TCRN TCRN Shock and Resuscitation 2 — Questions and Answers
Question 1: A trauma patient has BP 78/50, HR 128, distended neck veins, and muffled heart sounds after a steering wheel injury. Which intervention is the priority?
- Needle thoracostomy
- Pericardiocentesis (Correct answer)
- Emergency thoracotomy
- Massive transfusion protocol
Correct answer: Pericardiocentesis
Beck's triad (hypotension, distended neck veins, muffled heart sounds) indicates cardiac tamponade, treated emergently with pericardiocentesis.
Question 2: Which blood product ratio is recommended in damage control resuscitation for hemorrhagic shock?
- 1:1:1 (PRBCs:FFP:platelets) (Correct answer)
- 4:1:1 (PRBCs:FFP:platelets)
- 2:1:0 (PRBCs:FFP)
- 6:1:1 (PRBCs:FFP:platelets)
Correct answer: 1:1:1 (PRBCs:FFP:platelets)
Damage control resuscitation targets a 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets to approximate whole blood.
Question 3: A patient in neurogenic shock following a C5 spinal cord injury has BP 82/50 and HR 52. After fluids, BP remains low. What vasopressor is preferred?
- Norepinephrine
- Vasopressin
- Dopamine (Correct answer)
- Phenylephrine
Correct answer: Dopamine
Dopamine is preferred in neurogenic shock when bradycardia accompanies hypotension because it increases both heart rate and blood pressure.
Question 4: Which finding best distinguishes obstructive shock from hypovolemic shock on assessment?
- Tachycardia and hypotension
- Elevated JVD with hypotension (Correct answer)
- Cool clammy skin
- Narrowed pulse pressure
Correct answer: Elevated JVD with hypotension
Elevated jugular venous distension (JVD) with hypotension indicates obstructive shock (e.g., tension pneumothorax, cardiac tamponade), not hypovolemic shock.
Question 5: Tranexamic acid (TXA) is most effective when administered to hemorrhagic trauma patients within what time frame?
- Within 1 hour of injury
- Within 3 hours of injury (Correct answer)
- Within 6 hours of injury
- Within 12 hours of injury
Correct answer: Within 3 hours of injury
The CRASH-2 trial established TXA is most effective when given within 3 hours of injury; administration after 3 hours may increase mortality.
Question 6: A patient in distributive shock has warm, flushed skin and bounding pulses. What is the underlying hemodynamic mechanism?
- Decreased preload
- Decreased cardiac contractility
- Decreased systemic vascular resistance (Correct answer)
- Increased afterload
Correct answer: Decreased systemic vascular resistance
Distributive shock is characterized by pathological vasodilation causing decreased systemic vascular resistance, leading to warm flushed skin and bounding pulses.
Question 7: During massive transfusion, which electrolyte imbalance is most commonly associated with rapid infusion of packed red blood cells?
- Hypernatremia
- Hypocalcemia (Correct answer)
- Hyperkalemia
- Hypomagnesemia
Correct answer: Hypocalcemia
Citrate preservative in PRBCs chelates calcium, causing hypocalcemia during massive transfusion, which can impair cardiac contractility and coagulation.
TCRN TCRN Shock and Resuscitation 2
A trauma patient has BP 78/50, HR 128, distended neck veins, and muffled heart sounds after a steering wheel injury.
Which intervention is the priority?