Abdominal, Pelvic, and Multisystem Trauma - NREMT Paramedic Level

1. Which skin finding on the flank suggests retroperitoneal bleeding after abdominal trauma?

   Grey Turner sign (flank ecchymosis). Retroperitoneal hemorrhage tracks along fascial planes, causing delayed bruising on the flanks as blood dissects subcutaneously.

2. Which finding after abdominal trauma most strongly suggests spinal cord injury rather than hemorrhagic shock?

   Hypotension with bradycardia (neurogenic shock pattern). Neurogenic shock from spinal injury causes vasodilation and relative bradycardia, contrasting with the tachycardia of hypovolemic shock.

3. What is the best field management for an impaled object in the abdomen?

   Stabilize in place and do not remove. Removing impaled objects risks uncontrolled hemorrhage, so stabilization maintains tamponade until surgical intervention.

4. What is the correct prehospital intervention for suspected unstable pelvic fracture?

   Apply a pelvic binder at the greater trochanters. Binding at the trochanters approximates pelvic bones, reducing volume and tamponading venous bleeding in the pelvic space.

5. Which action is correct for penetrating abdominal trauma with severe hemorrhage from a wound?

   Apply direct pressure and hemostatic dressing as indicated. Direct pressure controls external bleeding, with hemostatics promoting clot formation in wounds resistant to pressure alone.

6. Which organ injury is most associated with left upper quadrant blunt trauma?

   Spleen. The spleen is located in the left upper quadrant, making it vulnerable to injury from direct blunt force to that area.

7. Which mechanism is most associated with traumatic rupture of the diaphragm?

   High-energy blunt trauma to the lower chest/upper abdomen. Sudden pressure increases from high-energy impacts can tear the diaphragm, especially at the thoracoabdominal junction.

8. Identify the classic finding that suggests peritoneal irritation after abdominal trauma.

   Guarding and rebound tenderness. Peritoneal irritation from inflammation or bleeding causes involuntary muscle contraction and pain on palpation release, indicating intra-abdominal pathology.

9. What is the correct dressing for abdominal evisceration in the prehospital setting?

   Sterile saline-moistened dressing with occlusive cover. Moist dressings prevent desiccation of exposed organs, while occlusion maintains a sterile barrier and supports organ viability during transport.

10. Which pediatric abdominal trauma feature increases risk for solid organ injury compared with adults?

    Less protective abdominal musculature and larger solid organs. Children's thinner abdominal walls and proportionally larger organs offer less protection against blunt forces, heightening injury risk.

11. What is the primary life threat from an unstable pelvic fracture?

    Massive hemorrhage into the pelvis/retroperitoneum. Unstable pelvic fractures create a large potential space for blood accumulation, leading to life-threatening hypovolemia.

12. What is the correct number of times to assess pelvic stability in suspected pelvic trauma?

    Once only (or not at all if obvious instability). Repeated assessments can exacerbate bleeding or injury, so evaluation is limited to minimize harm in unstable cases.

13. Which urinary finding after pelvic trauma suggests urethral injury and contraindicates Foley placement?

    Blood at the urethral meatus. Urethral trauma often presents with meatal bleeding, indicating potential disruption that could be worsened by catheterization.

14. Which abdominal quadrant is most likely injured by blunt trauma to the right lower abdomen?

    Right lower quadrant (RLQ). Blunt trauma to a specific abdominal region directly affects the underlying quadrant due to the anatomical division of the abdomen into four quadrants.

15. Identify the most concerning exam finding for intra-abdominal injury in a patient with a seatbelt sign.

    Abdominal tenderness or rigidity. The seatbelt sign indicates potential underlying injury, with tenderness or rigidity signaling peritoneal involvement or organ damage.

16. What is the preferred patient position for an evisceration when spinal injury is not suspected?

    Supine with knees flexed. This position reduces abdominal wall tension, minimizing further protrusion of viscera without compromising spinal precautions.

17. What is the correct fluid strategy in suspected hemorrhagic shock from abdominal or pelvic trauma?

    Permissive hypotension until hemorrhage control (if no TBI). Permissive hypotension avoids disrupting clots in uncontrolled bleeding, unless traumatic brain injury requires higher pressures.

18. What is the most appropriate destination decision for suspected abdominal or pelvic hemorrhage with instability?

    Rapid transport to the highest appropriate trauma center. Unstable patients with suspected hemorrhage require facilities equipped for immediate surgical intervention and massive transfusion.

19. What is the most reliable field sign of significant intra-abdominal hemorrhage?

    Signs of shock (tachycardia, hypotension, poor perfusion). Intra-abdominal bleeding leads to hypovolemic shock, manifesting as compensatory tachycardia, low blood pressure, and reduced tissue perfusion in the field.

20. Which finding most strongly suggests a pelvic fracture after blunt trauma?

    Pelvic instability or pain with gentle compression. Pelvic fractures disrupt the ring structure, causing abnormal movement or pain upon manual assessment of stability.

21. What is the most appropriate initial priority for multisystem trauma with suspected hemorrhage?

    Control external bleeding and treat shock while managing airway/breathing. Multisystem trauma requires prioritizing ABCs with simultaneous hemorrhage control to stabilize life-threatening conditions rapidly.

22. What is the key prehospital concern with a suspected hollow viscus injury?

    Peritonitis and sepsis from bowel content leakage. Hollow organ perforation allows gastrointestinal contents to spill into the peritoneal cavity, leading to inflammation and potential systemic infection.

23. Which periumbilical skin finding suggests intra-abdominal bleeding?

    Cullen sign (periumbilical ecchymosis). Intra-abdominal hemorrhage can lead to blood pooling around the umbilicus via ligamentous pathways, resulting in ecchymosis.

24. Which trauma patient should be considered for transport to a trauma center due to multisystem risk?

    Any patient with hypotension or signs of shock after trauma. Hypotension or shock indicates potential multisystem involvement, necessitating advanced trauma care for optimal outcomes.

25. Which organ injury is most associated with right upper quadrant blunt trauma?

    Liver. The liver occupies the right upper quadrant, rendering it susceptible to trauma from impacts in that region.

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