ABEM Trauma & Procedural Skills 2

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?

Accepted Answer

Needle decompression at left 2nd ICS MCL

Answer

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?

Accepted Answer

Finger occlusion followed by stapling or suture repair

Answer

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?

Accepted Answer

Activate massive transfusion protocol and FAST exam

Answer

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?

Accepted Answer

Mid-axillary line

Answer

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?

Accepted Answer

Immediate surgical exploration

Answer

An expanding hematoma in zone II neck trauma indicates vascular injury requiring immediate surgical exploration.

(ABEM) American Board of Emergency Medicine Practice Test

(ABEM) American Board of Emergency Medicine Practice Test

ABEM Trauma & Procedural Skills 2