CPR Trauma Management & Intervention 2 — Questions and Answers
Question 1: A patient with a suspected pelvic fracture is hemodynamically unstable. Which intervention is the highest priority?
- Apply a commercial pelvic binder or improvised sheet wrap (Correct answer)
- Initiate bilateral large-bore IV access only
- Elevate both legs to 45 degrees
- Administer high-flow oxygen and reassess in 10 minutes
Correct answer: Apply a commercial pelvic binder or improvised sheet wrap
A pelvic binder reduces pelvic volume, tamponades venous bleeding, and is the primary mechanical intervention for unstable pelvic fractures.
Question 2: Which assessment finding most strongly indicates a tension pneumothorax rather than a simple pneumothorax?
- Absent breath sounds on one side with tracheal deviation and hypotension (Correct answer)
- Decreased breath sounds on one side with pleuritic chest pain
- Subcutaneous emphysema without hemodynamic compromise
- Dull percussion on the affected side with tachycardia
Correct answer: Absent breath sounds on one side with tracheal deviation and hypotension
Tension pneumothorax classically presents with absent breath sounds, tracheal deviation away from the affected side, and hypotension due to mediastinal shift impairing venous return.
Question 3: During a high-speed MVC, a restrained driver presents with bruising across the upper abdomen in a seatbelt pattern. Which injury should you most suspect?
- Hollow organ injury (bowel or bladder) (Correct answer)
- Aortic transection
- Diaphragmatic rupture
- Cardiac contusion
Correct answer: Hollow organ injury (bowel or bladder)
The 'seatbelt sign' across the abdomen is strongly associated with hollow viscus injuries such as small bowel rupture or bladder laceration due to compression forces.
Question 4: A paramedic applies a tourniquet to a patient's mid-thigh for arterial bleeding. The bleeding does not stop. What is the correct next step?
- Apply a second tourniquet proximal to the first (Correct answer)
- Remove the first tourniquet and apply direct pressure instead
- Loosen the tourniquet and reapply more distally
- Irrigate the wound before retightening
Correct answer: Apply a second tourniquet proximal to the first
If a single tourniquet fails to control arterial hemorrhage, a second tourniquet should be applied immediately proximal to the first to achieve adequate occlusion pressure.
Question 5: When managing a trauma patient in hemorrhagic shock, the ideal initial fluid resuscitation strategy in the prehospital setting is:
- Permissive hypotension with small boluses targeting a systolic of 80–90 mmHg (Correct answer)
- Aggressive 2-liter crystalloid bolus to restore normal blood pressure
- No IV fluids until the patient reaches the OR
- 1:1:1 packed red cells, plasma, and platelets immediately
Correct answer: Permissive hypotension with small boluses targeting a systolic of 80–90 mmHg
Permissive hypotension (targeting SBP 80–90 mmHg in penetrating trauma, ~90 mmHg in blunt) limits clot disruption and reduces coagulopathy while maintaining minimal perfusion.
Question 6: A patient has an impaled object in the left eye. The correct prehospital management is:
- Stabilize the object in place with bulky dressings and cover both eyes (Correct answer)
- Remove the object carefully and apply a pressure patch
- Leave the object and cover only the injured eye
- Irrigate the eye and transport without covering
Correct answer: Stabilize the object in place with bulky dressings and cover both eyes
Impaled objects should never be removed in the field; stabilizing the object and covering both eyes prevents sympathetic movement that could worsen injury.
Question 7: Which injury pattern is most consistent with a Chance fracture?
- Horizontal fracture through a lumbar vertebra caused by flexion-distraction (Correct answer)
- Burst fracture of the thoracic spine from axial compression
- Anterior wedge compression fracture of a cervical vertebra
- Rotational fracture-dislocation of the thoracolumbar junction
Correct answer: Horizontal fracture through a lumbar vertebra caused by flexion-distraction
A Chance fracture is a seat-belt injury where the lumbar spine is distracted horizontally, splitting the vertebra through the body, pedicles, and posterior elements.
CPR Trauma Management & Intervention 2
A patient with a suspected pelvic fracture is hemodynamically unstable.
Which intervention is the highest priority?