TNCC Pediatric Trauma 2 — Questions and Answers
Question 1: A 3-year-old is brought in after a motor vehicle crash. Which anatomical feature makes pediatric airway management uniquely challenging compared to adults?
- Larger tracheal diameter
- Proportionally larger occiput causing neck flexion when supine (Correct answer)
- More rigid chest wall reducing lung compliance
- Smaller tongue relative to oral cavity
Correct answer: Proportionally larger occiput causing neck flexion when supine
The proportionally larger occiput in young children causes passive neck flexion when supine, which can obstruct the airway without proper positioning.
Question 2: When calculating estimated blood volume for a pediatric trauma patient weighing 20 kg, what is the approximate total blood volume?
- 800 mL
- 1000 mL
- 1600 mL (Correct answer)
- 2000 mL
Correct answer: 1600 mL
Pediatric blood volume is approximately 80 mL/kg, so a 20 kg child has an estimated blood volume of 1600 mL.
Question 3: A 7-year-old with blunt abdominal trauma has a rigid abdomen and tachycardia. Which organ is most commonly injured in pediatric blunt abdominal trauma?
- Liver
- Spleen (Correct answer)
- Kidney
- Bowel
Correct answer: Spleen
The spleen is the most commonly injured organ in pediatric blunt abdominal trauma due to its relatively unprotected position and large size.
Question 4: Which pain scale is most appropriate for assessing pain in a 2-year-old pediatric trauma patient who cannot verbalize?
- Numeric Rating Scale (NRS)
- Visual Analog Scale (VAS)
- FLACC scale (Correct answer)
- Wong-Baker FACES scale
Correct answer: FLACC scale
The FLACC (Face, Legs, Activity, Cry, Consolability) scale is the validated tool for assessing pain in non-verbal and pre-verbal children.
Question 5: A 5-year-old trauma patient is in compensated shock. Which vital sign finding best indicates early compensated shock in a pediatric patient?
- Hypotension
- Bradycardia
- Tachycardia with normal blood pressure (Correct answer)
- Widened pulse pressure
Correct answer: Tachycardia with normal blood pressure
Children compensate effectively for blood loss by increasing heart rate while maintaining blood pressure until approximately 30–40% of blood volume is lost.
Question 6: When immobilizing a pediatric patient on a long backboard, what modification is required for children under age 8?
- Apply a rigid cervical collar two sizes larger than adults
- Place padding under the occiput to maintain neutral alignment
- Place padding under the torso to elevate the chest (Correct answer)
- Avoid cervical collar application entirely
Correct answer: Place padding under the torso to elevate the chest
In children under 8, the large occiput causes neck flexion on a flat board, so padding is placed under the torso (not the head) to maintain neutral cervical alignment.
Question 7: A pediatric trauma patient weighing 15 kg presents in hemorrhagic shock. What is the initial isotonic crystalloid bolus volume per TNCC guidelines?
- 150 mL
- 300 mL (Correct answer)
- 450 mL
- 600 mL
Correct answer: 300 mL
TNCC guidelines recommend an initial fluid bolus of 20 mL/kg isotonic crystalloid for pediatric hemorrhagic shock; 20 mL/kg × 15 kg = 300 mL.
TNCC Pediatric Trauma 2
A 3-year-old is brought in after a motor vehicle crash.
Which anatomical feature makes pediatric airway management uniquely challenging compared to adults?