CEP Trauma Assessment & Prehospital Interventions 5 — Questions and Answers
Question 1: A trauma patient has a GCS of 6 (E1V2M3) with unequal pupils. The MOST appropriate airway management is:
- Nasopharyngeal airway and BVM ventilation
- Oropharyngeal airway and supplemental O2
- Rapid sequence intubation with inline spinal stabilization (Correct answer)
- Surgical cricothyrotomy immediately
Correct answer: Rapid sequence intubation with inline spinal stabilization
GCS ≤8 with signs of herniation (unequal pupils) requires definitive airway management via RSI while maintaining spinal precautions.
Question 2: Which of the following BEST describes 'damage control resuscitation' in prehospital trauma care?
- Aggressive IV crystalloid to restore normal blood pressure
- Limiting crystalloids, targeting permissive hypotension, and preferring blood products (Correct answer)
- Rapid surgical hemorrhage control in the field
- Applying tourniquets to all four extremities prophylactically
Correct answer: Limiting crystalloids, targeting permissive hypotension, and preferring blood products
Damage control resuscitation minimizes crystalloids, accepts lower-than-normal BP, and when available, uses blood products to restore coagulation capacity.
Question 3: A 22-year-old is shot in the neck (Zone II). He is anxious, hoarse, and has expanding subcutaneous emphysema. Which airway intervention is MOST appropriate?
- Wait and monitor — symptoms may resolve
- Perform nasotracheal intubation to avoid oral manipulation
- Early orotracheal intubation before progressive airway edema occludes the airway (Correct answer)
- Immediate surgical cricothyrotomy as first-line
Correct answer: Early orotracheal intubation before progressive airway edema occludes the airway
Expanding hematoma and emphysema signal impending airway loss; early orotracheal intubation is preferred before anatomy is distorted.
Question 4: During transport of a head-injured patient with suspected elevated ICP, you should position the patient:
- Flat supine to maintain spinal precautions strictly
- Head elevated 30 degrees with the spine inline (Correct answer)
- Trendelenburg to improve cerebral perfusion
- Left lateral decubitus to prevent aspiration
Correct answer: Head elevated 30 degrees with the spine inline
30-degree head-of-bed elevation promotes cerebral venous drainage and reduces ICP while maintaining spinal precautions with the spine kept neutral.
Question 5: Which finding on scene size-up MOST suggests a patient involved in a blast injury may have a primary blast injury?
- Visible burns over more than 20% BSA
- Perforated tympanic membranes and respiratory distress (Correct answer)
- Multiple penetrating fragments embedded in extremities
- Blunt trauma from being thrown by the explosion
Correct answer: Perforated tympanic membranes and respiratory distress
Tympanic membrane rupture and pulmonary blast injury are classic primary blast injuries caused directly by the overpressure wave.
Question 6: A 35-year-old trauma patient in cardiac arrest has PEA on the monitor. Which reversible cause should be addressed FIRST in the prehospital setting?
- Hypothermia — apply active rewarming
- Tension pneumothorax — perform bilateral needle decompression (Correct answer)
- Hypovolemia — initiate IO and rapid fluid bolus
- Toxins — administer empirical naloxone
Correct answer: Tension pneumothorax — perform bilateral needle decompression
Tension pneumothorax is the most rapidly reversible and common cause of traumatic PEA arrest, and bilateral needle decompression should occur immediately.
Question 7: You apply a traction splint to a mid-shaft femur fracture. Which finding MOST indicates the splint is correctly applied and effective?
- Increased pain at the fracture site due to realignment
- Decreased pain, limb length equalized, and neurovascular status intact (Correct answer)
- Skin blanching distal to the splint
- Absence of pedal pulses confirming maximum traction
Correct answer: Decreased pain, limb length equalized, and neurovascular status intact
Correct traction splint application reduces pain by countering muscle spasm, restores approximate limb length, and must preserve distal neurovascular status.
CEP Trauma Assessment & Prehospital Interventions 5
A trauma patient has a GCS of 6 (E1V2M3) with unequal pupils.
The MOST appropriate airway management is: