DCAS Trauma Management 2 — Questions and Answers
Question 1: Traumatic brain injury (TBI) secondary injury is caused by:
- Hypoxia, hypotension, hypercapnia, hyperthermia, and seizures after the initial impact (Correct answer)
- The initial mechanical impact only
- Oedema that develops months after injury
- Surgical intervention for haemorrhage evacuation
Correct answer: Hypoxia, hypotension, hypercapnia, hyperthermia, and seizures after the initial impact
Secondary brain injury occurs after the initial impact through preventable physiological insults — hypoxia, hypotension, hypercapnia (vasodilatation increasing ICP), fever, and seizures — all of which paramedics can actively prevent.
Question 2: The classic Cushing's Triad, indicating raised intracranial pressure, consists of:
- Hypertension (wide pulse pressure), bradycardia, and irregular respirations (Correct answer)
- Hypotension, tachycardia, and tachypnoea
- Hypertension, tachycardia, and apnoea
- Hypotension, bradycardia, and fever
Correct answer: Hypertension (wide pulse pressure), bradycardia, and irregular respirations
Cushing's Triad is a late, ominous sign of severely raised ICP causing brainstem compression: hypertension with widened pulse pressure, reflex bradycardia, and irregular (Cheyne-Stokes) respirations — indicating imminent herniation.
Question 3: In traumatic cardiac arrest, which reversible cause should be addressed first?
- Tension pneumothorax — bilateral thoracostomy should be performed immediately (Correct answer)
- Hypovolaemia — 2L fluid bolus should be given first
- Hypoxia — intubation should precede everything
- Cardiac tamponade — pericardiocentesis is always first
Correct answer: Tension pneumothorax — bilateral thoracostomy should be performed immediately
Bilateral thoracostomy for presumed bilateral tension pneumothorax is the first priority in traumatic cardiac arrest as it is rapidly reversible in the field; tamponade may require resuscitative thoracotomy depending on the setting.
Question 4: Open chest wounds ('sucking chest wounds') are treated with:
- 3-sided occlusive dressing (or vented chest seal) to allow air out but not in (Correct answer)
- Complete occlusion with airtight dressing on all four sides
- Leaving open to allow chest to drain naturally
- Immediate needle thoracostomy without dressing
Correct answer: 3-sided occlusive dressing (or vented chest seal) to allow air out but not in
A 3-sided (or vented) dressing allows air to exit the pleural space during expiration while preventing air entrainment during inspiration, treating the open pneumothorax without converting it to a tension pneumothorax.
Question 5: The 'Zone of injury' concept in blast trauma describes:
- Three zones: the blast wave (primary), projectile fragmentation (secondary), and thrown victim (tertiary) (Correct answer)
- A single injury pattern affecting only the ears and lungs
- Exclusively penetrating injuries from shell fragments
- Only burns from the fireball
Correct answer: Three zones: the blast wave (primary), projectile fragmentation (secondary), and thrown victim (tertiary)
Blast injuries are classified by mechanism: primary (blast overpressure wave — hollow organ injuries), secondary (fragmentation — penetrating injuries), tertiary (victim displacement — blunt trauma), and quaternary (burns, toxic inhalation).
Question 6: Traction splints are specifically indicated for:
- Isolated mid-shaft femur fractures (Correct answer)
- Tibial fractures
- Open femur fractures with vascular injury
- Femoral neck (hip) fractures
Correct answer: Isolated mid-shaft femur fractures
Traction splints are indicated for isolated mid-shaft femur fractures to reduce pain, blood loss (the thigh can hold 1-2L of blood), and the risk of fat embolism by realigning the fracture under longitudinal traction.
DCAS Trauma Management 2
Traumatic brain injury (TBI) secondary injury is caused by: