Abdominal Trauma ATCN Questions
With Correct Solutions!!
Physical Exam: Inspection - ANSWER1. fully undress patient
2. examine anterior and posterior abdomen
3. examine chest and flank
4. inspect perineum, scrotum, and perianal area
5. logroll patient to inspect ack
AFTER INSPECTION, COVER THE PATIENT TO PREVENT HYPOTHERMIA
Signs of Pelvic Fracture - ANSWER1. evidence of ruptured urethra (scrotal
hematoma or blood at the urethral meatus)
2. discrepancy in limb length
3. rotation deformity of a leg without obvious fracture
IN PATIENTS WITH THESE SIGNS, AVOID MANUALLY MANIPULATING THE
PELVIS
Hypotension and pelvic fracture = high mortality
Therefore... - ANSWERSound, rapid diagnosis and treatment are critical to patient
outcome
Pelvic assessment key points - ANSWER1. diagnose pelvic hemorrhage and treat
without delay
2. unexplained hypotension may be the only sign of pelvic disruption
3. place a pelvic binder of pelvic fractures, hypotension, and no other source of blood
loss
4. avoid pelvic manipulation and distraction
5. may gently palpate the bony pelvis for tenderness, not stability
Pelvic Farrctures: Initial Management - ANSWER1. hemorrhage control
a. emergent: stabilization, with sheet, binder, internal rotation or lower extremities
b. definitive: angiographic embolization, operative hemorrhage control
2. fluid resuscitation (avoid hypothermia)
3. early transfer
Signs of urethral injury - ANSWER1. blood at the urethral meatus, scrotal and
perineal ecchymosis
Rectal exam (blunt trauma) - ANSWER1. assess sphincter tone and rectal mucosal
integrity, and identify palpale fractures of pelvis
PITFALL: Passage of a gastric tube may be impossible in patients with hiatal hernias
(more common in older adults) - ANSWERSolution: to avoid iatrogenic injury, do not
With Correct Solutions!!
Physical Exam: Inspection - ANSWER1. fully undress patient
2. examine anterior and posterior abdomen
3. examine chest and flank
4. inspect perineum, scrotum, and perianal area
5. logroll patient to inspect ack
AFTER INSPECTION, COVER THE PATIENT TO PREVENT HYPOTHERMIA
Signs of Pelvic Fracture - ANSWER1. evidence of ruptured urethra (scrotal
hematoma or blood at the urethral meatus)
2. discrepancy in limb length
3. rotation deformity of a leg without obvious fracture
IN PATIENTS WITH THESE SIGNS, AVOID MANUALLY MANIPULATING THE
PELVIS
Hypotension and pelvic fracture = high mortality
Therefore... - ANSWERSound, rapid diagnosis and treatment are critical to patient
outcome
Pelvic assessment key points - ANSWER1. diagnose pelvic hemorrhage and treat
without delay
2. unexplained hypotension may be the only sign of pelvic disruption
3. place a pelvic binder of pelvic fractures, hypotension, and no other source of blood
loss
4. avoid pelvic manipulation and distraction
5. may gently palpate the bony pelvis for tenderness, not stability
Pelvic Farrctures: Initial Management - ANSWER1. hemorrhage control
a. emergent: stabilization, with sheet, binder, internal rotation or lower extremities
b. definitive: angiographic embolization, operative hemorrhage control
2. fluid resuscitation (avoid hypothermia)
3. early transfer
Signs of urethral injury - ANSWER1. blood at the urethral meatus, scrotal and
perineal ecchymosis
Rectal exam (blunt trauma) - ANSWER1. assess sphincter tone and rectal mucosal
integrity, and identify palpale fractures of pelvis
PITFALL: Passage of a gastric tube may be impossible in patients with hiatal hernias
(more common in older adults) - ANSWERSolution: to avoid iatrogenic injury, do not
