TNCC Abdominal Trauma 3 — Questions and Answers
Question 1: A patient with splenic laceration is being managed non-operatively. Which vital sign trend is the most critical indicator requiring reassessment for operative intervention?
- Persistent tachycardia above 100 bpm despite 2L crystalloid (Correct answer)
- SpO2 dropping from 99% to 97%
- Temperature of 37.8°C
- Respiratory rate of 20 breaths per minute
Correct answer: Persistent tachycardia above 100 bpm despite 2L crystalloid
Persistent tachycardia despite adequate fluid resuscitation indicates ongoing hemorrhage and failure of non-operative management, requiring surgical intervention.
Question 2: In the TNCC framework, which finding on abdominal inspection is considered a high-priority finding suggesting serious intra-abdominal injury?
- Mild periumbilical ecchymosis appearing 6 hours post-injury (Correct answer)
- Cullen's sign present on initial assessment
- Visible peristalsis through thin abdominal wall
- Symmetric abdominal contour
Correct answer: Mild periumbilical ecchymosis appearing 6 hours post-injury
Cullen's sign (periumbilical ecchymosis) indicates retroperitoneal hemorrhage tracking to the umbilicus, suggesting significant intra-abdominal injury; its presence within hours is a serious finding.
Question 3: When performing the abdominal assessment in the TNCC primary survey, auscultation is performed before palpation because:
- Palpation can cause a vasovagal response altering heart rate auscultation
- Palpation may stimulate bowel sounds and falsely alter auscultation findings (Correct answer)
- Auscultation is less painful for the patient if done first
- TNCC protocol requires percussion before palpation
Correct answer: Palpation may stimulate bowel sounds and falsely alter auscultation findings
Palpation can artificially stimulate or suppress bowel sounds, so auscultation must precede palpation to obtain accurate bowel sound assessment.
Question 4: A patient with abdominal trauma has Grey Turner's sign. This finding is associated with:
- Intraperitoneal hemorrhage from splenic injury
- Retroperitoneal hemorrhage tracking to the flank (Correct answer)
- Mesenteric vessel injury causing bowel ischemia
- Pelvic fracture with pelvic hematoma
Correct answer: Retroperitoneal hemorrhage tracking to the flank
Grey Turner's sign is flank ecchymosis caused by retroperitoneal blood dissecting through fascial planes to the flank region.
Question 5: Which of the following is the most appropriate fluid resuscitation strategy for a hemodynamically unstable patient with suspected massive intra-abdominal hemorrhage?
- 3L of normal saline boluses to restore normal blood pressure
- Permissive hypotension with damage control resuscitation using blood products (Correct answer)
- High-dose vasopressors to maintain MAP above 90 mmHg
- Colloid infusion (albumin) as first-line resuscitation fluid
Correct answer: Permissive hypotension with damage control resuscitation using blood products
Damage control resuscitation with permissive hypotension (target SBP 80–90 mmHg) and balanced blood product transfusion prevents dilutional coagulopathy and reduces ongoing hemorrhage.
Question 6: A patient with a grade III liver laceration is being monitored in the ICU. Which complication, specific to liver injury, must the trauma nurse monitor for in the first 72 hours?
- Hepatic artery aneurysm formation
- Delayed bile leak or biloma formation (Correct answer)
- Spontaneous bacterial peritonitis
- Hepatic vein thrombosis
Correct answer: Delayed bile leak or biloma formation
Bile leaks and biloma formation are delayed complications of liver lacerations, typically presenting 48–72 hours post-injury with rising abdominal pain, fever, and elevated bilirubin.
Question 7: In a child with blunt abdominal trauma, which organ is most commonly injured, and why is it at greater risk compared to adults?
- Liver, because children have a proportionally smaller thoracic cage offering less protection
- Spleen, because the pediatric spleen is proportionally larger and the rib cage is more pliable (Correct answer)
- Kidney, because pediatric kidneys are not yet encased in perirenal fat
- Pancreas, because children have a thinner abdominal wall
Correct answer: Spleen, because the pediatric spleen is proportionally larger and the rib cage is more pliable
The spleen is the most commonly injured solid organ in pediatric abdominal trauma because it is relatively larger and the flexible rib cage provides less protection than in adults.
TNCC Abdominal Trauma 3
A patient with splenic laceration is being managed non-operatively.
Which vital sign trend is the most critical indicator requiring reassessment for operative intervention?