BCEN Trauma and Injury Management 2 — Questions and Answers
Question 1: A patient arrives after a high-speed MVC with hypotension, distended neck veins, and muffled heart sounds. Which condition does this triad indicate?
- Tension pneumothorax
- Cardiac tamponade (Correct answer)
- Massive hemothorax
- Aortic dissection
Correct answer: Cardiac tamponade
Beck's triad (hypotension, distended neck veins, muffled heart sounds) is classic for cardiac tamponade requiring emergent pericardiocentesis.
Question 2: A trauma patient has a GCS of 8. After intubation, the nurse should set initial ventilator settings to target a PaCO2 of:
- 20-25 mmHg
- 25-30 mmHg
- 35-45 mmHg (Correct answer)
- 50-55 mmHg
Correct answer: 35-45 mmHg
Normal PaCO2 (35-45 mmHg) is targeted unless signs of herniation require brief hyperventilation; routine hyperventilation is no longer recommended in TBI.
Question 3: Which assessment finding is most consistent with a splenic injury in a blunt abdominal trauma patient?
- Pain radiating to the right shoulder
- Left upper quadrant tenderness with Kehr's sign (Correct answer)
- Cullen's sign with periumbilical bruising
- Right lower quadrant rebound tenderness
Correct answer: Left upper quadrant tenderness with Kehr's sign
Left upper quadrant tenderness with Kehr's sign (referred left shoulder pain from diaphragmatic irritation by blood) suggests splenic injury.
Question 4: A construction worker falls 20 feet and presents with midline thoracic back pain and inability to move his legs. Spinal precautions are in place. Which intervention has the highest priority?
- Administer IV methylprednisolone
- Obtain an urgent MRI of the spine
- Ensure airway patency and adequate ventilation (Correct answer)
- Insert a urinary catheter to monitor output
Correct answer: Ensure airway patency and adequate ventilation
Airway and breathing always take priority in trauma management; thoracic cord injury can impair respiratory muscles.
Question 5: When using the FAST exam (Focused Assessment with Sonography in Trauma), which finding indicates a positive result requiring immediate intervention?
- Air visible in the pleural space
- Free fluid in the hepatorenal space (Morrison's pouch) (Correct answer)
- Bowel gas obscuring the view
- Normal cardiac motion without pericardial fluid
Correct answer: Free fluid in the hepatorenal space (Morrison's pouch)
Free fluid in Morrison's pouch on FAST indicates intraperitoneal hemorrhage and warrants urgent surgical evaluation.
Question 6: A patient with a femur fracture develops sudden onset chest pain, tachycardia, and hypoxia 48 hours after admission. The most likely diagnosis is:
- Acute MI
- Fat embolism syndrome (Correct answer)
- Aortic rupture
- Tension pneumothorax
Correct answer: Fat embolism syndrome
Fat embolism syndrome classically presents 24-72 hours after long bone fracture with pulmonary, neurologic, and petechial manifestations.
Question 7: Which blood product ratio is recommended when activating a massive transfusion protocol (MTP) to replicate whole blood?
- 1:1:1 (pRBC:FFP:platelets) (Correct answer)
- 4:1:0 (pRBC:FFP:platelets)
- 2:1:1 (pRBC:FFP:platelets)
- 1:0:1 (pRBC:platelets)
Correct answer: 1:1:1 (pRBC:FFP:platelets)
A 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets is the standard for massive transfusion protocols to optimize hemostasis.
BCEN Trauma and Injury Management 2
A patient arrives after a high-speed MVC with hypotension, distended neck veins, and muffled heart sounds.
Which condition does this triad indicate?