BCEN Trauma Care 2 — Questions and Answers
Question 1: A patient arrives after a high-speed MVC with a GCS of 8. The primary survey reveals no airway obstruction. What is the most appropriate next step?
- Obtain a CT head immediately
- Perform rapid sequence intubation (Correct answer)
- Apply a cervical collar and observe
- Administer 1L normal saline bolus
Correct answer: Perform rapid sequence intubation
A GCS of 8 or below indicates inability to protect the airway, making rapid sequence intubation the priority.
Question 2: Which finding is most indicative of a tension pneumothorax in a trauma patient?
- Bilateral crackles and SpO2 88%
- Tracheal deviation away from the affected side with absent breath sounds (Correct answer)
- Subcutaneous emphysema with equal breath sounds
- Hemoptysis and tachycardia
Correct answer: Tracheal deviation away from the affected side with absent breath sounds
Tracheal deviation away from the affected side combined with absent breath sounds on that side is the classic presentation of tension pneumothorax.
Question 3: A trauma patient has a systolic BP of 80 mmHg despite 2L of crystalloid. FAST exam shows free fluid in Morrison's pouch. What is the priority intervention?
- Administer a second 2L crystalloid bolus
- Activate massive transfusion protocol and prepare for emergent surgery (Correct answer)
- Obtain CT abdomen/pelvis with contrast
- Insert a nasogastric tube
Correct answer: Activate massive transfusion protocol and prepare for emergent surgery
Hemorrhagic shock unresponsive to crystalloid with positive FAST requires massive transfusion protocol activation and emergent surgical hemorrhage control.
Question 4: What is the recommended ratio of packed red blood cells to fresh frozen plasma in damage control resuscitation?
- 4:1
- 1:1 (Correct answer)
- 3:1
- 6:1
Correct answer: 1:1
A 1:1 ratio of pRBC to FFP is the standard in damage control resuscitation to correct coagulopathy alongside hemorrhage.
Question 5: A patient sustains blunt abdominal trauma and develops involuntary guarding, rigidity, and rebound tenderness. These findings are most consistent with:
- Retroperitoneal hematoma
- Splenic laceration without peritoneal involvement
- Peritoneal irritation from hollow viscus injury (Correct answer)
- Pelvic fracture
Correct answer: Peritoneal irritation from hollow viscus injury
Peritoneal signs (guarding, rigidity, rebound) suggest bowel or hollow viscus injury with spillage of contents causing peritoneal irritation.
Question 6: Which cervical spine clearance criterion allows clinical clearance without imaging in a low-risk alert trauma patient?
- Ottawa Cervical Spine Rules
- NEXUS criteria (Correct answer)
- Canadian CT Head Rule
- Pittsburgh Decision Rule
Correct answer: NEXUS criteria
The NEXUS criteria (National Emergency X-Radiography Utilization Study) allow clinical clearance of the cervical spine without imaging when all five criteria are met.
Question 7: In a patient with suspected cardiac tamponade after penetrating chest trauma, which finding is part of Beck's triad?
- Hypertension, bradycardia, and irregular respirations
- Hypotension, muffled heart sounds, and jugular venous distension (Correct answer)
- Tachycardia, fever, and pleuritic chest pain
- Pulsus paradoxus, ST elevation, and friction rub
Correct answer: Hypotension, muffled heart sounds, and jugular venous distension
Beck's triad consists of hypotension, muffled heart sounds, and jugular venous distension, indicating cardiac tamponade.
BCEN Trauma Care 2
A patient arrives after a high-speed MVC with a GCS of 8.
The primary survey reveals no airway obstruction.
What is the most appropriate next step?