"Kehr's sign" is found in:¬
a. The history and physical examination continue to be the basis from which splenic injury is diagnosed.
b. Percussion tenderness or evidence of bruising and soft tissue contusion in the posterior left lower costal margin is usually present when direct blows have produced splenic injury.
c. Complaints of left upper quadrant pain or of pain referred to the left shoulder (Kehr sign) are highly correlated with injury. At least one fourth of patients with left lower rib fractures have associated injury to the spleen.
d. Significant injury producing hemorrhage is indicated by the hemodynamic status of the patient.
e. Hypotension or tachycardia should alert the clinician to the potential for splenic injury.
f. At the initial trauma assessment, apparent injuries that may yield enough blood loss individually or in aggregate to produce physiologic changes in hemodynamics need to be noted.
g. If blood loss from long bone or pelvic fractures or from external losses from lacerations cannot be attributed, an intra-abdominal source must be assumed, and the spleen is the most common source.