SSM TCAR Exam Study Guide 2026 | Trauma
Care After Resuscitation (TCAR)
Certification Prep | Updated Questions &
Verified Answers with Detailed Rationales
• This TCAR Certification Prep guide delivers 200 exam-style questions with verified
answers and detailed EXPERT RATIONALE to reinforce clinical reasoning and
trauma care mastery.
• Study by attempting each question independently before reviewing the bold
correct answer and EXPERT RATIONALE — repetition across all domains builds the
retention needed to pass.
SSM TCAR Exam Study Guide 2026 | Trauma Care After Resuscitation (TCAR)
Certification Prep | Updated Questions & Verified Answers with Detailed
EXPERT RATIONALE
Question 1: A trauma patient arrives with a GCS of 8, BP of 80/50 mmHg, and a
respiratory rate of 28. Which of the following best describes the priority of
care?
A. Obtain a full head-to-toe assessment before any intervention
B. Administer oral fluids to improve blood pressure
C. Place the patient in Trendelenburg position immediately
D. Begin neurological assessment first due to low GCS
E. Simultaneously manage airway, breathing, and circulation using the
primary survey
EXPERT RATIONALE: The primary survey (ABCDE) is the cornerstone of initial
trauma management. A GCS of 8 indicates severe neurological compromise
requiring airway protection, while hypotension and tachypnea indicate circulatory
and respiratory compromise. All critical issues must be addressed simultaneously
rather than sequentially to prevent deterioration and death.
,Question 2: Which mechanism of injury is most associated with aortic
transection?
A. Low-speed fall from standing height
B. Penetrating abdominal trauma
C. Direct blow to the sternum during CPR
D. Blast injury to the lower extremities
E. High-speed deceleration such as a motor vehicle collision or fall from
height
EXPERT RATIONALE: Aortic transection occurs at points of fixation — most
commonly the aortic isthmus — due to rapid deceleration forces. High-speed MVCs
and falls from significant height produce the shear forces necessary to tear the
aorta. This is why chest X-ray and CT angiography are critical in high-speed
deceleration trauma.
Question 3: A patient with penetrating chest trauma develops absent breath
sounds on the left, tracheal deviation to the right, hypotension, and
distended neck veins. What is the immediate intervention?
A. Obtain chest X-ray to confirm diagnosis
B. Administer 2 liters of normal saline rapidly
C. Perform pericardiocentesis
D. Intubate and provide positive pressure ventilation
E. Perform immediate needle decompression at the second intercostal
space, midclavicular line
EXPERT RATIONALE: The clinical presentation is classic for tension pneumothorax
— tracheal deviation away from the affected side, absent breath sounds,
hypotension, and JVD. This is a life-threatening emergency requiring immediate
needle decompression without waiting for imaging. Delaying for a chest X-ray can
result in cardiac arrest.
,Question 4: What is the target systolic blood pressure for permissive
hypotension in a penetrating trauma patient without traumatic brain injury?
A. 120 mmHg
B. 110 mmHg
C. 100 mmHg
D. 70 mmHg
E. 80–90 mmHg
EXPERT RATIONALE: Permissive hypotension (hypotensive resuscitation) targets a
systolic BP of 80–90 mmHg in penetrating trauma patients without TBI. The goal is
to maintain enough perfusion to vital organs while avoiding the dilution of clotting
factors and worsening of coagulopathy associated with aggressive fluid
resuscitation before hemorrhage is controlled.
Question 5: Which of the following is the most reliable early indicator of
hemorrhagic shock in a trauma patient?
A. Decreased urine output
B. Drop in hemoglobin on initial labs
C. Hypotension
D. Loss of consciousness
E. Tachycardia and narrowed pulse pressure
EXPERT RATIONALE: Tachycardia and narrowed pulse pressure are among the
earliest compensatory signs of hemorrhagic shock. The body compensates by
increasing heart rate and peripheral vasoconstriction before frank hypotension
develops. Hemoglobin drop may not appear immediately due to hemodilution lag,
and hypotension is a late sign indicating decompensation.
, Question 6: What does the "D" in the ABCDE primary survey stand for in
trauma assessment?
A. Drainage
B. Defibrillation
C. Dressing
D. Dilation
E. Disability (neurological assessment)
EXPERT RATIONALE: In the primary survey, D stands for Disability, which involves a
rapid neurological assessment including GCS scoring, pupillary response, and
assessment for lateralizing signs. This is done after airway, breathing, and
circulation are addressed to identify life-threatening neurological compromise such
as herniation.
Question 7: A trauma patient has a blood pressure of 70/40 mmHg and is not
responding to 2 liters of crystalloid. What should be the next step?
A. Administer a third liter of normal saline
B. Insert a Foley catheter to monitor output
C. Obtain a FAST exam and wait for results before proceeding
D. Administer vasopressors as the first-line agent
E. Activate massive transfusion protocol with a 1:1:1 ratio of packed red
blood cells, fresh frozen plasma, and platelets
EXPERT RATIONALE: In hemorrhagic shock unresponsive to initial crystalloid
resuscitation, massive transfusion protocol (MTP) should be activated. The 1:1:1
ratio of PRBCs, FFP, and platelets mimics whole blood and addresses the lethal triad
of coagulopathy, acidosis, and hypothermia. Continued crystalloid administration
worsens dilutional coagulopathy.
Care After Resuscitation (TCAR)
Certification Prep | Updated Questions &
Verified Answers with Detailed Rationales
• This TCAR Certification Prep guide delivers 200 exam-style questions with verified
answers and detailed EXPERT RATIONALE to reinforce clinical reasoning and
trauma care mastery.
• Study by attempting each question independently before reviewing the bold
correct answer and EXPERT RATIONALE — repetition across all domains builds the
retention needed to pass.
SSM TCAR Exam Study Guide 2026 | Trauma Care After Resuscitation (TCAR)
Certification Prep | Updated Questions & Verified Answers with Detailed
EXPERT RATIONALE
Question 1: A trauma patient arrives with a GCS of 8, BP of 80/50 mmHg, and a
respiratory rate of 28. Which of the following best describes the priority of
care?
A. Obtain a full head-to-toe assessment before any intervention
B. Administer oral fluids to improve blood pressure
C. Place the patient in Trendelenburg position immediately
D. Begin neurological assessment first due to low GCS
E. Simultaneously manage airway, breathing, and circulation using the
primary survey
EXPERT RATIONALE: The primary survey (ABCDE) is the cornerstone of initial
trauma management. A GCS of 8 indicates severe neurological compromise
requiring airway protection, while hypotension and tachypnea indicate circulatory
and respiratory compromise. All critical issues must be addressed simultaneously
rather than sequentially to prevent deterioration and death.
,Question 2: Which mechanism of injury is most associated with aortic
transection?
A. Low-speed fall from standing height
B. Penetrating abdominal trauma
C. Direct blow to the sternum during CPR
D. Blast injury to the lower extremities
E. High-speed deceleration such as a motor vehicle collision or fall from
height
EXPERT RATIONALE: Aortic transection occurs at points of fixation — most
commonly the aortic isthmus — due to rapid deceleration forces. High-speed MVCs
and falls from significant height produce the shear forces necessary to tear the
aorta. This is why chest X-ray and CT angiography are critical in high-speed
deceleration trauma.
Question 3: A patient with penetrating chest trauma develops absent breath
sounds on the left, tracheal deviation to the right, hypotension, and
distended neck veins. What is the immediate intervention?
A. Obtain chest X-ray to confirm diagnosis
B. Administer 2 liters of normal saline rapidly
C. Perform pericardiocentesis
D. Intubate and provide positive pressure ventilation
E. Perform immediate needle decompression at the second intercostal
space, midclavicular line
EXPERT RATIONALE: The clinical presentation is classic for tension pneumothorax
— tracheal deviation away from the affected side, absent breath sounds,
hypotension, and JVD. This is a life-threatening emergency requiring immediate
needle decompression without waiting for imaging. Delaying for a chest X-ray can
result in cardiac arrest.
,Question 4: What is the target systolic blood pressure for permissive
hypotension in a penetrating trauma patient without traumatic brain injury?
A. 120 mmHg
B. 110 mmHg
C. 100 mmHg
D. 70 mmHg
E. 80–90 mmHg
EXPERT RATIONALE: Permissive hypotension (hypotensive resuscitation) targets a
systolic BP of 80–90 mmHg in penetrating trauma patients without TBI. The goal is
to maintain enough perfusion to vital organs while avoiding the dilution of clotting
factors and worsening of coagulopathy associated with aggressive fluid
resuscitation before hemorrhage is controlled.
Question 5: Which of the following is the most reliable early indicator of
hemorrhagic shock in a trauma patient?
A. Decreased urine output
B. Drop in hemoglobin on initial labs
C. Hypotension
D. Loss of consciousness
E. Tachycardia and narrowed pulse pressure
EXPERT RATIONALE: Tachycardia and narrowed pulse pressure are among the
earliest compensatory signs of hemorrhagic shock. The body compensates by
increasing heart rate and peripheral vasoconstriction before frank hypotension
develops. Hemoglobin drop may not appear immediately due to hemodilution lag,
and hypotension is a late sign indicating decompensation.
, Question 6: What does the "D" in the ABCDE primary survey stand for in
trauma assessment?
A. Drainage
B. Defibrillation
C. Dressing
D. Dilation
E. Disability (neurological assessment)
EXPERT RATIONALE: In the primary survey, D stands for Disability, which involves a
rapid neurological assessment including GCS scoring, pupillary response, and
assessment for lateralizing signs. This is done after airway, breathing, and
circulation are addressed to identify life-threatening neurological compromise such
as herniation.
Question 7: A trauma patient has a blood pressure of 70/40 mmHg and is not
responding to 2 liters of crystalloid. What should be the next step?
A. Administer a third liter of normal saline
B. Insert a Foley catheter to monitor output
C. Obtain a FAST exam and wait for results before proceeding
D. Administer vasopressors as the first-line agent
E. Activate massive transfusion protocol with a 1:1:1 ratio of packed red
blood cells, fresh frozen plasma, and platelets
EXPERT RATIONALE: In hemorrhagic shock unresponsive to initial crystalloid
resuscitation, massive transfusion protocol (MTP) should be activated. The 1:1:1
ratio of PRBCs, FFP, and platelets mimics whole blood and addresses the lethal triad
of coagulopathy, acidosis, and hypothermia. Continued crystalloid administration
worsens dilutional coagulopathy.
