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

An open book pelvic fracture disrupts the pelvic ring, dramatically increasing pelvic volume and allowing massive hemorrhage. Applying a circumferential pelvic binder or improvised sheet wrap at the greater trochanters closes the pelvic ring, reduces volume, and provides tamponade of venous bleeding — the key prehospital hemorrhage control maneuver.

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

Kehr's sign occurs when blood from a splenic laceration tracks beneath the left hemidiaphragm, irritating the phrenic nerve (C3–C5). Because these nerve roots also supply the left shoulder, the patient perceives pain there. It is a classic — though not always present — indicator of splenic injury.

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

A lap belt without a shoulder harness concentrates deceleration force across the lower abdomen. This compresses and shears the small bowel against the lumbar spine, making bowel perforation — along with Chance fractures of the lumbar vertebrae — a hallmark injury pattern of lap-belt–only restraint in frontal crashes.

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

Cullen's sign (periumbilical ecchymosis) results from blood dissecting through fascial planes and pooling around the umbilicus. It indicates significant retroperitoneal or intraperitoneal hemorrhage. Because it takes hours to develop, its absence in the prehospital setting does not rule out serious injury.

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

Involuntary guarding or rigidity on palpation reflects peritoneal irritation from blood or bowel contents and is the most reliable early physical sign of significant intra-abdominal injury. Bowel sound assessment is unreliable in the field, nausea is nonspecific, and normal vitals can persist even with significant hemorrhage due to compensatory mechanisms.

PHTLS - Prehospital Trauma Life Support Practice Test

PHTLS - Prehospital Trauma Life Support Practice Test

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