NREMT Paramedic Cognitive ExamTraumaMedium
A 60-year-old male presents with severe abdominal pain after being struck by a car while crossing the street. He is hypotensive (BP 80/50 mmHg), tachycardic (HR 120 bpm), and pale. His abdomen is rigid and distended. What is the most appropriate immediate intervention?
- AAdminister oral pain medication
- BApply a tourniquet to the lower extremities
- CInitiate two large-bore IVs with crystalloid fluid boluses
- DPrepare for immediate surgical intervention on scene
Show answer & explanationAnswer & explanation
Correct answer: C. Initiate two large-bore IVs with crystalloid fluid boluses
The patient's signs (hypotension, tachycardia, rigid/distended abdomen after blunt trauma) are highly indicative of internal abdominal hemorrhage and hypovolemic shock. Immediate intervention involves establishing large-bore IV access and administering crystalloid fluid boluses to support blood pressure and perfusion.
Why the other options are wrong
- A. Oral pain medication is inappropriate for a patient in shock and with suspected severe internal bleeding; IV analgesia might be considered after stabilization.
- B. Tourniquets are used for severe extremity hemorrhage, not for internal abdominal bleeding.
- D. Surgical intervention is the definitive treatment but cannot be performed on scene by paramedics. Rapid transport to a trauma center is required.
Management of Abdominal Trauma with Shock
Immediate prehospital management of blunt or penetrating abdominal trauma with signs of hypovolemic shock focuses on airway, breathing, circulation (ABC) with aggressive fluid resuscitation and rapid transport.
- Hypotension and tachycardia indicate significant internal bleeding.
- Rigid/distended abdomen suggests peritonitis or internal hemorrhage.
- Large-bore IVs and crystalloid are crucial for fluid resuscitation.
Memory trick: ABCDE: Air, Blood, Circulation, Disability, Expose