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The main ideas from this information are: - When examining a patient with abdominal injuries, it is important to visually inspect and palpate the abdomen for deformities, distention, and tenderness. - Hollow organ involvement can cause rebound tenderness and should be assessed. - Vital signs should be monitored and evaluated for signs of shock. - For open abdominal injuries, occlusive dressings should be applied to control bleeding and prevent infection. - The genitourinary system controls reproduction and function and is located in the abdomen. - In males, the testicles produce and store sperm, while in females, the uterus and fallopian tubes are involved in reproduction. - Kidney and urinary bladder injuries can be caused by trauma and may result in blood in the urine and abdominal pain. - Injuries to the sternal and female genitalia should be assessed but may not be life-threatening. Summary: When assessing patients with abdominal injuries, it is important to visually inspect and But if you do, you're going to expect a bleeding, you're going to loose it, remove, close, to expose injuries. You can't fix what you can't see. The patient should remain in a position of comfort and examine the entire abdomen. Somebody talks about palpation. Somebody with an injury with pain in the abdomen, I'm not really keen on palpating the abdomen. I'll just hover my hand over it. If I see the patient go, gee, without even touching them, that's enough for me. I don't want to cause jarting. I don't want the muscles to tense up because the doctor won't be able to do his assessment. Use Z-Cap E-TLS, inspected palpate for deformities. You know what they are. Palpate the quadrant. If you are going to palpate the abdomen and the patient says they have pain, palpate the farthest quadrant away and then move toward it. The last quadrant to palpate should be the one with the most pain. You may not even palpate it at all. Looking for distention, rigidity, and rebound tenderness. By pushing the abdomen and release very rapidly, and the patient winces at that point, that's called hollow organ involvement. Hollow organ involvement causes pain when you rebound. I've never been able to see rebound tenderness because once you touch the abdomen, the patient is like, oh, anyway, so. Z-Cap E-TLS for tenderness, bruising, swelling, or trauma. Hollow organ spillway, contraceptive, the peritoneal cavity, dyspneas, peritonitis, infection, sepsis, and death. Vital signs. Get your vital signs. Rapid pulse and low blood pressure is a sign of decompensation. Record vital signs and get the trending so you can tell if the patient is doing better or doing worse. Visually inspect the abdomen for penetrating wounds. Inspect the front and the back, because if it came in, it shouldn't come out. And as your wound is found, check for the corresponding exit wound and do not remove impaled objects. Repeat your primary assessment by constantly talking to your patient. Do your vitals every five minutes. Reassess your interventions. Maybe you have to step up your interventions, put more bandaging in. Position the patient. Hypo, oxygen, call ALS, whatever. Close abdominal injuries. Monitor and evaluate for the progression of shock. The patient may experience nausea and vomiting. Be prepared. Have suction available. Abdominal injuries, peritonitis will lead to vomiting, nausea, and vomiting. Be prepared for it. It's going to happen. Administer oxygen to any patient in shock, any patient with abdominal injury. Give them oxygen. It's not going to hurt them. Assist ventilations and call ALS. Maybe ALS has to put in a C2 tube. They have to do pain management. For open abdominal injuries, we want an occlusive dressing from the neck to the umbilicus. If it's an evisceration, moist sparrow dressing on top, underneath, and an occlusive dressing on top. We have a high index of suspicion for that unseen bleeding. Again, you might have a small hole, but there could be significant bleeding underneath. Inspect the patient's back and sides for exit wounds. Apply dry sparrow dressing to all open wounds. If the penetrating object is in place, stabilize it. That is an actual evisceration right there. That's a serious one. What are we going to do? As you can see here, there's the moist sparrow dressing, and probably outside of that was an airtight seal dressing, and they just flopped that over. You don't want that to get dry. You don't want the dog to get a hold of that and start dragging it around the yard. Put that picture in mind. Never try to replace it. Never poke it back in. Leave it out. Keep the organs moist and warm. Cover the moist sparrow dressing. Secure the dressing with bandage. If you're going to tape, do not tape to skin. Do not tape to the intestines. Tape on tape. Or tape on dressing. So there we go right there. The other thing you can do is you can put the occlusive dressing right over that. If it's big enough, seal it, but you don't want sticky parts. You get like the occlusive dressing is all sticky, so you really don't want that on the intestines. You'd have to put something underneath it, yes. So the genitourinary system controls reproduction, function, and weight discharge. Organs of the genitourinary system are located in the abdomen. The male genitalia lie outside, whereas the female genitalia lie inside. So this is the male genitalia we've seen before. The testicles lie outside of the body because sperm is produced at an optimum temperature of 95 degrees. Sperm is produced in the testicle and is stored in the epididymis. It's released up the vas deferentia, which kind of runs this way. And then down into the seminal vesicle. The seminal vesicle lies outside of the bladder. I should say that the vas deferentia comes up this way and then down into the bladder. It goes through the abdominal wall. And then it sits on the outside of the bladder, where the seminal fluid, 10% of the ejaculant is sperm. 30% of the ejaculant is the seminal fluid. And then 40% is the prostatic fluid. The prostate does two things. It closes off the ureter so the sperm doesn't mix with urine. It also releases 60% of the ejaculant in the form of the prostatic fluid. And it kind of gives you a little idea of what goes on here. And this is where men develop inguinal hernias. Like I have an inguinal hernia right in that area, where a loop of bottles kind of pokes its way through every now and then. It hurts. This is the female reproductive organ. This is the uterus right here. It's about the size of a woman's fist. And as you can see, it doesn't sit upright. It kind of sits like this in the polycavity. The most protected organ in the human species. We have the fallopian tubes leading to the fembrae. And the fembrae are what catch the ovum or the egg as it's released from the follicle after the release of follicular stimulating hormone, FSH, which happens during ovulation. The egg travels down the fallopian tube. If it's fertilized, 90% of fertilization is happening in the fallopian tube. It adheres to the uterine wall and begins to develop as a pregnancy. If not, it's excreted during the menstrual cycle. This is the cervix. The cervix is that seal because this is a very pristine environment. But there is a normal flora and fauna of bacteria in the woman's vagina. So we don't want that to get up in there because then you can have uterine infections. And this kind of gives you the picture, like a side view of it. And you can see, we'll talk about this during OB, but as the baby grows, the uterine grows, the uterus grows up and out. What does it do? It puts pressure on the bladder. A woman has to urinate more frequently. During labor, the baby starts pushing on the rectum and mom feels like she has to have a bowel movement. Women go into the bathroom thinking they have to poop and the baby comes out of the toilet. I had that in Gardner about five years ago. We had a baby delivered in the toilet. And it puts pressure on the intestines, causing gas and bloating. And after... What's that? Did she touch the baby? The baby went in the toilet and she took the baby out of the toilet when she realized that we got there. It was after we had gotten there. We cleaned up and bought the baby. The baby was fine. Mom and baby went to the hospital. She just didn't know. She thought she had to poop. Give me injury. What's that? That was an injury. That was an injury. Shitty deal for the kid, though. Kidney injury. Not uncommon and rarely occur in isolation. Usually a kidney injury is involved or some other injury as well. The kidneys lie well protected in this area, usually behind the 11th and 12th pre-floating rib, but a forceful blow or penetrating injury are often involved. This is one of the reasons why football players like Wyman and they'll wear the... For defensive ends, they'll wear the kidney protectors. It's like it goes around here at this point and it protects the 11th and 12th rib in the kidney. Suspected kidney damage from a patient is evidence of any of the following abrasions, lacerations, contusions to the flank, penetrating wound to the upper flank or abdomen, fractures on either side of the lower rib cage, or a hematoma in the flank region. You've got a swelling right here. Bad sign. Or if it's urine, blood in the urine, blood in the underwear, blood in the head of the penis. Urinary bladder injuries may result in rupture and then the urine spills into the surrounding tissue causing peritonitis. In males, a sudden deceleration can shear the bladder from the urethra, literally pull it away. Third trimester of pregnancy, bladder injuries increase because this 30-pound uterus in baby are putting pressure on it and it gets hot. Notice this is what happens when you get that fracture of the ischial tuberosity and the piece of the bone penetrates into the bladder causing the bladder to leak. Male sternal genitalia, soft tissue wounds, painful and a great concern for the patient. Oh yeah. But not necessarily life-threatening. Should not be given priority over arterial bleeds, airways, that kind of thing. Pain may refer to the lower abdomen. It is possible, I think they talk about it, I don't get that. Female genitalia injuries, internal, most of it's internal, right? Uterus, ovaries, fallopian tube, the exception is the pregnant uterus where the uterus is kind of out. It's the first thing that walks through the room. So when you get into impacts or injuries, especially motor vehicle crashes, it's the abdomen and the uterus that gets affected. I highly recommend if you have a woman in her second or third trimester of pregnancy, she should go to the hospital even with minor motor vehicle crashes. I don't take refusals. I don't accept them. Obviously, if I have to, if I have to, but I've never had to. I've always convinced a woman to go. She should always go because you never know what kind of trauma is affecting the baby, unless you... The external female genitalia, the vulva, the clitoris, the labia majora, major and minor, generally not very blood-rich but definitely very nerve-rich, very sensitive and it can cause a lot of pain. Remember, the genital region is very emotionally as well as physically painful. So you should have a patient of the same sex if you can. Females to females and males to males. It doesn't always work. I've had to take care of female patients. It happens. But if you can find a patient of the same sex, it definitely makes it easier on the patient as well as yourself. Consider sexual assault in pregnancy. If it is bleeding, you've got 5x9s, you could take a face cloth or a towel and put it between the legs and have mom close her legs or sanitary napkin if you have it. I don't... Unless... I'm going to ask the female, are you having bleeding? If the female says yes, then I'll inspect. But if the female says no, then I'm not going to inspect. I'll take the patient's word for it. I don't want to make the patient feel more uncomfortable than they already are. Never ever insert anything in the vagina. Don't pack the vagina if it's bleeding. We allow it to bleed. We allow it to bleed. You just put dressing outside to control bleeding. Potential patient embarrassment. Maintain a professional presence. You're going to have to ask a lot of questions. Things like have you had a menstrual... when was the last menstrual cycle? Are you sexually active? Have you been pooping and peeing in the consistency? These are all personal questions. I find that if you just ask them like you ask them every day. Just ask them professionally. Don't giggle, don't smile. Just ask straight. The patient will answer in time. They'll answer just as professionally as you are. Provide privacy. Don't ask these questions in the middle of the mall. Have an EMT of the same gender perform. Sometimes you go to like an emergency call and you'll have five firefighters, four cops, and three EMTs all in the room. And you've got this little 15-year-old girl answering these questions. She's not going to feel very comfortable. Everybody else. Myself, maybe me and a partner and that's it. Remember, you want the patient to feel comfortable and make it a comfortable environment. So scene safety. Assess the scene for hazards and threats. Standard precautions. The patient may avoid discussing to undergo a physical exam. Also, I have the I also am of the belief that whatever you do in the privacy of your own bedroom is entirely up to you. But when it comes to an injury and I have to treat you, I need to know what it is. So a lot of times patients will tell you one story and they'll tell you another story and they'll tell you one story but something else. And then when you get to the hospital and the nurse starts talking to them and they start telling them what really happened and the nurse looks at you and is like what they told me. So would you in a situation where maybe there was no other EMTs who are of the same gender would you if there was a police officer would it be okay for them to do kind of that physical inspection? No. It has to be an EMT. If the police officer is going to assess the patient then the police officer has to be an EMT. Okay. Because who's going to write the report? You guys. Quickly scan the patient to identify any life threats. As a general rule they are not. Genital urinary systems are very vascular but they generally most injuries do not bleed a lot. If you see life threatening hemorrhage it must be addressed immediately. Airway and breathing that's the big thing. Genital urinary most of your genital urinary abdominal injuries have a good patient airway. They're conscious they're talking to you. They might be uncomfortable but they're talking to you. Again all your vital signs and if you see shocks or the potential for shock treat aggressively. Call ALS. ALS transdomestic acid TXA we talked about that that helps to keep flush. That was actually designed for postpartum hemorrhage. That was designed to help women after delivering babies when they were still bleeding. That's what it was originally designed for. So it's perfect for genital urinary bleeding internal abdominal bleeding. It's perfect for that. That's what it's designed for. Call ALS we can hear you. Common associated complaints with genital urinary bleeding stool vomiting abnormal bowel and bladder habits. So you got to ask these questions. Right? Have you been pooping and peeing? What is the consistency? Is there any blood? Have you vomited? What was the consistency of the vomit? Is there any blood? You have to ask all these questions. And the events leading up to it. And if you look at and if the patient tells you one thing but it doesn't add up. Don't go to the patient. Come on. That's not what it looks like. Don't do that. Genital urinary system injuries can be awkward to assess and treat. Focus on specific body regions and you're stabilizing the patient and transporting them. Look for decaf E.T.L.S. Identify wounds. Control bleeding. Get your vitals. Do you teach your primary assessment and your interventions? Again, give them oxygen. You know, put dressing socks on the bleeding. Position of comfort. Keep them warm. Oxygen. Injuries may not be obvious. You'll see signs of shock and maybe blood in the urine. They'll have signs of injury here. Transport properly. High priority. Bladder injuries. Blood in the urethral opening. Signs of trauma to the lower abdomen and the pelvis. In the presence of shock, any area, any urethral, any, any mucosal opening, any opening within the body, urethra, the vagina, the mouth, whatever. Moist, sterile dressings. Don't put dry dressings on it. Apply it. Control bleeding. Never manipulate any foreign objects from the urethra. We see this in the prisons a lot. The prison has batteries in the urethra and then they have to be surgically removed. Seen it. What do you usually get them away from? Water? Sterile water and normal saline. You carry bottles of it in your ambulance. Sterile water and normal saline. It is possible to have avulsions. It is possible to have avulsions. It is possible to have avulsions. It is possible to have avulsions. It is possible to have avulsions. 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