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Chapter 35

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Detailed Lesson PlanChapter 35Abdominal and Genitourinary Trauma50–60 minutesChapter 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 Notes5I. IntroductionA. During this lesson, students will learn about assessment and emergency medical care for patients suffering from abdominal and genitourinary injuries.B. Case Study1. 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?5II. The Abdomen—Anatomy of the Abdominal CavityA. Types of organs and vascular structures1. Hollow organsa. Stomachb. Gall bladderc. Urinary bladderd. Ureterse. Internal urethraf. Fallopian tubesg. Small intestineh. Large intestine2. Solid organsa. Liverb. Spleenc. Pancreasd. Kidneys3. Vascular structuresa. Abdominal aortab. Inferior vena cavaB. Additional structures1. Diaphragm2. Abdominal wallTeaching TipDraw 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.PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 35 PAGE 1MASTER TEACHING NOTES- Case Study Discussion- Teaching Tips- Discussion Questions- Class Activities- Media Links- Knowledge Application- Critical Thinking DiscussionChapter 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 Notes10III. The Abdomen—Abdominal InjuriesA. 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 theabdomen?- From what abdominal organ injuries would youexpect significant hemorrhage?Critical Thinking DiscussionWhy can the early indications of blunt abdominal trauma be subtle?WeblinkGo to www.bradybooks.com and click on the mykit link for Prehospital Emergency Care, 9th edition to access a web resource on penetrating abdominal trauma.20IV. The Abdomen—Assessment-Based Approach: Abdominal TraumaA. Scene size-up1. Take necessaryStandard 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.a. Type of vehicleb. Approximate speed at which it was travelingc. Type of collision and point(s) of impactd. Whether the patient was driver, passenger, or pedestriane. Where the patient was found and in what positionf. Whether the patient was thrown from the vehicleg. Impact marks to the windshield, steering wheel, and dashboardh. Whether the patient was wearing a seat beltDiscussion 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 ApplicationStudents should be able to identify patients with mechanisms of injury and assessment findings consistent with abdominal trauma.PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 35 PAGE 2Chapter 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 NotesB. Primary assessment1. Form a general assessment of the patient’s condition.a. Is he lying still with knees flexed up toward the chest?b. Is he moaning and complaining of severe pain?2. If you suspect aspine injury, establish in-line spinal stabilization.3. Ensure an openairway and adequate breathing.a. Inspect the airway for evidence of bloody vomitus and suction if necessary.b. If breathing is adequate, deliver oxygen by nonrebreather mask at 15 lpm.c. Administer positive pressure ventilation if necessary.4. Assess the patient’s circulation for signs of shock and abdominal injury.a. Weak or absent radial pulseb. Abnormally rapid heart ratec. Moist, pale, cool skin5. If the above signs are present, patient is a priority for immediate transport.C. Secondary assessment1. 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 aspine 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 Discussion QuestionWhat is Kehr’s sign?PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 35 PAGE 3Chapter 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 Notesprovide 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 abackboard 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


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