AEMCA Trauma and Shock Management 5 — Questions and Answers
Question 1: A patient who was in a high-speed MVA is now hypotensive and tachycardic with abdominal rigidity and guarding. On the way to the trauma center, IV access cannot be established peripherally. What is the next best vascular access option?
- Intraosseous access at the proximal tibia or humeral head (Correct answer)
- External jugular vein catheterization
- Femoral vein cutdown
- Delay fluids until arrival at the ED
Correct answer: Intraosseous access at the proximal tibia or humeral head
Intraosseous access provides rapid, reliable vascular access equivalent to central IV access when peripheral access fails in a critical patient.
Question 2: Which mechanism of injury is most associated with aortic transection (traumatic aortic rupture)?
- High-speed deceleration, such as a head-on MVA or fall from height (Correct answer)
- Penetrating trauma directly over the sternum
- Crush injury to the thorax
- Blast overpressure from an explosion
Correct answer: High-speed deceleration, such as a head-on MVA or fall from height
Sudden deceleration creates shear forces at the aortic isthmus where the mobile aorta meets the fixed ligamentum arteriosum, causing transection.
Question 3: A patient with hypovolemic shock has received 2 liters of normal saline but remains hypotensive. What complication of large-volume crystalloid resuscitation should you anticipate?
- Dilutional coagulopathy and hypothermia (Correct answer)
- Hyperkalemia from cellular lysis
- Metabolic alkalosis
- Acute hypernatremia
Correct answer: Dilutional coagulopathy and hypothermia
Large volumes of crystalloid dilute clotting factors and cool the patient, contributing to the lethal triad of coagulopathy and hypothermia.
Question 4: Which sign indicates impending herniation in a head-injured patient and requires immediate intervention?
- Unilateral fixed and dilated pupil with decreasing GCS (Correct answer)
- Bilateral pinpoint pupils with altered mental status
- Cheyne-Stokes respirations alone
- Systolic hypertension without bradycardia
Correct answer: Unilateral fixed and dilated pupil with decreasing GCS
A blown pupil (fixed, dilated, unilateral) with declining GCS indicates uncal herniation from rising intracranial pressure requiring emergent action.
Question 5: During rapid sequence intubation of a trauma patient with a suspected full stomach, which step prevents gastric content aspiration?
- Sellick's maneuver (cricoid pressure) during induction (Correct answer)
- Positioning the patient in Trendelenburg before intubation
- Administering metoclopramide to speed gastric emptying
- Using a King airway as a first-line device
Correct answer: Sellick's maneuver (cricoid pressure) during induction
Cricoid pressure compresses the esophagus against the vertebral body to reduce passive regurgitation during RSI in patients at aspiration risk.
Question 6: A patient is in distributive (septic) shock 6 hours after a stab wound with bowel evisceration. Which clinical finding differentiates distributive from hypovolemic shock?
- Warm, flushed skin with bounding pulses (Correct answer)
- Cool, clammy skin with weak pulses
- Flat neck veins with tachycardia
- Oliguria with elevated hematocrit
Correct answer: Warm, flushed skin with bounding pulses
Distributive shock causes massive vasodilation, producing warm, flushed skin and bounding pulses due to inappropriately low vascular resistance.
Question 7: When applying a windlass tourniquet to a bleeding extremity, how should you document the application?
- Write the time of application directly on the tourniquet and on the patient's forehead in marker (Correct answer)
- Record only in the patient care report at the hospital
- Note the time in a verbal report to receiving staff only
- Apply a second tourniquet as a timer reference
Correct answer: Write the time of application directly on the tourniquet and on the patient's forehead in marker
Tourniquet time must be written on the device and visible on the patient so all providers, including surgeons, can calculate total ischemia time.
AEMCA Trauma and Shock Management 5
A patient who was in a high-speed MVA is now hypotensive and tachycardic with abdominal rigidity and guarding.
On the way to the trauma center, IV access cannot be established peripherally.
What is the next best vascular access option?