In a motor-vehicle collision with left-sided thoracic pain and abdominal tenderness and signs of shock, which potential injuries should triage staff assess?

• A. Fractured liver and ruptured spleen
• B. Cardiac contusion
• C. Pulmonary contusion
• D. Renal laceration

Answer: (A)

In blunt trauma like a motor-vehicle collision, when there is abdominal tenderness accompanied by signs of shock, the priority is to identify potential intra-abdominal hemorrhage from solid organs. The spleen, located in the left upper quadrant, is highly susceptible to rupture after impact; a splenic rupture can bleed rapidly into the peritoneal cavity and drive hemorrhagic shock. The liver, though primarily on the right, can also be injured in high-energy crashes and contribute to life-threatening bleeding. Therefore, triage staff should focus on assessing for injuries to these solid abdominal organs—splenic rupture and possible hepatic injury—using rapid bedside tools (such as the FAST exam) and clinical monitoring for ongoing bleeding.

Cardiac contusion and pulmonary contusion involve chest injuries and typically present with chest pain, dyspnea, or arrhythmias rather than abdominal tenderness and shock from intra-abdominal bleeding. Renal laceration could cause flank pain and hematuria, but the combination described most strongly points to splenic (and potential liver) injury as the source of shock.