CEN Trauma Emergencies 2 — Questions and Answers
Question 1: A patient sustains a gunshot wound to the abdomen with evisceration of bowel through the wound. What is the correct initial management of the eviscerated bowel?
- Push the bowel back into the abdomen
- Cover with a moist, sterile dressing (Correct answer)
- Apply a dry sterile gauze and pressure dressing
- Clamp and ligate protruding bowel
Correct answer: Cover with a moist, sterile dressing
Eviscerated bowel should be covered with a moist, sterile dressing to prevent desiccation and contamination while the patient is prepared for surgical repair.
Question 2: Which fracture pattern is associated with massive pelvic hemorrhage and hemodynamic instability?
- Isolated pubic ramus fracture
- Open-book pelvic fracture (AP compression injury) (Correct answer)
- Stable lateral compression fracture
- Avulsion fracture of the ischial tuberosity
Correct answer: Open-book pelvic fracture (AP compression injury)
An open-book pelvis (AP compression) disrupts the pelvic ring and stretches or tears the pelvic venous plexus and iliac vessels, causing massive hemorrhage.
Question 3: The 'lethal triad' in trauma refers to which three conditions?
- Hypovolemia, hypoxia, and hyponatremia
- Hypothermia, acidosis, and coagulopathy (Correct answer)
- Tachycardia, hypotension, and anemia
- Metabolic alkalosis, hyperkalemia, and hypothermia
Correct answer: Hypothermia, acidosis, and coagulopathy
The lethal triad of trauma—hypothermia, acidosis, and coagulopathy—creates a self-perpetuating cycle that leads to exsanguination if not interrupted.
Question 4: A patient has a zone II penetrating neck injury with active bleeding. Which is the priority intervention?
- CT angiography of the neck
- Immediate surgical exploration
- Direct pressure and airway management (Correct answer)
- Diagnostic angiography and embolization
Correct answer: Direct pressure and airway management
For any penetrating neck injury with active hemorrhage, direct pressure to control bleeding combined with airway management is the immediate priority before any imaging or surgical planning.
Question 5: A patient has a suspected tension pneumothorax in the field. What is the prehospital treatment?
- Wait for chest X-ray before treatment
- Needle thoracostomy at the 2nd intercostal space, midclavicular line (Correct answer)
- Apply a flutter valve occlusive dressing
- Immediate chest tube placement
Correct answer: Needle thoracostomy at the 2nd intercostal space, midclavicular line
Prehospital needle thoracostomy (14–16g needle at 2nd ICS, MCL) is the emergency intervention for suspected tension pneumothorax to relieve pressure.
Question 6: Which scoring system is used prehospital to predict which trauma patients need transfer to a trauma center?
- APACHE II
- Revised Trauma Score (RTS) (Correct answer)
- Glasgow Coma Scale alone
- SOFA score
Correct answer: Revised Trauma Score (RTS)
The Revised Trauma Score (RTS) uses GCS, systolic BP, and respiratory rate to predict injury severity and guide trauma center triage decisions.
CEN Trauma Emergencies 2
A patient sustains a gunshot wound to the abdomen with evisceration of bowel through the wound.
What is the correct initial management of the eviscerated bowel?