AEMCA Trauma and Shock Management 3 — Questions and Answers
Question 1: Which fluid resuscitation strategy is currently recommended for hemorrhagic shock in penetrating trauma to prevent worsening coagulopathy?
- Permissive hypotension with limited crystalloid (Correct answer)
- Aggressive 2-liter crystalloid bolus
- Colloid-only resuscitation
- No IV fluids until surgical hemorrhage control
Correct answer: Permissive hypotension with limited crystalloid
Permissive hypotension (targeting SBP ~80–90 mmHg) with limited crystalloid minimizes dilutional coagulopathy and clot disruption until surgical control.
Question 2: A cyclist struck by a car has a closed femur fracture. Approximately how much blood can be lost into the thigh from this injury?
- Up to 1,500 mL (Correct answer)
- Up to 300 mL
- Up to 500 mL
- Up to 3,000 mL
Correct answer: Up to 1,500 mL
A closed femur fracture can conceal up to 1,000–1,500 mL of blood within the thigh compartment, contributing significantly to hypovolemic shock.
Question 3: Which assessment finding best differentiates cardiogenic shock from hypovolemic shock in a trauma patient?
- Jugular venous distension with pulmonary edema (Correct answer)
- Flat neck veins with cool, clammy skin
- Tachycardia with narrow pulse pressure
- Altered mental status with hypotension
Correct answer: Jugular venous distension with pulmonary edema
Cardiogenic shock causes fluid backup, presenting with JVD and pulmonary edema, while hypovolemic shock presents with flat neck veins and no pulmonary edema.
Question 4: You are packaging a patient with a suspected pelvic fracture and hemodynamic instability. What prehospital intervention is most appropriate?
- Apply a pelvic binder at the level of the greater trochanters (Correct answer)
- Manually compress the iliac wings and hold during transport
- Elevate the legs 8–12 inches to tamponade the bleeding
- Apply traction splinting to reduce blood loss
Correct answer: Apply a pelvic binder at the level of the greater trochanters
A circumferential pelvic binder at the greater trochanters reduces pelvic volume and tamponades venous hemorrhage from an unstable pelvic fracture.
Question 5: When using the Revised Trauma Score (RTS) to triage patients, which three parameters are assessed?
- Glasgow Coma Scale, systolic BP, respiratory rate (Correct answer)
- Heart rate, oxygen saturation, GCS
- Pupil response, BP, respiratory rate
- GCS, heart rate, skin color
Correct answer: Glasgow Coma Scale, systolic BP, respiratory rate
The Revised Trauma Score uses GCS, systolic blood pressure, and respiratory rate to predict survival and guide triage decisions.
Question 6: A patient has Beck's triad following blunt chest trauma. Which emergency procedure does this finding indicate?
- Pericardiocentesis for cardiac tamponade (Correct answer)
- Needle decompression for tension pneumothorax
- Endotracheal intubation for airway protection
- Chest tube insertion for hemothorax
Correct answer: Pericardiocentesis for cardiac tamponade
Beck's triad (hypotension, muffled heart sounds, JVD) indicates cardiac tamponade, which requires pericardiocentesis to relieve pericardial pressure.
Question 7: In the context of trauma, what does the 'lethal triad' refer to?
- Hypothermia, acidosis, and coagulopathy (Correct answer)
- Hypotension, tachycardia, and altered mental status
- Hemorrhage, airway obstruction, and tension pneumothorax
- Hypovolemia, hypoxia, and hypoglycemia
Correct answer: Hypothermia, acidosis, and coagulopathy
The lethal triad of hypothermia, acidosis, and coagulopathy is a self-reinforcing cycle that dramatically increases mortality in trauma patients.
AEMCA Trauma and Shock Management 3
Which fluid resuscitation strategy is currently recommended for hemorrhagic shock in penetrating trauma to prevent worsening coagulopathy?