NREMT Emergency Medical Technician (EMT) Cognitive ExamTraumaHard
A 45-year-old male was involved in a motor vehicle collision and presents with significant abdominal pain, distention, and signs of shock. He was wearing a lap belt only. Upon palpation, you note tenderness and rigidity in the lower abdomen. What abdominal organ is MOST susceptible to injury with this mechanism?
- ASpleen
- BKidneys
- CSmall intestine
- DLiver
Show answer & explanationAnswer & explanation
Correct answer: C. Small intestine
The 'seatbelt sign' or 'lap belt injury' often causes compression injuries to the abdominal contents. With a lap belt only, the small intestine, specifically the jejunum and ileum, is commonly compressed against the vertebral column, leading to rupture, mesenteric tears, or avulsion injuries. The signs of shock and distention suggest internal bleeding or peritonitis.
Why the other options are wrong
- A. The spleen is in the upper left quadrant and less commonly injured by a lap belt alone, though possible with severe blunt trauma.
- B. The kidneys are retroperitoneal and more protected, typically injured by direct flank trauma or deceleration forces, not primarily by a lap belt.
- D. The liver is in the upper right quadrant and less commonly injured by a lap belt alone, though possible with severe blunt trauma.
Lap Belt Syndrome
A pattern of injuries, including abdominal organ damage (especially small bowel), lumbar spine fractures, and sometimes head or chest injuries, resulting from the use of a lap belt without a shoulder harness during a collision.
- Small intestine is highly vulnerable to compression against the spine.
- Can cause rupture, mesenteric tears, and severe internal bleeding.
- Often presents with abdominal pain, distention, and signs of shock.
Memory trick: Lap belt tight, small bowel in fright, against the spine, a painful plight.