Specialized Trauma Care Flashcards

A flight nurse is caring for a patient with a suspected tension pneumothorax during transport. Which finding most urgently requires needle decompression before definitive chest tube placement?

Answer: Absent breath sounds with tracheal deviation and hypotension

Tension pneumothorax is identified by absent breath sounds, tracheal deviation away from the affected side, and hemodynamic compromise requiring immediate needle decompression.

During a rotor-wing transport of a patient with a traumatic brain injury, the flight nurse notes a GCS drop from 11 to 7 and unilateral pupil dilation. What is the most appropriate immediate intervention?

Answer: Administer 20% mannitol 1 g/kg IV

Mannitol 1 g/kg IV is the standard osmotic therapy for herniation signs in TBI, while hyperventilation is reserved only as a bridge therapy when herniation is imminent and other measures fail.

A flight nurse responds to a scene where a motorcyclist struck a guardrail at high speed. The patient has a deformed left thigh and no palpable distal pulse. Estimated blood loss is 1,500 mL. Which hemorrhage control intervention is highest priority?

Answer: Apply a tourniquet proximal to the fracture site

A femur fracture with vascular compromise and major hemorrhage requires immediate tourniquet application proximal to the injury to control life-threatening bleeding.

When performing a primary survey on a multi-system trauma patient in the flight environment, which finding during 'Circulation' assessment takes priority over all others?

Answer: Systolic BP of 88 mmHg with external arterial bleeding

Active arterial hemorrhage causing hypotension represents an immediately life-threatening circulation problem requiring direct hemorrhage control before other assessments proceed.

A patient with a stab wound to zone II of the neck is intubated and hemodynamically stable. During flight, the pilot reports significant turbulence ahead. What is the most important nursing action regarding the airway?

Answer: Confirm ETT position with waveform capnography and secure the tube thoroughly

Confirming ETT position with waveform capnography and ensuring the tube is well-secured is critical before turbulence to prevent inadvertent extubation in a difficult airway patient.

A 28-year-old male with blunt abdominal trauma has a FAST exam showing free fluid in Morrison's pouch. His BP is 70/40 mmHg despite 1L crystalloid. Applying damage-control resuscitation principles, what is the target resuscitation strategy?

Answer: Permissive hypotension targeting SBP 80-90 mmHg with blood products in 1:1:1 ratio

Damage-control resuscitation uses permissive hypotension (SBP 80-90 for blunt trauma) and balanced blood product resuscitation (1:1:1 ratio of pRBC:FFP:platelets) to minimize coagulopathy.

During transport of a pediatric trauma patient (8 years old, 25 kg) with a suspected pelvic fracture, the flight nurse needs to estimate the systolic blood pressure lower limit of normal. What is the correct calculation?

Answer: 70 + (age in years × 2)

The formula for the lower limit of normal systolic blood pressure in pediatric patients is 70 + (age in years × 2), giving approximately 86 mmHg for this 8-year-old.