Free Chest Decompression & Advanced Hemorrhage Practice Questions

1. A trauma patient with blunt chest injury develops Beck's triad: muffled heart tones, JVD, and hypotension. You suspect cardiac tamponade. What is the pathophysiology causing this patient's hemodynamic compromise?

• Blood in the pericardial sac compresses the heart, preventing adequate diastolic filling and reducing cardiac output
• Air in the pericardium is compressing the coronary arteries
• The heart has ruptured and blood is filling the chest cavity
• A tension pneumothorax is compressing the heart from the outside

2. A trauma patient in cardiac arrest from penetrating thoracic injury is intubated and receiving CPR. Bilateral needle decompressions have been performed. ETCO2 remains <5 mmHg despite high-quality compressions. The presenting rhythm is PEA. Which reversible cause should be prioritized in this presentation?

• Cardiac tamponade — pericardial blood is preventing cardiac filling despite decompressed pleural spaces
• Hypovolemia — administer 3 liters of normal saline
• Hyperkalemia — administer calcium chloride
• Hypothermia — begin active rewarming

3. You perform needle decompression on a tension pneumothorax patient and hear a rush of air. The patient initially improves but 15 minutes into transport, signs of tension physiology recur (worsening hypotension, JVD, absent breath sounds). What has MOST likely occurred?

• The catheter has kinked, clotted, or become dislodged, and the tension pneumothorax has re-accumulated
• The patient has developed a new tension pneumothorax on the opposite side
• The initial decompression was unnecessary
• The patient is having a cardiac event unrelated to the pneumothorax

4. A trauma patient with a stab wound to the left chest has absent breath sounds on the left, JVD, hypotension, and tachycardia. You perform needle decompression at the 2nd ICS MCL but get no rush of air. The patient continues to deteriorate. What should you consider NEXT?

• Reattempt decompression at the 5th ICS anterior axillary line (alternative site) — the needle may have been too short to reach the pleural space at the MCL
• The patient does not have a tension pneumothorax; stop interventions
• Perform CPR as the patient is in cardiac arrest from the stab wound
• Administer a 2-liter fluid bolus

5. An intubated trauma patient with a right-sided tension pneumothorax is undergoing positive pressure ventilation. What effect does positive pressure ventilation have on an untreated tension pneumothorax?

• It rapidly worsens the tension pneumothorax by forcing more air into the pleural space with each ventilation
• It has no effect on the pneumothorax
• It treats the pneumothorax by re-expanding the lung
• It converts the tension pneumothorax to a simple pneumothorax