APEx Trauma and Burn

A patient is exhibiting signs of citrate toxicity after receiving multiple units of packed red blood cells (PRBCs). What medication is indicated in this patient?

A 16-year-old sustained an aortic arch tear during a motor vehicle collision, which is commonly associated with which of the following?

A 5-year-old pediatric patient presents with a left lower leg fracture that has been splinted but not straightened. The child is now screaming with pain every time you try to do an assessment. What is your first action before transport?

A 70kg patient was involved in a motor vehicle collision with resultant fire. They have received first-degree burns to their abdomen and lower back, and second- and third-degree burns to their face, head, hands, and both arms. What would the calculated total body surface area burned percentage be?

A 70kg patient with second- and third-degree burns involving 45% total body surface area (TBSA) is being transferred 26 hours post-injury. The physician reports that the patient has had a total of six liters of fluid in a 24-hour period. Using the Parkland formula, how much fluid should this patient have received in the first 24 hours of burn care?

A 72kg patient presents with second- and third-degree burns to their face, anterior torso and complete left arm. How much fluid should the patient receive in the first 8 hours using the Parkland formula?

A burn patient weighing 90kg has sustained a second-degree burn covering 65% TBSA. How much fluid should this patient receive over the first eight hours if calculated using the Parkland formula?

A multi-trauma patient undergoes fluid resuscitation with three liters of normal saline and five units of unwarmed packed red blood cells. They remain unconscious, intubated and ventilated with 100% oxygen. They have received sedation and remain immobilized on a backboard. Which of the following secondary complications should be of concern?

A patient has sustained significant head, chest and abdominal trauma from a motor vehicle collision. They have received five units of packed red blood cells thus far. They continue to bleed profusely from all wounds despite direct pressure to control bleeding secondary to suspected disseminated intravascular coagulation (DIC). What treatment do you expect to administer?

A patient sustained commotio cordis after being hit in the chest with a baseball. This condition occurs as a result of which of the following?

A patient sustained numerous injuries after falling from a roof. You receive a report from the transferring nurse and are told that the patient has a right tension pneumothorax. Upon assessment, you expect to find?

A patient was involved in a domestic disturbance, and sustained 8-10th left posterior rib fractures and multiple abrasions and bruising noted on the back and abdomen. They are complaining of sharp pain in their left shoulder as well. What do you suspect?

A patient weighing 120kg has second- and third-degree burns covering 45% TBSA. Using the Consensus formula for fluid resuscitation, what is total volume to be infused over the first 8 hours?

A patient who sustained extensive electrical burns is being transferred. Upon entering the room, there is brown urine noted in the foley bag, and myoglobinuria on the urinalysis. To prevent the development of acute tubular necrosis and further renal failure, what is the anticipated treatment?

A pediatric patient has sustained a pelvic fracture. What is the most likely secondary complication associated with this?

After a multi-system trauma occurs, death within minutes is usually a result of which of the following?

An 8-year-old has an orbital wall and floor fracture which can be associated with which of the following findings?

An elderly patient who is severely kyphotic has sustained an acute spinal fracture of the 6th cervical vertebra. What is the best way to stabilize/maintain alignment in this patient?

Blood loss (per liter) should be replaced with crystalloid solutions (per liter) at what ratio?

During transport of a burn patient, they are noted to have an absent P wave and an increase in the QRS interval on their ECG. The initial ECG showed sinus tachycardia at 160 with a peaked T wave. What electrolyte abnormality is suspected?

Fractures of the 1st-3rd ribs should indicate a high index of suspicion for which injury?

In a patient with a diaphragmatic injury, what organ would also have a high suspicion of injury along with this?

Injury patterns associated with rear impact collisions are?

Of the following, what is the most common cause of myocardial contusion?

The team is transporting a patient who has sustained multiple gunshot wounds. They have received five units of packed red blood cells prior to transport. The team anticipates monitoring the patient’s ECG closely for changes indicating what?

The team arrives at the scene of a serious motor vehicle accident with substantial damage to both cars. There are four critically injured patients.  Which patient is a candidate for a needle cricothyrotomy?

The team is caring for a five-year-old, 20-kilogram victim of a motor vehicle accident.  The patient’s blood pressure was 64/43 mmHg and received a 400 mL bolus of IV fluid.  The next blood pressure obtained is 72/50 mmHg.  The best action is to:

The team is caring for a patient with a circumferential, full thickness burn to the anterior and posterior thorax.  The patient has been sedated, intubated, and paralyzed for transport and is being mechanically ventilated.  During transport, the patient’s peak inspiratory pressure has increased from 15 cmH₂0 to 50 cmH₂0, with a corresponding plateau pressure increase from 10 cmH₂0 to 45 cmH₂0 with poor chest excursion.  The next best action is to:

What is the recommended insertion site for a chest tube?

Which of the following represents the consensus formula calculation for hourly fluid replacement in the pediatric burn patient?

You are caring for a pediatric burn patient weighing 20kg with second- and third-degree burns involving 45% total body surface area (TBSA). The injury occurred approximately 26 hours ago.  The physician reports that the patient has had a total of 3 liters of fluid in 24 hours because he does not want the patient to get cerebral edema.  Using the consensus formula, how much fluid should this pediatric patient have received in the first 24 hours of post-burn care?

You are caring for a pediatric burn patient weighing 20kg with second- and third-degree burns involving 45% total burn surface area (TBSA). The injury occurred two hours previously, and the referring facility administered 300 mL of LR thus far. Using the consensus formula, what would the fluid resuscitation amount be for the first 8 hours, taking into account volume already administered?

You are preparing to intubate a patient who has sustained an extensive burn. Before administering succinylcholine, it is essential to establish the time of injury. Use of this agent in patients with burns greater than 12 hours old can cause severe electrolyte disturbances including?

You are transferring a patient that was involved in a head-on collision. They are currently on a non-rebreather at 15 L/min but are demonstrating signs of hypoxia. Current vitals: BP 100/70, HR 139, RR 28 (shallow and rapid). Assessment reveals a GCS of 10; skin is pale, dry and warm. The patient’s current hemoglobin and hematocrit are 7 and 19 with a current urine output of 0.5 mL/kg/hr for the past three hours. What type of shock is this patient experiencing?

You have a 7kg pediatric patient involved in a motor vehicle collision where the vehicle caught fire.  They have received first-degree burns to their abdomen and lower back, and second and third-degree burns to the face, head, and both arms.  What are the calculated total body surface area (TBSA) burns?

You respond to the transport of a patient who sustained head, chest, and thoracic spine trauma. Upon viewing the chest x-ray, you note a widened mediastinum, obliteration of the aortic knob, and the presence of a pleural cap. You suspect what injury?

Your patient was a restrained driver that was struck on the driver’s side by another vehicle. The patient had a brief loss of consciousness and is now conversing with you with a GCS of 15. The patient is complaining of left shoulder pain. This is described as:

Your patient was involved in a motor vehicle collision and sustained moderate head injuries. They are currently awake and talking and have no neurologic deficits noted. Current vitals: BP 112/76, HR 82, RR 18 and regular. Labs have been normal. Over the past couple of days, they have had a urine output of approximately 50 mL/hr; however, they have recently had an increase to 350-375 mL/hr for the last few hours. Their current urine specific gravity is 1.001. Which IV solution would you find most appropriate for this patient?