10 free Paramedic practice questions: Advanced Trauma Assessment and Resuscitation

The patient is developing decompensated shock from occult blood loss: Decompensated shock from hidden blood loss would drop the blood pressure, and the pressure did fall here. The skin is warm and dry and the radial pulse is strong, and those are not signs of decompensated shock. A blood pressure that comes down while the heart rate returns toward normal fits the same improvement as the EtCO₂ and the pupil.

The endotracheal tube has slipped out of the trachea into the esophagus: A tube that slips into the esophagus loses the EtCO₂ reading. The number falls toward zero or becomes erratic. This patient's EtCO₂ is 39 mmHg, a normal and well formed reading. Waveform capnography and equal breath sounds already confirmed the tube.

Cerebral perfusion pressure has fallen to a critically low level: A critically low cerebral perfusion pressure means the brain is not getting enough blood flow. The pupil and the level of consciousness would get worse. This patient's pupil got better over the same 10 minutes.

The narrow gap between the systolic and diastolic pressures: A narrow pulse pressure does show up in tamponade. A narrow pulse pressure also shows up in many other low output states, including a tension pneumothorax. The narrow gap supports the picture, but it does not separate the two.

The heart rate of 132 alongside a systolic pressure of 84: A heart rate of 132 with a systolic pressure of 84 is the body's response to shock. Every cause of obstructive shock produces that response.

The distended neck veins in a hypotensive patient: Distended neck veins are the finding tamponade and a tension pneumothorax share. Both raise the pressure the heart has to fill against, and that backs blood up into the neck veins.

A complete cord transection: means the cord is cut all the way through, and a stab wound to the back can do that. A complete transection leaves no movement and no feeling below the injury on either side. This patient still moves the right leg and still feels pinprick in the left leg. The injury is incomplete.

Anterior cord syndrome: takes away movement, pain, and temperature, while position sense, vibration, and light touch are kept. Anterior cord syndrome hits both sides the same way. This patient lost position sense on the left and pain on the right, and a split by side is a hemisection.

Central cord syndrome: causes weakness that is worse in the arms than in the legs. Central cord syndrome usually follows a hyperextension injury, often in an older patient with a narrow spinal canal. This patient is 24 with one stab wound to the back, and the findings are in the legs.

A subdural bleed, because venous blood collects over hours: A subdural bleed is common after a head strike and belongs on the list. A subdural bleed comes from veins, and venous pressure fills the space slowly. Subdurals take hours to days to show up, not 25 minutes.

A diffuse axonal injury, because shearing causes deficits right away: Diffuse axonal injury comes from shearing during violent head movement, and it does cause a severe deficit. The deficit from shearing is there from the moment of injury. This patient talked normally for about 25 minutes first.

A subarachnoid bleed, because it is at its worst from the start: A subarachnoid bleed does start suddenly and severely, and those patients do get worse. A subarachnoid bleed is at its worst the moment it starts. This patient had a normal stretch before getting worse.

An epidural bleed from a torn middle meningeal artery: An epidural bleed is the classic fast decline after a head injury. This bleed usually comes from a blow to the side of the head that leaves a mark. An epidural also gives a lucid interval, where the patient talks normally before getting worse. This patient's deficit has been there from the start.

A basilar skull fracture with bleeding into the sinuses: A basilar skull fracture can come from a serious crash like this one. A basilar fracture shows bruising around the eyes or behind the ears, or fluid from the nose or ears. None of those findings are present.

A depressed skull fracture pressing on the motor cortex: A depressed skull fracture presses on brain tissue and can cause a focal deficit. You can usually see or feel the depression. This patient's head has no wound, no swelling, and no deformity.

Hyperventilate through the attempt to keep the intracranial pressure down: Hyperventilation does lower the pressure inside the skull, and it has a narrow role when a patient is actively herniating. Routine hyperventilation narrows the blood vessels in the brain and cuts blood flow to tissue that is already short on blood flow. This patient has no signs of herniation.

Use a full induction dose so the first attempt is not interrupted: A full induction dose makes the patient easier to intubate, and a failed first attempt costs time. At 86 systolic, a full dose gets you that first pass along with a hypotensive episode. One hypotensive episode roughly doubles the death rate in a severe head injury.

Skip preoxygenation to shorten the time without ventilation: Speed does matter when a patient is desaturating, and a shorter time without breaths sounds safer. Preoxygenation is what gives you safe seconds during the attempt. Skipping preoxygenation at 87% guarantees the hypoxic episode you were trying to avoid.

Remove the collar and hold manual stabilization instead: Manual stabilization is a real technique, and holding the head by hand avoids the pressure a collar puts on the neck. Holding a head by hand for a whole transport is not practical. Manual stabilization also leaves the real problem in place, which is the tight straps and a head that is not midline.

Tighten the straps further and pad under the head: Secure packaging matters, and a patient who shifts during transport is a real problem. Tightening the straps squeezes the same neck veins the head drains through, and the pressure inside the skull goes up.

Leave the packaging as it is and raise the foot end: Raising the foot end moves blood toward the core in a patient with a pressure problem. Putting a head injured patient head down raises the pressure inside the skull.

Two minutes of compressions before any shock: This child is already in ventricular fibrillation with a defibrillator attached, so the shock comes first. Holding it for two minutes keeps the heart in ventricular fibrillation for two more minutes. The two minutes of compressions come after a shock, before the next rhythm check.

Rapid transport with compressions only: The monitor already shows ventricular fibrillation, and what this child needs is a shock. Loading the child first delays it. Rapid transport with compressions is for an arrest whose fix is at a trauma center, like a penetrating chest wound with a short down time.

Needle decompression of the left chest: Needle decompression treats a tension pneumothorax, with absent lung sounds and hypotension from a shifted mediastinum. This child has ventricular fibrillation from a blow to the chest, not a collapsed lung.

A single area of point tenderness over one rib with a normal 12-lead: Blunt cardiac injury shows dysrhythmias and ECG changes, and this 12-lead is normal. Point tenderness over one rib with a normal 12-lead points to an isolated rib fracture.

Diffuse abdominal tenderness with a rigid abdomen: C describes the abdomen, not the heart. A rigid, tender abdomen points to an injured abdominal organ from the same crash, while blunt cardiac injury causes chest pain and dysrhythmias.

A widened pulse pressure with warm, flushed skin: a distributive shock pattern. Retrosternal pain and dysrhythmias are what point to a blunt cardiac injury, and warm, flushed skin is not part of that injury.

The community hospital, because it is closest: The community hospital has no surgeon to stop the bleeding from this unstable pelvis. This patient has an open airway, is breathing at 28, and can handle 22 minutes with resuscitation going. The closest hospital is the destination only when it can fix the problem, or when the patient cannot survive a longer ride, like an airway you cannot manage or a cardiac arrest.

The trauma center, only if air transport is available: Air or ground does not change which hospital this patient needs, and the trauma center is 22 minutes away by ground. Setting up a landing zone would usually cost more time than air saves. Air transport is for a long transport or a scene ground units cannot reach.

The community hospital, to stabilize before transfer: A patient bleeding from an unstable pelvis cannot be stabilized without surgery, and the community hospital has none. The stop adds a second assessment, a second packaging, and a second transport while the bleeding keeps going. The exception is a patient who cannot survive the longer trip at all, and this patient can.