Specialized Trauma Care Flashcards

A flight nurse responds to a scene where a patient fell 30 feet from scaffolding and is found supine with paradoxical chest wall movement of the right chest. What injury pattern does this represent and what is the immediate treatment?

Answer: Flail chest — provide positive pressure ventilation and consider intubation

Paradoxical chest wall movement indicates flail chest (≥3 consecutive ribs fractured in ≥2 places); treatment focuses on positive pressure ventilation to restore normal chest mechanics and intubation for severe respiratory compromise.

A patient with a high-velocity gunshot wound to the abdomen is hemodynamically unstable with a distended, rigid abdomen. In the context of damage-control surgery principles, what is the flight nurse's primary goal during transport?

Answer: Minimize transport time and maintain the patient viable for damage-control surgery

Damage-control resuscitation aims to minimize the lethal triad (hypothermia, acidosis, coagulopathy) while expediting transport so surgeons can perform abbreviated hemorrhage control rather than awaiting full physiologic optimization.

During transport of a patient with a severe traumatic brain injury, the flight nurse notes Cushing's triad. Which set of findings correctly identifies Cushing's triad?

Answer: Hypertension, bradycardia, and irregular respirations

Cushing's triad (hypertension, bradycardia, and irregular respirations) is a late, ominous sign of severely increased intracranial pressure and impending brainstem herniation.

A flight nurse is assessing a patient from a high-speed MVC who complains of mid-sternal chest pain and has a new right bundle branch block on ECG. What injury should be strongly suspected?

Answer: Myocardial contusion

Myocardial contusion from blunt chest trauma can cause dysrhythmias, conduction abnormalities such as RBBB, ST changes, and reduced cardiac output, and must be monitored closely during transport.

A trauma patient is intubated and mechanically ventilated during transport. Peak airway pressures rise from 28 to 52 cmH2O suddenly. Breath sounds are absent on the left, trachea is midline, and BP drops to 75/45. What is the most likely diagnosis and next intervention?

Answer: Left tension pneumothorax — perform needle decompression at left 2nd ICS MCL

Sudden increase in peak airway pressures with absent unilateral breath sounds, hemodynamic instability, and ventilated patient strongly indicates tension pneumothorax, requiring immediate needle decompression.

A 45-year-old male involved in a blast injury from an improvised explosive device presents with tympanic membrane rupture, respiratory distress with hemoptysis, and abdominal pain. These findings are consistent with which phase of blast injury?

Answer: Primary blast injury from overpressure wave damage to air-filled structures

Primary blast injury is caused by the overpressure wave directly affecting air-filled organs such as the tympanic membranes, lungs (blast lung), and gastrointestinal tract.

A flight nurse is assessing a trauma patient with an obvious open book pelvic fracture. The patient has a Foley catheter in place and 50 mL of gross blood is seen in the drainage bag. What does this finding most likely indicate?

Answer: Urethral or bladder injury requiring urologic evaluation

Gross hematuria in a patient with a pelvic fracture strongly suggests associated urethral or bladder injury, which must be evaluated urologically; a Foley catheter should not have been placed if urethral injury was suspected.