ATLS Abdominal and Pelvic Trauma questions
with correct answers
Primary survey - answers -assessment of circulation includes early evaluation for
possible intra-abdominal and/or pelvic hemorrhage in patients who have sustained blunt
trauma
-unrecognized abdominal and pelvic injuries continue to cause preventable death after
truncal trauma
-significant blood loss can be present in abdominal cavity without a dramatic change in
external appearance or dimensions of abdomen and without obvious signs of peritoneal
irritaiton
Blunt mechanism of injury - answers -direct blow
-lower rim of steering wheel, bicycle or motor cycle handle bars, or intruded door in
motor vehicle collision, can cause compression and crushing injuries to abdominal
pelvic viscera and pelvic bones
-shearing injuries and deceleration injuries
shearing injuries - answers -form of crush injury that can result when restraint device is
worn inappropriately
deceleration injuries - answers -patients who are injured in motor vehicle crashes and
who fall from significant heights
-there is a differential movement of fixed and mobile parts of the body
Ex. laceration of liver and spleen, bucket handle injuries to small bowel
what organs are most frequently injured in blunt trauma? - answers spleen, liver, and
small bowel
Airbag deployment does not preclude abdominal injury - answers true
Penetrating injuries - answers -stab wounds and low energy gunshot wounds cause
tissue damage by lacerating and tearing
-high energy gunshot wounds transfer kinetic energy causing increased damage
surrounding track of the missile due to temporary cavitation
-stab wounds most commonly involve the liver
-Gunshot wounds most commonly involve small bowel
what are important determinants of degree of tissue injury? - answers -type of weapon,
muzzle velocity, and type of ammunition
Blast injuries - answers -from explosive devices occur through several mechanisms
including penetrating fragment wounds and blunt injuries from patient being thrown or
struck by projectiles
,-potential for overpressure injury following explosion should not distract the clinician
from a systematic approach to identifying and treating blunt and penetrating injuries
Assessment and Management - answers -In hypotensive patients, goal is to rapidly
identify an abdominal or pelvic injury and determine whether it is cause of hypotension
-Hemodynamically normal patients without signs of peritonitis may undergo a more
detailed evaluation to determine presence of injuries that can cause delayed morbidity
and mortality
What is important to know in the history of motor vehicle collision patients? - answers -
vehicle speed, type of collision (frontal impact, lateral impact, side swipe, rear impact, or
rollover), any intrusion into passenger compartment, types of restraints, deployment of
airbags, patient position in vehicle, and status of other occupants
what is important to know in the history of a patient who was injured by falling? -
answers -height of fall
what is important to know in the history of patient who has sustained penetrating
trauma? - answers -type of injury, type of weapon, distance from assailant (importance
with shotgun wounds as likelihood of major visceral injuries decreases beyond 10ft or 3
meters range), number of stab wounds or gunshots sustained, and amount of external
bleeding noted at scene, and magnitude and location of abdominal pain
what is important to know in the history of a patient involved in explosions? - answers -
produce visceral overpressure injuries
-risk increases when patient is in close proximity to blast and when blast occurs within a
closed space
what does physical exam involve with abdominal and pelvic trauma? - answers -
abdominal exam conducted in systematic sequence- inspection, auscultation,
percussion, and palpation
-followed by exam of pelvis and buttocks as well as urethral, perineal, and if indicated
rectal and vaginal exams
Inspection, auscultation, percussion, and palpation - answers -Most circumstances, the
patient must be fully undressed to allow thorough inspection
what is involved during inspection? - answers -examine anterior and posterior abdomen
as well as lower chest and perineum, for abrasions and contusions from restraint
devices, lacerations, penetrating wounds, impaled foreign bodies, evisceration of
omentum or bowel, and pregnant state
-inspect flank, scrotum, urethral meatus, and perianal area for blood, swelling, and
bruising
-inspect for laceration of perineum, vagina, rectum, or buttocks may be associated with
an open pelvic fracture
, -At conclusion of rapid physical exam, cover patient with warmed blankets to help
prevent hypothermia
what is involved in the pelvic assessment? - answers -unexplained hypotension may be
the only initial indication of major pelvic disruption
-placement of a pelvic binder is priority and may be lifesaving
-Physical exam: of pelvic fracture include evidence of rupture urethra (scrotal hematoma
or blood at urethral meatus), discrepancy in limb length and rotational deformity of a leg
without obvious fracture
-Avoid manual manipulation of pelvis
-gentle palpation of bony pelvis for pelvic fracture
-distraction of pelvis is not recommended
Urethral, perineal, rectal, vaginal, and gluteal exam - answers -presence of blood at
urethral meatus strongly suggests a urethral injury
-Ecchymosis or hematoma of the scrotum and perineum is suggestive of urethral injury
-In patients with blunt trauma, goals of rectal exam is to assess sphincter tone and
rectal mucosal integrity and to identify palpable fractures of pelvis
-Patients with perforating wounds, rectal exam is used to assess sphincter tone and
look for gross blood which may indicate bowel perforation
-Bony fragments from pelvic fracture or penetrating wounds can lacerate vagina
when do you perform vaginal exam? - answers when injury suspected such as
presence of complex perineal laceration, pelvic fracture, or transpelvic gunshot wound
-unresponsive menstruating women, examine vagina for presence of tampons, left in
place they can cause delayed sepsis
when do you exam gluteal regions? - answers penetrating injuries are associated with
up to 50% incidence of significant intra-abdominal injuries include rectal injuries below
the peritoneal reflection
what are the therapeutic goals of a gastric tube placed early in the primary survey? -
answers -relief of acute gastric dilation and stomach decompression before performing
DPL (if needed)
Gastric tubes - answers -may reduce incidence of aspiration
-can trigger vomiting with gag reflex
what does the presence of bleeding in the gastric contents mean? - answers injury to
esophagus or upper GI tract if nasopharyngeal and/or oropharyngeal
how do you insert gastric tube if severe facial fractures or possible basilar skull fracture?
- answers insert gastric tube through mouth to prevent passage of nasal tube through
cribriform plate into brain
with correct answers
Primary survey - answers -assessment of circulation includes early evaluation for
possible intra-abdominal and/or pelvic hemorrhage in patients who have sustained blunt
trauma
-unrecognized abdominal and pelvic injuries continue to cause preventable death after
truncal trauma
-significant blood loss can be present in abdominal cavity without a dramatic change in
external appearance or dimensions of abdomen and without obvious signs of peritoneal
irritaiton
Blunt mechanism of injury - answers -direct blow
-lower rim of steering wheel, bicycle or motor cycle handle bars, or intruded door in
motor vehicle collision, can cause compression and crushing injuries to abdominal
pelvic viscera and pelvic bones
-shearing injuries and deceleration injuries
shearing injuries - answers -form of crush injury that can result when restraint device is
worn inappropriately
deceleration injuries - answers -patients who are injured in motor vehicle crashes and
who fall from significant heights
-there is a differential movement of fixed and mobile parts of the body
Ex. laceration of liver and spleen, bucket handle injuries to small bowel
what organs are most frequently injured in blunt trauma? - answers spleen, liver, and
small bowel
Airbag deployment does not preclude abdominal injury - answers true
Penetrating injuries - answers -stab wounds and low energy gunshot wounds cause
tissue damage by lacerating and tearing
-high energy gunshot wounds transfer kinetic energy causing increased damage
surrounding track of the missile due to temporary cavitation
-stab wounds most commonly involve the liver
-Gunshot wounds most commonly involve small bowel
what are important determinants of degree of tissue injury? - answers -type of weapon,
muzzle velocity, and type of ammunition
Blast injuries - answers -from explosive devices occur through several mechanisms
including penetrating fragment wounds and blunt injuries from patient being thrown or
struck by projectiles
,-potential for overpressure injury following explosion should not distract the clinician
from a systematic approach to identifying and treating blunt and penetrating injuries
Assessment and Management - answers -In hypotensive patients, goal is to rapidly
identify an abdominal or pelvic injury and determine whether it is cause of hypotension
-Hemodynamically normal patients without signs of peritonitis may undergo a more
detailed evaluation to determine presence of injuries that can cause delayed morbidity
and mortality
What is important to know in the history of motor vehicle collision patients? - answers -
vehicle speed, type of collision (frontal impact, lateral impact, side swipe, rear impact, or
rollover), any intrusion into passenger compartment, types of restraints, deployment of
airbags, patient position in vehicle, and status of other occupants
what is important to know in the history of a patient who was injured by falling? -
answers -height of fall
what is important to know in the history of patient who has sustained penetrating
trauma? - answers -type of injury, type of weapon, distance from assailant (importance
with shotgun wounds as likelihood of major visceral injuries decreases beyond 10ft or 3
meters range), number of stab wounds or gunshots sustained, and amount of external
bleeding noted at scene, and magnitude and location of abdominal pain
what is important to know in the history of a patient involved in explosions? - answers -
produce visceral overpressure injuries
-risk increases when patient is in close proximity to blast and when blast occurs within a
closed space
what does physical exam involve with abdominal and pelvic trauma? - answers -
abdominal exam conducted in systematic sequence- inspection, auscultation,
percussion, and palpation
-followed by exam of pelvis and buttocks as well as urethral, perineal, and if indicated
rectal and vaginal exams
Inspection, auscultation, percussion, and palpation - answers -Most circumstances, the
patient must be fully undressed to allow thorough inspection
what is involved during inspection? - answers -examine anterior and posterior abdomen
as well as lower chest and perineum, for abrasions and contusions from restraint
devices, lacerations, penetrating wounds, impaled foreign bodies, evisceration of
omentum or bowel, and pregnant state
-inspect flank, scrotum, urethral meatus, and perianal area for blood, swelling, and
bruising
-inspect for laceration of perineum, vagina, rectum, or buttocks may be associated with
an open pelvic fracture
, -At conclusion of rapid physical exam, cover patient with warmed blankets to help
prevent hypothermia
what is involved in the pelvic assessment? - answers -unexplained hypotension may be
the only initial indication of major pelvic disruption
-placement of a pelvic binder is priority and may be lifesaving
-Physical exam: of pelvic fracture include evidence of rupture urethra (scrotal hematoma
or blood at urethral meatus), discrepancy in limb length and rotational deformity of a leg
without obvious fracture
-Avoid manual manipulation of pelvis
-gentle palpation of bony pelvis for pelvic fracture
-distraction of pelvis is not recommended
Urethral, perineal, rectal, vaginal, and gluteal exam - answers -presence of blood at
urethral meatus strongly suggests a urethral injury
-Ecchymosis or hematoma of the scrotum and perineum is suggestive of urethral injury
-In patients with blunt trauma, goals of rectal exam is to assess sphincter tone and
rectal mucosal integrity and to identify palpable fractures of pelvis
-Patients with perforating wounds, rectal exam is used to assess sphincter tone and
look for gross blood which may indicate bowel perforation
-Bony fragments from pelvic fracture or penetrating wounds can lacerate vagina
when do you perform vaginal exam? - answers when injury suspected such as
presence of complex perineal laceration, pelvic fracture, or transpelvic gunshot wound
-unresponsive menstruating women, examine vagina for presence of tampons, left in
place they can cause delayed sepsis
when do you exam gluteal regions? - answers penetrating injuries are associated with
up to 50% incidence of significant intra-abdominal injuries include rectal injuries below
the peritoneal reflection
what are the therapeutic goals of a gastric tube placed early in the primary survey? -
answers -relief of acute gastric dilation and stomach decompression before performing
DPL (if needed)
Gastric tubes - answers -may reduce incidence of aspiration
-can trigger vomiting with gag reflex
what does the presence of bleeding in the gastric contents mean? - answers injury to
esophagus or upper GI tract if nasopharyngeal and/or oropharyngeal
how do you insert gastric tube if severe facial fractures or possible basilar skull fracture?
- answers insert gastric tube through mouth to prevent passage of nasal tube through
cribriform plate into brain
