CFRN Specialized Trauma Care 3 — Questions and Answers
Question 1: A flight nurse is treating a patient with a traumatic open femur fracture and Class III hemorrhagic shock. Using Tactical Combat Casualty Care (TCCC) principles, which resuscitation fluid is preferred in the flight environment?
- Normal saline 2 L bolus
- Lactated Ringer's 1 L bolus
- Packed red blood cells and fresh frozen plasma (Correct answer)
- Hypertonic saline 250 mL bolus
Correct answer: Packed red blood cells and fresh frozen plasma
TCCC and damage-control resuscitation principles favor blood products (pRBC and FFP) over crystalloids in Class III/IV hemorrhagic shock to restore oxygen-carrying capacity and clotting factors.
Question 2: A patient with a C5 spinal cord injury is being transported and develops a BP of 170/100 mmHg, bradycardia, and profuse sweating above the level of injury with cool skin below. What condition does this describe?
- Neurogenic shock
- Autonomic dysreflexia (Correct answer)
- Vasovagal syncope
- Hypertensive emergency from pain
Correct answer: Autonomic dysreflexia
Autonomic dysreflexia in spinal cord injuries at T6 or above presents with hypertension, bradycardia, and diaphoresis above the lesion level triggered by a noxious stimulus below the level of injury.
Question 3: During a scene response to a construction accident, a worker is found with a steel rod impaled through the left flank. The patient is awake and anxious with BP 100/70 mmHg. What is the correct management of the impaled object?
- Remove the object immediately to assess the wound
- Stabilize the object in place and do not remove it (Correct answer)
- Shorten the object with bolt cutters to facilitate transport
- Apply direct pressure around the object and attempt removal
Correct answer: Stabilize the object in place and do not remove it
Impaled objects must be stabilized in place because removal can cause massive hemorrhage by releasing the tamponade effect the object provides on injured vessels.
Question 4: A flight nurse responds to a patient with traumatic arrest after a motor vehicle collision. ACLS guidelines for traumatic cardiac arrest differ from medical arrest primarily in that:
- Epinephrine 1 mg IV is given every 3 minutes
- Reversible causes (Hs and Ts) are addressed simultaneously with CPR (Correct answer)
- High-dose epinephrine (5 mg) is first-line therapy
- Compressions are paused while reversible causes are treated
Correct answer: Reversible causes (Hs and Ts) are addressed simultaneously with CPR
In traumatic cardiac arrest, all potentially reversible causes (tension pneumothorax, hypovolemia, cardiac tamponade, hypoxia) must be simultaneously addressed while performing CPR.
Question 5: A flight nurse is assessing a patient with suspected cardiac tamponade after a stab wound to the chest. Which classic triad of findings supports this diagnosis?
- Hypertension, tachycardia, and distended neck veins
- Hypotension, muffled heart sounds, and distended neck veins (Beck's triad) (Correct answer)
- Hypotension, bradycardia, and absent breath sounds
- Tachycardia, fever, and pulsus paradoxus >20 mmHg
Correct answer: Hypotension, muffled heart sounds, and distended neck veins (Beck's triad)
Beck's triad of cardiac tamponade consists of hypotension, muffled heart sounds, and distended neck veins due to impaired cardiac filling from pericardial fluid accumulation.
Question 6: A burn patient sustained 45% TBSA partial and full thickness burns 2 hours ago. Using the Parkland formula, what is the correct fluid volume for the first 8 hours?
- 2 mL × 80 kg × 45% TBSA, entire amount over 8 hours
- 4 mL × 80 kg × 45% TBSA, half over 8 hours from time of burn (Correct answer)
- 4 mL × 80 kg × 45% TBSA, entire amount over 24 hours
- 2 mL × 80 kg × 45% TBSA, half over first 16 hours
Correct answer: 4 mL × 80 kg × 45% TBSA, half over 8 hours from time of burn
The Parkland formula calculates 4 mL/kg/% TBSA total over 24 hours, with half given in the first 8 hours from time of burn (not from presentation), and the remainder over the next 16 hours.
Question 7: A patient is transported following a high-speed MVC with suspected traumatic aortic injury. During transport, the flight nurse notes increasing left hemothorax and BP drops to 80/50. What is the most appropriate management?
- Aggressive fluid resuscitation to normalize blood pressure
- Thoracotomy needle decompression bilaterally
- Permissive hypotension, consider MTP activation, expedite transport (Correct answer)
- Place a chest tube and autotransfuse drained blood
Correct answer: Permissive hypotension, consider MTP activation, expedite transport
Traumatic aortic injury with hemorrhagic shock warrants permissive hypotension to avoid increasing aortic wall stress, massive transfusion protocol activation, and rapid transport to a Level I trauma center.
CFRN Specialized Trauma Care 3
A flight nurse is treating a patient with a traumatic open femur fracture and Class III hemorrhagic shock.
Using Tactical Combat Casualty Care (TCCC) principles, which resuscitation fluid is preferred in the flight environment?