CFRN Specialized Trauma Care 5

Question 1

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?

Accepted Answer

Flail chest — provide positive pressure ventilation and consider intubation

Answer

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.

Question 2

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?

Accepted Answer

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

Answer

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.

Question 3

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?

Accepted Answer

Hypertension, bradycardia, and irregular respirations

Answer

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

Question 4

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?

Accepted Answer

Myocardial contusion

Answer

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.

Question 5

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?

Accepted Answer

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

Answer

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

CFRN - Certified Flight Registered Nurse Practice Test

CFRN - Certified Flight Registered Nurse Practice Test

CFRN Specialized Trauma Care 5