CFRN Specialized Trauma Care 4

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?

Accepted Answer

Hyperkalemia and myoglobinuria leading to renal failure

Answer

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?

Accepted Answer

Decreased atmospheric pressure causes gas expansion, enlarging the pneumothorax

Answer

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?

Accepted Answer

Tension pneumothorax developing under the sealed dressing

Answer

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?

Accepted Answer

Pelvic binder application at the greater trochanters

Answer

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?

Accepted Answer

Bag-valve-mask ventilation with 100% FiO2 for 3-5 minutes with suction available

Answer

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.

CFRN - Certified Flight Registered Nurse Practice Test

CFRN - Certified Flight Registered Nurse Practice Test

CFRN Specialized Trauma Care 4