ABEM Trauma & Procedural Skills 3 — Questions and Answers
Question 1: Which of the following is the preferred initial airway management in a patient with suspected C-spine injury and a GCS of 6?
- Nasotracheal intubation
- Surgical cricothyrotomy
- Orotracheal RSI with inline stabilization (Correct answer)
- Awake fiberoptic intubation
Correct answer: Orotracheal RSI with inline stabilization
RSI with manual inline cervical stabilization is the standard approach for airway management in trauma patients with suspected C-spine injury.
Question 2: A patient with a gunshot wound to the right upper quadrant has a BP of 90/60 despite 2L NS. FAST shows free fluid in Morison's pouch. What is the next step?
- CT abdomen with contrast
- Repeat FAST in 15 minutes
- Emergent operative laparotomy (Correct answer)
- IR embolization
Correct answer: Emergent operative laparotomy
Hemodynamically unstable penetrating abdominal trauma with positive FAST requires emergent surgical intervention.
Question 3: During a difficult airway attempt, the patient becomes apneic and you cannot intubate or ventilate. What is the definitive rescue procedure?
- LMA insertion
- Nasopharyngeal airway
- Surgical cricothyrotomy (Correct answer)
- Transtracheal jet ventilation
Correct answer: Surgical cricothyrotomy
Surgical cricothyrotomy is the definitive rescue airway in the cannot-intubate-cannot-oxygenate scenario.
Question 4: A patient with pelvic fracture and hemodynamic instability has a negative FAST. What is the next most appropriate intervention?
- CT pelvis with contrast
- Pelvic binder application and angioembolization or operative packing (Correct answer)
- DPL
- Repeat FAST
Correct answer: Pelvic binder application and angioembolization or operative packing
Pelvic binder reduces pelvic volume and hemorrhage; angioembolization or preperitoneal packing addresses arterial and venous bleeding.
Question 5: What is the most common cause of preventable death in penetrating extremity trauma?
- Infection
- Compressible hemorrhage (Correct answer)
- Nerve injury
- Compartment syndrome
Correct answer: Compressible hemorrhage
Compressible extremity hemorrhage is the leading preventable cause of death in combat and civilian penetrating trauma.
Question 6: In a trauma patient with a suspected thoracic aortic injury after deceleration, which initial imaging study is most appropriate?
- Transthoracic echocardiogram
- Plain chest X-ray followed by CT angiography of the chest (Correct answer)
- MRI thorax
- Pulmonary arteriography
Correct answer: Plain chest X-ray followed by CT angiography of the chest
CXR serves as the initial screen; CT angiography is the definitive study for blunt thoracic aortic injury.
Question 7: Which finding during FAST examination suggests cardiac tamponade?
- Right ventricular dilation
- Pericardial effusion with diastolic right heart collapse (Correct answer)
- Hypokinetic left ventricle
- Aortic root dilation
Correct answer: Pericardial effusion with diastolic right heart collapse
Pericardial effusion with diastolic collapse of the right ventricle on FAST indicates tamponade physiology.
ABEM Trauma & Procedural Skills 3
Which of the following is the preferred initial airway management in a patient with suspected C-spine injury and a GCS of 6?