CEN Trauma Emergencies 1 — Questions and Answers
Question 1: During the primary survey of a trauma patient, which step follows airway management?
- Disability (neurological status)
- Circulation with hemorrhage control
- Breathing and ventilation (Correct answer)
- Exposure and environment control
Correct answer: Breathing and ventilation
The ATLS primary survey follows A-B-C-D-E: Airway → Breathing → Circulation → Disability → Exposure.
Question 2: A patient arrives after a motor vehicle accident. He is hypotensive with a distended abdomen and a seatbelt sign. What is the most appropriate rapid assessment?
- CT abdomen/pelvis with contrast
- Diagnostic peritoneal lavage (DPL)
- Focused Assessment with Sonography for Trauma (FAST) (Correct answer)
- Plain abdominal X-ray
Correct answer: Focused Assessment with Sonography for Trauma (FAST)
FAST exam rapidly detects free intra-abdominal fluid (blood) at the bedside and can immediately guide surgical decision-making in a hemodynamically unstable patient.
Question 3: What is the initial fluid of choice for hemorrhagic shock in a trauma patient according to current guidelines?
- Normal saline 2L IV bolus
- Packed red blood cells with balanced resuscitation (Correct answer)
- Dextrose 5% in water 1L
- Colloid solution (albumin) 500 mL
Correct answer: Packed red blood cells with balanced resuscitation
Current damage control resuscitation guidelines favor early use of packed RBCs in a 1:1:1 ratio with FFP and platelets rather than crystalloid, to restore both volume and coagulation factors.
Question 4: A trauma patient has a blood pressure of 70/40 mmHg with absent JVD and dullness to percussion at the left lung base. What injury is most likely?
- Tension pneumothorax
- Cardiac tamponade
- Hemothorax (Correct answer)
- Diaphragmatic rupture
Correct answer: Hemothorax
Hemothorax presents with hypotension, absent JVD (volume loss), and dullness to percussion due to fluid (blood) in the pleural space.
Question 5: A patient with a suspected C-spine injury arrives immobilized. NEXUS criteria would allow cervical spine clearance WITHOUT imaging if which criterion is met?
- Patient has midline cervical tenderness
- Patient is alert, not intoxicated, has no distracting injury, no focal neuro deficit, no midline tenderness (Correct answer)
- Patient is alert with GCS 15 only
- Patient has no visible neck injury
Correct answer: Patient is alert, not intoxicated, has no distracting injury, no focal neuro deficit, no midline tenderness
NEXUS criteria allow clinical C-spine clearance without imaging if all five criteria are met: alert, no intoxication, no focal neurological deficit, no midline tenderness, and no distracting injuries.
Question 6: Which type of traumatic brain injury is associated with a 'lucid interval' followed by rapid deterioration?
- Subdural hematoma
- Epidural hematoma (Correct answer)
- Diffuse axonal injury
- Intracerebral contusion
Correct answer: Epidural hematoma
Epidural hematoma, usually from a torn middle meningeal artery after temporal bone fracture, classically presents with a brief lucid interval followed by rapid neurological deterioration.
CEN Trauma Emergencies 1
During the primary survey of a trauma patient, which step follows airway management?