TCRN Abdominal and Pelvic Trauma Questions and Answers

Question 1

A patient brought to the trauma center after a high-speed motor vehicle collision is hemodynamically unstable with a suspected unstable pelvic fracture. After initiating massive transfusion protocol, what is the most appropriate next step for hemorrhage control?

Accepted Answer

Application of a pelvic binder or sheet.

Answer

In a hemodynamically unstable patient with a suspected pelvic fracture, the immediate priority after starting resuscitation is to stabilize the pelvis mechanically. Applying a pelvic binder or sheet provides temporary stabilization, reduces the pelvic volume, and can help control venous and bony bleeding sources, which are the most common causes of hemorrhage in these injuries. While angioembolization or surgery may be necessary, mechanical stabilization is the crucial first intervention.

Question 2

A trauma nurse is assessing a restrained driver from a frontal impact collision and notes a linear ecchymosis across the lower abdomen. This finding, known as the 'seatbelt sign,' should raise the highest suspicion for which type of injury?

Accepted Answer

Hollow viscus injury

Answer

The 'seatbelt sign' is strongly associated with underlying intra-abdominal injuries, particularly hollow viscus injuries like bowel perforation or mesenteric lacerations. The mechanism involves the compression of the bowel between the seatbelt and the vertebral column during sudden deceleration. While solid organ and spine injuries can also occur, the highest index of suspicion should be for bowel and mesenteric trauma.

Question 3

A patient with blunt abdominal trauma is complaining of acute, sharp pain in the left shoulder. This finding, known as Kehr's sign, is most indicative of an injury to which organ?

Accepted Answer

Spleen

Answer

Kehr's sign is referred pain to the left shoulder caused by irritation of the diaphragm from blood in the peritoneal cavity. This sign is a classic clinical indicator of a ruptured or injured spleen, as the phrenic nerve (which innervates the diaphragm) shares the same nerve roots (C3-C5) as the supraclavicular nerves that supply the shoulder area.

Question 4

A trauma patient is undergoing a Focused Assessment with Sonography for Trauma (FAST) exam. The primary purpose of this examination in the initial assessment of a trauma patient is to detect:

Accepted Answer

The presence of free fluid in the peritoneum or pericardium.

Answer

The FAST exam is a rapid, non-invasive ultrasound screening tool designed to identify the presence of free fluid (assumed to be blood in the context of trauma) in dependent areas of the peritoneal, pericardial, and pleural spaces. It is used to rapidly identify potential life-threatening hemorrhage, not to grade specific organ injuries, definitively diagnose retroperitoneal bleeding, or identify bowel injuries.

Question 5

A patient with a pelvic fracture has gross hematuria. A CT cystogram reveals extravasation of contrast into the peritoneal cavity. Which of the following is the most definitive management for this type of injury?

Accepted Answer

Surgical exploration and repair.

Answer

The finding of contrast in the peritoneal cavity on a cystogram confirms an intraperitoneal bladder rupture. This type of injury requires surgical exploration and repair to prevent complications such as urinary ascites, peritonitis, and sepsis. Conservative management with catheter drainage alone is typically reserved for uncomplicated extraperitoneal bladder ruptures.

TCRN Exam Practice Test

TCRN Exam Practice Test

TCRN Abdominal and Pelvic Trauma Questions and Answers