Detailed Lesson Plan

Chapter 35

Abdominal and Genitourinary Trauma

50–60 minutes

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
5 / I.Introduction
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.
/ Case Study Discussion
  • 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?

5 / II.The Abdomen—Anatomy of the Abdominal Cavity
  1. Types of organs and vascular structures
  1. Hollow organs
  1. Stomach
  2. Gall bladder
  3. Urinary bladder
  4. Ureters
  5. Internal urethra
  6. Fallopian tubes
  7. Small intestine
  8. Large intestine
  1. Solid organs
  1. Liver
  2. Spleen
  3. Pancreas
  4. Kidneys
  1. Vascular structures
  1. Abdominal aorta
  2. Inferior vena cava
  3. Additional structures
  1. Diaphragm
  2. Abdominal wall
/ 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.
10 / 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 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.
  5. Type of vehicle
  6. Approximate speed at which it was traveling
  7. Type of collision and point(s) of impact
  8. Whether the patient was driver, passenger, or pedestrian
  9. Where the patient was found and in what position
  10. Whether the patient was thrown from the vehicle
  11. Impact marks to the windshield, steering wheel, and dashboard
  12. Whether the patient was wearing a seat belt
B.Primary assessment
  1. Form a general assessment of the patient’s condition.
  1. Is he lying still with knees flexed up toward the chest?
  2. Is he moaning and complaining of severe pain?
  1. If you suspect a spine injury, establish in-line spinal stabilization.
  2. Ensure an open airway and adequate breathing.
  1. Inspect the airway for evidence of bloody vomitus and suction if necessary.
  2. If breathing is adequate, deliver oxygen by nonrebreather mask at 15 lpm.
  3. Administer positive pressure ventilation if necessary.
  1. Assess the patient’s circulation for signs of shock and abdominal injury.
  1. Weak or absent radial pulse
  2. Abnormally rapid heart rate
  3. Moist, pale, cool skin
  1. 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.
  1. Contusions, abrasions, lacerations, punctures, or other signs of blunt or penetrating trauma
  2. Pain that continues to get worse
  3. Tenderness on palpation to areas besides injury site
  4. Rigid abdominal muscles.
  5. Patient who has drawn his legs up to his chest to reduce the pain
  6. Distended abdomen
  7. Discoloration around the umbilicus or to the flank (late sign)
  8. Rapid, shallow breathing
  9. Signs of hemorrhagic shock
  10. Decreasing blood pressure
  11. Narrowing pulse pressure
  12. Increasing heart rate
  13. Increasing respiratory rate
  14. Nausea and vomiting (may contain blood).
  15. Abdominal cramping.
  16. Pain that radiates to either shoulder.
  17. 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.
/ 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.
Discussion Question
What is Kehr’s sign?
5 / V. The Abdomen—Summary: Assessment and Care—Abdominal Trauma
  1. Review possible assessment findings and emergency care for abdominal trauma.
  2. Review Figures 35-3 and 35-4.
/ Critical Thinking Discussion
How might technology allow EMTs to play a more specific role in the future in diagnosis of abdominal injuries?
10 / VI.Genital Trauma
  1. Injuries to male genitalia
  2. Include lacerations, abrasions, avulsions, penetrations, amputations, contusions
  3. Usually produce excruciating pain and cause patient great concern
  4. Penis is very vascular (can bleed excessively).
  5. Treat as a soft-tissue injury; apply direct pressure and cold compress to reduce pain and swelling.
  6. Wrap any avulsed parts in sterile, moist dressing; place on ice; and transport with patient.
  7. Apply oxygen by nonrebreather mask at 15 lpm.
  8. Assess for signs and symptoms of shock and transport.
  9. 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
Given several scenarios, students should be able to identify and manage patients with injuries to the genitalia.
Weblinks
Go to
and click on the mykit link for Prehospital EmergencyCare, 9th edition to access web resources about genital trauma and female genital cutting.
10 / VII. Follow-Up
  1. Answer student questions.
  2. 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 would or would not change their answers.
  4. Follow-Up Assignments
  5. Review Chapter 35 Summary.
  6. Complete Chapter 35 In Review questions.
  7. Complete Chapter 35 Critical Thinking.
  8. Assessments
  1. Handouts
  2. Chapter 35 quiz
/ Case Study Follow-Up Discussion
  • 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
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

PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 35 PAGE1