Your patient is a 19-year-old man who was thrown from a horse while riding in a rodeo. After throwing the patient off, the horse stepped on the patient's abdomen. When you reach the patient, you note that his face, neck, and shoulders are pale, cool, and diaphoretic but that the patient's skin is otherwise warm and dry. The patient has some movement and sensation in his forearms and hands but otherwise no movement or sensation below the shoulders. He is anxious and has a respiratory rate of 24, a heart rate of 68, and a blood pressure of 106/66. Which of the following should be the primary concern when determining this patient's transport priority?
A) The potential for neurologic shock, requiring immediate surgery
B) The potential for intraabdominal hemorrhage that may be masked by loss of nervous function
C) The potential for traumatic brain injury
D) The potential for respiratory failure secondary to paralysis of the diaphragm

Question

Quizplus · Accepted Answer

The primary concern when determining this patient's transport priority should be the potential for intraabdominal hemorrhage that may be masked by loss of nervous function. The mechanism of injury (being stepped on by a horse) and the patient's symptoms (pale, cool, and diaphoretic skin) suggest the possibility of significant internal bleeding. Additionally, the loss of sensation and movement below the shoulders indicates a spinal cord injury, which can make it difficult to identify abdominal trauma due to a lack of pain sensation. Immediate transport to a trauma center is crucial to properly assess and treat any potential internal injuries.

Your Patient Is a 19-Year-Old Man Who Was Thrown from a Horse