TNCC - Trauma Nurse Core Curriculum Head and Neck Trauma Questions and Answers 1 — Questions and Answers
Question 1: A patient arrives following a high-speed motor vehicle collision. During the secondary survey, the nurse notes clear fluid draining from the patient's left ear and ecchymosis over the mastoid process. Which type of injury are these findings most indicative of?
- Mandibular fracture
- Basilar skull fracture (Correct answer)
- Nasal bone fracture
- Cervical spine dislocation
Correct answer: Basilar skull fracture
Clear fluid drainage from the ear (CSF otorrhea) and bruising behind the ear over the mastoid process (Battle's sign) are classic clinical signs of a basilar skull fracture. These signs indicate a fracture at the base of the skull, which can tear the underlying dura mater, allowing cerebrospinal fluid to leak.
Question 2: A trauma patient presents with significant mid-face instability. Physical examination reveals that the entire hard palate and maxillary teeth can be moved as a single unit, separate from the rest of the facial skeleton. This finding is characteristic of which type of injury?
- Zygomatic arch fracture
- Naso-orbito-ethmoid (NOE) fracture
- Le Fort I fracture (Correct answer)
- Le Fort III fracture
Correct answer: Le Fort I fracture
A Le Fort I fracture is a horizontal fracture of the maxilla that runs above the level of the teeth, separating the hard palate and maxillary alveolar process from the rest of the skull. This results in a mobile or "floating palate," which is the key finding described.
Question 3: A patient is brought to the emergency department after an assault with a knife impaled in the lateral aspect of their neck, Zone II. The patient is conscious, and the airway is patent. What is the priority nursing intervention?
- Prepare for immediate removal of the knife to assess the wound.
- Apply a bulky dressing to stabilize the object in place. (Correct answer)
- Perform a detailed neurologic exam of all four extremities.
- Obtain a stat portable chest x-ray to rule out pneumothorax.
Correct answer: Apply a bulky dressing to stabilize the object in place.
The standard of care for an impaled object is to stabilize it in place and not remove it in the pre-operative setting. Removal can dislodge a clot that is tamponading a major vascular injury, leading to catastrophic hemorrhage. A bulky dressing secures the object, preventing further movement and tissue damage during transport and evaluation.
Question 4: The clinical presentation of a brief loss of consciousness at the time of injury, followed by a period of alertness and normal conversation, and then a rapid decline in neurologic status is the classic pattern for which head injury?
- Subdural hematoma
- Diffuse axonal injury
- Epidural hematoma (Correct answer)
- Intracerebral hemorrhage
Correct answer: Epidural hematoma
The classic presentation for an epidural hematoma involves an initial loss of consciousness, a subsequent "lucid interval" where the patient is awake and coherent, followed by rapid neurologic deterioration as the hematoma expands and increases intracranial pressure. This pattern is often associated with a tear in the middle meningeal artery secondary to a temporal bone fracture.
Question 5: A patient involved in a fight was struck in the anterior neck. The nurse assesses hoarseness, neck tenderness, and palpable subcutaneous emphysema. Which of the following is the MOST critical and immediate concern for this patient?
- Cervical spine fracture
- Impending airway compromise (Correct answer)
- Carotid artery dissection
- Esophageal perforation
Correct answer: Impending airway compromise
The combination of hoarseness (dysphonia), subcutaneous emphysema, and tenderness over the larynx are cardinal signs of a laryngeal or tracheal injury. These injuries can lead to rapid swelling and edema, causing a life-threatening loss of the airway. Securing the airway is the highest priority.
Question 6: A trauma patient complains of neck pain and bilateral arm paresthesia after being thrown from a horse. The patient is awake, alert, and protecting their airway. What is the immediate priority nursing action?
- Administer an anti-inflammatory medication.
- Obtain a detailed history of the event.
- Apply manual cervical spine stabilization. (Correct answer)
- Assess for perianal sensation.
Correct answer: Apply manual cervical spine stabilization.
Given the mechanism of injury and the patient's symptoms (neck pain and bilateral paresthesia), a cervical spine injury must be assumed until proven otherwise. The immediate priority is to prevent any movement of the spine that could cause or worsen a neurological deficit. Manual stabilization is the first step in spinal motion restriction.
TNCC - Trauma Nurse Core Curriculum Head and Neck Trauma Questions and Answers 1
A patient arrives following a high-speed motor vehicle collision.
During the secondary survey, the nurse notes clear fluid draining from the patient's left ear and ecchymosis over the mastoid process.
Which type of injury are these findings most indicative of?