AEMCA Trauma and Shock Management 4 — Questions and Answers
Question 1: A construction worker fell 30 feet and has paradoxical chest wall movement over the right lateral chest. This finding is consistent with:
- Flail chest (Correct answer)
- Tension pneumothorax
- Open pneumothorax
- Rib contusion
Correct answer: Flail chest
Flail chest occurs when three or more adjacent ribs are fractured in two or more places, causing a segment to move paradoxically inward with inhalation.
Question 2: Which burn percentage is used as the threshold requiring transport to a burn center per ABA guidelines for a full-thickness burn?
- Any full-thickness burn (Correct answer)
- Greater than 10% TBSA
- Greater than 20% TBSA
- Greater than 5% TBSA in adults only
Correct answer: Any full-thickness burn
ABA guidelines recommend burn center referral for any full-thickness burn regardless of size due to complexity of care and risk of complications.
Question 3: You are treating a patient in anaphylactic shock with severe bronchospasm and hypotension. After epinephrine 0.3 mg IM, the patient remains hemodynamically unstable. What is the next appropriate intervention?
- Repeat epinephrine IM and establish IV access for fluid bolus (Correct answer)
- Administer diphenhydramine IV as first-line rescue
- Apply CPAP for respiratory support only
- Administer albuterol nebulizer and observe
Correct answer: Repeat epinephrine IM and establish IV access for fluid bolus
If initial epinephrine IM fails, a repeat dose should be given while establishing IV access for fluid resuscitation to counter vasodilation.
Question 4: During a mass casualty incident using START triage, an adult patient is breathing at 24 breaths/minute, has a radial pulse, and can follow simple commands. This patient is tagged:
- Yellow (delayed) (Correct answer)
- Red (immediate)
- Green (minor)
- Black (expectant/deceased)
Correct answer: Yellow (delayed)
In START triage, a patient breathing >30 or <10 is red; this patient breathes at 24, has a pulse, and is responsive — meeting yellow (delayed) criteria.
Question 5: A patient with a crush injury to the lower extremities is extricated after 4 hours. You should be most concerned about which life-threatening complication upon release?
- Hyperkalemia and acute renal failure from rhabdomyolysis (Correct answer)
- Pulmonary embolism from fat emboli
- Disseminated intravascular coagulation immediately
- Tension pneumothorax from chest compression
Correct answer: Hyperkalemia and acute renal failure from rhabdomyolysis
Crush syndrome releases myoglobin and potassium from damaged muscle into circulation, causing hyperkalemia and tubular obstruction leading to renal failure.
Question 6: Which of the following is the correct order of priorities in the MARCH acronym used in tactical/military trauma care?
- Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia (Correct answer)
- Mechanism, Airway, Respiration, Circulation, Head injury
- Massive hemorrhage, Assessment, Respiration, Cardiac, Hypothermia
- Movement, Airway, Resuscitation, Circulation, Hypothermia
Correct answer: Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia
MARCH stands for Massive hemorrhage control, Airway, Respiration, Circulation, and Hypothermia prevention — the tactical trauma priority sequence.
Question 7: A patient sustained a gunshot wound to the right upper quadrant. On assessment, right shoulder pain is noted without direct shoulder injury. This referred pain is most likely due to:
- Diaphragmatic irritation from hepatic bleeding (Correct answer)
- Pneumothorax on the right side
- Brachial plexus injury from projectile path
- Aortic injury causing referred pain
Correct answer: Diaphragmatic irritation from hepatic bleeding
Blood or injury beneath the diaphragm irritates the phrenic nerve (C3-C5), causing referred pain to the ipsilateral shoulder — known as Kehr's sign.
AEMCA Trauma and Shock Management 4
A construction worker fell 30 feet and has paradoxical chest wall movement over the right lateral chest.
This finding is consistent with: