Free Paramedics Trauma Assessment and Management Questions and Answers — Questions and Answers
Question 1: A 22-year-old male presents with a single stab wound to the right side of his chest. He is anxious, tachycardic at 130 bpm, and hypotensive at 80/50 mmHg. You note absent breath sounds on the right, jugular vein distention, and tracheal deviation to the left. What is the most critical immediate intervention?
- Apply a high-flow oxygen mask.
- Perform needle decompression of the right chest. (Correct answer)
- Apply an occlusive dressing to the chest wound.
- Initiate a rapid fluid bolus with normal saline.
Correct answer: Perform needle decompression of the right chest.
The patient's signs and symptoms (hypotension, JVD, absent breath sounds, and tracheal deviation) are classic for a tension pneumothorax, which is an immediate life-threatening emergency. Needle decompression is the critical intervention to relieve the pressure in the pleural space, allowing the lung to re-expand and relieving pressure on the heart and great vessels.
Question 2: You are treating a 45-year-old female who fell from a ladder. She has a decreased level of consciousness (GCS 9) and a fixed and dilated right pupil. Her vital signs are: BP 180/100 mmHg, HR 50 bpm, and an irregular respiratory rate of 8 breaths/minute. This presentation is most consistent with which of the following?
- Neurogenic shock
- Beck's triad
- Cushing's triad (Correct answer)
- Decompensated hypovolemic shock
Correct answer: Cushing's triad
Cushing's triad is a late sign of increased intracranial pressure (ICP) and impending brain herniation. It consists of hypertension (specifically, a widening pulse pressure), bradycardia, and irregular respirations. Beck's triad (hypotension, JVD, muffled heart sounds) indicates cardiac tamponade.
Question 3: In the management of a trauma patient with suspected internal, uncontrolled hemorrhage and signs of shock, which of the following fluid resuscitation strategies is most appropriate prior to definitive surgical control?
- Administer two large-bore IVs with fluids wide open to rapidly normalize blood pressure to 120/80 mmHg.
- Withhold all IV fluids until arrival at the hospital to avoid hemodilution.
- Administer vasopressors as the first-line treatment to increase systemic vascular resistance.
- Administer small fluid boluses with the goal of achieving a palpable radial pulse or a systolic blood pressure of 80-90 mmHg. (Correct answer)
Correct answer: Administer small fluid boluses with the goal of achieving a palpable radial pulse or a systolic blood pressure of 80-90 mmHg.
The concept of permissive hypotension, or hypotensive resuscitation, is the current standard for trauma patients with uncontrolled hemorrhage. The goal is to maintain just enough blood pressure to perfuse vital organs without raising the pressure so high that it disrupts existing clots ('popping the clot') and worsens the hemorrhage. Aggressive fluid resuscitation to normalize blood pressure can also lead to hemodilution and coagulopathy.
Question 4: A 30-year-old unrestrained driver was involved in a high-speed frontal collision. The patient is pale, diaphoretic, and complaining of severe lower abdominal and hip pain. Palpation of the pelvis reveals instability. Vital signs are BP 88/50 mmHg and HR 128 bpm. What is the most appropriate initial intervention?
- Log roll the patient onto a long spine board for immobilization.
- Apply a commercially approved pelvic binder or an improvised sheet sling. (Correct answer)
- Vigorously palpate the pelvis again to confirm the extent of the fracture.
- Place the patient in a position of comfort with knees flexed.
Correct answer: Apply a commercially approved pelvic binder or an improvised sheet sling.
The signs and symptoms strongly suggest an unstable pelvic fracture, which can cause massive internal hemorrhage. Applying a pelvic binder is a critical intervention to stabilize the pelvis, reduce the pelvic volume, and help tamponade bleeding. Log rolling can worsen the injury and increase bleeding and should be avoided.
Question 5: A 70 kg adult patient has sustained full-thickness burns to his entire left arm and the anterior trunk. According to the Parkland formula, how much intravenous fluid should be administered in the first 8 hours from the time of the burn?
- 2,520 mL
- 5,040 mL
- 3,780 mL (Correct answer)
- 7,560 mL
Correct answer: 3,780 mL
First, calculate the Total Body Surface Area (TBSA) burned using the Rule of Nines: Entire left arm = 9%, Anterior trunk = 18%. Total TBSA = 27%. The Parkland formula is 4 mL x patient weight (kg) x %TBSA. Calculation: 4 mL x 70 kg x 27% = 7,560 mL total fluid in 24 hours. The first half of this total is given in the first 8 hours: 7,560 mL / 2 = 3,780 mL.
Question 6: When applying a commercially manufactured windlass-style tourniquet to control massive hemorrhage from a limb, which of the following is the most appropriate procedure?
- Apply the tourniquet 2-3 inches proximal to the wound and tighten until the distal pulse is absent. (Correct answer)
- Place the tourniquet directly over the wound to apply pressure.
- Tighten the tourniquet until the bleeding slows to a manageable ooze.
- Loosen the tourniquet every 15 minutes to allow for distal perfusion.
Correct answer: Apply the tourniquet 2-3 inches proximal to the wound and tighten until the distal pulse is absent.
According to TCCC and other modern hemorrhage control guidelines, a tourniquet should be placed 2-3 inches proximal to the injury (but not over a joint). It must be tightened until all distal pulses are eliminated and the bleeding has stopped completely. Loosening a tourniquet in the prehospital setting is not recommended as it can lead to re-bleeding and is ineffective.
Free Paramedics Trauma Assessment and Management Questions and Answers
A 22-year-old male presents with a single stab wound to the right side of his chest.
He is anxious, tachycardic at 130 bpm, and hypotensive at 80/50 mmHg.
You note absent breath sounds on the right, jugular vein distention, and tracheal deviation to the left.
What is the most critical immediate intervention?