PHTLS Abdominal and Pelvic Trauma 5 — Questions and Answers
Question 1: A motorcyclist is thrown from his bike and presents with lower rib fractures on the left. Which underlying organ injury must be STRONGLY suspected?
- Left lung contusion only
- Splenic injury (Correct answer)
- Liver injury
- Left colon injury
Correct answer: Splenic injury
Left lower rib fractures are closely associated with splenic injury because the spleen lies immediately beneath these ribs.
Question 2: In the context of PHTLS, 'damage control resuscitation' in the prehospital phase refers to:
- Aggressive crystalloid resuscitation to maintain normal blood pressure
- Limiting crystalloids, using blood products when available, and permissive hypotension (Correct answer)
- Immediate surgical hemostasis in the field
- Applying tourniquets to all extremity injuries first
Correct answer: Limiting crystalloids, using blood products when available, and permissive hypotension
Damage control resuscitation limits crystalloids to prevent dilutional coagulopathy, uses blood products, and accepts permissive hypotension until surgical control.
Question 3: A female patient in her third trimester of pregnancy suffers blunt abdominal trauma. Which placental injury is the MOST life-threatening to the fetus?
- Placenta previa
- Placental abruption (Correct answer)
- Umbilical cord compression
- Uterine contusion
Correct answer: Placental abruption
Placental abruption, premature separation of the placenta from the uterine wall, is the leading cause of fetal death following maternal trauma.
Question 4: Which of the following best explains why the pediatric patient is at higher risk for solid organ injury from blunt abdominal trauma compared to adults?
- Children have a proportionally larger rib cage that transmits force better
- Children have less subcutaneous fat and a more compliant chest wall, providing less protection (Correct answer)
- Children's organs are more fibrous and resistant to lacerations
- Children have higher pain thresholds that mask the injury initially
Correct answer: Children have less subcutaneous fat and a more compliant chest wall, providing less protection
The pediatric thorax is highly compliant, so significant force is transmitted directly to underlying organs without rib fractures serving as a warning sign.
Question 5: A trauma patient has a gunshot wound to the right flank and is hemodynamically stable. During transport, vital signs suddenly deteriorate. The MOST likely explanation is:
- Tension pneumothorax from a missed chest wound
- Delayed rupture of a solid organ or vascular structure (Correct answer)
- Medication reaction from IV fluids administered
- Neurogenic shock from a spinal cord injury
Correct answer: Delayed rupture of a solid organ or vascular structure
Delayed hemodynamic deterioration following penetrating abdominal trauma typically indicates delayed solid organ rupture or vascular injury that was not bleeding initially.
Question 6: Which of the following findings on abdominal exam is MOST consistent with intraperitoneal hemorrhage rather than retroperitoneal hemorrhage?
- Flank ecchymosis (Grey Turner's sign)
- Periumbilical ecchymosis (Cullen's sign)
- Diffuse rebound tenderness throughout the abdomen (Correct answer)
- Isolated flank pain with hematuria
Correct answer: Diffuse rebound tenderness throughout the abdomen
Diffuse rebound tenderness indicates peritoneal irritation from blood or bowel contents freely in the peritoneal cavity, characteristic of intraperitoneal injury.
Question 7: After applying a pelvic binder to an open-book pelvic fracture, the paramedic notes an open wound over the sacrum. The MOST appropriate action is to:
- Remove the binder to address the wound
- Pack the wound with gauze, then reapply the binder over the dressing (Correct answer)
- Ignore the wound until hospital arrival since the binder takes priority
- Apply a tourniquet around the pelvis above the wound
Correct answer: Pack the wound with gauze, then reapply the binder over the dressing
Open wounds should be packed with hemostatic or plain gauze before reapplying the binder, addressing both hemorrhage control priorities simultaneously.
PHTLS Abdominal and Pelvic Trauma 5
A motorcyclist is thrown from his bike and presents with lower rib fractures on the left.
Which underlying organ injury must be STRONGLY suspected?