Question

An adult patient was a restrained passenger involved in a high-speed motor vehicle collision. The patient complained of generalized abdominal and left leg pain. A FAST exam was negative for fluid in the abdominal cavity. While awaiting inpatient bed placement, the patient develops increased abdominal pain with rebound tenderness, fever, and an elevated white blood cell count. These findings are most consistent with an injury to which organ

Answer 1

The patient's increased abdominal pain with rebound tenderness, fever, and elevated white blood cell count following a motor vehicle accident and negative FAST exam are most consistent with appendicitis, indicating possible injury to the appendix.

Step-by-step explanation:

An adult patient involved in a high-speed motor vehicle collision developed increased abdominal pain with rebound tenderness, fever, and an elevated white blood cell count after an initially negative Focused Assessment with Sonography for Trauma (FAST) exam for fluid in the abdominal cavity. These findings are suggestive of an intra-abdominal injury that has progressed to an inflammation or infection within the abdomen; the organ most consistently associated with these symptoms, especially when considering the clinical presentation of rebound tenderness, is the appendix, indicating a possible appendicitis. Given the patient's symptoms developed after the initial assessment, this could imply a delayed rupture or progression of an inflammatory process in the appendix, leading to peritonitis and worsening clinical signs.

Answer 2

The symptoms of increased abdominal pain with rebound tenderness, fever, and elevated white blood cell count could suggest an injury to the intestines or the development of an intra-abdominal abscess, requiring immediate investigation and potential surgical intervention.

Step-by-step explanation:

The patient develops increased abdominal pain with rebound tenderness, fever, and an elevated white blood cell count following a high-speed motor vehicle collision and a negative FAST exam. These symptoms suggest that the patient could be suffering from an internal organ injury, potentially involving an inflammatory process or infection post-trauma. Although the FAST exam was negative for fluid in the abdominal cavity, this does not rule out all types of injury. Given the symptoms of rebound tenderness (indicating irritation of the peritoneum), fever, and elevated white blood cells, an injury to the intestines or the development of an intra-abdominal abscess should be highly suspected. These symptoms could point towards a perforated viscus or other serious complications requiring immediate further investigation, such as a CT scan, and possibly surgical intervention.