TCRN TCRN Abdominal and Pelvic Trauma 5 — Questions and Answers
Question 1: What is the American Association for the Surgery of Trauma (AAST) grade of a splenic injury with vascular injury or active bleeding confined within the splenic capsule?
- Grade II
- Grade IV (Correct answer)
- Grade III
- Grade V
Correct answer: Grade IV
Grade IV splenic injuries involve vascular injury or active bleeding confined within the splenic capsule, representing a high-grade injury that often requires intervention.
Question 2: A patient arrives after a gunshot wound to the abdomen with eviscerated bowel through the wound. What is the appropriate initial management of the eviscerated bowel?
- Attempt to replace the bowel back into the abdomen
- Cover with warm, moist saline-soaked dressings and prepare for surgery (Correct answer)
- Apply dry sterile gauze and wait for surgical consultation
- Irrigate the bowel with normal saline and apply an occlusive dressing
Correct answer: Cover with warm, moist saline-soaked dressings and prepare for surgery
Eviscerated bowel should be covered with warm, moist saline dressings to prevent desiccation while the patient is urgently taken to the operating room.
Question 3: When should a pelvic binder be placed on a trauma patient with suspected pelvic ring injury?
- Only after confirming fracture by X-ray
- As soon as a pelvic fracture is suspected in a hemodynamically unstable patient (Correct answer)
- Only in the operating room after anesthesia induction
- After CT scanning confirms ring disruption
Correct answer: As soon as a pelvic fracture is suspected in a hemodynamically unstable patient
Pelvic binders should be applied early when a pelvic ring fracture is suspected in a hemodynamically unstable patient to reduce pelvic volume and tamponade venous hemorrhage.
Question 4: Which type of liver injury is characterized by hepatic avulsion from the retrohepatic vena cava and is typically fatal?
- Grade III liver laceration
- Grade VI (juxtahepatic venous injury) (Correct answer)
- Grade IV liver laceration
- Grade II subcapsular hematoma
Correct answer: Grade VI (juxtahepatic venous injury)
Grade VI liver injuries (formerly described as hepatic avulsion) involve the retrohepatic vena cava or major hepatic veins and carry an extremely high mortality rate.
Question 5: A patient with blunt abdominal trauma is noted to have bile-stained peritoneal fluid on diagnostic peritoneal lavage. Which injury is most likely?
- Splenic laceration
- Duodenal or biliary tract injury (Correct answer)
- Renal laceration
- Mesenteric hematoma
Correct answer: Duodenal or biliary tract injury
Bile-stained fluid on DPL indicates injury to a bile-containing structure such as the duodenum, gallbladder, or biliary tract, requiring operative exploration.
Question 6: Intra-abdominal pressure (IAP) is most accurately measured using which method in the trauma ICU?
- Nasogastric tube manometry
- Bladder (intravesical) pressure via Foley catheter (Correct answer)
- Rectal pressure transducer
- Direct peritoneal catheter manometry
Correct answer: Bladder (intravesical) pressure via Foley catheter
Intravesical pressure measurement via the Foley catheter is the standard surrogate for intra-abdominal pressure measurement and is recommended by the WSACS guidelines.
Question 7: A trauma patient with a pelvic fracture and hemodynamic instability has a pelvic binder applied but remains unstable. After ruling out other sources of hemorrhage, which procedure provides definitive hemorrhage control when angiography is not immediately available?
- External pelvic fixation alone
- Pelvic preperitoneal packing (Correct answer)
- Peritoneal lavage
- Bilateral femoral artery ligation
Correct answer: Pelvic preperitoneal packing
Preperitoneal pelvic packing directly compresses the pelvic venous plexus and is the recommended damage-control procedure when angioembolization is unavailable or fails.
TCRN TCRN Abdominal and Pelvic Trauma 5
What is the American Association for the Surgery of Trauma (AAST) grade of a splenic injury with vascular injury or active bleeding confined within the splenic capsule?