PHTLS - Prehospital Trauma Life Support Abdominal and Pelvic Trauma 2 — Questions and Answers
Question 1: Which organ is the most commonly injured solid organ in blunt abdominal trauma?
- Liver
- Spleen (Correct answer)
- Kidneys
- Pancreas
Correct answer: Spleen
The spleen is the most commonly injured solid organ in blunt abdominal trauma due to its location, vascularity, and relatively fragile capsule.
The spleen accounts for approximately 40-55% of solid organ injuries in blunt abdominal trauma. Its location beneath the left lower ribs, high vascularity, and thin capsule make it vulnerable to both direct and deceleration forces.
Question 2: What is the primary prehospital concern with penetrating abdominal trauma?
- Infection at the wound site
- Internal hemorrhage and hollow organ injury (Correct answer)
- Cosmetic damage to the abdominal wall
- Need for tetanus prophylaxis
Correct answer: Internal hemorrhage and hollow organ injury
Penetrating abdominal trauma can cause significant internal hemorrhage from solid organ or vascular injury and peritonitis from hollow organ perforation.
Solid organ injuries cause hemorrhage, while hollow organ injuries release contents that cause peritonitis. Major vascular injuries can produce rapid exsanguination. PHTLS teaches that external wound appearance does not predict internal injury severity.
Question 3: How should eviscerated abdominal organs be managed in the prehospital setting?
- Push the organs back into the abdomen
- Cover with moist sterile dressings and protect from further injury (Correct answer)
- Apply direct pressure to the eviscerated organs
- Leave completely uncovered for continuous monitoring
Correct answer: Cover with moist sterile dressings and protect from further injury
Eviscerated organs should be covered with moist sterile dressings moistened with saline to prevent drying and contamination.
The exposed organs should be covered with sterile dressings moistened with warm normal saline, then covered with an occlusive material to retain moisture and warmth. The organs should NEVER be pushed back into the abdomen as this can introduce contamination and worsen injury.
Question 4: A patient involved in a motorcycle crash complains of left flank pain and has signs of shock. Which injury should be suspected?
- Ruptured appendix
- Bladder rupture
- Splenic laceration with hemorrhage (Correct answer)
- Small bowel obstruction
Correct answer: Splenic laceration with hemorrhage
Left flank pain with signs of shock after blunt trauma strongly suggests splenic injury with significant hemorrhage.
The spleen receives approximately 5% of cardiac output, so laceration can produce rapid hemorrhage. Associated findings may include left shoulder pain (Kehr's sign), left lower rib fractures, and progressive abdominal distension.
Question 5: What is the significance of pelvic instability found during physical assessment of a trauma patient?
- It confirms a simple pelvic fracture only
- It suggests potential life-threatening pelvic hemorrhage (Correct answer)
- It indicates the patient has osteoporosis
- It means the sacroiliac joint is dislocated
Correct answer: It suggests potential life-threatening pelvic hemorrhage
Pelvic instability suggests a significant pelvic fracture with high risk of life-threatening hemorrhage from the rich pelvic vascular network.
An unstable pelvis can accommodate several liters of blood. PHTLS emphasizes that the pelvis should only be tested ONCE to avoid disrupting clots. A pelvic binder should be applied immediately at the greater trochanter level.
Question 6: Which of the following findings during abdominal assessment is most suggestive of peritoneal irritation?
- Soft, non-tender abdomen
- Involuntary guarding and rigidity (Correct answer)
- Hyperactive bowel sounds
- Umbilical bruising only
Correct answer: Involuntary guarding and rigidity
Involuntary guarding and rigidity indicate peritoneal irritation, often from blood or intestinal contents irritating the peritoneal lining.
Involuntary guarding is a reflexive contraction of the abdominal musculature in response to peritoneal irritation. Unlike voluntary guarding, involuntary guarding persists regardless of distraction and indicates true peritonitis. In trauma, this results from blood or intestinal contents.
PHTLS - Prehospital Trauma Life Support Abdominal and Pelvic Trauma 2
Which organ is the most commonly injured solid organ in blunt abdominal trauma?