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The Scenario:
Now that she is back for her junior year at college, Kara is quite excited about getting back onto the rugby field. Her team did exceptionally well last year, losing only in the last five minutes of the championship finals. This year, they are looking to go all the way: Kara wants revenge.
In the first game of the season, they found themselves pretty well matched. Their conditioning wasn't as good as it should have been, and the heat of an early autumn day made things a little rough.
On a sweep run to the right, as Kara was running with the ball, a defender approached. Kara turned to toss the ball, and was struck hard on the left side by the defender's shoulder, knocking her to the ground, and knocking the wind out of her. She lay on the ground and could hardly breathe. She felt intense pain from her left side and upper abdomen. Several minutes went by, and she was able to get to the sidelines, but only with the help of her teammates. She was still having a hard time taking a deep breath. Her coach initially kept her out of the game but later went to check on her. Kara was found sitting on the bench, hunched over in pain, looking very pale and sweaty. An ambulance was called and she was sent to the hospital with a blood pressure of 70/40 (this is low).
Questions:
Answer:
Kara's symptoms suggest a number of internal injuries, but the most likely one is a ruptured spleen. The spleen is a highly vascular organ located in the left upper quadrant of the abdomen. Being a firm organ (not a squishy one like the intestines), blunt trauma may rupture its capsule, resulting in hemorrhage. In that event, especially with low blood pressure caused presumably by internal bleeding, she has a true emergency and will need to have surgical exploration of the abdomen as soon as possible.
Many people suggested that she might have broken ribs and a punctured lung. This is certainly possible, and would explain her shortness of breath. But it would be unlikely to cause pain in the abdomen, which she was experiencing, and would not cause a drop in blood pressure unless she were also bleeding into her chest. A ruptured kidney is also something to consider, in which case a urine test might show the presence of blood.
If you were to examine Kara right now you would be likely to find her in considerable pain with a very rigid, very tender abdomen. A quick procedure called peritoneal lavage to check for bloody fluid within the abdomen, or a CT scan of the abdomen, would likely confirm your suspicions of an abdominal hemorrhage. Knowing exactly where the blood was coming from, however, might have to wait until surgical exploration is done.
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