Critical Care Paramedic Practice Exam

Kehr's sign is characterized by referred pain in the left shoulder, specifically when there is irritation of the diaphragm due to blood or fluid accumulation in the peritoneal cavity, which is a common occurrence in splenic rupture. This pain occurs because the phrenic nerve, which innervates the diaphragm, also shares sensory nerve pathways with the left shoulder. As a result, irritation in the abdominal cavity can manifest as pain in the shoulder area. In the context of splenic rupture, the mechanism involves the spleen's vascular supply and surrounding structures. When the spleen ruptures, blood leaks into the abdominal cavity, leading to irritation of the diaphragm and subsequent shoulder pain. Recognizing Kehr's sign can be critical in diagnosing splenic injuries in patients presenting with abdominal trauma and should raise suspicion for internal bleeding that SAMPLErequires immediate medical intervention.