BCEN Trauma Care 3 — Questions and Answers
Question 1: A patient with a pelvic fracture is hemodynamically unstable despite resuscitation. What is the most effective immediate intervention to reduce pelvic hemorrhage?
- Emergent exploratory laparotomy
- Application of a pelvic binder or sheet (Correct answer)
- Bilateral femoral artery compression
- Placement of a REBOA catheter at Zone 3
Correct answer: Application of a pelvic binder or sheet
A pelvic binder reduces pelvic volume and tamponades venous hemorrhage, making it the fastest first-line intervention for unstable pelvic fractures.
Question 2: During a secondary trauma survey, you note a patient has a scrotal hematoma and blood at the urethral meatus after a straddle injury. What should you avoid?
- Inserting an IV line
- Inserting a urinary catheter before urologic consultation (Correct answer)
- Administering IV opioids
- Obtaining a pelvic X-ray
Correct answer: Inserting a urinary catheter before urologic consultation
Blood at the urethral meatus is a sign of urethral injury; a Foley catheter must not be inserted until urethral integrity is confirmed, typically via urethrogram.
Question 3: A pediatric trauma patient weighs 20 kg. Using the Broselow tape, what is the correct estimated weight-based fluid bolus for hemorrhagic shock?
- 100 mL
- 200 mL
- 400 mL (Correct answer)
- 1000 mL
Correct answer: 400 mL
Pediatric initial fluid resuscitation for hemorrhagic shock is 20 mL/kg, so for a 20 kg child the bolus is 400 mL.
Question 4: Which mechanism is most likely to cause an aortic disruption (traumatic aortic injury)?
- Low-speed rear-end collision
- High-speed deceleration or horizontal impact MVC (Correct answer)
- Direct anterior sternal blow from a fist
- Fall from standing height
Correct answer: High-speed deceleration or horizontal impact MVC
Sudden deceleration creates shear forces at the aortic isthmus (ligamentum arteriosum), making high-speed MVCs the most common cause of traumatic aortic injury.
Question 5: A patient has a gunshot wound to the right upper quadrant. CT scan shows a Grade III liver laceration. The patient is hemodynamically stable. What management is preferred?
- Emergent exploratory laparotomy
- Nonoperative management with serial abdominal exams and repeat imaging (Correct answer)
- Diagnostic peritoneal lavage
- Empiric IV antibiotics and discharge
Correct answer: Nonoperative management with serial abdominal exams and repeat imaging
Hemodynamically stable patients with Grade III liver lacerations are candidates for nonoperative management with close monitoring.
Question 6: Which assessment tool is used to identify occult hypoperfusion in trauma patients who appear hemodynamically stable?
- Central venous pressure
- Serum lactate level (Correct answer)
- Urine specific gravity
- Capillary refill time
Correct answer: Serum lactate level
An elevated serum lactate indicates anaerobic metabolism and tissue hypoperfusion even when blood pressure appears normal.
Question 7: A trauma nurse is assessing an unresponsive patient with a suspected spinal cord injury at C5. Which respiratory pattern is expected?
- Normal, unassisted breathing
- Diaphragmatic breathing with intercostal paralysis (Correct answer)
- Complete apnea requiring full ventilatory support
- Cheyne-Stokes respirations
Correct answer: Diaphragmatic breathing with intercostal paralysis
C5 injury spares the phrenic nerve (C3-C5), allowing diaphragmatic breathing, but intercostal muscles (T1-T12) are paralyzed.
BCEN Trauma Care 3
A patient with a pelvic fracture is hemodynamically unstable despite resuscitation.
What is the most effective immediate intervention to reduce pelvic hemorrhage?