Unilateral absent breath sounds with obstructive shock is tension pneumothorax.
Before you read
Test yourself first: 5 questions
Question 1 of 5
Why does the time since injury matter when an antifibrinolytic such as tranexamic acid is considered for a bleeding trauma patient?
Answer: A. Tranexamic acid blocks the breakdown of formed clot, and large trauma trials showed reduced death from bleeding when given within about three hours of injury, with worse outcomes when started later. It does not require prior transfusion, it is meant for ongoing bleeding, and the timing principle applies to blunt and penetrating trauma alike.
Question 2 of 5
A stabbing victim becomes pulseless while the monitor shows an organized narrow-complex rhythm at 110. How should this finding shape care?
Answer: A. An organized, fast, narrow rhythm without a pulse after trauma often means the heart is still contracting but has too little volume or is obstructed (tamponade, tension). That is the traumatic arrest with the best chance of reversal, so volume and decompression come first. PEA is not shockable, and a vasopressor cannot fill an empty or compressed heart.
Question 3 of 5
A bleeding trauma patient is at risk of becoming hypothermic even on a warm day because:
Answer: A. Shock shuts down the metabolic heat production the body normally uses, and exposure, cold fluid and an unheated compartment then strip away what is left, so the patient cools regardless of the weather. Assuming hypothermia needs freezing air is the reason trauma patients arrive cold in summer, and wet clothing is one route of heat loss rather than the only one.
Question 4 of 5
A trauma patient found outdoors overnight is profoundly cold with a slow, weak pulse. Your handling of this patient should be:
Answer: A. A deeply cold myocardium is electrically irritable and jostling can tip it into ventricular fibrillation, so the cold trauma patient is moved smoothly, kept horizontal and insulated against further loss. Rubbing the limbs drives cold peripheral blood back to the core, and treating temperature as irrelevant ignores the reason a slow pulse must be assessed over a long interval.
Question 5 of 5
A patient with cirrhosis sustains blunt abdominal trauma. The feature of their liver disease that most changes their trauma course is:
Answer: A. The liver makes most of the clotting factors, so a cirrhotic patient begins bleeding with a coagulation system that is already failing and cannot limit an injury the way a healthy one would. Platelet counts fall rather than rise in cirrhosis, and a scarred liver is stiffer and tears more readily rather than being protected by its size.
Keep the streak going with more questions like these, each with a full rationale.
Key points to remember
- Unilateral absent breath sounds with obstructive shock is tension pneumothorax.
- The pelvis and abdomen bleed heavily with nothing visible externally.
- Hypotension in an 'isolated' head injury means another source until proven otherwise.
- Hypoxia and hypotension are the preventable second injury after TBI.
Field priorities
- Minimize time to surgical control for bleeding you cannot reach.
- Protect the airway early when an inhalation injury is suspected.
Coaching the patient
- Driving the pressure to normal in uncontrolled bleeding displaces clot.
Red flags: act now
- Distended neck veins with unilateral silence
- Perineal bruising
- Hoarseness or singed nasal hair after a burn
Trauma: FAQs
What are the priority actions for Trauma in the field?
Minimize time to surgical control for bleeding you cannot reach. Protect the airway early when an inhalation injury is suspected.
What findings in Trauma change your plan or your transport decision?
Distended neck veins with unilateral silence. Perineal bruising. Hoarseness or singed nasal hair after a burn.
What do I need to know about Trauma for the NREMT?
Unilateral absent breath sounds with obstructive shock is tension pneumothorax. The pelvis and abdomen bleed heavily with nothing visible externally. Hypotension in an 'isolated' head injury means another source until proven otherwise. Hypoxia and hypotension are the preventable second injury after TBI.
What should the crew communicate or document for Trauma?
Driving the pressure to normal in uncontrolled bleeding displaces clot.
