NREMT Paramedic Cognitive ExamTraumaEasy
A 45-year-old male presents with severe right upper quadrant pain after being struck by a baseball bat. He is hypotensive (BP 90/60 mmHg), tachycardic (HR 120 bpm), and tachypneic (RR 24 bpm). Physical examination reveals guarding and rigidity in the right upper quadrant. Based on the mechanism of injury and clinical presentation, which of the following organs is most likely injured?
- ALiver
- BSpleen
- CKidney
- DPancreas
Show answer & explanationAnswer & explanation
Correct answer: A. Liver
The liver is located in the right upper quadrant and is highly vascular, making it susceptible to injury and significant bleeding following blunt trauma to this area. The patient's signs of shock (hypotension, tachycardia) further support a significant hemorrhage, consistent with liver trauma.
Why the other options are wrong
- B. The spleen is located in the left upper quadrant, making injury less likely with right upper quadrant impact.
- C. The kidneys are retroperitoneal and located more posteriorly, making direct impact to the right upper quadrant less likely to cause isolated kidney injury compared to the liver.
- D. The pancreas is retroperitoneal and less commonly injured by isolated blunt force to the right upper quadrant without deeper penetration.
Liver Trauma
Injury to the liver, often caused by blunt abdominal trauma, leading to internal hemorrhage due to its high vascularity.
- Located in the right upper quadrant.
- Highly vascular organ, prone to significant bleeding.
- Presents with RUQ pain, tenderness, and signs of hypovolemic shock.
Memory trick: Right Upper Quadrant Trauma: Liver's Lair of Leaks.