ITLS Thoracic and Abdominal Trauma 2

Question 1

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

Accepted Answer

Left ventricle of the heart

Answer

Left lung only

Answer

Liver

Answer

Left kidney

Question 2

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

Accepted 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

Answer

They are the same condition

Answer

Simple pneumothorax is always larger than open pneumothorax

Answer

Open pneumothorax only occurs with rib fractures

Question 3

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

Accepted Answer

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

Answer

Bowel obstruction requiring NG tube placement

Answer

Urinary retention requiring catheterization

Answer

Gastric distension from air swallowing

Question 4

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

Accepted 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

Answer

Apply tight circumferential bandaging to stabilize the chest

Answer

Flail chest requires immediate surgical fixation in the field

Answer

Tape the flail segment to the adjacent chest wall

Question 5

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?

Accepted Answer

Bilateral calcaneal fractures with associated lumbar burst fracture from axial loading

Answer

Isolated bilateral calcaneal fractures

Answer

Ankle sprains bilateral

Answer

Hip dislocations from ground impact

Question 6

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

Accepted 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

Answer

It indicates the seatbelt was properly worn and the patient is unlikely to be injured

Answer

It only causes superficial skin bruising with no deeper significance

Answer

Seatbelt signs are normal and require no special attention