Thoracic and Abdominal Trauma Flashcards

A stab wound to the left chest at the 5th intercostal space, midclavicular line is most concerning for injury to which organ?

Answer: Left ventricle of the heart

The 5th intercostal space at the midclavicular line overlies the cardiac silhouette. Penetrating trauma at this location has a high probability of cardiac injury, specifically the left ventricle which forms most of the anterior cardiac surface.

What is the difference between a simple pneumothorax and an open pneumothorax, and how is each managed in the field?

Answer: A simple pneumothorax has no chest wall opening (air enters from a lung tear) and is monitored; an open pneumothorax has a chest wall defect communicating with the pleural space and requires an occlusive dressing with a vented seal

A simple pneumothorax involves air in the pleural space from internal lung injury without a chest wall defect. An open pneumothorax has an external wound creating a communication between the atmosphere and pleural space, requiring a vented occlusive dressing.

A blunt trauma patient has a rigid, distended abdomen with hemodynamic instability. What is the most likely diagnosis and what is the definitive treatment?

Answer: Intra-abdominal hemorrhage from solid organ injury (liver or spleen) requiring emergency surgical exploration (laparotomy)

A rigid, distended abdomen with hemodynamic instability following blunt trauma indicates significant intra-abdominal hemorrhage, most commonly from liver or splenic laceration, requiring emergency laparotomy as the only definitive treatment.

How do you identify and manage a flail chest with underlying pulmonary contusion in the prehospital setting?

Answer: Identify paradoxical movement on inspection, provide high-flow oxygen, consider positive pressure ventilation for respiratory failure, position with injured side down if possible, and avoid fluid overload

Flail chest is identified by paradoxical chest wall movement. Treatment focuses on managing the underlying pulmonary contusion: oxygen, positive pressure ventilation when needed (which also internally splints the flail), positioning, and judicious fluid management.

A construction worker falls 20 feet and lands on his feet, then collapses. He has bilateral heel pain and lower back pain. What injury should be suspected based on this mechanism?

Answer: Bilateral calcaneal fractures with associated lumbar burst fracture from axial loading

Feet-first landing from height causes bilateral calcaneal fractures, and the axial loading force continues up the skeletal system to the lumbar spine, commonly causing burst fractures at L1-L2 (the thoracolumbar junction).

What is the significance of a seatbelt sign (linear ecchymosis across the abdomen) in a restrained MVC occupant?

Answer: It is associated with a 30% incidence of intra-abdominal injury (mesenteric tears, bowel perforation, solid organ injury) and 10% incidence of lumbar spine fractures

A seatbelt sign is a sentinel marker for significant underlying injuries. The lap belt concentrates force on the abdomen and lumbar spine, causing mesenteric lacerations, bowel injuries, and Chance-type lumbar fractures.