CFRN Specialized Trauma Care 4 — Questions and Answers
Question 1: A flight nurse is assessing a patient with a crush injury to both lower extremities who was extricated after 4 hours of entrapment. What metabolic complication is most critical to monitor for during transport?
- Hypoglycemia from muscle glycogen depletion
- Hyperkalemia and myoglobinuria leading to renal failure (Correct answer)
- Hyponatremia from third-space fluid shifts
- Metabolic alkalosis from lactic acid clearance
Correct answer: Hyperkalemia and myoglobinuria leading to renal failure
Crush syndrome causes massive release of intracellular potassium and myoglobin, leading to potentially fatal hyperkalemia and myoglobinuria-induced acute kidney injury (rhabdomyolysis).
Question 2: During helicopter transport at altitude, a trauma patient has a pneumothorax that was treated with a 14-gauge needle at the scene. The patient's respiratory status is deteriorating. What altitude-related physiological principle explains this worsening?
- Decreased atmospheric pressure causes gas expansion, enlarging the pneumothorax (Correct answer)
- Increased nitrogen narcosis at altitude impairs ventilatory drive
- Hyperbaric conditions compress the lung further
- Altitude-induced tachycardia increases intrathoracic pressure
Correct answer: Decreased atmospheric pressure causes gas expansion, enlarging the pneumothorax
Boyle's Law dictates that as altitude increases and atmospheric pressure decreases, gas within a pneumothorax expands, potentially converting a simple pneumothorax into a tension pneumothorax.
Question 3: A gunshot wound victim has a bullet entry wound at the right chest and exit at the upper back. Breath sounds are decreased on the right with SpO2 84%. The flight nurse applies an occlusive dressing. Shortly after, the patient's BP drops to 70/40 and trachea deviates left. What is the most likely cause?
- Massive hemothorax filling the right pleural space
- Tension pneumothorax developing under the sealed dressing (Correct answer)
- Pulmonary contusion causing V/Q mismatch
- Pericardial tamponade from mediastinal injury
Correct answer: Tension pneumothorax developing under the sealed dressing
Sealing all four sides of a chest wound can convert an open pneumothorax into a tension pneumothorax by preventing air escape; the occlusive dressing should be vented or a chest seal with flutter valve used.
Question 4: A flight nurse is managing a patient in hemorrhagic shock with a suspected retroperitoneal hematoma from a pelvic fracture. What intervention best addresses this specific mechanism of injury?
- Immediate laparotomy for hemorrhage control
- Pelvic binder application at the greater trochanters (Correct answer)
- Bilateral femoral artery compressions
- Foley catheter insertion to monitor urine output
Correct answer: Pelvic binder application at the greater trochanters
A pelvic binder applied at the level of the greater trochanters reduces pelvic volume, provides tamponade effect on retroperitoneal vessels, and decreases hemorrhage from unstable pelvic fractures.
Question 5: A flight nurse is preparing to intubate a patient with facial trauma, blood in the airway, and a GCS of 7. Rapid sequence intubation is planned. Which pre-oxygenation technique is most appropriate for this scenario?
- Passive apneic oxygenation via nasal cannula at 15 L/min only
- Bag-valve-mask ventilation with 100% FiO2 for 3-5 minutes with suction available (Correct answer)
- Non-rebreather mask at 15 L/min for 8 breaths
- Delayed sequence intubation using ketamine followed by 3 minutes of BVM
Correct answer: Bag-valve-mask ventilation with 100% FiO2 for 3-5 minutes with suction available
BVM pre-oxygenation with 100% FiO2 for 3-5 minutes with suction immediately available is optimal for maximizing nitrogen washout and oxygen reserve in a patient with a compromised, bloody airway.
Question 6: A trauma patient with a femur fracture is receiving a massive transfusion protocol. The flight nurse notices the patient developing prolonged QT interval, peaked T-waves, and muscle twitching. Which electrolyte abnormality is most likely causing these findings?
- Hyponatremia from dilutional effect of blood products
- Hypocalcemia from citrate chelation in transfused blood (Correct answer)
- Hypermagnesemia from massive cellular destruction
- Hypokalemia from insulin-glucose administration
Correct answer: Hypocalcemia from citrate chelation in transfused blood
Massive transfusion leads to hypocalcemia because the citrate preservative in blood products chelates ionized calcium, impairing cardiac conduction and muscle function.
Question 7: A patient sustains a traumatic amputation of the right hand at the wrist. The amputated part is recovered at the scene. What is the correct method for preserving the amputated part during transport?
- Place the part directly in a bag of ice water to keep it cold
- Wrap in a dry sterile dressing, place in a sealed bag, then place that bag on ice (Correct answer)
- Wrap in saline-soaked gauze and place directly on ice cubes
- Store the part in a container of normal saline at room temperature
Correct answer: Wrap in a dry sterile dressing, place in a sealed bag, then place that bag on ice
The amputated part should be wrapped in a moist sterile dressing, placed in a sealed plastic bag, and then placed on ice — direct contact with ice causes frostbite and tissue damage that may prevent reimplantation.
CFRN Specialized Trauma Care 4
A flight nurse is assessing a patient with a crush injury to both lower extremities who was extricated after 4 hours of entrapment.
What metabolic complication is most critical to monitor for during transport?