Injuries of the Torso

Question 1

If a patient has a skiing accident into the tree and has pain with inhalation and on his left chest, as well as local crepitus, what injury did he likely sustain?

Answer 1

This is a Rib Fracture, likely:
Pain at the site with inhalation/exhalation
Shortness of breath
Deformity
Crepitus
Bruising
TRT: Anticipate pneumothorax, consider arm immobilization to reduce pain, and encourage deep breathing/coughing.

Question 2

If a patient is found to have rib fractures, what sign would demonstrate likely Flail Chest, and how should you treat it?

Answer 2

All of the symptoms of a rib fracture plus an area of paradoxical chest wall movement.
TRT: Immobilize the flail segments with strips of tape, consider BVM for positive pressure ventilation, give O2 and analgesics.

Question 3

If a patient has a blunt trauma injury and is found to be hypoxic, short of breath, and having absent breath sounds on his left, but otherwise normal BP and equal pulse pressures, what is the likely diagnosis, and what should you do?

Answer 3

This is a regular pneumothorax. Note no progression, JVD, narrowed pulse pressures, signs of shock.
TRT: Fowlers or semi fowlers, O2, monitor for tension PTX. **Book does not mention needle D.
**Treat open wounds with an occlusive dressing.

Question 4

If a blunt trauma patient is found to have a broken clavicle, decreased left sided breath sounds, as well as pallor, altered mentation, and shortness of breath, what is the likely diagnosis?

Answer 4

Hemothorax or hemopneumothorax.
If Needle D is performed and blood is withdrawn, immediately remove needle and catheter.
Treat shock and give O2.

Question 5

Name the 5 organs in the right upper abdominal compartment.

Answer 5

Colon
Right Kidney
Pancreas
Liver
Gallbladder

Question 6

Name the 5 organs of the left upper abdominal compartment.

Answer 6

Colon
Left Kidney
Stomach
Spleen
Pancreas

Question 7

Name the 4 organs (include 1 major vessel) of the right lower abdominal compartment.

Answer 7

Ascending Colon
Small Intestine
Iliac Artery/vein
Appendix

Question 8

Name the 3 organs (include 1 major vessel) of the left lower abdominal compartment.

Answer 8

Descending Colon
*Small Intestine
Iliac Artery and Vein
* This is for test purposes, but the small intestine runs through the majority of the central abdomen.

Question 9

Which organs are more likely to be injured in blunt trauma, hollow or solid organs?

Answer 9

Solid Organs will fracture, hollow organs can absorb the impact/blast/pressure changes.

Question 10

What is the most reliable indicator of intra-abdominal bleeding?

Answer 10

Shock from an unexplained source with a mechanism that is consistent with blunt or penetrating trauma.

Question 11

What should be done with eviscerated bowel in the field?

Answer 11

Cover with a moistened dressing (Saline, sterile H20).

Question 12

If a patient presents with umbilical pain that migrates to the right lower quadrant associated with nausea, and they have rebound tenderness, what is the most likely diagnosis?

Answer 12

Appendicitis.

Question 13

What factors lead to constipation in the wilderness environment?

Answer 13

Diet changes
Dehydration
Withholding