CEP Trauma Assessment & Prehospital Interventions 4 — Questions and Answers
Question 1: A patient sustains blunt abdominal trauma with referred pain to the left shoulder (Kehr's sign). This finding MOST suggests injury to the:
- Liver
- Spleen (Correct answer)
- Kidney
- Colon
Correct answer: Spleen
Kehr's sign — left shoulder pain due to diaphragmatic irritation from blood — is classically associated with splenic injury.
Question 2: Which of the following is the MOST reliable indicator of internal hemorrhage in a blunt abdominal trauma patient?
- Presence of seat belt sign
- Abdominal tenderness and distension
- Decreasing blood pressure with tachycardia (Correct answer)
- Increasing pain on deep palpation
Correct answer: Decreasing blood pressure with tachycardia
Progressive hemodynamic instability (hypotension + tachycardia) is the most reliable field indicator of significant internal hemorrhage.
Question 3: During endotracheal intubation of a trauma patient, a right mainstem intubation is confirmed. Correct action is to:
- Remove the tube and ventilate with BVM
- Deflate the cuff, withdraw tube 2–3 cm, re-inflate, and reconfirm (Correct answer)
- Apply PEEP to recruit the left lung
- Advance the tube further to ensure proper placement
Correct answer: Deflate the cuff, withdraw tube 2–3 cm, re-inflate, and reconfirm
Withdrawing the ETT 2–3 cm above the carina and reconfirming placement corrects right mainstem intubation without removing the secured airway.
Question 4: A 60-year-old male on warfarin is involved in a ground-level fall and strikes his head. He is alert with a GCS of 15 and no neuro deficits. Your management should include:
- Discharge from scene after normal assessment
- Transport for evaluation due to anticoagulation increasing intracranial bleed risk (Correct answer)
- IV access only if vitals deteriorate
- Spinal restriction only if patient reports neck pain
Correct answer: Transport for evaluation due to anticoagulation increasing intracranial bleed risk
Anticoagulated patients have significantly higher risk of intracranial hemorrhage after even minor head trauma, requiring hospital evaluation.
Question 5: Which of the following BEST indicates successful needle decompression for tension pneumothorax?
- Return of normal breath sounds bilaterally and hemodynamic improvement (Correct answer)
- Audible hiss of air at needle insertion site
- SpO2 increase from 88% to 90%
- Decrease in heart rate to below 100 bpm only
Correct answer: Return of normal breath sounds bilaterally and hemodynamic improvement
Successful decompression is confirmed by bilateral breath sounds returning and hemodynamic improvement, not just air release or partial SpO2 improvement.
Question 6: A patient has an open chest wound ('sucking chest wound'). The correct prehospital treatment is:
- Fully occlusive dressing taped on all four sides
- Vented (3-sided) chest seal or commercial vented dressing (Correct answer)
- Wet sterile dressing covered with an impermeable layer
- Immediate needle decompression prior to wound covering
Correct answer: Vented (3-sided) chest seal or commercial vented dressing
A vented chest seal allows air to escape during exhalation while preventing air entrainment, reducing the risk of tension pneumothorax.
Question 7: What is the CORRECT target systolic blood pressure during permissive hypotension for a penetrating torso trauma patient without TBI?
- 100–110 mmHg
- 80–90 mmHg (Correct answer)
- 70 mmHg or MAP ≥50
- 60 mmHg or MAP ≥40
Correct answer: 80–90 mmHg
Permissive hypotension targets SBP 80–90 mmHg in penetrating torso trauma to limit clot disruption while maintaining minimal perfusion until surgical control.
CEP Trauma Assessment & Prehospital Interventions 4
A patient sustains blunt abdominal trauma with referred pain to the left shoulder (Kehr's sign).
This finding MOST suggests injury to the: