TSS Critical Care & Stabilization 5 — Questions and Answers
Question 1: Using the Parkland formula, how much fluid should a 70 kg adult with 30% TBSA burns receive in the first 8 hours?
- 2,100 mL
- 2,800 mL
- 8,400 mL
- 4,200 mL (Correct answer)
Correct answer: 4,200 mL
4 mL × 70 kg × 30% equals 8,400 mL over 24 hours, and half (4,200 mL) is given in the first 8 hours from the time of injury.
Question 2: What is the appropriate prehospital treatment for an open (sucking) chest wound?
- Fully occlusive gauze packed into the wound
- Vented chest seal or three-sided occlusive dressing (Correct answer)
- Leave the wound uncovered
- Immediate needle decompression on the opposite side
Correct answer: Vented chest seal or three-sided occlusive dressing
A vented or three-sided dressing lets air escape and prevents a tension pneumothorax from developing.
Question 3: Which initial chest tube output suggests a massive hemothorax that may need operative thoracotomy?
- 1,500 mL or more of immediate blood output (Correct answer)
- 200 mL of immediate blood output
- 500 mL of serous fluid
- Any amount of air leak
Correct answer: 1,500 mL or more of immediate blood output
An immediate return of 1,500 mL or more, or continued output above 200 mL/h for 2–4 hours, is a typical trigger for thoracotomy.
Question 4: A patient with a cervical spinal cord injury stays hypotensive after appropriate fluid resuscitation, and hemorrhage has been ruled out. What is the next step?
- Additional large-volume crystalloid boluses
- High-dose methylprednisolone
- Vasopressor support such as norepinephrine (Correct answer)
- Trendelenburg positioning only
Correct answer: Vasopressor support such as norepinephrine
Neurogenic shock is a problem of lost vascular tone, so vasopressors are needed once volume has been replaced.
Question 5: What is the main purpose of the FAST exam in an unstable trauma patient?
- Grading solid-organ injury
- Diagnosing pelvic fractures
- Identifying hollow-viscus perforation
- Detecting free fluid in the pericardium and peritoneum (Correct answer)
Correct answer: Detecting free fluid in the pericardium and peritoneum
FAST quickly finds hemoperitoneum or pericardial fluid at the bedside to guide decisions about surgery.
Question 6: After a prolonged crush entrapment is released, which ECG finding suggests a dangerous electrolyte shift?
- Prominent U waves
- Peaked T waves (Correct answer)
- Prolonged QT with flattened T waves
- Delta waves
Correct answer: Peaked T waves
Reperfusion releases potassium from damaged muscle, and hyperkalemia appears first as peaked T waves.
Question 7: In a ventilated patient with severe TBI and no signs of herniation, what PaCO2 range is generally targeted?
- 20–25 mmHg
- 25–30 mmHg
- 35–45 mmHg (Correct answer)
- 50–55 mmHg
Correct answer: 35–45 mmHg
Normocapnia is maintained routinely, and brief hyperventilation is reserved for signs of herniation because low CO2 causes cerebral vasoconstriction and ischemia.
