Prehospital Trauma Life Support (PHTLS) Practice Test

Deterioration of ventilation after inflation of a PASG following high-pressure abdominal compression suggests which injury?

1. Abdominal aortic aneurysm

2. Ruptured diaphragm

3. Ruptured esophagus

4. "Paper bag" syndrome of the lungs

The correct answer is: Ruptured diaphragm

The correct answer is linked to the concept of thoracic and abdominal compartment syndrome, particularly in the case of a ruptured diaphragm. When high pressures are applied to the abdomen through the use of a Pneumatic Antishock Garment (PASG), it can severely affect diaphragm function, especially if there is an existing injury to the diaphragm. A ruptured diaphragm would allow abdominal contents, including the stomach and intestines, to move into the thoracic cavity, which would compromise lung function and ventilation. This shift can lead to reduced chest expansion and ventilatory effort, manifesting as deterioration in ventilation after the application of the PASG. This situation highlights how mechanical effects from abdominal pressure can exacerbate an already compromised respiratory system due to the injury. In contrast, other injuries like an abdominal aortic aneurysm, a ruptured esophagus, or "paper bag" syndrome don't directly lead to a significant deterioration in ventilation specifically caused by inflation of a PASG. An abdominal aortic aneurysm primarily presents with vascular symptoms; a ruptured esophagus may lead to mediastinal complications but not directly from high abdominal pressure; and "paper bag" syndrome refers to lung injury from asphyxiation but is not a direct result of abdominal compression impacts.