PHTLS - Prehospital Trauma Life Support Prehospital Trauma Life Support Abdominal and Pelvic Trauma 1

Question 1

A patient with a suspected open book pelvic fracture is in hemorrhagic shock. Which prehospital intervention is most appropriate to reduce pelvic volume and control hemorrhage?

Accepted Answer

Apply a pelvic binder or sheet wrap at the level of the greater trochanters

Answer

Pack the pelvic wound with sterile gauze and apply direct pressure

Answer

Elevate both legs to 45 degrees to tamponade pelvic vessels

Answer

Administer high-flow oxygen and defer all interventions until hospital arrival

Question 2

Kehr's sign, defined as referred pain to the left shoulder, is a classic indicator of which abdominal injury?

Accepted Answer

Splenic laceration with diaphragmatic irritation

Answer

Hollow viscus perforation

Answer

Retroperitoneal hematoma

Answer

Mesenteric tear with bowel ischemia

Question 3

Which mechanism of injury is most associated with a hollow organ (bowel) rupture in blunt abdominal trauma?

Accepted Answer

Lap belt restraint in a high-speed frontal collision

Answer

Lateral impact motor vehicle collision

Answer

Unrestrained driver striking the steering wheel

Answer

Direct blow to the right upper quadrant

Question 4

A restrained passenger after a high-speed collision has periumbilical bruising (Cullen's sign). This finding is associated with which type of abdominal injury?

Accepted Answer

Retroperitoneal or intraperitoneal hemorrhage tracking to the umbilicus

Answer

Splenic rupture with immediate hemorrhage

Answer

Bladder rupture with urine extravasation

Answer

Mesenteric vascular injury with venous engorgement

Question 5

When assessing a patient for abdominal trauma in the prehospital setting, which finding is the MOST reliable early indicator of significant intra-abdominal injury?

Accepted Answer

Rigid or involuntary guarding on abdominal palpation

Answer

Bowel sounds absent on auscultation

Answer

Patient report of nausea and vomiting

Answer

Normal vital signs ruling out hemorrhage

Question 6

A patient struck by a vehicle has a suspected pelvic fracture and is hemodynamically unstable. After applying a pelvic binder, the MOST important next prehospital priority is:

Accepted Answer

Establish large-bore IV access en route and initiate permissive hypotension fluid strategy

Answer

Perform a secondary survey and document all injuries before transport

Answer

Immobilize both lower extremities with traction splints to reduce blood loss

Answer

Obtain a 12-lead ECG to rule out traumatic cardiac contusion