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Subskill of Traumatic Diaphragmatic Injury Simulation

Welcome to the procedure part of the penetrating thoracoabdominal trauma module. Here the learner will go through a pre-test and interactive case scenario to learn about laparoscopic management of penetrating thoracoabdominal trauma and diaphragmatic repair.

Pre-test[edit | edit source]

Learners will first take a pre-test to assess their baseline knowledge of the topic. This test is available on our interactive platform and gives real-time grading for learners to immediately assess their knowledge coming into the module. It is also copied in appropedia format below. On our platform, answer explanations are not displayed for the pre-test (but are displayed in the post-test).

1 You assess a patient’s penetrating trauma wound and see that it is primarily in the thoracoabdominal region and may have resulted in diaphragmatic trauma. What are the boundaries of this area that raise suspicion for this type of injury?

Between the 4th intercostal space and level of the umbilicus
Between the 2nd intercostal space and level of the umbilicus
Between the 4th intercostal space and inferior costal margin
Between the 2nd intercostal space and inferior costal margin

2 What area of the patient’s body should be prepped into the operative field in the case of thoracoabdominal penetrating trauma?

From the shoulders to the hips
From the shoulders to the thighs
From the chin to the thighs
From the chin to the hips

3 What is the sensitivity and specificity of diagnosing diaphragmatic injury using laparoscopy?

66% and 94%
66% and 100%
72% and 96%
88% and 100%

4 In selecting a patient for diagnostic laparoscopy, which of the following is a contraindication for the laparoscopic approach?

Tachypnea
Diffuse peritonitis
Concurrent head injury
Presence of chest tube

5 You begin a laparoscopic case and insufflate the abdominal cavity with CO2. The insufflation process should be halted if the patient develops

Rise in peak airway pressure
Hypertension
Tachycardia
Lower extremity edema

6 When performing laparoscopy, a 3-cm laceration is noted in the left diaphragm. How would you repair this injury?

Observation because repair may not be necessary
Suture repair of laceration and thoracostomy tube placement
Placement of a prosthetic bridging mesh
Immediate thoracostomy tube placement, no repair of laceration needed

7 Upon commencement of diagnostic laparoscopy for trauma, you note small flecks of blood on the bowel. What is the grading of this hemoperitoneum?

Grade 0
Grade 1
Grade 2
Grade 3

8 Why is bradycardia the most common arrhythmia seen during laparoscopic procedures?

Insufflation of the abdomen decreases cardiac rate and output
As a result of patient sedation this is a common arrhythmia for any procedure
Abrupt stretch of the peritoneal membrane causes a vasovagal response
Port placement causes a decrease in abdominal pressure and increased venous return

9 Why might a right-sided thoracoabdominal trauma require a thoracoscopy rather than laparoscopy?

The difference in pulmonary anatomy increases the risk of pulmonary embolism
Diaphragmatic muscle mass is less on the right side of the body compared to the left side of the body
Visualization via laparoscopy is worse due to the presence of the liver on the right side
Only thoracoscopy is indicated in cases of thoracoabdominal trauma on either side of the body

10 Venous gas embolism (VGE) is a rare but potential complication for diagnostic laparoscopy. Which of the following can increase the risk of VGE during this procedure?

Liver laceration
Aortic aneurysm
Intra-abdominal arterial damage
Splenic injury


The answers, with explanations, are available for review in the post-test which is accessible here for download as a pdf.

ALL-SAFE Penetrating Trauma Pre & Post Test PDF

Case scenario[edit | edit source]

The psychomotor learning is embedded in the sequence of a full clinical case, allowing the learner to digest pre-, intra-, and operative concepts of ectopic pregnancy.

Learners will go through an interactive case scenario with embedded course material. The case scenario is presented in a question / answer format. As learners progress through the case, they will digest information that is presented to them as they answer case questions. It is highly recommended that the learner be familiar with this content before proceeding to the skill pages.

PDF of Trauma Case Scenario
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How the penetrating thoracoabdominal trauma case scenario looks on our site

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Part of ALL-SAFE
Keywords penetrating thoracoabdominal trauma, diaphragmatic repair, laparoscopy
Authors ALL-SAFE Team
License CC-BY-SA-4.0
Organizations Global Surgical Training Challenge
Language English (en)
Related 0 subpages, 3 pages link here
Aliases ALL-SAFE/Traumatic Diaphragmatic Injury Procedure, Laparoscopic Diaphragmatic Repair/Traumatic Diaphragmatic Injury Procedure
Impact 325 page views
Created October 23, 2022 by ALL-SAFE Team
Modified February 28, 2024 by Felipe Schenone
Cite as ALL-SAFE Team (2022–2024). "Traumatic Diaphragmatic Injury Procedure". Appropedia. Retrieved April 22, 2024.
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