ABEM Trauma & Procedural Skills 2 — Questions and Answers
Question 1: A patient with blunt chest trauma has absent breath sounds on the left and tracheal deviation to the right. BP is 70/40 mmHg. What is the immediate next step?
- Chest X-ray
- Needle decompression at left 2nd ICS MCL (Correct answer)
- Chest tube insertion
- Intubation
Correct answer: Needle decompression at left 2nd ICS MCL
Tension pneumothorax causing hemodynamic instability requires immediate needle decompression before imaging.
Question 2: During a resuscitative thoracotomy for penetrating cardiac trauma, you find a laceration to the right ventricle. Which maneuver is most appropriate to control bleeding?
- Finger occlusion followed by stapling or suture repair (Correct answer)
- Aortic cross-clamp only
- Pericardial patch
- Pulmonary artery clamping
Correct answer: Finger occlusion followed by stapling or suture repair
Finger occlusion of the ventricular laceration followed by suture or staple repair is the standard initial control technique.
Question 3: A motorcyclist is brought in after a high-speed crash with a GCS of 8, bilateral femur fractures, and BP 80/50. After two large-bore IVs and 2L crystalloid, BP remains 85/55. What is the priority?
- CT scan of head and abdomen
- Activate massive transfusion protocol and FAST exam (Correct answer)
- Foley catheter insertion
- Pelvic binder application only
Correct answer: Activate massive transfusion protocol and FAST exam
Persistent hypotension after initial resuscitation warrants MTP activation and bedside FAST to identify hemorrhage source.
Question 4: Which landmark is used for needle decompression of tension pneumothorax using the 4th or 5th intercostal space approach?
- Anterior axillary line
- Mid-axillary line (Correct answer)
- Posterior axillary line
- Mid-clavicular line
Correct answer: Mid-axillary line
The mid-axillary line at the 4th–5th ICS is the preferred alternate site, especially in obese patients where MCL decompression may fail.
Question 5: A patient with a stab wound to zone II of the neck is hemodynamically stable with an expanding hematoma. What is the correct management?
- CT angiography of the neck
- Immediate surgical exploration (Correct answer)
- Observation and serial exams
- MRI neck
Correct answer: Immediate surgical exploration
An expanding hematoma in zone II neck trauma indicates vascular injury requiring immediate surgical exploration.
Question 6: When performing a diagnostic peritoneal lavage (DPL), a positive result for blunt abdominal trauma includes which finding?
- WBC > 100 cells/µL on lavage return
- RBC > 100,000 cells/µL on lavage return (Correct answer)
- Amylase > 20 IU/L
- Bile on gross inspection only
Correct answer: RBC > 100,000 cells/µL on lavage return
DPL is positive for hemoperitoneum when lavage fluid contains >100,000 RBC/µL in blunt trauma.
Question 7: A trauma patient develops paradoxical chest wall movement involving multiple ribs bilaterally after a crush injury. What is the primary concern?
- Pneumothorax
- Flail chest with underlying pulmonary contusion (Correct answer)
- Aortic dissection
- Diaphragmatic rupture
Correct answer: Flail chest with underlying pulmonary contusion
Paradoxical chest wall movement indicates flail chest, and the underlying pulmonary contusion is the primary driver of respiratory failure.
ABEM Trauma & Procedural Skills 2
A patient with blunt chest trauma has absent breath sounds on the left and tracheal deviation to the right.
BP is 70/40 mmHg.
What is the immediate next step?