1. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley CHAPTER Caring for Chest and Abdominal Emergencies 21

2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.Review the anatomy of the chest and abdomen from Chapter 4. 2.Define the following terms: a.Closed chest injury b.Crepitus c.Diaphragm d.Distention e.Evisceration f.Flail chest g.Guarding h.Hemothorax Objectives (continued)

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 2.Define the following terms: i.Mediastinum j.Occlusive dressing k.Open chest injury l.Paradoxical movement m.Penetrating injury n.Pleura o.Pleural space p.Pneumothorax q.Quadrant r.Retroperitoneal cavity Objectives (continued)

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 2.Define the following terms: s.Spontaneous pneumothorax t.Sucking chest wound u.Tension pneumothorax 3.Describe the major structures of the thoracic cavity. 4.Explain the relationship between chest injury and perfusion. 5.Differentiate between an open and closed chest injury. Objectives (continued)

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 6.Describe the signs and symptoms of a closed chest injury. 7.Explain the appropriate assessment of a patient with a chest injury. 8.Explain the appropriate care of a patient with a closed chest injury. 9.Explain the appropriate care of a patient with an open chest injury. 10.Describe the major structures of the abdominal and pelvic cavities. Objectives (continued)

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 11.Describe the signs and symptoms of internal bleeding. 12.Explain the appropriate assessment and care of a patient with abdominal pain. 13.Explain the appropriate assessment and care of a patient with an open abdominal injury. 14.Demonstrate the appropriate assessment and care of a patient with a chest injury. Objectives (continued)

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 15.Demonstrate the appropriate assessment and care of a patient with abdominal pain. 16.Demonstrate the appropriate assessment and care of an open abdominal injury. 17.Value the importance of proper body substance isolation (BSI) precautions when assisting with chest and abdominal injuries. Objectives

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Media Slide 39Digestive System Animation Slide 40Human Anatomy Labeling Exercise

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Topics Anatomy of the Chest Chest Injuries Abdominal Emergencies Abdominal Injuries

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley ANATOMY OF THE CHEST

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Anatomy of the Chest Chest cavity (thoracic cavity) makes up approximately half of torso. Gets shape from 12 pairs of ribs. Major organs contained within chest are heart and lungs. Mediastinum houses trachea, esophagus, heart, vena cava, and aorta.

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley The chest contains the heart and lungs and is separated from the abdominal cavity by the diaphragm muscle.

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Anatomy of the Chest Left and right sides of chest are occupied by the lungs. – Pleura: thin saclike structure that surrounds each lung. – Pleural space: potential space that exists between visceral and parietal pleura in chest.

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Each lung is surrounded by a thin lining of tissue called the pleura.

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It What might happen if a chest injury disrupts the parietal pleura? What might happen if a lung injury disrupts the visceral pleura? What if there is a problem with the fluid that provides lubrication between the pleural layers?

16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley CHEST INJURIES

17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Chest Injuries Closed Chest Injuries – Result of blunt force trauma from falls, contact sports, vehicle collisions, blasts. Open Chest Injuries – Result of penetrating injury from bullet, knife, or similar projectile.

18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley An open chest injury.

19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Chest Injuries Blunt trauma – Blow to chest can fracture ribs, sternum, and rib cartilages. Penetrating objects – Bullets, knives, pieces of metal or glass, steel rods, pipes can penetrate chest wall, damaging internal organs and impairing respiration.

20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Chest Injuries Compression – Results from severe blunt trauma in which chest is rapidly compressed (driver in motor-vehicle collision strikes chest on steering column).

21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Chest Injuries Closed Chest Injuries: often caused by blunt force trauma to chest or back and are not associated with open wound. – Damage to ribs. – Pneumothorax: chest cavity filling with air from ruptured lung. – Hemothorax: blood from damaged soft- tissues and vessels enter chest cavity. (continued)

22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Injured ribs can be splinted by securing bulky dressings tightly over the injured area.

23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Chest Injuries Closed Chest Injuries – Flail chest  Results when two or more ribs are broken in two or more places; can be life-threatening.  Causes paradoxical movement  Use bulky dressing to treat injury – Crepitus  Grating sound when bones rub together.

24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley A flail segment results when two or more ribs are fractured in two or more places.

25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Chest Injuries Closed Chest Injuries: Signs-Symptoms – Pain on breathing – Ecchymosis – Increased difficulty breathing – Accessory muscle use – Uneven chest wall movement during breathing – Signs and symptoms of shock

26. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Chest Injuries Chest Injury Assessment – Perform primary assessment; ensure ABCs are intact. – Provide positive pressure ventilations, if breathing is inadequate. – Remove clothing over area where there is complaint of pain. – Observe and palpate for signs of deformity. (continued)

27. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Chest Injuries Chest Injury Assessment – Administer oxygen; follow local protocols. – Splint chest using bulky dressings or towels. – Place patient in a position of comfort, if no suspected spine injury. – Care for shock. – Transport patient.

28. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Use both hands to carefully and thoroughly palpate the chest for pain and deformity.

29. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Chest Injuries Open chest injuries – Injury to chest that is associated with open wound. Sucking chest wound – Open chest wound characterized by sucking sound each time patient inhales. Tension pneumothorax – Air builds up inside chest cavity, causing excessive pressure on one side of chest.

30. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley (A) Penetrating chest injuries can allow air and blood to enter the chest cavity. (B) A collapsed lung (spontaneous pneumothorax) can occur without outside trauma. B A

31. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Chest Injuries Open Chest Wounds – Immediately seal with something that prevents air from entering wound, like gloved hand. – Take appropriate Standard Precautions. – Occlusive dressing: sterile gauze saturated with petroleum jelly. – Place occlusive dressing directly over wound and hold it in place. – Provide high-flow oxygen; care for shock.

32. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Teaching Tip: Present examples of occlusive dressings. Place an occlusive dressing over an open chest wound and tape in either three sides. Follow local protocol.

33. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Chest Injuries Impaled Chest Wounds – Impaled objects must be stabilized and left in place. – Take appropriate Standard Precautions. – Perform primary assessment; ensure ABCs are intact. – Assist ventilations as appropriate. (continued)

34. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Chest Injuries Impaled Chest Wounds – Provide high-flow oxygen per local protocol. – Provide care for shock. – Initiate immediate transport.

35. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Stabilize impaled objects using bulky dressings.

36. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It You respond to a residential home to find a 26-year-old female who was struck by a felled tree which impacted her chest. What are your concerns? How do you proceed?

37. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley ABDOMINAL EMERGENCIES

38. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Abdominal Emergencies Anatomy of the Abdomen and Pelvis – Diaphragm  Primary muscle of respiration; divides chest cavity from abdominal cavity. – Quadrant  Area of abdomen; used to identify location of pain during palpation. (continued)

39. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Click here to view a three-dimensional animation of the digestive system.here BACK TO DIRECTORY

40. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Click here to participate in an interactive labeling exercise on human anatomy and body areas.here BACK TO DIRECTORY

41. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Abdominal Emergencies Anatomy of the Abdomen and Pelvis – Retroperitoneal cavity  Area behind abdominal cavity that contains kidneys and ureters.

42. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Solid and Hollow Organs

43. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley For assessment purposes, the abdomen is divided into four quadrants.

44. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Abdominal Emergencies Generalized Abdominal Pain – Bleeding – Infection – Ulcers – Indigestion – Constipation – Food poisoning – Menstrual cramps (continued)

45. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Abdominal Emergencies Generalized Abdominal Pain – Diabetic emergencies – Kidney stones – Gallstones – Appendicitis – Ectopic pregnancy (continued)

46. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Abdominal Emergencies Acute Abdominal Pain: Signs- Symptoms – Pain that is either sharp or dull – Pain on palpation – Rigid or tight abdomen – Bloating (distention) – Nausea/vomiting – Cramping – Pain that radiates to other areas – Guarding (protecting abdomen)

47. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Abdominal Emergencies Acute Abdominal Pain: Assessment – Rule out history of trauma. – Injuries to abdomen can cause bleeding that is very slow. – Signs and symptoms can be delayed for hours, sometimes days. – Thorough medical history.

48. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It You respond to the home of a 14-year- old female. Her mother reports that she dismissed her from school because of severe abdominal pain. She attempted to take the girl to the pediatrician, but the pain had intensified and she is unable to walk. (continued)

49. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It The patient has no other medical history, takes no medication, and has no allergies. She has a pulse of 100, blood pressure of 90/60, and respiratory rate of 24. You palpate the abdomen and find the patient guarding her RLQ, so you palpate that quadrant last (gently). She screams out in pain. (continued)

50. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It What are your suspicions? How will you proceed? What other questions should you be sure to include in your assessment of this patient?

51. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley ABDOMINAL INJURIES

52. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Abdominal Injuries Abdominal injuries can produce life- threatening emergencies. Signs and Symptoms – Deep cut or puncture wound to abdomen, pelvis, or lower back – Blunt trauma to abdomen or pelvis – Pain or cramps in abdominal or pelvic region (continued)

53. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Abdominal Injuries Signs and Symptoms – Guarding – Lying still with legs drawn up – Rapid, shallow breathing; rapid pulse – Rigid, distended, and/or tender abdomen

54. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Abdominal Injuries Caring for Closed Abdominal Injury – Perform thorough assessment of abdomen; palpate all quadrants. – Expose abdomen to observe for signs of injury. – Allow patient to maintain position of comfort.

55. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Abdominal Injuries Abdominal Evisceration: open wound of abdomen characterized by protrusion of intestines through abdominal wall. – Never attempt to place spilled abdominal contents back into open wound.

56. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Cut away clothing to expose the entire injury.

57. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Place a large sterile dressing moistened with sterile water or saline over the exposed abdominal contents.

58. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Place a plastic sheet over the dressing and secure in place.

59. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley An abdominal evisceration.

60. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It You respond to a skateboard park where a 17-year-old boy has fallen onto concrete from a 20 foot height following a failed ramp jump attempt. He's complaining of persistent LUQ abdominal pain and nausea. His friends tell you he tried to get up but felt lightheaded. (continued)

61. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It Your patient is left lateral recumbent, guarding his abdomen, and moaning in pain. He has no other medical history, takes no medication, and is allergic to penicillin. His pulse is 100, blood pressure 100/70, and respirations are 28. (continued)

62. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Think About It What are your suspicions? How will you proceed? What else could be going on?

63. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley SUMMARY

64. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Injuries to chest can affect ability of patient to breathe adequately and cause damage to internal organs. Injuries to chest classified as either open or closed. Types of closed injuries: broken ribs; collapse of a lung (pneumothorax); blood in chest cavity (hemothorax).

65. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Signs and Symptoms of Closed Chest Injuries – Pain on breathing – Difficulty breathing – Discoloration – Deformity – Paradoxical movement

66. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Flail Chest: caused when two or more ribs are broken in two or more places. – Compromises integrity of chest wall. – Makes it very difficult for patient to breathe adequately.

67. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Be sure to expose all areas and palpate thoroughly with both hands. Consider high-flow oxygen when local protocols indicate.

68. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Open chest injuries result in sucking chest wound; must be covered immediately with occlusive dressing. Stabilize all impaled objects and secure object in place. Do not attempt to remove an impaled object.

69. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Abdomen and pelvis contain organs that are both hollow and solid. Injuries to organs can cause organ failure and severe internal bleeding.

70. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Signs and Symptoms of Abdominal Emergency – Pain – Rigidity – Distention – Blood in vomit, or feces

71. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Abdominal injuries classified as closed or open. Closed injuries result in organ damage and/or severe bleeding.

72. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Summary Abdominal evisceration is open wound that has allowed abdominal contents to spill out. Cover with a sterile moist dressing and cover with plastic to minimize chances that exposed organs will dry out.

73. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley REVIEW QUESTIONS

74. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 1.What are the major structures of the thoracic cavity? 2.What is the relationship between chest injury and perfusion? 3.What is the difference between an open and closed chest injury? 4.What are the signs and symptoms of a closed chest injury? Review Questions (continued)

75. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 5.What is the appropriate assessment of a patient with a chest injury? 6.What is the appropriate care of a patient with a closed chest injury? 7.What is the appropriate care of a patient with an open chest injury? 8.What are the major structures of the abdominal and pelvic cavities? Review Questions (continued)

76. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley 9.What are the signs and symptoms of internal bleeding? 10.What is the appropriate assessment and care of a patient with abdominal pain? 11.What is the appropriate assessment and care of a patient with an open abdominal injury? Review Questions

77. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Daniel J. Limmer O’Keefe Grant Murray Bergeron Dickinson Emergency Medical Responder: First on Scene, Ninth Edition Le Baudour Bergeron Wesley Please visit www.bradybooks.com and follow the Resource Central links to access content for this text. www.bradybooks.com