Page 18 of 20
SU17.1-10 | Trauma — Graded Quiz
Click any question card to reveal the correct answer.
You are alone and find an adult collapsed and unresponsive in a hospital corridor. After confirming the scene is safe and that he is unresponsive and not breathing normally, what is the correct immediate sequence of actions for an adult?
Correct. In adult BLS, once arrest is recognised you call for help/activate the response and start compressions without delay (C-A-B emphasis), 30:2 at 100–120/min.
Modern adult BLS emphasises early, high-quality compressions (C-A-B). Minimise any interruption before starting compressions.
Recognise arrest, shout for help/activate the response, and start chest compressions immediately (30:2, 100–120/min). Prolonged pulse checks and delayed compressions worsen outcome.
Click to reveal answer
In START triage, after the walking wounded have been directed away, you assess a non-walking casualty: respiratory rate is 36 per minute. Without checking anything else, what category does this respiratory rate alone assign?
Correct. In START, a respiratory rate over 30/min flags the casualty as RED (immediate) — abnormal respiration is the first life-threat the algorithm screens for.
START thresholds: RR >30, absent radial pulse / cap refill >2 s, or failure to obey commands → RED. The algorithm is designed to be applied in under a minute per casualty.
START assesses Respiration, Perfusion and Mental status. A respiratory rate over 30/min is abnormal and assigns the RED (immediate) category straight away.
Click to reveal answer
A patient with a moderate head injury has a GCS that has just dropped from 14 to 9. After ensuring airway, breathing and circulation, what is the single most appropriate next investigation?
Correct. A deteriorating conscious level after head injury mandates an urgent non-contrast CT head to identify an evacuable haematoma. Resuscitation precedes the scan.
The overriding aim in head injury is to prevent secondary brain injury: resuscitate first (avoid hypoxia and hypotension), then image urgently and evacuate clots.
An urgent non-contrast CT head is the investigation of choice for a deteriorating GCS — it rapidly identifies surgically treatable haematomas. Skull X-ray and LP are inappropriate here.
Click to reveal answer
A farmer presents with a contaminated forearm wound from a soil-covered blade. His tetanus status is uncertain. Which statement reflects correct wound management?
Correct. A contaminated wound must never be closed primarily — clean, debride and leave open for delayed primary closure, and always address tetanus status.
Wound management order: control bleeding, analgesia, clean/debride, decide closure (delayed for contaminated wounds), tetanus prophylaxis, antibiotics where indicated.
Never close a contaminated wound primarily: stitching it tight traps bacteria and devitalised tissue in an anaerobic pocket, risking tetanus and infection. Clean, debride, leave open, cover tetanus.
Click to reveal answer
A blunt-trauma patient arrives shocked with absent breath sounds and stony dull percussion over the left chest base, and the chest drain you insert immediately yields 1700 mL of blood. What is the most appropriate next step?
Correct. A massive haemothorax with an initial drainage of more than 1500 mL (or ongoing brisk loss) is an indication for urgent thoracotomy.
Haemothorax: dull percussion + absent breath sounds. Drain it; if >1500 mL initially or >200 mL/hr ongoing, the patient needs thoracotomy. Contrast with the hyper-resonant tension pneumothorax.
Massive haemothorax is defined by >1500 mL initial drainage (or continued high-rate loss); this mandates urgent thoracotomy, not observation or drain removal.
Click to reveal answer
A patient has multiple adjacent rib fractures in two places each, producing a segment of chest wall that moves paradoxically (in on inspiration, out on expiration). Besides analgesia and oxygen, what is the principal underlying threat to this patient's gas exchange?
Correct. In flail chest the paradoxical segment is visible, but the main cause of hypoxia is the underlying pulmonary contusion. Management centres on analgesia, oxygen and supporting ventilation.
Flail chest = two or more ribs fractured in two or more places. Watch for the underlying contusion and treat pain aggressively so the patient can ventilate; intubate if respiratory failure develops.
Flail chest produces paradoxical movement, but the principal threat to oxygenation is the underlying lung (pulmonary) contusion. Treatment is good analgesia, oxygen, and ventilatory support if needed.
Click to reveal answer