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emq: trauma week 1.
Match each pattern of trauma to the likely injury.
large bowel perforation
liver laceration
retroperitoneal haemorrhage
hiatus hernia
small bowel perforation
intra-abdominal haemorrhage
rupture of the diaphragm
splenic laceration
large bowel perforation
liver laceration
retroperitoneal haemorrhage
hiatus hernia
small bowel perforation
intra-abdominal haemorrhage
rupture of the diaphragm
splenic laceration
Question 1.
A 15 year old male presents after an MVA. She has abdominal pain and a large lap-sash seatbelt mark across her mid abdomen.
Answer: Small bowel perforation. The high speed bending mechanism and seatbelt sign indicate an increased probability of perforation of the small intestine.
Question 2.
A 45 year old male presents after a horse riding accident. He fell whilst cantering and landed on his left flank. On examination he has significant bruising around both flanks and the umbilicus.
Answer: retroperitoneal haemorrhage.
Comment: the presence of Grey-Turner sign and Cullen’s sign are suggestive of haemorrhage into the retroperitoneal space.
Question 3.
A 32 year old male presents after a push bike accident. On examination he has pain and crepitus over the right costal margin extending into the anterior axillary line.
Answer: liver laceration
Comment: the suggestion of rib fractures over the liver correlates with a higher incidence of liver injury.
Question 4.
A 60 year old male presents after a high speed MVA. During the primary survey the doctor ascultating the chest notes the presence of bowel sounds in the tricuspid area.
Answer: ruptured diaphragm
Comment: the presence of bowel sounds this high in the chest is highly suspicious for diaphragmatic rupture.
Question 5.
A 22 year old male presents after falling from a scaffold. He has an audible bruit in his left upper quadrant.
Answer: traumatic fistula of the splenic artery
Comment: the finding of a bruit in a patient this young almost certainly suggests traumatic vascular injury.
A 15 year old male presents after an MVA. She has abdominal pain and a large lap-sash seatbelt mark across her mid abdomen.
Answer: Small bowel perforation. The high speed bending mechanism and seatbelt sign indicate an increased probability of perforation of the small intestine.
Question 2.
A 45 year old male presents after a horse riding accident. He fell whilst cantering and landed on his left flank. On examination he has significant bruising around both flanks and the umbilicus.
Answer: retroperitoneal haemorrhage.
Comment: the presence of Grey-Turner sign and Cullen’s sign are suggestive of haemorrhage into the retroperitoneal space.
Question 3.
A 32 year old male presents after a push bike accident. On examination he has pain and crepitus over the right costal margin extending into the anterior axillary line.
Answer: liver laceration
Comment: the suggestion of rib fractures over the liver correlates with a higher incidence of liver injury.
Question 4.
A 60 year old male presents after a high speed MVA. During the primary survey the doctor ascultating the chest notes the presence of bowel sounds in the tricuspid area.
Answer: ruptured diaphragm
Comment: the presence of bowel sounds this high in the chest is highly suspicious for diaphragmatic rupture.
Question 5.
A 22 year old male presents after falling from a scaffold. He has an audible bruit in his left upper quadrant.
Answer: traumatic fistula of the splenic artery
Comment: the finding of a bruit in a patient this young almost certainly suggests traumatic vascular injury.