TCRN Thoracic and Cardiovascular Trauma 2 — Questions and Answers
Question 1: Which chest injury is characterized by multiple rib fractures in two or more places creating a free-floating segment?
- Open pneumothorax
- Flail chest (Correct answer)
- Pulmonary contusion
- Diaphragmatic rupture
Correct answer: Flail chest
Flail chest occurs when multiple contiguous ribs fracture in two or more places, creating a segment that moves independently.
Question 2: An intubated trauma patient's ventilator shows rising peak airway pressures with sudden hemodynamic deterioration. What should the nurse suspect?
- Endotracheal tube displacement into the esophagus
- Tension pneumothorax (Correct answer)
- Ventilator malfunction
- Pulmonary embolism
Correct answer: Tension pneumothorax
Rising peak pressures combined with hemodynamic collapse in a ventilated patient strongly suggests tension pneumothorax.
Question 3: What is the most immediate intervention for an open (sucking) chest wound?
- Needle decompression at the second intercostal space
- Apply a three-sided occlusive dressing and prepare for chest tube (Correct answer)
- Pack the wound with sterile gauze
- Initiate positive pressure ventilation before any dressing
Correct answer: Apply a three-sided occlusive dressing and prepare for chest tube
A three-sided occlusive dressing allows air to escape on expiration while preventing air from entering on inspiration.
Question 4: Which finding would most suggest cardiac tamponade in a trauma patient?
- Tracheal deviation, flat neck veins, hypotension
- Beck's triad: hypotension, muffled heart sounds, and distended neck veins (Correct answer)
- Hyperresonance to percussion and absent breath sounds
- Widened pulse pressure and bounding pulses
Correct answer: Beck's triad: hypotension, muffled heart sounds, and distended neck veins
Beck's triad—hypotension, muffled heart sounds, and JVD—classically indicates pericardial tamponade.
Question 5: A penetrating chest wound at the fifth intercostal space, left midclavicular line is most likely to injure which structure?
- Thoracic aorta
- Trachea
- Heart (Correct answer)
- Left kidney
Correct answer: Heart
The heart occupies the mediastinum between approximately the second and sixth intercostal spaces; a wound at the fifth left ICL puts the left ventricle at high risk.
Question 6: Which radiographic sign on chest X-ray suggests traumatic aortic injury?
- Pneumomediastinum with subcutaneous emphysema only
- Widened mediastinum (>8 cm) with obliteration of the aortic knob (Correct answer)
- Unilateral pleural effusion without rib fractures
- Elevated left hemidiaphragm
Correct answer: Widened mediastinum (>8 cm) with obliteration of the aortic knob
A widened mediastinum on chest X-ray is a classic early radiographic sign prompting further evaluation for aortic disruption.
TCRN Thoracic and Cardiovascular Trauma 2
Which chest injury is characterized by multiple rib fractures in two or more places creating a free-floating segment?