CCRN - Review Multisystem Trauma and Shock Questions and Answers 1 — Questions and Answers
Question 1: A 34-year-old male is admitted to the ICU after a high-speed motor vehicle collision. The patient is intubated, has bilateral chest tubes, and an external fixator on a fractured pelvis. Initial labs show a pH of 7.18, a temperature of 35.1°C (95.2°F), and an INR of 2.1. The nurse recognizes these findings as components of which critical condition in trauma?
- Disseminated Intravascular Coagulation (DIC)
- Systemic Inflammatory Response Syndrome (SIRS)
- The Trauma Triad of Death (Correct answer)
- Multiple Organ Dysfunction Syndrome (MODS)
Correct answer: The Trauma Triad of Death
The Trauma Triad of Death is a vicious cycle consisting of hypothermia, metabolic acidosis, and coagulopathy. The patient's low temperature (35.1°C), low pH (7.18), and elevated INR (2.1) directly represent these three components. This triad significantly increases mortality in severely injured patients.
Question 2: A patient arrives in the ICU after a severe crush injury to both lower extremities. The urine is dark reddish-brown, and the serum Creatine Kinase (CK) level is 65,000 U/L. Which of the following interventions is the highest priority to prevent a common, life-threatening complication of this condition?
- Administering sodium polystyrene sulfonate
- Preparing the patient for emergent fasciotomy
- Initiating aggressive intravenous fluid resuscitation (Correct answer)
- Applying a warming blanket to correct hypothermia
Correct answer: Initiating aggressive intravenous fluid resuscitation
The patient is experiencing rhabdomyolysis, where myoglobin is released from damaged muscle tissue. Myoglobin is nephrotoxic and can cause acute kidney injury (AKI) by obstructing renal tubules. The priority intervention is aggressive intravenous fluid resuscitation to increase renal blood flow and flush the myoglobin through the kidneys, thereby preventing AKI.
Question 3: A 25-year-old patient with a C4 spinal cord injury is hypotensive with a blood pressure of 82/46 mmHg and a heart rate of 50 bpm. The skin is warm and dry. Which type of shock is most consistent with this clinical presentation?
- Cardiogenic Shock
- Hypovolemic Shock
- Anaphylactic Shock
- Neurogenic Shock (Correct answer)
Correct answer: Neurogenic Shock
Neurogenic shock is characterized by hypotension due to massive vasodilation and bradycardia due to the loss of sympathetic nervous system tone and unopposed vagal (parasympathetic) activity. The presence of hypotension combined with a low heart rate and warm, dry skin is the classic presentation, distinguishing it from other forms of shock that typically involve a compensatory tachycardia.
Question 4: A patient with blunt abdominal trauma has received 12 units of packed red blood cells, 8 units of fresh frozen plasma, and 2 units of platelets. The nurse notes the development of a prolonged QT interval on the cardiac monitor and new-onset muscle tremors. Which electrolyte imbalance should the nurse suspect?
- Hyperkalemia
- Hypocalcemia (Correct answer)
- Hypermagnesemia
- Hyponatremia
Correct answer: Hypocalcemia
Blood products are preserved with citrate, which acts as an anticoagulant by binding to calcium. During massive transfusion, the liver's ability to metabolize citrate can be overwhelmed, leading to a rapid decrease in ionized calcium levels (hypocalcemia). Clinical signs of hypocalcemia include muscle tremors, a prolonged QT interval, and myocardial depression.
Question 5: A critical care nurse is caring for a patient who underwent an emergency laparotomy for a ruptured spleen. Over the past two hours, the nurse notes the patient's abdomen is becoming increasingly tense and distended, peak airway pressures are rising, and urine output has dropped to less than 10 mL/hr despite adequate MAP. These findings are most indicative of what complication?
- Septic shock
- Hemorrhagic shock
- Abdominal Compartment Syndrome (Correct answer)
- Acute mesenteric ischemia
Correct answer: Abdominal Compartment Syndrome
Abdominal Compartment Syndrome (ACS) is a life-threatening condition caused by increased intra-abdominal pressure. This pressure compromises blood flow to organs and impairs physiologic function. Key signs include a tense, distended abdomen, increased airway pressures (due to elevation of the diaphragm), and oliguria/anuria from renal vein compression and reduced perfusion, all of which are present in this patient.
Question 6: A patient is admitted to the ICU with multiple stab wounds to the chest. The patient is hypotensive (BP 80/55 mmHg), tachycardic (HR 130 bpm), has muffled heart sounds, and pronounced jugular venous distention (JVD). A bedside ultrasound reveals fluid in the pericardial sac. Which type of shock is this patient experiencing?
- Obstructive Shock (Correct answer)
- Distributive Shock
- Hypovolemic Shock
- Cardiogenic Shock
Correct answer: Obstructive Shock
This patient's presentation is classic for cardiac tamponade, a cause of obstructive shock. The combination of hypotension, muffled heart sounds, and JVD is known as Beck's triad. In obstructive shock, a physical obstruction (in this case, fluid in the pericardium) prevents the heart from filling and pumping effectively, leading to decreased cardiac output and shock, despite normal myocardial function and intravascular volume.
CCRN - Review Multisystem Trauma and Shock Questions and Answers 1
A 34-year-old male is admitted to the ICU after a high-speed motor vehicle collision.
The patient is intubated, has bilateral chest tubes, and an external fixator on a fractured pelvis.
Initial labs show a pH of 7.18, a temperature of 35.1°C (95.2°F), and an INR of 2.1.
The nurse recognizes these findings as components of which critical condition in trauma?