ABEM Trauma & Procedural Skills 4 — Questions and Answers
Question 1: A patient has a shotgun wound to the right chest with sucking chest wound. After occlusive dressing placement the patient acutely deteriorates. What is the most likely cause?
- Hemothorax
- Tension pneumothorax from occluded dressing (Correct answer)
- Pulmonary contusion
- Air embolism
Correct answer: Tension pneumothorax from occluded dressing
A fully occlusive dressing on an open pneumothorax can convert it to a tension pneumothorax if air cannot escape.
Question 2: What is the correct placement site for an intraosseous (IO) needle in an adult trauma patient when IV access is unavailable?
- Greater trochanter of femur
- Proximal tibia 2 cm below tibial tuberosity medially (Correct answer)
- Calcaneus
- Distal radius
Correct answer: Proximal tibia 2 cm below tibial tuberosity medially
The proximal tibia 2 cm below and medial to the tibial tuberosity is the preferred IO site in adults.
Question 3: A trauma patient with a suspected diaphragmatic rupture is intubated. Which finding on chest X-ray is most specific?
- Elevated hemidiaphragm
- Nasogastric tube coiled in left chest (Correct answer)
- Left lower lobe atelectasis
- Mediastinal shift
Correct answer: Nasogastric tube coiled in left chest
A nasogastric tube visible in the left chest cavity is pathognomonic for left-sided diaphragmatic rupture with gastric herniation.
Question 4: Which maneuver is used to confirm proper endotracheal tube placement in a trauma patient immediately after intubation?
- Chest X-ray alone
- Waveform capnography combined with clinical assessment (Correct answer)
- Pulse oximetry
- Bilateral breath sounds alone
Correct answer: Waveform capnography combined with clinical assessment
Continuous waveform capnography is the gold standard for confirming ETT placement, especially during trauma resuscitation.
Question 5: In damage control resuscitation, what ratio of packed red blood cells to fresh frozen plasma to platelets is recommended?
- 4:1:1
- 1:1:1 (Correct answer)
- 6:4:1
- 2:1:0
Correct answer: 1:1:1
A 1:1:1 ratio of pRBC:FFP:platelets approximates whole blood and is the standard for damage control resuscitation.
Question 6: A 25-year-old with a stab wound to the left chest develops JVD, hypotension, and muffled heart sounds. What procedure is indicated?
- Chest tube insertion
- Needle pericardiocentesis or ED thoracotomy (Correct answer)
- Intubation
- Bilateral needle decompression
Correct answer: Needle pericardiocentesis or ED thoracotomy
Beck's triad (JVD, hypotension, muffled heart sounds) indicates cardiac tamponade requiring pericardiocentesis or ED thoracotomy.
Question 7: During central venous line placement in a trauma patient, which complication is identified by worsening hypoxia, hypotension, and distended neck veins after line insertion?
- Line sepsis
- Catheter-associated DVT
- Iatrogenic tension pneumothorax (Correct answer)
- Air embolism
Correct answer: Iatrogenic tension pneumothorax
Pneumothorax complicating subclavian or internal jugular CVC placement can tension if the patient is on positive pressure ventilation.
ABEM Trauma & Procedural Skills 4
A patient has a shotgun wound to the right chest with sucking chest wound.
After occlusive dressing placement the patient acutely deteriorates.
What is the most likely cause?