DCAS Trauma Management 3 — Questions and Answers
Question 1: A tension pneumothorax causes tracheal deviation toward which side?
- Away from the affected side (tension side) (Correct answer)
- Toward the affected side
- Tracheal deviation does not occur in tension pneumothorax
- Toward the midline
Correct answer: Away from the affected side (tension side)
As air accumulates under tension, the affected side's pressure pushes mediastinal structures — including the trachea — toward the contralateral (unaffected) side; this is a late and unreliable sign.
Question 2: Massive haemothorax is defined as initial drainage of more than:
- 1500ml of blood from the chest on tube thoracostomy (Correct answer)
- 500ml
- 750ml
- 300ml
Correct answer: 1500ml of blood from the chest on tube thoracostomy
Massive haemothorax is defined by drainage of ≥1500ml immediately on chest tube insertion, or ongoing haemorrhage >200ml/hour — indicating injury to major vessels requiring surgical intervention.
Question 3: In a penetrating abdominal trauma with evisceration, pre-hospital management includes:
- Covering eviscerated organs with moist dressing without attempting to replace them, and rapid transport (Correct answer)
- Pushing organs back into the abdominal cavity and covering with a dry dressing
- Cutting the eviscerated bowel and sending the patient to surgery
- Applying firm circumferential bandaging directly over the organs
Correct answer: Covering eviscerated organs with moist dressing without attempting to replace them, and rapid transport
Eviscerated organs should be covered with a moist sterile dressing to prevent desiccation, not pushed back (risk of contamination and injury), and the patient transported urgently to surgery.
Question 4: Spinal cord injury management in the pre-hospital setting focuses on:
- Preventing secondary cord injury through maintaining perfusion, oxygenation, and avoiding hypotension (Correct answer)
- Complete neurological assessment before any movement
- Immediate pharmacological neuroprotection with high-dose steroids
- Spinal surgical planning at the scene
Correct answer: Preventing secondary cord injury through maintaining perfusion, oxygenation, and avoiding hypotension
Secondary spinal cord injury from hypotension, hypoxia, and excessive movement can worsen outcomes; maintaining MAP ≥85-90 mmHg (in suspected spinal cord injury) and adequate oxygenation are the key pre-hospital interventions.
Question 5: Pre-hospital wound packing with haemostatic dressings (e.g., Combat Gauze) is indicated for:
- Junctional haemorrhage (groin, axilla, neck) where tourniquets cannot be applied (Correct answer)
- All surface wounds regardless of severity
- Minor lacerations that are actively bleeding
- Wounds that have already stopped bleeding
Correct answer: Junctional haemorrhage (groin, axilla, neck) where tourniquets cannot be applied
Junctional areas (groin, axillary, and neck) cannot be controlled with conventional tourniquets; haemostatic gauze packed firmly into the wound with direct manual pressure for 3-5 minutes controls these life-threatening bleeds.
Question 6: The abdominal trauma assessment tool used in hospitals (FAST exam) evaluates:
- Focused Assessment with Sonography in Trauma — looking for free fluid in pericardium, Morrison's pouch, splenorenal space, and pelvis (Correct answer)
- Functional Assessment of Surgical Trauma
- Field Assessment and Stabilisation Tool
- Full Abdominal Screening Test
Correct answer: Focused Assessment with Sonography in Trauma — looking for free fluid in pericardium, Morrison's pouch, splenorenal space, and pelvis
FAST uses bedside ultrasound to detect haemoperitoneum and haemopericardium, identifying free fluid (blood) in four standard views — pericardial, hepatorenal, splenorenal, and pelvic — guiding urgent surgical intervention.
DCAS Trauma Management 3
A tension pneumothorax causes tracheal deviation toward which side?