TCRN TCRN Shock and Resuscitation 5 — Questions and Answers
Question 1: A trauma patient with known coagulopathy and hemorrhagic shock has a fibrinogen level of 80 mg/dL. Which product should be prioritized?
- Fresh frozen plasma
- Cryoprecipitate (Correct answer)
- Platelets
- Packed red blood cells
Correct answer: Cryoprecipitate
Cryoprecipitate is the most concentrated source of fibrinogen and is indicated when fibrinogen is critically low (below 100-150 mg/dL) in coagulopathic hemorrhage.
Question 2: When managing hemorrhagic shock with a junctional wound (groin/axilla) where direct pressure is ineffective, what device is recommended?
- Wound packing with hemostatic gauze only
- Junctional tourniquet (e.g., JETT or SAM-JT) (Correct answer)
- Standard pneumatic tourniquet
- Pressure dressing and elevation
Correct answer: Junctional tourniquet (e.g., JETT or SAM-JT)
Junctional tourniquets like the JETT or SAM-JT are designed to control hemorrhage in anatomical junctions where limb tourniquets cannot be applied.
Question 3: A patient presents with anaphylactic shock with refractory hypotension despite epinephrine. The patient takes lisinopril daily. Why may epinephrine be less effective?
- Lisinopril blocks beta receptors used by epinephrine
- ACE inhibitor use is associated with bradykinin accumulation causing refractory vasodilation (Correct answer)
- Lisinopril prevents histamine release, masking epinephrine response
- ACE inhibitors sensitize mast cells to catecholamines
Correct answer: ACE inhibitor use is associated with bradykinin accumulation causing refractory vasodilation
ACE inhibitors block bradykinin breakdown, leading to bradykinin accumulation that causes severe vasodilation refractory to epinephrine in anaphylaxis.
Question 4: Which finding on point-of-care ultrasound (POCUS/FAST exam) indicates a hemodynamically significant pericardial effusion causing obstructive shock?
- Left ventricular hypertrophy
- Right ventricular diastolic collapse (Correct answer)
- Dilated inferior vena cava with respiratory variation
- Hyperkinetic left ventricle
Correct answer: Right ventricular diastolic collapse
Right ventricular diastolic collapse on ultrasound is the hallmark sign of cardiac tamponade causing hemodynamically significant pericardial effusion.
Question 5: A pediatric trauma patient weighing 20 kg is in hemorrhagic shock. What is the initial fluid bolus dose?
- 200 mL of normal saline
- 300 mL of normal saline (Correct answer)
- 1,000 mL of lactated Ringer's
- 500 mL of normal saline
Correct answer: 300 mL of normal saline
Pediatric initial fluid resuscitation for hemorrhagic shock is 10-20 mL/kg; for a 20 kg child, 300 mL represents a 15 mL/kg bolus within this range.
Question 6: Which vasopressor has both alpha-1 and beta-1 agonist activity, making it first-line for most types of shock requiring vasopressor support?
- Phenylephrine
- Vasopressin
- Norepinephrine (Correct answer)
- Dobutamine
Correct answer: Norepinephrine
Norepinephrine's combined alpha-1 (vasoconstriction) and beta-1 (inotropy) activity makes it the first-line vasopressor for most shock states including septic and distributive shock.
Question 7: A trauma patient is in shock with penetrating abdominal trauma. The FAST exam shows free fluid. Despite two large-bore IVs and rapid infusion, BP remains 68/40. What is the definitive management?
- Continue aggressive IV fluid resuscitation until normotensive
- Administer vasopressors to bridge to OR
- Emergent surgical hemorrhage control in the operating room (Correct answer)
- Interventional radiology embolization
Correct answer: Emergent surgical hemorrhage control in the operating room
Hemorrhagic shock from penetrating abdominal trauma with free fluid requires emergent operative hemorrhage control; ongoing resuscitation without source control is futile.
TCRN TCRN Shock and Resuscitation 5
A trauma patient with known coagulopathy and hemorrhagic shock has a fibrinogen level of 80 mg/dL.
Which product should be prioritized?