Abdominal Trauma Flashcards

A pregnant trauma patient at 28 weeks gestation presents after a motor vehicle collision. Where is the uterine fundus at this gestational age, and why is this significant in abdominal trauma assessment?

Answer: Above the umbilicus; the uterus is now an intra-abdominal organ susceptible to direct injury

By 28 weeks, the fundus is above the umbilicus, making the uterus an exposed intra-abdominal organ vulnerable to direct trauma, deceleration forces, and placental abruption.

Which intervention takes priority when managing a pregnant trauma patient at 20+ weeks gestation who is in hemorrhagic shock?

Answer: Left lateral uterine displacement to relieve aortocaval compression

Left lateral uterine displacement (or left lateral tilt) relieves compression of the inferior vena cava by the gravid uterus, improving venous return and maternal cardiac output.

A patient with a pancreatic transection from handlebar injury is admitted to the ICU. Which serum enzyme elevation is most diagnostic of pancreatic injury?

Answer: Persistently elevated or rising serum lipase over 24–48 hours

While amylase may rise transiently from salivary sources, persistent or rising lipase over 24–48 hours is more specific for pancreatic injury.

A patient with abdominal trauma has a urinalysis showing gross hematuria. Which statement regarding genitourinary injury in trauma is correct?

Answer: Ureteral injuries rarely cause hematuria and are often diagnosed late

Ureteral injuries frequently do not cause significant hematuria and may present late with urinoma formation, flank pain, or sepsis, making them difficult to diagnose acutely.

During a mass casualty incident involving abdominal trauma victims, which triage category (START system) should be assigned to a patient with penetrating abdominal trauma who has a respiratory rate of 24/min, capillary refill of 2 seconds, and follows commands?

Answer: Red (immediate)

This patient meets Red (immediate) criteria: respiratory rate >20, borderline capillary refill, and penetrating abdominal trauma indicates high injury severity requiring immediate intervention.

A patient with abdominal trauma undergoes damage control laparotomy and returns to the ICU with an open abdomen covered by a temporary closure device. Which nursing priority is most critical in the first 4 hours post-operatively?

Answer: Monitoring abdominal wound output and achieving negative fluid balance

After damage control surgery, monitoring wound output and achieving a negative fluid balance are critical to prevent abdominal compartment syndrome and facilitate early definitive closure.

Which finding on CT of the abdomen after blunt trauma is most predictive of the need for angioembolization rather than operative management?

Answer: Active arterial extravasation (contrast blush) with hemodynamic stability

An arterial contrast blush (active extravasation) on CT in a hemodynamically stable patient identifies a bleeding vessel amenable to interventional radiology angioembolization.