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SU17.1-10 | Trauma — Practice Quiz
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A pedestrian is knocked down by a car. You are the first person at the scene and have basic first-aid training. Before you touch the casualty, which single action is the absolute first priority?
Correct. The first rule of first aid is rescuer safety — Danger before anything else (the 'D' of DRSABC). An injured rescuer helps no one.
First aid follows DRSABC: Danger, Response, Shout/Send for help, Airway, Breathing, Circulation. The three aims are to preserve life, prevent worsening and promote recovery — but always after securing rescuer safety.
The first rule of first aid is rescuer safety. Approaching an unsafe scene risks a second casualty. Confirm the scene is safe before any assessment or intervention.
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You find an unresponsive adult who is not breathing normally. You have started high-quality chest compressions. What is the correct rate and compression-to-ventilation ratio for adult basic life support by a trained rescuer?
Correct. Adult BLS uses a 30:2 compression-to-ventilation ratio at a rate of 100–120 per minute, with a depth of 5–6 cm and full chest recoil between compressions.
High-quality compressions: rate 100–120/min, depth 5–6 cm, full recoil, minimise interruptions. Push hard, push fast in the centre of the chest.
Adult BLS is 30 compressions to 2 breaths at 100–120 per minute, depth 5–6 cm, allowing full recoil. The 15:2 ratio applies to two-rescuer paediatric resuscitation, not adults.
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During resuscitation a bystander insists 'he is still breathing' because the collapsed man takes occasional slow, noisy, gasping breaths. How should you interpret this finding?
Correct. Occasional slow, gasping breaths in the first minutes after arrest are agonal breaths — a sign of cardiac arrest, NOT effective breathing. Start CPR.
Do not be fooled by gasping. Agonal breathing is common in the first minutes after arrest and must trigger immediate CPR.
Agonal (gasping) breathing is a sign of cardiac arrest, not effective ventilation. Mistaking it for normal breathing fatally delays CPR. Treat 'not breathing normally' as arrest.
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An overturned bus produces 40 casualties and you have a handful of responders. Using START triage you reach a casualty who is walking and complaining loudly about a painful arm. Which triage category does this casualty receive?
Correct. In START, anyone who can walk to a designated area is GREEN (minor). A patient who walks and talks is moving air and perfusing the brain.
START triage: the loudest patients are rarely the sickest. Walking = GREEN. The quiet, not-breathing or poorly-perfused casualties are the RED priorities.
START begins by asking the walking wounded to move to a safe area — they are GREEN by definition. A casualty who walks and shouts is ventilating and perfusing, so cannot be RED.
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The guiding ethical and operational principle that changes how care is delivered in a declared mass casualty incident (compared with a single patient) is best expressed as:
Correct. An MCI overwhelms resources, so the aim shifts from doing everything for one patient to achieving the greatest good for the greatest number.
MCI response rests on command, zones and the logic of triage. Only seconds-long life-saving interventions (open airway, control major bleeding) are done during triage itself.
A mass casualty incident overwhelms resources; the aim becomes the greatest good for the greatest number, delivered through command, zoning and triage — not maximal effort on each individual.
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A head-injured patient opens his eyes to voice, is confused in his speech, and localises to a painful stimulus. What is his Glasgow Coma Scale score?
Correct. Eye opening to voice = 3, confused speech = 4, localises to pain = 5. Total = 3 + 4 + 5 = 13.
GCS = Eye (out of 4) + Verbal (out of 5) + Motor (out of 6), range 3–15. A GCS of 8 or less defines coma and the need for definitive airway protection.
Score each component: eyes to voice = 3, confused speech = 4, localising to pain = 5. The sum is 13, placing this in the mild-to-moderate range.
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A motorcyclist is lucid immediately after a head injury, then over the next two hours becomes drowsy, develops a dilating pupil on one side, and shows a rising blood pressure with a slowing pulse. What is the most likely diagnosis?
Correct. The 'lucid interval' followed by deterioration, an enlarging ipsilateral pupil and Cushing's response (rising BP, falling pulse) is the textbook expanding extradural haematoma from middle meningeal artery bleeding.
Cushing's response (hypertension + bradycardia) signals raised intracranial pressure. An extradural haematoma is a neurosurgical emergency — urgent CT and evacuation.
A lucid interval that gives way to drowsiness, an enlarging pupil and Cushing's response is the classic course of an arterial extradural haematoma. A talking head-injured patient is not a safe one.
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A road-crash victim is shocked and severely breathless, with absent breath sounds and a hyper-resonant left chest, distended neck veins and a trachea deviated to the right. What is the immediate life-saving intervention?
Correct. This is a tension pneumothorax — a clinical diagnosis treated immediately with needle decompression, then a definitive intercostal chest drain. Do not wait for an X-ray.
A tension pneumothorax is diagnosed with eyes and hands, treated with a needle. Massive haemothorax (>1500 mL drained) calls for thoracotomy; cardiac tamponade (Beck's triad) calls for pericardiocentesis/surgery.
Tension pneumothorax is diagnosed clinically (shock, absent breath sounds, hyper-resonance, distended neck veins, tracheal deviation away from the affected side) and treated at once by needle decompression, then chest drain — never delayed for imaging.
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