DCAS Trauma Management 1 — Questions and Answers
Question 1: The ABCDE approach in trauma places haemorrhage control at which priority level?
- C (Circulation) — simultaneous with or immediately after Airway and Breathing (Correct answer)
- E (Exposure) — last priority
- D (Disability) — neurological assessment first
- It is not part of the ABCDE approach
Correct answer: C (Circulation) — simultaneous with or immediately after Airway and Breathing
In trauma, catastrophic external haemorrhage control (using the <C>ABCDE mnemonic, or 'C' in ABCDE) is treated as a simultaneous priority with airway, as uncontrolled haemorrhage is the leading preventable cause of trauma death.
Question 2: The 'Lethal Triad' in trauma refers to:
- Hypothermia, acidosis, and coagulopathy — three mutually reinforcing killers in haemorrhagic shock (Correct answer)
- Hypotension, hypoxia, and hyponatraemia
- Head injury, chest injury, and abdominal injury
- Tachycardia, hypotension, and anaemia
Correct answer: Hypothermia, acidosis, and coagulopathy — three mutually reinforcing killers in haemorrhagic shock
The lethal triad: hypothermia (impairs clotting and cardiac function), acidosis (from tissue hypoperfusion), and coagulopathy (failure of clotting mechanisms) — each worsens the others in a deadly cycle.
Question 3: Tourniquet application for extremity haemorrhage should be placed:
- 5-8cm proximal to the wound on the mid-shaft of the affected limb (Correct answer)
- Directly over the wound
- At the most distal point of the limb
- Over a joint for best compression
Correct answer: 5-8cm proximal to the wound on the mid-shaft of the affected limb
Tourniquets are applied 5-8cm proximal to the wound, mid-shaft (not over a joint), tightened until bleeding stops, time documented, and left in place until surgical haemostasis in hospital.
Question 4: In the trauma patient, haemothorax is suspected when:
- Absent breath sounds, dull percussion, and signs of hypovolaemic shock after chest trauma (Correct answer)
- Absent breath sounds and hyper-resonance to percussion
- Tracheal deviation away from the affected side
- Normal breath sounds with pleuritic chest pain
Correct answer: Absent breath sounds, dull percussion, and signs of hypovolaemic shock after chest trauma
Haemothorax presents with decreased/absent breath sounds and dullness to percussion (blood in pleural space) combined with signs of haemodynamic compromise; tracheal deviation occurs in tension pneumothorax, not simple haemothorax.
Question 5: Damage Control Surgery (DCS) focuses on:
- Rapid control of haemorrhage and contamination, temporary closure, and ICU resuscitation before definitive repair (Correct answer)
- Complete definitive surgical repair at initial operation regardless of physiological status
- Non-operative management of all abdominal injuries
- Laparoscopic repair of all penetrating abdominal wounds
Correct answer: Rapid control of haemorrhage and contamination, temporary closure, and ICU resuscitation before definitive repair
DCS limits initial surgery to abbreviated haemorrhage and contamination control, then resuscitates the patient in ICU to correct the lethal triad before returning for definitive repair when physiologically optimised.
Question 6: The preferred initial fluid for haemorrhagic shock in modern damage control resuscitation is:
- Blood products in a 1:1:1 ratio (packed red cells : plasma : platelets) where available (Correct answer)
- 2 litres of normal saline as an immediate bolus
- Colloid solutions (albumin or gelatin)
- Dextrose 5% in water
Correct answer: Blood products in a 1:1:1 ratio (packed red cells : plasma : platelets) where available
Modern damage control resuscitation prioritises blood products in balanced ratios to replace haemorrhage losses while preserving coagulation, avoiding the dilutional coagulopathy caused by large volumes of crystalloid.
DCAS Trauma Management 1
The ABCDE approach in trauma places haemorrhage control at which priority level?