CPR Trauma Management & Intervention 3 — Questions and Answers
Question 1: A paramedic suspects cardiac tamponade following a stab wound to the chest. Which triad of findings supports this diagnosis?
- Hypotension, muffled heart sounds, and jugular venous distension (Beck's triad) (Correct answer)
- Tracheal deviation, absent breath sounds, and hypotension
- Tachycardia, hypertension, and bradypnea (Cushing's triad)
- Fever, hypotension, and altered mental status
Correct answer: Hypotension, muffled heart sounds, and jugular venous distension (Beck's triad)
Beck's triad — hypotension, muffled heart sounds, and JVD — classically indicates cardiac tamponade caused by blood accumulation in the pericardial sac.
Question 2: When performing a needle thoracostomy for tension pneumothorax, the traditional landmark on a male adult is:
- 2nd intercostal space, midclavicular line, above the 3rd rib (Correct answer)
- 4th intercostal space, anterior axillary line, below the 5th rib
- 2nd intercostal space, midaxillary line, above the 3rd rib
- 5th intercostal space, midclavicular line, above the 6th rib
Correct answer: 2nd intercostal space, midclavicular line, above the 3rd rib
The classic landmark is the 2nd ICS at the midclavicular line, inserting just above the 3rd rib to avoid the neurovascular bundle running below each rib.
Question 3: A trauma patient has a GCS of 8 and active facial bleeding. After cervical spine precautions, what is the priority airway intervention?
- Rapid sequence intubation (RSI) with in-line stabilization (Correct answer)
- Nasopharyngeal airway and BVM ventilation until hospital arrival
- Oropharyngeal airway insertion and supplemental oxygen
- Immediate surgical cricothyrotomy without attempting intubation
Correct answer: Rapid sequence intubation (RSI) with in-line stabilization
GCS ≤8 with active airway compromise requires definitive airway management; RSI with manual in-line stabilization allows intubation while protecting the cervical spine.
Question 4: Which burn pattern is most consistent with non-accidental trauma (abuse) in a pediatric patient?
- Symmetrical scald burns with a distinct tide line on bilateral lower extremities (Correct answer)
- Irregular splash-pattern burn on the face and one arm
- Flame burn with singed hair and inhalation injury
- Chemical burn from household cleaner on the hands
Correct answer: Symmetrical scald burns with a distinct tide line on bilateral lower extremities
Forcible immersion scalds produce symmetrical, sharply demarcated burns with a tide line, inconsistent with accidental splash injuries, and are a hallmark of inflicted burns.
Question 5: A patient sustained blunt abdominal trauma and now has referred pain to the left shoulder while supine. This finding most suggests:
- Splenic laceration causing diaphragmatic irritation (Kehr's sign) (Correct answer)
- Left pneumothorax with phrenic nerve involvement
- Mesenteric avulsion injury
- Left-sided rib fractures with intercostal nerve irritation
Correct answer: Splenic laceration causing diaphragmatic irritation (Kehr's sign)
Kehr's sign is left shoulder pain caused by blood irritating the left hemidiaphragm from splenic injury, mediated by the phrenic nerve (C3-C5).
Question 6: The 'load and go' philosophy is most appropriate for which trauma patient?
- Patient with penetrating abdominal injury, GCS 12, and hypotension not responding to initial fluids (Correct answer)
- Patient with an isolated closed femur fracture and stable vitals
- Patient with an open tibia fracture, normal GCS, and normal blood pressure
- Elderly patient with rib fractures and mild tachycardia
Correct answer: Patient with penetrating abdominal injury, GCS 12, and hypotension not responding to initial fluids
Penetrating abdominal injury with hemodynamic instability unresponsive to initial resuscitation requires immediate surgical intervention, making rapid transport the priority.
Question 7: A construction worker fell 20 feet and presents with midshaft femur fracture. Estimated blood loss into the thigh can be as high as:
- 1,000–1,500 mL (Correct answer)
- 200–400 mL
- 2,500–3,000 mL
- 500–700 mL
Correct answer: 1,000–1,500 mL
A closed midshaft femur fracture can sequester 1,000–1,500 mL of blood into the thigh compartment, representing a significant hemorrhagic risk.
CPR Trauma Management & Intervention 3
A paramedic suspects cardiac tamponade following a stab wound to the chest.
Which triad of findings supports this diagnosis?