PHTLS Abdominal and Pelvic Trauma 4 — Questions and Answers
Question 1: Which of the following injuries is MOST likely to be missed during the initial prehospital assessment of abdominal trauma?
- Liver laceration with active hemorrhage
- Hollow viscus injury (bowel perforation) (Correct answer)
- Splenic rupture
- Mesenteric vessel injury
Correct answer: Hollow viscus injury (bowel perforation)
Hollow viscus injuries such as bowel perforation often have delayed signs and symptoms, making them easy to miss on initial assessment.
Question 2: A patient fell from 20 feet and has diffuse lower abdominal pain, inability to urinate, and perineal bruising. The MOST likely injury is:
- Bladder rupture (Correct answer)
- Splenic laceration
- Hepatic contusion
- Small bowel injury
Correct answer: Bladder rupture
Bladder rupture classically presents with perineal bruising, inability to void, and lower abdominal pain following high-energy pelvic trauma.
Question 3: In penetrating abdominal trauma, which area of the abdomen has the highest density of vascular structures and poses the greatest risk of exsanguination?
- Right upper quadrant
- Left lower quadrant
- Central (epigastric/periumbilical) zone (Correct answer)
- Suprapubic region
Correct answer: Central (epigastric/periumbilical) zone
The central abdominal zone contains the aorta, inferior vena cava, superior mesenteric vessels, and portal vein, making injuries there most lethal.
Question 4: A child is struck by a car and presents with right upper quadrant tenderness and referred right shoulder pain. Which injury pattern does this suggest?
- Splenic laceration
- Liver laceration with diaphragmatic irritation (Correct answer)
- Right kidney contusion
- Right colon injury
Correct answer: Liver laceration with diaphragmatic irritation
Right-sided referred shoulder pain following blunt trauma indicates liver injury with blood irritating the right hemidiaphragm via the phrenic nerve.
Question 5: When performing a scene assessment after a shooting, which finding MOST accurately predicts intra-abdominal organ injury?
- Caliber of the weapon used
- Number of entrance wounds relative to exit wounds
- Trajectory through the abdomen based on wound locations (Correct answer)
- Distance from which the shot was fired
Correct answer: Trajectory through the abdomen based on wound locations
Wound trajectory (entrance and exit wound locations) is the best predictor of which organs may have been injured by the bullet's path.
Question 6: A patient with a pelvic fracture receives a pelvic binder. After application, the provider notes the patient's legs are internally rotated. This suggests:
- The binder is too tight and should be loosened
- Internal rotation is a sign of femur fracture, unrelated to the binder
- The binder is correctly applied and internal rotation helps close the pelvic ring (Correct answer)
- The binder should be removed and repositioned higher
Correct answer: The binder is correctly applied and internal rotation helps close the pelvic ring
Internal rotation of the legs after pelvic binder application is expected and desirable, as it helps close the anterior pelvic ring and reduce hemorrhage.
Question 7: Which of the following patients with abdominal trauma has the HIGHEST priority for immediate transport?
- Stable patient with bruising over the left flank and normal vital signs
- Patient with moderate abdominal tenderness and HR 100
- Patient with distended abdomen, absent bowel sounds, and BP 70/40 (Correct answer)
- Patient with isolated penetrating wound and normal hemodynamics
Correct answer: Patient with distended abdomen, absent bowel sounds, and BP 70/40
Abdominal distension combined with hemodynamic instability (BP 70/40) indicates massive intra-abdominal hemorrhage requiring immediate surgical intervention.
PHTLS Abdominal and Pelvic Trauma 4
Which of the following injuries is MOST likely to be missed during the initial prehospital assessment of abdominal trauma?