BCEN Trauma and Injury Management 1 — Questions and Answers
Question 1: A 30-year-old male is brought to the ER after a high-speed motor vehicle collision. He is unresponsive, with a Glasgow Coma Scale (GCS) score of 8. Which of the following should be your first priority?
- Administer pain relief
- Obtain a full set of vital signs
- Secure the airway and provide oxygenation (Correct answer)
- Perform a full trauma assessment
Correct answer: Secure the airway and provide oxygenation
In a trauma patient with a Glasgow Coma Scale (GCS) score of 8, the patient is considered to have a compromised airway and is at high risk for aspiration and respiratory compromise. According to the ABCs (Airway, Breathing, Circulation) of trauma management, securing the airway (e.g., intubation) and ensuring adequate oxygenation are the absolute first priorities. This prevents further brain injury and ensures vital organ perfusion.
Question 2: A 24-year-old female presents with a suspected fractured femur after a fall from a height. She is in severe pain, with visible deformity in the leg. What is the most appropriate intervention?
- Administer intravenous pain medication and immobilize the limb (Correct answer)
- Perform a neurovascular assessment of the extremity
- Apply traction to the fractured leg
- Immediately initiate blood transfusion
Correct answer: Administer intravenous pain medication and immobilize the limb
For a suspected fractured femur with severe pain and visible deformity, the immediate priorities are to manage pain and prevent further injury. Administering intravenous pain medication provides rapid relief, while immobilizing the limb (e.g., with a splint) prevents movement at the fracture site. This reduces pain, prevents further soft tissue damage, and minimizes the risk of neurovascular compromise, improving patient comfort and outcomes.
Question 3: A 45-year-old male with a history of alcohol use disorder presents with confusion, slurred speech, and weakness on the right side after falling down stairs. He is conscious but disoriented. What is the most appropriate next step in your assessment?
- Perform a CT scan to rule out a head injury or hemorrhage (Correct answer)
- Administer glucose to rule out hypoglycemia
- Check for cervical spine injury
- Obtain an electrocardiogram (ECG) to rule out arrhythmia
Correct answer: Perform a CT scan to rule out a head injury or hemorrhage
The patient's presentation with confusion, slurred speech, and unilateral weakness after a fall, especially with a history of alcohol use disorder (which increases the risk of falls and head injury), is highly concerning for an intracranial injury such as a subdural or epidural hematoma, or a stroke. A CT scan of the head is the most appropriate and urgent diagnostic step to identify or rule out these critical conditions, guiding immediate management.
Question 4: A 52-year-old male presents with a stab wound to the abdomen. He is conscious but appears pale and diaphoretic. His blood pressure is 90/60, and his heart rate is 120 bpm. What is the most appropriate first intervention?
- Administer pain medication and prepare for surgery
- Initiate fluid resuscitation with IV normal saline (Correct answer)
- Place a chest tube to relieve tension pneumothorax
- Perform a detailed abdominal exam to locate the injury
Correct answer: Initiate fluid resuscitation with IV normal saline
A patient with a stab wound to the abdomen, appearing pale, diaphoretic, hypotensive (90/60), and tachycardic (120 bpm), is showing signs of hypovolemic shock likely due to internal bleeding. The most appropriate first intervention is rapid fluid resuscitation with IV normal saline to restore circulating volume and improve perfusion. This is a critical life-saving measure to stabilize the patient before definitive surgical intervention.
Question 5: A 65-year-old male presents with a suspected spinal cord injury after a fall. He has no sensation or movement in his legs and is unable to move his arms. His blood pressure is 85/50, heart rate 50 bpm, and his respiratory rate is 8. What is the most appropriate intervention?
- Administer high-dose corticosteroids to reduce swelling
- Administer fluids and atropine to address hypotension and bradycardia (Correct answer)
- Intubate the patient and secure the airway
- Place the patient in a sitting position to facilitate breathing
Correct answer: Administer fluids and atropine to address hypotension and bradycardia
The patient's presentation with suspected spinal cord injury, absent sensation/movement in legs and arms, hypotension (85/50), bradycardia (50 bpm), and bradypnea (8 bpm) is classic for neurogenic shock. This condition results from loss of sympathetic tone, leading to vasodilation and bradycardia. Administering fluids helps address vasodilation, while atropine is used to treat symptomatic bradycardia, both crucial for stabilizing hemodynamics and ensuring organ perfusion.
BCEN Trauma and Injury Management 1
A 30-year-old male is brought to the ER after a high-speed motor vehicle collision.
He is unresponsive, with a Glasgow Coma Scale (GCS) score of 8.
Which of the following should be your first priority?