A 24-Year-Old Man Is Brought to the Emergency Department After

question 37

Multiple Choice

A 24-year-old man is brought to the emergency department after the all-terrain vehicle he was driving rolled over and landed on him.  Blood pressure is 82/50 mm Hg, pulse is 128/min, and respirations are 24/min.  The patient is alert but anxious and diaphoretic.  He has a scalp laceration that has stopped bleeding.  The pupils are equal and reactive to light.  The trachea is midline.  Bruising is present over the chest wall and abdomen.  Breath sounds are present bilaterally.  Heart sounds are normal.  The abdomen is distended and has diffuse tenderness.  Portable chest x-ray shows fracture of multiple ribs, including the right eighth and ninth ribs and the left fourth rib, with no pneumothorax.  Focused Assessment with Sonography for Trauma shows no pericardial effusion but a large amount of intraperitoneal free fluid.  Pelvic x-ray is negative for fractures.  The patient remains hypotensive after the rapid infusion of 2 L of intravenous crystalloid and is taken for emergency exploratory laparotomy.  Which of the following injuries is the most likely cause of this patient's persistent hypotension?

• A)Abdominal aortic injury
• B)Duodenal hematoma
• C)Liver laceration
• D)Pancreatic transection
• E)Splenic hematoma
• F)Urinary bladder rupture

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Definitions:

Competitive Sports

Athletic contests that are characterized by rivalry and require skill and effort to win or succeed.

Genetic Predisposition

The increased likelihood of developing a particular disease or condition based on an individual's genetic makeup.

Goal-directed Behaviour

describes actions that are motivated by an intention to achieve a specific outcome or objective.

Motivation

The inner drive or process that energizes, guides, and maintains behavior towards achieving a goal.