Thoracic and Abdominal Trauma Flashcards

A patient with left lower rib fractures (ribs 9-11) has left upper quadrant tenderness and a blood pressure that drops from 110/70 to 90/60 over 15 minutes. What injury is most likely?

Answer: Splenic laceration with progressive hemorrhage

The spleen sits beneath ribs 9-12 on the left. Lower left rib fractures combined with LUQ tenderness and declining blood pressure strongly suggest splenic laceration with ongoing hemorrhage.

How does a traumatic aortic injury typically present in the prehospital setting, and why is the mortality rate so high?

Answer: 80-90% die at the scene from exsanguination; survivors may have upper extremity hypertension with lower extremity hypotension (pseudocoarctation), and wide mediastinum on imaging

Traumatic aortic injury kills 80-90% at the scene. Survivors have a partial tear contained by the adventitia, which can rupture at any time. Findings may include BP differential between upper and lower extremities and interscapular pain.

A patient has an evisceration—bowel protruding through an open abdominal wound. What is the correct prehospital management?

Answer: Cover the exposed bowel with a sterile saline-moistened dressing, then cover with an occlusive layer to prevent heat and moisture loss; do not attempt to replace it

Eviscerated bowel must never be replaced into the abdomen. Cover with sterile saline-moistened dressings to prevent desiccation, then an occlusive outer layer to retain warmth and moisture. Transport in a position that reduces tension on the mesentery.

What thoracic injury can result from a sudden compression of the chest against a closed glottis, and what are its characteristic findings?

Answer: Traumatic asphyxia, presenting with cervicofacial cyanosis, petechiae, subconjunctival hemorrhage, and possible neurological symptoms from cerebral venous engorgement

Traumatic asphyxia occurs when sudden severe thoracic compression against a closed glottis forces blood retrograde from the right heart into the SVC and head/neck veins, causing characteristic cervicofacial cyanosis, petechiae, and subconjunctival hemorrhages.

Why is a hollow viscus (bowel) injury from blunt trauma often difficult to diagnose in the prehospital setting?

Answer: Peritoneal signs develop slowly (hours) as bowel contents gradually contaminate the peritoneum, and initial vital signs may be normal since bowel is not highly vascular

Hollow viscus injuries from blunt trauma develop peritoneal signs gradually as intestinal contents leak into the peritoneum. Initial presentation may be benign with stable vital signs, as the bowel itself does not bleed profusely.

A patient involved in a motorcycle crash has a fractured pelvis and blood at the urethral meatus. What does this combination suggest, and what precaution must be taken?

Answer: Urethral injury is likely; do NOT insert a urinary catheter as it may convert a partial tear to a complete disruption or create a false passage

Blood at the urethral meatus in the setting of pelvic fracture strongly suggests urethral injury. Catheter insertion is contraindicated as it can worsen the injury, convert a partial tear to complete disruption, or create a false passage into surrounding tissues.