CCRN Multisystem Trauma and Shock 2 — Questions and Answers
Question 1: A trauma patient presents with hypotension, jugular venous distention, and muffled heart sounds. Which condition is most likely?
- Tension pneumothorax
- Cardiac tamponade (Correct answer)
- Hemorrhagic shock
- Pulmonary embolism
Correct answer: Cardiac tamponade
Beck's triad (hypotension, JVD, muffled heart sounds) is the classic presentation of cardiac tamponade.
Question 2: What is the earliest reliable sign of compensated shock in a young trauma patient?
- Hypotension
- Tachycardia (Correct answer)
- Bradycardia
- Decreased urine output
Correct answer: Tachycardia
Tachycardia is an early compensatory response, while hypotension is a late and ominous sign.
Question 3: Which class of hemorrhagic shock corresponds to a 30-40% blood volume loss?
- Class I
- Class II
- Class III (Correct answer)
- Class IV
Correct answer: Class III
Class III hemorrhage involves 30-40% blood loss with marked tachycardia, hypotension, and altered mental status.
Question 4: A patient with a femur fracture develops sudden dyspnea, petechiae, and confusion 24-48 hours after injury. What is the likely cause?
- Fat embolism syndrome (Correct answer)
- Pulmonary contusion
- ARDS
- Tension pneumothorax
Correct answer: Fat embolism syndrome
Fat embolism syndrome classically presents with the triad of respiratory distress, neurologic changes, and petechial rash after long bone fracture.
Question 5: What is the recommended target for permissive hypotension in an actively bleeding trauma patient without head injury?
- SBP 60-70 mmHg
- SBP 80-90 mmHg (Correct answer)
- SBP 110-120 mmHg
- MAP greater than 90 mmHg
Correct answer: SBP 80-90 mmHg
Permissive hypotension targets an SBP of approximately 80-90 mmHg to limit clot disruption until surgical control is achieved.
Question 6: Which laboratory finding best reflects the adequacy of tissue perfusion in shock?
- Serum sodium
- Lactate (Correct answer)
- White blood cell count
- Serum potassium
Correct answer: Lactate
Elevated serum lactate indicates anaerobic metabolism and inadequate tissue oxygen delivery, a key marker of shock severity.
Question 7: In neurogenic shock from a spinal cord injury, which combination of findings is expected?
- Hypotension with tachycardia
- Hypotension with bradycardia (Correct answer)
- Hypertension with bradycardia
- Hypertension with tachycardia
Correct answer: Hypotension with bradycardia
Neurogenic shock causes hypotension with bradycardia due to loss of sympathetic tone and unopposed vagal activity.
CCRN Multisystem Trauma and Shock 2
A trauma patient presents with hypotension, jugular venous distention, and muffled heart sounds.
Which condition is most likely?