CCRN Multisystem Trauma and Shock 3 — Questions and Answers
Question 1: What is the recommended ratio of packed red blood cells, plasma, and platelets in a massive transfusion protocol?
- 4:1:1
- 1:1:1 (Correct answer)
- 2:1:1
- 3:2:1
Correct answer: 1:1:1
A balanced 1:1:1 ratio of PRBCs, FFP, and platelets best mimics whole blood and reduces coagulopathy.
Question 2: Which component of the 'lethal triad' of trauma worsens as a result of large-volume crystalloid resuscitation?
- Hypercoagulability
- Hypothermia and coagulopathy (Correct answer)
- Hyperthermia
- Alkalosis
Correct answer: Hypothermia and coagulopathy
The lethal triad is hypothermia, acidosis, and coagulopathy, all aggravated by excessive crystalloid.
Question 3: A trauma patient receiving massive transfusion develops perioral tingling and a prolonged QT interval. What electrolyte abnormality is most likely?
- Hyperkalemia
- Hypocalcemia (Correct answer)
- Hypernatremia
- Hypomagnesemia
Correct answer: Hypocalcemia
Citrate in stored blood binds calcium, causing hypocalcemia with QT prolongation and perioral tingling.
Question 4: Which assessment finding most strongly suggests an obstructive cause of shock rather than hypovolemia?
- Flat neck veins
- Distended neck veins (Correct answer)
- Warm extremities
- Bounding pulses
Correct answer: Distended neck veins
Distended neck veins suggest obstructive shock (tamponade or tension pneumothorax), whereas hypovolemia produces flat neck veins.
Question 5: What is the primary goal of damage control surgery in the unstable polytrauma patient?
- Complete definitive repair
- Control hemorrhage and contamination (Correct answer)
- Cosmetic restoration
- Immediate fracture fixation
Correct answer: Control hemorrhage and contamination
Damage control surgery prioritizes rapid hemorrhage and contamination control over definitive repair to avoid the lethal triad.
Question 6: Tranexamic acid (TXA) is most beneficial when administered to a trauma patient within what timeframe?
- Within 3 hours of injury (Correct answer)
- Within 12 hours of injury
- Within 24 hours of injury
- Only after 6 hours
Correct answer: Within 3 hours of injury
TXA reduces mortality when given within 3 hours of injury and may increase harm if given later.
Question 7: Which sign indicates that fluid resuscitation has restored adequate end-organ perfusion?
- Rising lactate
- Urine output of 0.5 mL/kg/hr or more (Correct answer)
- Worsening base deficit
- Increasing capillary refill time
Correct answer: Urine output of 0.5 mL/kg/hr or more
Urine output of at least 0.5 mL/kg/hr indicates adequate renal perfusion and effective resuscitation.
CCRN Multisystem Trauma and Shock 3
What is the recommended ratio of packed red blood cells, plasma, and platelets in a massive transfusion protocol?