Question

A 30-year-old man comes to the emergency department because of increasing pain in the left upper abdominal quadrant. Several hours ago, he was hit hard in that area during a tackle by the head of a football player who was wearing a helmet. He has no other health problems, and the only drug he takes on a regular basis is 325 mg of aspirin daily. These are his vital signs: pulse, 102; respirations, 22; blood pressure, 110/86; oxygen saturation, 96%. He has not eaten since he was hit but did drink a bottle of water on the way to the hospital because he was thirsty. When you examine his abdomen, bruising is present in the left upper quadrant and extends down his left side.

1. Where else should you look for evidence of bleeding?

Answer 1

When assessing a patient with left upper abdominal quadrant trauma, look for Kehr's sign, which includes pain in the left shoulder indicating a possible ruptured spleen, and monitor vital signs for internal bleeding.

Step-by-step explanation:

Identifying Additional Bleeding Sites

For a patient who has experienced a traumatic impact to the left upper abdominal quadrant, it is crucial to assess for potential internal bleeding beyond the visible bruising. Given the location of the impact and the presence of bruising, it is pertinent to consider the possibility of a ruptured spleen, which resides in the upper-left abdominopelvic cavity. The patient's use of aspirin, a known inhibitor of platelet aggregation, may exacerbate bleeding tendencies. Due to the proximity of the spleen to the diaphragm, Kehr's sign, which presents as referred pain in the left shoulder and potentially the chest and neck, should be checked. This sign may indicate a splenic rupture and thus, referred pain in these areas, aside from the left upper quadrant, should be carefully examined. Also, evaluation of hemodynamic stability and ongoing monitoring of vital signs will be important to identify signs of internal bleeding or hemodynamic compromise.