ABSTRACT
Anatomically, the abdominal contents extend into the chest. Therefore, in blunt trauma to the lower chest, liver and splenic injuries are common.
■➜ Covert injuries 4. D Ideally screening of at-risk patients should be carried out before clinical signs are obvious (Table 23.1). This can be done by the deductive approach, e.g., assessing for classical covert injuries. A look-everywhere approach is essential in an unconscious patient to exclude further injury once initial life-saving assessment and management is complete. The primary survey in ATLS includes radiographs of the C-spine, chest and pelvis. The term ‘secondary survey’ in the ATLS protocol is part of a look-everywhere approach and the threshold for further imaging, e.g., CT head to pelvis, is now low in many centres. A focused-exclusion approach is mandatory for life-threatening injuries (e.g., CT scan in suspected extradural haematoma, echocardiography in cardiac tamponade) and non-life-threatening injuries (e.g., scaphoid fracture, posterior dislocation of the shoulder). 5. D A left-sided impact would be associated with a splenic rupture and not a liver laceration.
