ATLS Shock Assessment and Management 2 — Questions and Answers
Question 1: A trauma patient has hypotension, distended neck veins, and muffled heart sounds. Most likely diagnosis?
- Tension pneumothorax
- Cardiac tamponade (Correct answer)
- Massive hemothorax
- Myocardial contusion
Correct answer: Cardiac tamponade
Beck's triad: hypotension, JVD, and muffled heart sounds is the classic presentation of cardiac tamponade.
Cardiac tamponade occurs when pericardial blood compresses the heart. As little as 100-150 mL can cause hemodynamic compromise. Treatment: pericardiocentesis as temporizing measure, then surgical thoracotomy.
Question 2: Which shock type is characterized by hypotension, bradycardia, and warm flushed skin below the injury?
- Hypovolemic shock
- Neurogenic shock (Correct answer)
- Cardiogenic shock
- Septic shock
Correct answer: Neurogenic shock
Neurogenic shock results from loss of sympathetic tone after spinal cord injury, causing vasodilation and bradycardia.
Neurogenic shock occurs with injuries at or above T6. Treatment: fluids, vasopressors (norepinephrine), atropine for bradycardia. It is a diagnosis of exclusion; hemorrhage must be ruled out first.
Question 3: In massive transfusion protocol, what is the recommended PRBC:FFP:Platelets ratio?
- 3:1:1
- 1:1:1 (Correct answer)
- 2:1:1
- 1:2:1
Correct answer: 1:1:1
A balanced 1:1:1 ratio mimics whole blood and prevents dilutional coagulopathy.
Based on the PROPPR trial and military experience. Additional: TXA within 3 hours, calcium replacement, warming all products. Use type O negative until crossmatched.
Question 4: A 25-year-old with a left chest stab wound develops PEA in the trauma bay. What is the most appropriate intervention?
- Start CPR and epinephrine
- Bilateral needle decompression
- Emergency department thoracotomy (Correct answer)
- Pericardiocentesis
Correct answer: Emergency department thoracotomy
PEA from penetrating thoracic trauma is an indication for ED thoracotomy.
EDT allows pericardiotomy, cardiac repair, aortic cross-clamping, and internal cardiac massage. Survival rates are 10-30% for stab wounds. Contraindicated in blunt trauma with no signs of life.
Question 5: What is the earliest and most reliable clinical indicator of adequate resuscitation?
- Blood pressure normalization
- Normal heart rate return
- Urine output of 0.5 mL/kg/hour (Correct answer)
- Skin color improvement
Correct answer: Urine output of 0.5 mL/kg/hour
Urine output (0.5 mL/kg/hr adults) is the most reliable indicator of end-organ perfusion.
Targets: adults 0.5 mL/kg/hr, children 1 mL/kg/hr, infants 2 mL/kg/hr. Other markers: normalizing lactate, clearing base deficit, improving mental status.
Question 6: Permissive hypotension targets what systolic BP in a patient without TBI?
- 60-70 mmHg
- 80-90 mmHg (Correct answer)
- 100-110 mmHg
- 120-130 mmHg
Correct answer: 80-90 mmHg
Target SBP 80-90 mmHg to avoid disrupting clot formation while maintaining organ perfusion.
Permissive hypotension does NOT apply to TBI patients (need MAP >80 for CPP). Also contraindicated in elderly with chronic hypertension.
ATLS Shock Assessment and Management 2
A trauma patient has hypotension, distended neck veins, and muffled heart sounds.
Most likely diagnosis?