CFRN Specialized Trauma Care 2 — Questions and Answers
Question 1: 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?
- SpO2 of 94% with mild tachycardia
- Absent breath sounds with tracheal deviation and hypotension (Correct answer)
- Decreased breath sounds with rib tenderness on palpation
- Mild respiratory distress with equal chest rise
Correct 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.
Question 2: 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?
- Increase IV fluid rate to 150 mL/hr
- Administer 20% mannitol 1 g/kg IV (Correct answer)
- Hyperventilate to a target EtCO2 of 25-30 mmHg
- Administer lorazepam for suspected seizure activity
Correct 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.
Question 3: 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?
- Splint the femur and reassess pulses
- Apply a tourniquet proximal to the fracture site (Correct answer)
- Start two large-bore IVs and begin crystalloid resuscitation
- Perform a focused assessment with sonography for trauma (FAST)
Correct 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.
Question 4: 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?
- Heart rate of 110 bpm
- Systolic BP of 88 mmHg with external arterial bleeding (Correct answer)
- Capillary refill of 3 seconds
- Skin pallor and diaphoresis
Correct 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.
Question 5: 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?
- Switch to a supraglottic airway device for stability
- Confirm ETT position with waveform capnography and secure the tube thoroughly (Correct answer)
- Request the pilot avoid turbulence at all costs
- Administer a paralytic to prevent patient movement
Correct 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.
Question 6: 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?
- Aggressive crystalloid until BP reaches 120 mmHg systolic
- Permissive hypotension targeting SBP 80-90 mmHg with blood products in 1:1:1 ratio (Correct answer)
- Vasopressors to maintain MAP >65 mmHg
- Normal saline boluses of 500 mL until HR normalizes
Correct 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.
Question 7: 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?
- 70 + (age in years × 2) (Correct answer)
- 80 + (age in years × 2)
- 90 + age in years
- 60 + (weight in kg / 2)
Correct 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.
CFRN Specialized Trauma Care 2
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?