threatening. If an injury occurs in any of the seven vertebrae present in the neck area, precaution must be taken to stabilize it and prevent further injury. It is important to know the MOI related to these types of injuries for insight into providing safe care and treatment.

Here are some terms to know:

  • blow out fracture—break in the bones that form the floor or wall of the eye socket

  • tragus—small, rounded piece of cartilage that sticks out in front of the ear canal opening

  • turbinates—curved bony structures inside the nose, covered with mucus membranes

  • subcutaneous emphysema—air trapped under the skin, usually from chest or airway injury

  • sternocleidomastoid muscles—large muscles on each side of the neck running from the sternum and clavicle to behind the ear

  • temporomandibular joint—hinge joint that connects the mandible to the skull

  • mastoid process—bony bump located just behind the ear on the skull

  • air embolism—When air enters the bloodstream and blocks blood flow in a vessel.

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