PHTLS Abdominal and Pelvic Trauma 2 — Questions and Answers
Question 1: A patient involved in a high-speed MVC has a seatbelt sign across the lower abdomen. Which organ is MOST likely injured?
- Spleen
- Small bowel (Correct answer)
- Liver
- Kidney
Correct answer: Small bowel
The seatbelt sign indicates compression injury to the small bowel, which is the most commonly injured hollow organ from lap belt trauma.
Question 2: Which of the following is the MOST reliable early sign of significant intra-abdominal hemorrhage in the field?
- Abdominal rigidity
- Signs of shock with a mechanism consistent with abdominal injury (Correct answer)
- Visible bruising over the abdomen
- Abdominal distension
Correct answer: Signs of shock with a mechanism consistent with abdominal injury
Shock with a consistent mechanism is the most reliable early indicator because physical signs like rigidity and distension often develop late.
Question 3: During assessment of a pelvic fracture patient, you apply a commercial pelvic binder. At what anatomic landmark should the binder be centered?
- Iliac crests
- Greater trochanters (Correct answer)
- Pubic symphysis
- Lumbar spine
Correct answer: Greater trochanters
The pelvic binder should be centered over the greater trochanters to effectively compress the pelvic ring and tamponade hemorrhage.
Question 4: A patient has suspected bowel evisceration through an abdominal wound. The correct prehospital management is to:
- Replace the organs back into the abdominal cavity
- Cover with a dry sterile dressing
- Cover with a moist sterile dressing and do not replace organs (Correct answer)
- Apply direct pressure directly over the exposed bowel
Correct answer: Cover with a moist sterile dressing and do not replace organs
Eviscerated organs should be covered with a moist sterile dressing to prevent desiccation and never replaced in the field.
Question 5: Which retroperitoneal organ is MOST commonly injured in blunt abdominal trauma?
- Pancreas
- Duodenum
- Kidney (Correct answer)
- Aorta
Correct answer: Kidney
The kidneys are the most commonly injured retroperitoneal organs due to their size and position, often presenting with flank pain and hematuria.
Question 6: A patient has a penetrating abdominal injury with an impaled object. The correct action is to:
- Remove the object to allow proper wound closure
- Shorten the object if it is very long, then stabilize it in place (Correct answer)
- Leave the object in place and stabilize it without shortening
- Apply pressure around the object to control bleeding
Correct answer: Shorten the object if it is very long, then stabilize it in place
In the prehospital setting, long impaled objects may be carefully shortened for extrication but must then be stabilized in place without removal.
Question 7: In a patient with suspected pelvic ring disruption and hemorrhagic shock, which intervention should be performed FIRST after airway management?
- IV fluid resuscitation with 2L crystalloid
- Application of a pelvic binder (Correct answer)
- Bilateral femur splinting
- FAST examination
Correct answer: Application of a pelvic binder
Applying a pelvic binder is the priority mechanical intervention to reduce pelvic volume and tamponade life-threatening hemorrhage.
PHTLS Abdominal and Pelvic Trauma 2
A patient involved in a high-speed MVC has a seatbelt sign across the lower abdomen.
Which organ is MOST likely injured?