Trauma Study Guide for the EMT Test

Page 4

Chest Injuries

It is imperative to be able to identify symptoms and manage injuries and complications to the chest. Injuries can occur from accidental or purposeful blunt or penetrating trauma. This can lead to trauma to the chest wall, ribs, and heart.

Anatomy and Physiology of the Chest

Understanding the organs, veins, and arteries encapsulated within the chest wall and rib cage is very important. Knowing where the anatomy is located is key to identification and treatment of emergency injuries and symptoms. The anterior cavity of the chest wall houses the critical respiratory system and heart, including major organs, vessels, and arteries. The anterior rib cage is connected to the posterior cage, which is connected to the vertebral column.

Terms/Concepts to Know: major organs beneath the anterior chest wall, impact to underlying organs when there is injury to the chest wall, hemithorax

How Ventilation Works

Ventilation is accomplished through the respiratory system. The respiratory system is made up of organs and tissues that aid in the inhalation of oxygen and exhalation of gaseous wastes, called carbon dioxide. The lungs are the organs that accomplish the function of this exchange of air. The air enters the lungs via the nose and mouth, and then it is carried to and from the lungs by the trachea. The alveoli and bronchi aid in the gas exchange and air passage process. Intercostal muscles and the diaphragm assist in the inhalation and exhalation work.

Terms/Concepts to Know: major components of the respiratory system, pathway and process of inhalation and exhalation, potential impacts to ventilation with chest wall injury, intrathoracic pressure

Types of Chest Injuries

The EMT may encounter closed or open chest injuries. An open injury involves the chest wall being pierced or penetrated by a bone or other foreign object. Symptoms associated with an open injury can be pain, bleeding, difficulty breathing, and a compromised airway. The closed chest injury involves contact with blunt force without puncture. Symptoms are pain, compromised airway, difficulty breathing, bruising, detached organs, ruptured aorta, chest wall damage, and/or internal bleeding.

Terms/Concepts to Know: types of open and closed chest injury, hypoxia, crepitus, cyanosis, tachypnea, pleurisy

Patient Assessment

The assessment for a patient with a chest injury includes the standard assessment process, including: scene size-up/MOI, primary assessment, history, secondary assessment, and reassessment, pertinent negatives, and nuances for special populations. Special attention should be paid to impacts that are related to the physiology of the injured location. This will aid in observing for signs and symptoms of dysfunction. This may include airway concerns, abnormal breathing mechanics, poor capillary refill, tachycardia, low oxygenation, collapsed lung, and other symptoms based on the type of injury.

Terms/Concepts to Know: hemoptysis, paradoxical motion, deadly dozen chest injuries

Complications and Management

Complications are possible when there is a breach in the integrity of the chest wall. The heart, lungs, and great vessels are at risk. Common signs and symptoms of complications are absent breath sounds, air and/or blood in the pleural spaces, the pericardial sac fills with fluid, shock, crackling sensation on skin upon palpation, cracked ribs, jugular vein distention, cyanosis, and tracheal deviation. Management of these symptoms and rapid transport is critical to patient survival and outcomes. There is an urgency to transport, especially for surgically indicated management, that may be vital to sustain life.

Terms/Concepts to Know: tension, open, simple, spontaneous types of pneumothorax, sucking chest wound, hemothorax, hemopneumothorax, occlusive dressing, flutter valve, subcutaneous emphysema, cardiac tamponade, pericardium, flail chest, how to identify JVD and tracheal deviation

Other Chest Injuries

There are quite a few injury types with regard to the chest wall, depending upon the type of trauma involved. The EMT should be prepared to identify and manage all of these, within the scope of practice: fractures, contusions, acute severe chest compression, heart muscle bruising, blunt chest impact, and laceration of great vessels.

Terms/Concepts to Know: pulmonary contusion, common types of chest fractures, traumatic asphyxia, myocardial contusion, commotio cordis

Abdominal and Genitourinary Injuries

This section covers identification and emergency management of blunt, penetrating, and evisceration injuries. There is also information on how to identify and manage trauma to external genitalia, vaginal bleeding, and sexual assault.

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 and left upper and lower quadrants, based on the patient’s viewpoint. Important points for the EMT to understand are where the organs reside, via quadrant, and where certain organs overlap quadrants. To triage the degree and impact of injuries, knowing the function of such organs is also important.

Terms/Concepts to Know: hollow and solid organs and function, peritoneal cavity, peritonitis

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 organ impact 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 can be pain, bleeding, and evisceration, depending upon the quadrant impacted.

Terms/Concepts to Know: closed and open abdominal trauma, guarding, flank, evisceration, levels of velocity

Abdominal Patient Assessment

The patient assessment of abdominal injuries includes scene size-up/MOI, primary assessment, patient history, secondary assessment, and reassessment. Many potential injuries are related to both open and closed trauma and a thorough and timely assessment is essential.
It is easy for the patient and EMT to get distracted from obvious and sometimes less threatening injuries, and fail to assess or report symptoms that may indicate a more severe problem. Therefore, special attention should be given to reassessment in these cases.

Terms/Concepts to Know: melena, pediatric special population nuances

Emergency Care of Abdominal Injuries

The patient with a closed abdominal injury is often at higher risk due to the inability to identify exact internal tissue and organ impacts. Severe injuries need to be presumed, leading to transport of the patient to the appropriate trauma level hospital with surgical staff. Patients with open, penetrating, or eviscerated injuries also require swift triage and emergency care. There are more visible signs and symptoms of injury and expertise is needed to triage accordingly, based on acuity. Pay special attention in assessing and treating any exit wounds.

Terms/Concepts to Know: mesentery, prehospital emergency treatment of open and closed abdominal wounds, dos and don’ts of evisceration management

Genitourinary Anatomy

The GU system is housed behind the digestive tract. It operates the reproductive system and system waste products. The system consists of the kidneys, urinary bladder, ureters, and urethra. This system has control over some of the body’s waste. The kidneys, which are solid organs, filter waste through the blood and are located in the abdominal cavity.

Terms/Concepts to Know: identification of parts of the GU system

Genitourinary Injuries

The GU system is made up of both hollow and solid organs. The risk for injury to these areas and their functions is possible through blunt or penetrating trauma. These injuries can often be more extensive as the kidneys and bladder are contained behind other organs. The genitourinary system and potential injury types differ for men and women, based on external and internal genitalia.

Terms/Concepts to Know: parts of male and female GU and genitalia, potential injuries to these body parts

Genitourinary Patient Assessment

The patient assessment of GU and genitalia injuries includes scene size-up/MOI, primary assessment, patient history, secondary assessment, and reassessment. Special attention should be given to gender differences and compound impacts, since this system lies beneath other major organs.

Terms/Concepts to Know: male and female genitalia and reproductive systems

Emergency Care of Genitourinary Injuries

The GU system organs are difficult to assess for damage because of their placement in the abdominal cavity, which is behind other organs. There may or may not be obvious signs of bruises or lacerations when a kidney has been impacted. Observe for signs of shock, hematuria, and blood at the opening of the urethra. Examine for blood on underclothes and clothing near the rectum or perineum. Assess and treat for signs of trauma at the lower abdomen, male external and female internal and external genitalia, pelvic, and perineal areas.

Terms/Concepts to Know: care of an avulsed penis

Rape and Sexual Assault

Rape and sexual assault can occur at any age and to any gender. When handling this emergency, treat any life-threatening injuries and follow any crime and standard evidence procedures for your jurisdiction. This injury is one with both physical and emotional impacts. Provide a same-sex care provider, if available, and approach the victim with patience, care, and empathy.

Terms/Concepts to Know: techniques for preserving evidence

All Study Guides for the EMT Test are now available as downloadable PDFs