The CFRN gives trauma 30 items; the CTRN folds injuries into its conditions domain. On this site, trauma-center care from the primary survey onward is taught on the TCRN pages. This page keeps what a transport crew decides: where the patient goes, what has to happen first, and what altitude does to an injury.
Principles: mechanism of injury, hemostasis, the trauma diamond (hypothermia, acidosis, coagulopathy, hypocalcemia), spinal motion restriction.
Neurologic: brain injury, primary and secondary, and spinal cord injury.
Maxillofacial and neck: facial, ocular, and blunt or penetrating neck injuries.
Thoracic and abdominal: chest wall, lung, cardiac and great vessel injuries; hollow, solid, diaphragmatic and retroperitoneal injuries.
Musculoskeletal and burns: pelvic, crush and extremity injuries; chemical, electrical and thermal burns.
Choosing the destination
The 2021 National Guideline for the Field Triage of Injured Patients, from the American College of Surgeons Committee on Trauma, sorts patients by red criteria, which call for the highest-level trauma center in the region, and yellow criteria, which call for a trauma center that need not be the highest level. Transport questions apply those categories together with distance, weather and the skills on board.
Trapped air in an injury, from a pneumothorax to an open globe, changes with altitude as described on flight physiology; what to do about it is decided before departure.
12 trauma calls from scene and cabin
0 of 12 attempted · 0 correct · 0 missed
Trauma · 30 items
A transport crew is managing a patient at the scene with blunt abdominal trauma. BP is 78/46 mmHg, HR is 136 beats/min, and the abdomen is distended. Which crew action conflicts with damage-control resuscitation principles?
Answer and why, all 4 options
Placing a binder on clinical suspicion, before imaging, stabilizes the pelvis early and fits damage-control resuscitation.
Starting blood products on clinical grounds, without waiting for labs, is the damage-control approach.
Accepting an SBP of 80–90 mmHg without head injury is permissive hypotension, a core part of damage-control resuscitation.
A repeat ultrasound will not change the plan for a hypotensive patient with a distended abdomen; extra scene time only delays surgical control of bleeding.
Item 1882639
Trauma · 30 items
At a rural multiple-casualty incident, one helicopter is available. The trauma center is 90 minutes away by ground. Which patient should be flown FIRST?
Answer and why, all 4 options
Blunt traumatic arrest after 10 minutes of CPR has a very low survival rate, and flying it would take the only aircraft from a salvageable patient.
An alert patient with a penetrating abdominal wound and hypotension has survivable bleeding that needs surgery fast, so the helicopter's time savings matter most.
A pulseless foot needs revascularization within hours, but limb loss ranks behind a threat to life.
A closed femur fracture with normal BP is stable and can go by ground.
Item 1882713
Trauma · 30 items
A chest tube placed for a right hemothorax at a rural hospital immediately drains 1,600 mL of blood and continues at 250 mL over the next 30 minutes. BP 86/50 mmHg HR 132 beats/min Which plan is MOST appropriate?
Answer and why, all 4 options
Clamping a chest tube with ongoing bleeding risks tension hemothorax and hides the blood loss.
Crystalloid dilutes clotting factors and red cells and does not address the source.
An initial 1,500 mL or more plus continued output signals massive hemothorax that needs a thoracotomy, so blood and fast transport to a thoracic surgeon are the plan.
A second small-bore drain will not stop bleeding; it only drains more blood.
Item 1882823
Trauma · 30 items
An intubated 80-kg patient with a traumatic brain injury develops a newly dilated right pupil and extensor posturing during flight. The flight physician orders 3% sodium chloride 3 mL/kg IV. What volume should the flight nurse administer?
Answer and why, all 4 options
3 mL/kg × 80 kg = 240 mL.
250 mL is a fixed bag volume, not the weight-based dose that was ordered.
720 mL multiplies 3 by 240, a double-calculation error.
80 mL gives 1 mL/kg, a third of the ordered dose.
Item 1882831
Trauma · 30 items
During a turbulent helicopter flight, the automated blood pressure cuff repeatedly fails or gives erratic readings in a trauma patient. The patient has no arterial line. The BEST way to trend perfusion until the readings are reliable is to
Answer and why, all 4 options
The artifact comes from aircraft motion, not patient anxiety, and sedation can drop the BP of a trauma patient.
Disconnecting the monitor loses the ECG and SpO2 that are still reliable.
Cycling the cuff every minute in turbulence gives repeated failures and can harm the limb.
Frequent checks of central and radial pulses, with mental status and skin signs, track perfusion when vibration defeats the automated cuff.
Item 1882944
Trauma · 30 items
At a scene, the pilot reports thunderstorms approaching and wants to lift off within 5 minutes. The trauma patient has a GCS of 7 and snoring respirations, and the flight nurse planned to intubate before departure. Which action is MOST appropriate?
Answer and why, all 4 options
Leaving the patient without discussion abandons a shared decision the crew must make together.
Intubating during the climb in a vibrating, confined cabin is far riskier than on the ground.
Telling the pilot about the airway risk and agreeing on a plan, for example a quick intubation before lift-off or ground transport, is crew resource management.
Insisting the aircraft wait overrides the pilot's weather judgment and puts the crew and patient at risk.
Item 1883030
Trauma · 30 items
Immediately after RSI, a patient in hemorrhagic shock drops from BP 86/50 to 62/38 mmHg. Settings: VT 8 mL/kg PBW, rate 24/min, PEEP 10 cmH2O. ETCO2 is 24 mmHg. Which ventilator change is MOST appropriate while blood is given?
Answer and why, all 4 options
A faster rate adds auto-PEEP and intrathoracic pressure and drops BP further.
Crystalloid does not fix the high thoracic pressure, and it dilutes clotting factors in hemorrhagic shock.
More PEEP raises intrathoracic pressure and cuts venous return further in a patient who is losing volume.
Positive pressure in a hypovolemic patient collapses venous return; lowering the rate and PEEP reduces intrathoracic pressure while blood restores volume.
Item 565932
Trauma · 30 items
An intubated patient with Le Fort II fractures has persistent brisk bleeding from both nares. BP is 94/58 mmHg and HR 118 beats/min. Which intervention BEST controls the bleeding before flight?
Answer and why, all 4 options
Waiting for surgery lets hemorrhagic shock progress during the flight.
Pinching the nose works for simple anterior nosebleeds, not for bleeding from midface fractures in a supine, intubated patient.
Balloon tamponade of both nasal cavities controls brisk midface bleeding in an intubated patient until surgery.
Ice packs alone cannot stop brisk bleeding from Le Fort II fractures.
Item 1883053
Trauma · 30 items
A rigid shield has been placed over a suspected open-globe injury. The patient is awake, nauseated and anxious before a 60-minute flight. Which additional measure is MOST important?
Answer and why, all 4 options
Vomiting and retching raise intraocular pressure and can push eye contents out of an open globe, so an antiemetic before departure prevents this.
Irrigation puts pressure on an open globe and can push contents out.
Any pressure on the eye, including a firm ice pack, risks extruding eye contents.
Topical anesthetic drops are not used on a suspected open globe, which should not be touched.
Item 1883047
Trauma · 30 items
A patient with a suspected thoracolumbar fracture is secured on a vacuum mattress for a helicopter flight that will climb 5,000 ft above the departure point. During the climb, which change in the mattress should the flight nurse anticipate?
Answer and why, all 4 options
An evacuated mattress still contains some air, and its rigidity depends on outside pressure, so it does change with altitude.
The mattress is rigid because outside air presses on the evacuated bead bag; as cabin pressure falls during the climb, the remaining air inside expands, the pressure difference shrinks, and the mattress softens until more air is pumped out.
Venting on ascent applies to air-filled splints; a vacuum mattress has air removed, so the risk is loss of support, not overinflation.
Hardening happens on descent, when cabin pressure rises; during the climb the mattress loses rigidity.
Item 9730002
Trauma · 30 items
A patient with Le Fort III fractures has pneumocephalus on CT and is scheduled for a fixed-wing transfer. The airway is secured with an oral endotracheal tube. Which request to the flight crew is MOST appropriate?
Answer and why, all 4 options
Pressurizing to sea level keeps the trapped cranial air from expanding and raising ICP.
A nasogastric tube is contraindicated with midface fractures and does not vent intracranial air.
Maximum altitude expands the cranial air the most and raises ICP.
The standard cabin altitude of 8,000 ft still expands trapped intracranial air.
Item 1883038
Trauma · 30 items
A worker has a 4-ft (1.2-m) steel bar impaled through the thigh. Bleeding is controlled, but the bar will not fit in the helicopter, and ground transport would take 2 hours. Which action is MOST appropriate?
Answer and why, all 4 options
A 2-hour ground trip delays surgery when the bar can be shortened safely and the patient flown.
Cutting the bar to a manageable length while it is stabilized keeps the object in place, where it may be tamponading vessels, and lets the patient fly.
Removing an impaled object in the field can release tamponade and cause uncontrolled bleeding.
Bending moves the object inside the wound and tears tissue and vessels.
Item 9730008
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Trauma traps that follow the patient aboard
A long-board ride. The 2018 joint position statement on spinal motion restriction (ACS Committee on Trauma, ACEP and NAEMSP) limits backboards to extrication; a collar and secure positioning on the stretcher maintain restriction en route.
Brain injury and blood pressure. The Brain Trauma Foundation's prehospital guidelines (3rd edition, 2023) keep oxygen saturation above 90% and adult systolic pressure at 110 mmHg or higher, because lower values go with worse outcomes.
Calling it neurogenic shock too early. Bradycardia with warm, dry skin fits a cord injury, but in a patient with several injuries bleeding has to be excluded first.
Steroids for spinal cord injury. Routine methylprednisolone is not recommended (AANS and CNS guidelines for acute cervical spine and spinal cord injury, 2013).
Burn time counted from your arrival. Fluid targets for the first 24 hours run from the time of the burn, so a patient handed over hours later may already be behind; superficial burns are not counted in the percentage of body surface.
Why does the CFRN have a trauma domain and the CTRN not?
BCEN's 2026 outlines are built differently. The CFRN lists trauma as its own domain of 30 items; the CTRN places injuries in Patient Conditions and Principles of Management, together with medical conditions.
What is the trauma diamond?
An extension of the lethal triad: hypocalcemia joins hypothermia, acidosis and coagulopathy as a fourth point. The CFRN outline lists it among the principles of trauma management.