CPEN Trauma Care 5 — Questions and Answers
Question 1: A 10-year-old sustains burns over the entire front torso and both arms. Using the Rule of Nines (modified for children), what percentage of total body surface area (TBSA) is burned?
- 18%
- 27% (Correct answer)
- 36%
- 45%
Correct answer: 27%
In children, the anterior torso is 18% and each arm is 9% (9% × 2 = 18%), but the Lund-Browder chart or pediatric-modified Rule of Nines gives the anterior trunk as 18% and both arms as 9% total, making approximately 27% TBSA.
Question 2: What is the Parkland formula for burn resuscitation, and how is it calculated for a 20 kg child with 30% TBSA burns?
- 2 mL × kg × %TBSA = 1200 mL over 8 hours
- 4 mL × kg × %TBSA = 2400 mL in first 24 hours (Correct answer)
- 3 mL × kg × %TBSA = 1800 mL over 12 hours
- 1 mL × kg × %TBSA = 600 mL over 6 hours
Correct answer: 4 mL × kg × %TBSA = 2400 mL in first 24 hours
The Parkland formula is 4 mL × weight (kg) × %TBSA = total mL in first 24 hours; for this patient: 4 × 20 × 30 = 2400 mL.
Question 3: A 13-year-old with penetrating abdominal trauma has tachycardia and peritoneal signs. The MOST appropriate next step is:
- CT scan of the abdomen with contrast
- Diagnostic peritoneal lavage
- Immediate surgical consultation for exploratory laparotomy (Correct answer)
- FAST exam followed by observation
Correct answer: Immediate surgical consultation for exploratory laparotomy
Peritoneal signs (rigidity, rebound tenderness) after penetrating trauma indicate the need for emergent surgical consultation and likely operative intervention.
Question 4: Which cervical spine clearance criterion is validated for use in children and helps avoid unnecessary CT radiation?
- Ottawa Cervical Spine Rules
- NEXUS criteria (Correct answer)
- Canadian C-Spine Rule
- Pittsburgh Knee Rules
Correct answer: NEXUS criteria
The NEXUS (National Emergency X-Radiography Utilization Study) criteria are validated for pediatric cervical spine clearance and include assessment of midline tenderness, distracting injury, intoxication, altered mentation, and neurological deficit.
Question 5: A 4-year-old is brought in after a near-drowning event in a backyard pool. Initial resuscitation is successful. The nurse should prioritize monitoring for:
- Immediate discharge if vital signs normalize
- Delayed pulmonary edema and secondary drowning (Correct answer)
- Hypertension and bradycardia
- Hyperglycemia
Correct answer: Delayed pulmonary edema and secondary drowning
Secondary drowning can occur hours after apparent recovery due to pulmonary edema from aspirated water, requiring at least 6-8 hours of observation.
Question 6: In pediatric trauma, which radiographic view is included in the primary survey imaging for hemodynamically unstable patients?
- CT of the head, chest, and abdomen with contrast
- Chest X-ray, pelvis X-ray, and FAST exam (Correct answer)
- Full skeletal survey
- MRI of the spine
Correct answer: Chest X-ray, pelvis X-ray, and FAST exam
In hemodynamically unstable pediatric trauma patients, the primary survey imaging includes chest X-ray, pelvis X-ray, and FAST exam to identify life-threatening hemorrhage without delaying resuscitation.
Question 7: A 16-year-old is involved in a high-speed motor vehicle collision and arrives with BP 70/40, HR 138, distended abdomen, and decreasing GCS. The PRIORITY intervention is:
- CT scan to identify the source of bleeding
- Two large-bore IV lines and immediate type and crossmatch (Correct answer)
- Fluid bolus of 60 mL/kg normal saline
- Foley catheter placement to monitor urine output
Correct answer: Two large-bore IV lines and immediate type and crossmatch
Establishing large-bore IV access and obtaining blood for type and crossmatch is the immediate priority to prepare for blood product transfusion in this patient with signs of hemorrhagic shock.
CPEN Trauma Care 5
A 10-year-old sustains burns over the entire front torso and both arms.
Using the Rule of Nines (modified for children), what percentage of total body surface area (TBSA) is burned?