CPEN Trauma Care 3 — Questions and Answers
Question 1: A 3-year-old presents with bilateral black eyes (raccoon eyes) and clear fluid from the nose after a fall. What injury should be suspected?
- Facial contusions
- Basilar skull fracture (Correct answer)
- Nasal bone fracture
- Orbital cellulitis
Correct answer: Basilar skull fracture
Raccoon eyes and CSF rhinorrhea are classic signs of a basilar skull fracture.
Question 2: Which is the preferred initial fluid resuscitation volume for hemorrhagic shock in a pediatric trauma patient?
- 5 mL/kg isotonic crystalloid
- 10 mL/kg isotonic crystalloid
- 20 mL/kg isotonic crystalloid (Correct answer)
- 40 mL/kg isotonic crystalloid
Correct answer: 20 mL/kg isotonic crystalloid
ATLS and pediatric trauma guidelines recommend 20 mL/kg of isotonic crystalloid as the initial fluid bolus for hemorrhagic shock.
Question 3: A 12-year-old hit by a car is combative, tachycardic, and has absent breath sounds on the left. After needle decompression, a chest tube is placed. The MOST common complication of chest tube insertion in children is:
- Hemothorax
- Intercostal nerve damage
- Tube malposition (Correct answer)
- Infection
Correct answer: Tube malposition
Tube malposition (too shallow, too deep, or kinked) is the most common complication of chest tube insertion in pediatric patients.
Question 4: Pediatric trauma patients are at higher risk for hypothermia than adults primarily because:
- They have higher metabolic rates
- They have a larger body surface area relative to body mass (Correct answer)
- They are less cooperative during assessment
- They receive more IV fluids
Correct answer: They have a larger body surface area relative to body mass
Children have a higher ratio of body surface area to mass, leading to rapid heat loss and greater risk of hypothermia.
Question 5: A 6-year-old sustained a stab wound to the right upper quadrant. On FAST exam, free fluid is noted in Morrison's pouch. This finding indicates:
- Bladder rupture
- Hemoperitoneum (Correct answer)
- Pneumothorax
- Pericardial effusion
Correct answer: Hemoperitoneum
Free fluid in Morrison's pouch (hepatorenal space) on FAST exam represents hemoperitoneum until proven otherwise.
Question 6: Which of the following is the MOST reliable early sign of shock in a pediatric trauma patient?
- Decreased blood pressure
- Tachycardia (Correct answer)
- Decreased urine output
- Altered mental status
Correct answer: Tachycardia
Tachycardia is the earliest and most sensitive sign of shock in children because they compensate by increasing heart rate before blood pressure falls.
Question 7: When using the Broselow tape for a pediatric trauma patient, what does it primarily estimate?
- Blood pressure by age
- Weight-based drug doses and equipment sizes (Correct answer)
- Glasgow Coma Scale score
- Expected blood volume
Correct answer: Weight-based drug doses and equipment sizes
The Broselow tape uses the child's length to estimate weight and provide color-coded drug dosing and equipment size recommendations.
CPEN Trauma Care 3
A 3-year-old presents with bilateral black eyes (raccoon eyes) and clear fluid from the nose after a fall.
What injury should be suspected?