TCRN TCRN Shock and Resuscitation 3 — Questions and Answers
Question 1: A trauma patient with suspected hemorrhagic shock has a lactate of 6.2 mmol/L. What does this value primarily indicate?
- Adequate tissue perfusion
- Severe tissue hypoperfusion and anaerobic metabolism (Correct answer)
- Mild dehydration
- Normal metabolic response to stress
Correct answer: Severe tissue hypoperfusion and anaerobic metabolism
A lactate greater than 4 mmol/L indicates severe tissue hypoperfusion and anaerobic metabolism, signaling significant hemorrhagic shock.
Question 2: Which parameter is the most sensitive early indicator of hemorrhagic shock in a healthy young trauma patient?
- Systolic blood pressure drop
- Tachycardia (Correct answer)
- Decreased urine output
- Altered mental status
Correct answer: Tachycardia
Tachycardia is the earliest and most sensitive compensatory response to hemorrhage, occurring before a significant drop in blood pressure.
Question 3: A patient receives 2L of normal saline for hemorrhagic shock resuscitation. Which metabolic complication is a concern?
- Metabolic alkalosis
- Hyperchloremic metabolic acidosis (Correct answer)
- Respiratory alkalosis
- Hyponatremic encephalopathy
Correct answer: Hyperchloremic metabolic acidosis
Large volumes of normal saline deliver a high chloride load, causing hyperchloremic (non-anion gap) metabolic acidosis.
Question 4: In permissive hypotension strategy for penetrating trauma, what is the target systolic blood pressure before hemorrhage control?
- 60-70 mmHg
- 80-90 mmHg (Correct answer)
- 100-110 mmHg
- 120 mmHg
Correct answer: 80-90 mmHg
Permissive hypotension targets a systolic BP of 80-90 mmHg to maintain minimal perfusion while avoiding dislodgment of clots before surgical hemorrhage control.
Question 5: A blunt trauma patient has absent breath sounds on the left, tracheal deviation to the right, hypotension, and SpO2 of 82%. What is the immediate action?
- Chest X-ray confirmation
- Needle decompression of the left chest (Correct answer)
- Intubation and positive pressure ventilation
- Chest tube insertion
Correct answer: Needle decompression of the left chest
Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression; do not delay for imaging in a hemodynamically unstable patient.
Question 6: Which coagulopathy triad is associated with worsening hemorrhagic shock and increased mortality in trauma?
- Hyperthermia, alkalosis, and thrombocytosis
- Hypothermia, acidosis, and coagulopathy (Correct answer)
- Hypertension, alkalosis, and hypercoagulability
- Bradycardia, hyperthermia, and polycythemia
Correct answer: Hypothermia, acidosis, and coagulopathy
The lethal triad of hypothermia, acidosis, and coagulopathy creates a self-reinforcing cycle that is associated with high mortality in hemorrhagic shock.
Question 7: A trauma patient's urine output drops to 10 mL/hr despite aggressive fluid resuscitation. What is the minimum acceptable urine output target in adults during resuscitation?
- 0.25 mL/kg/hr
- 0.5 mL/kg/hr (Correct answer)
- 1.0 mL/kg/hr
- 1.5 mL/kg/hr
Correct answer: 0.5 mL/kg/hr
A urine output of at least 0.5 mL/kg/hr is the accepted minimum target in adults, indicating adequate renal perfusion during resuscitation.
TCRN TCRN Shock and Resuscitation 3
A trauma patient with suspected hemorrhagic shock has a lactate of 6.2 mmol/L.
What does this value primarily indicate?