TCRN Head and Neck Trauma Questions and Answers

Question 1

A trauma patient presents with periorbital ecchymosis (raccoon eyes), postauricular ecchymosis (Battle's sign), and clear fluid draining from the nares. Which type of head injury are these findings most indicative of?

Accepted Answer

Basilar skull fracture

Answer

The classic signs of a basilar skull fracture include periorbital ecchymosis (raccoon eyes), postauricular ecchymosis (Battle's sign), hemotympanum (blood behind the eardrum), and cerebrospinal fluid (CSF) rhinorrhea or otorrhea. [2, 3, 4, 5] These signs result from fractures to the bones at the base of the skull.

Question 2

A patient involved in a high-speed motor vehicle collision has significant mid-face trauma, including mobility of the entire maxilla and zygomatic bones, resulting in craniofacial disjunction. Which Le Fort fracture classification does this presentation represent?

Accepted Answer

Le Fort III

Answer

A Le Fort III fracture, also known as craniofacial disjunction, is the most severe type of Le Fort fracture. It involves a transverse fracture line that passes through the nasofrontal suture, maxillo-frontal suture, orbital wall, and zygomatic arch, effectively separating the entire facial skeleton from the cranial base. [17, 23, 27] Le Fort I is a horizontal maxillary fracture, and Le Fort II is a pyramidal fracture.

Question 3

A trauma nurse is assessing a patient with a penetrating neck injury located in Zone II. Which of the following is considered a 'hard sign' of significant vascular or airway injury, mandating immediate surgical exploration?

Accepted Answer

Pulsatile external bleeding

Answer

Hard signs of penetrating neck trauma indicate a high probability of significant injury and often require immediate surgical intervention. These signs include active, pulsatile bleeding, an expanding hematoma, shock, diminished carotid pulse, bruit or thrill, and signs of airway obstruction like stridor. [7, 18] Dysphonia, non-expanding hematoma, and subcutaneous emphysema are considered 'soft signs,' which warrant further diagnostic evaluation but not necessarily immediate surgery.

Question 4

A patient arrives after being struck in the anterior neck with a baseball bat. They are hoarse, have subcutaneous emphysema, and are in moderate respiratory distress. What is the most appropriate initial airway management strategy for this patient?

Accepted Answer

Awake surgical cricothyroidotomy or tracheostomy

Answer

In patients with suspected severe laryngeal or tracheal trauma, attempts at endotracheal intubation can worsen the injury, create a false passage, or cause complete airway obstruction. [16, 21, 22] Therefore, the safest and most definitive airway is an awake surgical airway (cricothyroidotomy or tracheostomy), performed by an experienced provider, to bypass the injured area.

Question 5

According to the NEXUS (National Emergency X-Radiography Utilization Study) low-risk criteria, which of the following findings would require cervical spine imaging in a trauma patient?

Accepted Answer

A distracting painful injury, such as a femur fracture

Answer

The NEXUS criteria are used to clinically clear the cervical spine without imaging. Imaging is required if any of the five criteria are met: 1) posterior midline cervical tenderness, 2) focal neurologic deficit, 3) altered level of consciousness, 4) evidence of intoxication, or 5) a distracting painful injury. [1, 13] A distracting injury may prevent the patient from accurately reporting neck pain.

TCRN Exam Practice Test

TCRN Exam Practice Test

TCRN Head and Neck Trauma Questions and Answers