PARAMEDIC TRAUMA FISDAP V1 & V2 NEWEST 2026
ACTUAL EXAM| PARAMEDIC FISDAP TRAUMA V1 AND
V2 EXAM WITH COMPLETE REAL EXAM QUESTIONS
AND CORRECT VERIFIED ANSWERS/ ALREADY
GRADED A+ (MOST RECENT!! - 199 Questions
This rigorous exam assesses mastery of advanced trauma assessment and management principles, including
primary and secondary surveys, hemorrhage control, shock resuscitation, spinal immobilization, and trauma
triage protocols. Questions require synthesis of current evidence-based guidelines (PHTLS, ATLS, TCCC) and
complex clinical decision-making. It contains 199 multiple-choice questions, each with four distractors and a fully
worked rationale that explains why the keyed answer is correct. Content is organized into 10 focused sections:
Trauma Assessment and Management, Airway and Ventilation Management in Trauma, Shock and Hemorrhage
Control, Head and Spinal Trauma, Thoracic Trauma, Abdominal and Genitourinary Trauma, Musculoskeletal
Trauma, Burn and Environmental Trauma, Special Populations in Trauma (Pediatric, Geriatric, Obstetric),
Trauma in Mass Casualty Incidents and Disaster Management. Targeted learning outcomes include: Perform
systematic trauma assessment using a structured approach (ITLS/PHTLS).; Differentiate between various shock
states and initiate appropriate management.; Apply advanced hemorrhage control techniques including
tourniquet and hemostatic agents.; Make informed decisions regarding spinal immobilization based on
mechanism and exam.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that
students can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
Section 1: Trauma Assessment and Management (Questions 1-20)
1 During the primary survey of a trauma patient with a suspected pelvic fracture, the paramedic notes absent distal
pulses and a rapidly distending abdomen. The patient is diaphoretic and confused. Vital signs: HR 140, BP
80/50, RR 28. Which of the following represents the most appropriate immediate intervention?
A) Initiate two large-bore IV lines and administer a 500 mL crystalloid bolus, then reassess pulses.
B) Apply a pelvic binder, begin blood product transfusion (if available), and expedite transport to a trauma
center.
C) Perform a focused assessment with sonography in trauma (FAST) exam to confirm intra-abdominal
hemorrhage before fluid resuscitation.
D) Administer tranexamic acid (TXA) 1 gram IV over 10 minutes, then reassess blood pressure.
Answer: B
Rationale: In hemorrhagic shock from pelvic fracture, the priority is mechanical stabilization (pelvic binder) to
reduce volume and promote clot formation, along with early blood product transfusion and rapid transport.
Crystalloid boluses are avoided due to dilutional coagulopathy. FAST is secondary to life-saving interventions.
TXA is adjunctive but not the primary intervention.
2 A patient involved in a high-speed motor vehicle collision presents with paradoxical chest wall movement and
respiratory distress. Breath sounds are absent on the left. The trachea is deviated to the right. Which of the
following best describes the pathophysiology underlying the hemodynamic instability?
A) Increased intrathoracic pressure causing compression of the superior vena cava and reduced preload.
B) Loss of negative intrathoracic pressure leading to impaired venous return and mediastinal shift.
C) Myocardial contusion resulting in decreased contractility and cardiogenic shock.
,D) Air trapping in the pleural space causing tension physiology with contralateral mediastinal shift and
compromised venous return.
Answer: D
Rationale: Tension pneumothorax results from a one-way valve allowing air entry into the pleural space, increasing
pressure, shifting the mediastinum away, and kinking the vena cava, reducing preload and causing hypotension.
Paradoxical movement suggests flail chest, but absent breath sounds and tracheal deviation indicate tension
pneumothorax as the immediate threat.
3 A paramedic is assessing a patient with a penetrating injury to the anterior neck at the level of the cricoid
cartilage. The patient is speaking in a hoarse voice, has subcutaneous emphysema, and oxygen saturation is 92%
on high-flow oxygen. Which of the following airway maneuvers is most appropriate?
A) Perform rapid sequence intubation (RSI) with direct laryngoscopy to secure the airway.
B) Apply a cricoid pressure and attempt bag-valve-mask ventilation.
C) Prepare for a surgical cricothyrotomy due to potential laryngotracheal injury.
D) Insert a supraglottic airway device (i-gel or LMA) as a temporizing measure.
Answer: C
Rationale: Penetrating neck trauma with signs of airway injury (hoarseness, subcutaneous emphysema) suggests
laryngotracheal disruption. RSI may worsen the injury or cause complete airway obstruction. Surgical
cricothyrotomy bypasses the injured site and provides a definitive airway. BVM and supraglottic devices may force
air into tissues.
4 A trauma patient with a suspected spinal injury is found supine on a hard surface. The paramedic notes that the
patient is awake, alert, and complaining of midline neck pain without neurologic deficit. Which of the following
best supports the decision to withhold spinal immobilization?
A) The patient has a Glasgow Coma Scale (GCS) score of 15 and no distracting injuries.
B) The patient is able to walk independently after the injury.
C) The mechanism of injury was a low-speed rear-end collision with no loss of consciousness.
D) The patient has a history of osteoporosis and is at increased risk for fracture.
Answer: A
Rationale: According to the NEXUS criteria, spinal immobilization may be withheld if the patient is alert, not
intoxicated, has no neurologic deficit, no midline tenderness, and no distracting injury. A GCS of 15 and no
distracting injuries meet these criteria. Walking independently is not a validated criterion. Low-speed mechanism
alone is insufficient. Osteoporosis increases risk, so immobilization is indicated despite other criteria.
5 A patient with a traumatic amputation of the lower extremity at the mid-thigh has a tourniquet applied proximal
to the injury. The tourniquet has been in place for 90 minutes during transport. The patient is now in
hemorrhagic shock. Which of the following is the most appropriate management regarding the tourniquet?
A) Remove the tourniquet to assess bleeding, as prolonged ischemia may lead to reperfusion injury.
B) Leave the tourniquet in place and continue resuscitation, as removal could precipitate exsanguination.
C) Loosen the tourniquet every 15 minutes to allow intermittent perfusion.
D) Replace the tourniquet with a pressure dressing and elevate the limb.
Answer: B
Rationale: Current TCCC guidelines recommend leaving a tourniquet in place for up to 2 hours without loosening,
as removal can cause severe hemorrhage and worsen shock. Intermittent loosening is not recommended due to risk
of dislodging clots. The tourniquet should only be removed in a surgical setting. Resuscitation with blood products
is prioritized.
,6 A paramedic is assessing a patient with blunt chest trauma. The patient has multiple rib fractures and a flail
segment. Which of the following parameters is most indicative of the need for positive pressure ventilation?
A) Respiratory rate of 28 breaths per minute and use of accessory muscles.
B) Oxygen saturation of 92% on a non-rebreather mask.
C) Partial pressure of arterial carbon dioxide (PaCO2) of 55 mm Hg with respiratory acidosis.
D) Presence of paradoxical chest wall movement.
Answer: C
Rationale: In flail chest, the primary indication for mechanical ventilation is respiratory failure evidenced by
hypercapnia (PaCO2 >50 mm Hg) and acidosis. Tachypnea, accessory muscle use, and hypoxia are common but
not absolute indications. Paradoxical movement alone does not mandate ventilation if gas exchange is adequate.
7 A patient with a suspected traumatic brain injury (TBI) has a GCS of 12 (E3 V4 M5) and is agitated. Vital
signs: HR 90, BP 160/90, RR 14, SpO2 98%. Which of the following interventions is most appropriate to
prevent secondary brain injury?
A) Administer 1 gram/kg of mannitol IV and intubate for hyperventilation to a PaCO2 of 30 mm Hg.
B) Administer 0.5 mg/kg of ketamine IV for sedation and maintain normocapnia.
C) Administer 2 mg of lorazepam IV and place the patient in a 30-degree head-up position.
D) Administer 250 mL of hypertonic saline (3%) IV and maintain systolic BP >100 mm Hg.
Answer: D
Rationale: In TBI, maintaining cerebral perfusion pressure (CPP) is critical. Hypertonic saline reduces intracranial
pressure while supporting blood pressure. Mannitol is used but requires careful volume status. Ketamine is
controversial due to potential ICP increase. Lorazepam may cause hypotension. Hyperventilation is reserved for
impending herniation and can cause cerebral ischemia.
8 During the secondary survey of a trauma patient, the paramedic notes the following: bruising around the
umbilicus (Cullen sign) and flank ecchymosis (Grey Turner sign). These findings are most consistent with
which of the following injuries?
A) Ruptured spleen with intra-abdominal hemorrhage.
B) Retroperitoneal hemorrhage from a pancreatic or duodenal injury.
C) Pelvic fracture with associated vascular disruption.
D) Liver laceration with bile peritonitis.
Answer: B
Rationale: Cullen sign (periumbilical bruising) and Grey Turner sign (flank ecchymosis) are classic signs of
retroperitoneal hemorrhage, often from pancreatic, duodenal, or renal injuries. Spleen and liver injuries typically
present with peritoneal signs. Pelvic fractures may cause flank ecchymosis but not typically Cullen sign.
9 A patient with a crush injury to the pelvis is in severe pain and has a palpable bladder. The paramedic notes that
the patient has not urinated in 8 hours. Which of the following is the most appropriate intervention?
A) Insert a nasogastric tube and administer activated charcoal.
B) Perform a diagnostic peritoneal lavage (DPL) to assess for intra-abdominal injury.
C) Attempt to catheterize the patient to decompress the bladder.
D) Apply a pelvic binder and transport without catheterization.
Answer: C
Rationale: A palpable bladder with inability to void suggests urethral injury or bladder rupture. Catheterization is
indicated to decompress the bladder and assess for hematuria. However, if urethral injury is suspected (e.g., blood
at meatus, high-riding prostate), a retrograde urethrogram should be performed first. In this scenario, without those
signs, gentle catheterization is appropriate. Pelvic binder is already indicated.
, 10 A paramedic is managing a patient with a gunshot wound to the right upper quadrant. The patient is
hypotensive (BP 70/40) and has distended neck veins. Which of the following conditions should be suspected?
A) Tension pneumothorax causing decreased venous return.
B) Cardiac tamponade from pericardial blood accumulation.
C) Massive hemothorax with loss of circulating volume.
D) Air embolism from a bronchovenous fistula.
Answer: B
Rationale: Penetrating trauma near the cardiac box with hypotension and distended neck veins (Beck triad minus
muffled heart sounds) suggests cardiac tamponade. Tension pneumothorax would cause tracheal deviation and
absent breath sounds. Hemothorax would cause flat neck veins due to hypovolemia. Air embolism is rare and
presents with sudden cardiovascular collapse.
11 A patient involved in a high-speed motor vehicle collision presents with hypotension, distended neck veins, and
muffled heart sounds. Which of the following assessment findings would most directly contraindicate the
application of the pneumatic antishock garment (PASG) during initial trauma management?
A) Bilateral femoral fractures with palpable distal pulses
B) Penetrating thoracic injury with suspected cardiac tamponade
C) Pelvic instability with a palpable hematoma
D) Intra-abdominal hemorrhage with a positive FAST exam
Answer: B
Rationale: PASG is contraindicated in patients with thoracic injuries that may compromise respiratory mechanics or
exacerbate tamponade physiology. In cardiac tamponade, increased intrathoracic pressure from PASG can worsen
venous return and cardiac output. Options A, C, and D are relative indications for PASG use in hemorrhagic shock.
12 During the secondary assessment of a patient with blunt abdominal trauma, you note ecchymosis over the
flanks and a seat belt sign across the lower abdomen. Which of the following is the most appropriate next step
in management?
A) Immediate transport to a trauma center with serial abdominal exams en route
B) Placement of a nasogastric tube and urinary catheter prior to transport
C) Needle decompression of the left chest for suspected pneumothorax
D) Administration of 2 liters of isotonic crystalloid fluid bolus
Answer: A
Rationale: The presence of flank ecchymosis (Grey Turner sign) and seat belt sign suggests significant
intra-abdominal injury requiring trauma center evaluation. Immediate transport with serial exams is prioritized over
interventions that delay transport. NG tube and catheter may be placed en route if time permits. Needle
decompression is not indicated without evidence of tension pneumothorax. Fluid resuscitation should be permissive
hypotension, not routine bolus.
13 A patient with a traumatic brain injury (TBI) has a Glasgow Coma Scale (GCS) score of 9 (E2 V3 M4). Which
of the following management strategies is most consistent with current guidelines to optimize cerebral
perfusion and minimize secondary injury?
A) Maintain systolic blood pressure (SBP) > 110 mmHg and PaCO2 between 35-40 mmHg
B) Hyperventilate to a PaCO2 of 25-30 mmHg to reduce intracranial pressure
C) Administer hypertonic saline 3% 250 mL bolus for signs of herniation
D) Elevate the head of the bed to 30 degrees and maintain SBP > 90 mmHg
Answer: A
ACTUAL EXAM| PARAMEDIC FISDAP TRAUMA V1 AND
V2 EXAM WITH COMPLETE REAL EXAM QUESTIONS
AND CORRECT VERIFIED ANSWERS/ ALREADY
GRADED A+ (MOST RECENT!! - 199 Questions
This rigorous exam assesses mastery of advanced trauma assessment and management principles, including
primary and secondary surveys, hemorrhage control, shock resuscitation, spinal immobilization, and trauma
triage protocols. Questions require synthesis of current evidence-based guidelines (PHTLS, ATLS, TCCC) and
complex clinical decision-making. It contains 199 multiple-choice questions, each with four distractors and a fully
worked rationale that explains why the keyed answer is correct. Content is organized into 10 focused sections:
Trauma Assessment and Management, Airway and Ventilation Management in Trauma, Shock and Hemorrhage
Control, Head and Spinal Trauma, Thoracic Trauma, Abdominal and Genitourinary Trauma, Musculoskeletal
Trauma, Burn and Environmental Trauma, Special Populations in Trauma (Pediatric, Geriatric, Obstetric),
Trauma in Mass Casualty Incidents and Disaster Management. Targeted learning outcomes include: Perform
systematic trauma assessment using a structured approach (ITLS/PHTLS).; Differentiate between various shock
states and initiate appropriate management.; Apply advanced hemorrhage control techniques including
tourniquet and hemostatic agents.; Make informed decisions regarding spinal immobilization based on
mechanism and exam.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that
students can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
Section 1: Trauma Assessment and Management (Questions 1-20)
1 During the primary survey of a trauma patient with a suspected pelvic fracture, the paramedic notes absent distal
pulses and a rapidly distending abdomen. The patient is diaphoretic and confused. Vital signs: HR 140, BP
80/50, RR 28. Which of the following represents the most appropriate immediate intervention?
A) Initiate two large-bore IV lines and administer a 500 mL crystalloid bolus, then reassess pulses.
B) Apply a pelvic binder, begin blood product transfusion (if available), and expedite transport to a trauma
center.
C) Perform a focused assessment with sonography in trauma (FAST) exam to confirm intra-abdominal
hemorrhage before fluid resuscitation.
D) Administer tranexamic acid (TXA) 1 gram IV over 10 minutes, then reassess blood pressure.
Answer: B
Rationale: In hemorrhagic shock from pelvic fracture, the priority is mechanical stabilization (pelvic binder) to
reduce volume and promote clot formation, along with early blood product transfusion and rapid transport.
Crystalloid boluses are avoided due to dilutional coagulopathy. FAST is secondary to life-saving interventions.
TXA is adjunctive but not the primary intervention.
2 A patient involved in a high-speed motor vehicle collision presents with paradoxical chest wall movement and
respiratory distress. Breath sounds are absent on the left. The trachea is deviated to the right. Which of the
following best describes the pathophysiology underlying the hemodynamic instability?
A) Increased intrathoracic pressure causing compression of the superior vena cava and reduced preload.
B) Loss of negative intrathoracic pressure leading to impaired venous return and mediastinal shift.
C) Myocardial contusion resulting in decreased contractility and cardiogenic shock.
,D) Air trapping in the pleural space causing tension physiology with contralateral mediastinal shift and
compromised venous return.
Answer: D
Rationale: Tension pneumothorax results from a one-way valve allowing air entry into the pleural space, increasing
pressure, shifting the mediastinum away, and kinking the vena cava, reducing preload and causing hypotension.
Paradoxical movement suggests flail chest, but absent breath sounds and tracheal deviation indicate tension
pneumothorax as the immediate threat.
3 A paramedic is assessing a patient with a penetrating injury to the anterior neck at the level of the cricoid
cartilage. The patient is speaking in a hoarse voice, has subcutaneous emphysema, and oxygen saturation is 92%
on high-flow oxygen. Which of the following airway maneuvers is most appropriate?
A) Perform rapid sequence intubation (RSI) with direct laryngoscopy to secure the airway.
B) Apply a cricoid pressure and attempt bag-valve-mask ventilation.
C) Prepare for a surgical cricothyrotomy due to potential laryngotracheal injury.
D) Insert a supraglottic airway device (i-gel or LMA) as a temporizing measure.
Answer: C
Rationale: Penetrating neck trauma with signs of airway injury (hoarseness, subcutaneous emphysema) suggests
laryngotracheal disruption. RSI may worsen the injury or cause complete airway obstruction. Surgical
cricothyrotomy bypasses the injured site and provides a definitive airway. BVM and supraglottic devices may force
air into tissues.
4 A trauma patient with a suspected spinal injury is found supine on a hard surface. The paramedic notes that the
patient is awake, alert, and complaining of midline neck pain without neurologic deficit. Which of the following
best supports the decision to withhold spinal immobilization?
A) The patient has a Glasgow Coma Scale (GCS) score of 15 and no distracting injuries.
B) The patient is able to walk independently after the injury.
C) The mechanism of injury was a low-speed rear-end collision with no loss of consciousness.
D) The patient has a history of osteoporosis and is at increased risk for fracture.
Answer: A
Rationale: According to the NEXUS criteria, spinal immobilization may be withheld if the patient is alert, not
intoxicated, has no neurologic deficit, no midline tenderness, and no distracting injury. A GCS of 15 and no
distracting injuries meet these criteria. Walking independently is not a validated criterion. Low-speed mechanism
alone is insufficient. Osteoporosis increases risk, so immobilization is indicated despite other criteria.
5 A patient with a traumatic amputation of the lower extremity at the mid-thigh has a tourniquet applied proximal
to the injury. The tourniquet has been in place for 90 minutes during transport. The patient is now in
hemorrhagic shock. Which of the following is the most appropriate management regarding the tourniquet?
A) Remove the tourniquet to assess bleeding, as prolonged ischemia may lead to reperfusion injury.
B) Leave the tourniquet in place and continue resuscitation, as removal could precipitate exsanguination.
C) Loosen the tourniquet every 15 minutes to allow intermittent perfusion.
D) Replace the tourniquet with a pressure dressing and elevate the limb.
Answer: B
Rationale: Current TCCC guidelines recommend leaving a tourniquet in place for up to 2 hours without loosening,
as removal can cause severe hemorrhage and worsen shock. Intermittent loosening is not recommended due to risk
of dislodging clots. The tourniquet should only be removed in a surgical setting. Resuscitation with blood products
is prioritized.
,6 A paramedic is assessing a patient with blunt chest trauma. The patient has multiple rib fractures and a flail
segment. Which of the following parameters is most indicative of the need for positive pressure ventilation?
A) Respiratory rate of 28 breaths per minute and use of accessory muscles.
B) Oxygen saturation of 92% on a non-rebreather mask.
C) Partial pressure of arterial carbon dioxide (PaCO2) of 55 mm Hg with respiratory acidosis.
D) Presence of paradoxical chest wall movement.
Answer: C
Rationale: In flail chest, the primary indication for mechanical ventilation is respiratory failure evidenced by
hypercapnia (PaCO2 >50 mm Hg) and acidosis. Tachypnea, accessory muscle use, and hypoxia are common but
not absolute indications. Paradoxical movement alone does not mandate ventilation if gas exchange is adequate.
7 A patient with a suspected traumatic brain injury (TBI) has a GCS of 12 (E3 V4 M5) and is agitated. Vital
signs: HR 90, BP 160/90, RR 14, SpO2 98%. Which of the following interventions is most appropriate to
prevent secondary brain injury?
A) Administer 1 gram/kg of mannitol IV and intubate for hyperventilation to a PaCO2 of 30 mm Hg.
B) Administer 0.5 mg/kg of ketamine IV for sedation and maintain normocapnia.
C) Administer 2 mg of lorazepam IV and place the patient in a 30-degree head-up position.
D) Administer 250 mL of hypertonic saline (3%) IV and maintain systolic BP >100 mm Hg.
Answer: D
Rationale: In TBI, maintaining cerebral perfusion pressure (CPP) is critical. Hypertonic saline reduces intracranial
pressure while supporting blood pressure. Mannitol is used but requires careful volume status. Ketamine is
controversial due to potential ICP increase. Lorazepam may cause hypotension. Hyperventilation is reserved for
impending herniation and can cause cerebral ischemia.
8 During the secondary survey of a trauma patient, the paramedic notes the following: bruising around the
umbilicus (Cullen sign) and flank ecchymosis (Grey Turner sign). These findings are most consistent with
which of the following injuries?
A) Ruptured spleen with intra-abdominal hemorrhage.
B) Retroperitoneal hemorrhage from a pancreatic or duodenal injury.
C) Pelvic fracture with associated vascular disruption.
D) Liver laceration with bile peritonitis.
Answer: B
Rationale: Cullen sign (periumbilical bruising) and Grey Turner sign (flank ecchymosis) are classic signs of
retroperitoneal hemorrhage, often from pancreatic, duodenal, or renal injuries. Spleen and liver injuries typically
present with peritoneal signs. Pelvic fractures may cause flank ecchymosis but not typically Cullen sign.
9 A patient with a crush injury to the pelvis is in severe pain and has a palpable bladder. The paramedic notes that
the patient has not urinated in 8 hours. Which of the following is the most appropriate intervention?
A) Insert a nasogastric tube and administer activated charcoal.
B) Perform a diagnostic peritoneal lavage (DPL) to assess for intra-abdominal injury.
C) Attempt to catheterize the patient to decompress the bladder.
D) Apply a pelvic binder and transport without catheterization.
Answer: C
Rationale: A palpable bladder with inability to void suggests urethral injury or bladder rupture. Catheterization is
indicated to decompress the bladder and assess for hematuria. However, if urethral injury is suspected (e.g., blood
at meatus, high-riding prostate), a retrograde urethrogram should be performed first. In this scenario, without those
signs, gentle catheterization is appropriate. Pelvic binder is already indicated.
, 10 A paramedic is managing a patient with a gunshot wound to the right upper quadrant. The patient is
hypotensive (BP 70/40) and has distended neck veins. Which of the following conditions should be suspected?
A) Tension pneumothorax causing decreased venous return.
B) Cardiac tamponade from pericardial blood accumulation.
C) Massive hemothorax with loss of circulating volume.
D) Air embolism from a bronchovenous fistula.
Answer: B
Rationale: Penetrating trauma near the cardiac box with hypotension and distended neck veins (Beck triad minus
muffled heart sounds) suggests cardiac tamponade. Tension pneumothorax would cause tracheal deviation and
absent breath sounds. Hemothorax would cause flat neck veins due to hypovolemia. Air embolism is rare and
presents with sudden cardiovascular collapse.
11 A patient involved in a high-speed motor vehicle collision presents with hypotension, distended neck veins, and
muffled heart sounds. Which of the following assessment findings would most directly contraindicate the
application of the pneumatic antishock garment (PASG) during initial trauma management?
A) Bilateral femoral fractures with palpable distal pulses
B) Penetrating thoracic injury with suspected cardiac tamponade
C) Pelvic instability with a palpable hematoma
D) Intra-abdominal hemorrhage with a positive FAST exam
Answer: B
Rationale: PASG is contraindicated in patients with thoracic injuries that may compromise respiratory mechanics or
exacerbate tamponade physiology. In cardiac tamponade, increased intrathoracic pressure from PASG can worsen
venous return and cardiac output. Options A, C, and D are relative indications for PASG use in hemorrhagic shock.
12 During the secondary assessment of a patient with blunt abdominal trauma, you note ecchymosis over the
flanks and a seat belt sign across the lower abdomen. Which of the following is the most appropriate next step
in management?
A) Immediate transport to a trauma center with serial abdominal exams en route
B) Placement of a nasogastric tube and urinary catheter prior to transport
C) Needle decompression of the left chest for suspected pneumothorax
D) Administration of 2 liters of isotonic crystalloid fluid bolus
Answer: A
Rationale: The presence of flank ecchymosis (Grey Turner sign) and seat belt sign suggests significant
intra-abdominal injury requiring trauma center evaluation. Immediate transport with serial exams is prioritized over
interventions that delay transport. NG tube and catheter may be placed en route if time permits. Needle
decompression is not indicated without evidence of tension pneumothorax. Fluid resuscitation should be permissive
hypotension, not routine bolus.
13 A patient with a traumatic brain injury (TBI) has a Glasgow Coma Scale (GCS) score of 9 (E2 V3 M4). Which
of the following management strategies is most consistent with current guidelines to optimize cerebral
perfusion and minimize secondary injury?
A) Maintain systolic blood pressure (SBP) > 110 mmHg and PaCO2 between 35-40 mmHg
B) Hyperventilate to a PaCO2 of 25-30 mmHg to reduce intracranial pressure
C) Administer hypertonic saline 3% 250 mL bolus for signs of herniation
D) Elevate the head of the bed to 30 degrees and maintain SBP > 90 mmHg
Answer: A
