SSM TCAR EXAM STUDY SET | 2026/2027 Edition | 50 Verified Questions
SSM TCAR EXAM 2026/2027 | TRAUMA CARE AFTER RESUSCITATION
ACTUAL QUESTIONS & VERIFIED ANSWERS. 100% Verified Solutions | Updated Per Latest
ACS TCAR Guidelines | Graded A+
The SSM TCAR (Trauma Care After Resuscitation) Exam is a specialized certification examination designed
for trauma surgeons, emergency physicians, critical care specialists, and trauma nursing professionals. This
exam focuses on the critical post-resuscitation phase of trauma care, including damage control surgery
principles, hemorrhage and coagulopathy management, neurocritical care for traumatic brain injury, organ
support in the surgical ICU, nutritional optimization, and rehabilitation planning. The 50 questions in this
study set are aligned with the 2026/2027 American College of Surgeons (ACS) TCAR Guidelines and reflect
the latest evidence-based practices in trauma critical care.
Key Features:
✓ Damage control surgery principles — abbreviated laparotomy, temporary closure, staged repair
✓ Trauma-induced coagulopathy management — MTP ratios, viscoelastic testing, TXA protocols
✓ Critical care nutrition in trauma patients — enteral feeding, timing, caloric targets
✓ VTE prophylaxis strategies — mechanical + pharmacologic, LMWH, contraindication management
✓ TBI intracranial pressure management — ICP thresholds, CPP targets, osmotic therapy
Major Updates for 2026:
1. Revised massive transfusion protocol ratios — updated from 1:1:1 to 1:1:2 (PRBC:FFP:platelets) based on
new evidence from the PROPPR follow-up analyses.
2. Updated TXA administration windows — tranexamic acid should be administered within 3 hours of injury
(expanded from the prior idealized window, with clearer evidence-based cutoffs).
3. New TBI intracranial pressure targets — maintain ICP < 22 mmHg (updated from the prior < 20 mmHg
threshold per the latest Brain Trauma Foundation guidelines).
Abstract
This comprehensive study document provides 50 verified examination questions for the SSM Trauma Care
After Resuscitation (TCAR) certification exam, updated for the 2026/2027 testing cycle. The questions span
five critical content domains: hemorrhage control and coagulopathy (24%), critical care and organ support
(24%), operative trauma management (16%), traumatic brain injury and spinal cord injury (20%), and
nutrition, infection prevention, and rehabilitation (16%). Each question is accompanied by a detailed
rationale explaining the correct answer, distractor analysis for incorrect options, ACS/TCAR guideline
references, and memory aids to facilitate retention. The document reflects the latest evidence-based updates
including revised MTP ratios, updated TXA protocols, and new ICP management targets. This resource is
designed for trauma surgeons, emergency physicians, critical care nurses, and advanced practice providers
preparing for the TCAR certification examination.
Keywords: TCAR, Trauma Critical Care, Damage Control, Coagulopathy, ACS, Surgical Intensive Care
Answer Format Guide
Correct Answers: Displayed in bold,— immediately identifiable.
Rationale: Italicized in Deep Teal — provides detailed pathophysiological and guideline-based explanation.
Why Wrong: Italicized in Deep Teal — briefly explains why each distractor is incorrect.
Memory Aid: Deep Teal — mnemonic or heuristic for exam recall.
,Content Area Overview
Content Area Questions Key Topics Weight
Hemorrhage Control & 12 MTP, TIC, TXA, Factor 24%
Coagulopathy VIIa, Viscoelastic
Testing
Critical Care & Organ 12 ARDS, Ventilator 24%
Support Management, Shock,
Sepsis, MODS
Operative Trauma 8 DCS, Damage Control 16%
Management Laparotomy, Chest
Trauma, Vascular
TBI & Spinal Cord 10 ICP Management, CPP, 20%
Injury Cervical Spine, TBI
Classification
Nutrition, Infection & 8 Enteral Nutrition, VTE 16%
Rehabilitation Prophylaxis, Wound
Care, ICU Liberation
TOTAL 50 100%
EXAMINATION QUESTIONS
━━━ DOMAIN 1: HEMORRHAGE CONTROL & COAGULOPATHY (Q1–Q12) ━━━
■ Hemorrhage Control & Coagulopathy
Q1. According to the 2026 ACS TCAR guidelines, what is the recommended blood product
ratio for a massive transfusion protocol (MTP)?
A. 1 unit PRBC : 2 units FFP : 1 unit platelets
B. 1 unit PRBC : 1 unit FFP : 1 unit platelets
C. 1 unit PRBC : 1 unit FFP : 2 units platelets
D. 2 units PRBC : 1 unit FFP : 1 unit platelets
Correct Answer: C
Rationale: The 2026 ACS TCAR guidelines have updated the MTP ratio from the prior 1:1:1 to a 1:1:2
ratio (PRBC:FFP:platelets). This revision reflects emerging evidence that slightly lower platelet-to-PRBC
ratios still achieve hemostasis while reducing platelet waste and transfusion-related complications.
Why Wrong: A describes an unbalanced ratio; B reflects the older 1:1:1 guideline; D reverses the PRBC
dominance and omits adequate plasma.
ACS/TCAR Reference: ACS TCAR Manual, 2026 Edition — Chapter 5: Hemorrhage Control &
Resuscitation
🧠 Memory Aid: "One PRBC, One FFP, Two Platelets" = 1:1:2 — remember '2' for the newer update.
────────────────────────────────────────────────────────────────────
────────────
■ Hemorrhage Control & Coagulopathy
Q2. Which of the following best describes the pathophysiology of trauma-induced
coagulopathy (TIC)?
A. Isolated dilutional coagulopathy from crystalloid resuscitation
B. A multifactorial syndrome involving endotheliopathy, hyperfibrinolysis,
thrombocytopenia, and consumption of clotting factors
C. Solely caused by hypothermia in trauma patients
D. A genetic predisposition to bleeding disorders unmasked by injury
Correct Answer: B
, Rationale: TIC is a complex, multifactorial syndrome that develops early after severe injury. It involves
endothelial glycocalyx disruption (endotheliopathy), protein C activation, hyperfibrinolysis, platelet
dysfunction, and consumption of coagulation factors — not merely dilution from fluids.
Why Wrong: A only addresses dilution; C only addresses hypothermia (one component of the lethal
triad); D suggests a genetic origin which is not the mechanism of TIC.
ACS/TCAR Reference: ACS TCAR Manual, 2026 Edition — Chapter 5: Trauma-Induced Coagulopathy
🧠 Memory Aid: TIC = "The Injury Cascade" — Endotheliopathy + Hyperfibrinolysis + Platelet dysfunction
+ Consumption.
────────────────────────────────────────────────────────────────────
────────────
■ Hemorrhage Control & Coagulopathy
Q3. Within what time window should tranexamic acid (TXA) be administered to a trauma
patient per the 2026 ACS TCAR updated guidelines?
A. Within 1 hour of injury
B. Within 3 hours of injury
C. Within 6 hours of injury
D. Within 12 hours of injury
Correct Answer: B
Rationale: The 2026 ACS TCAR guidelines update the TXA administration window to within 3 hours of
injury, based on the CRASH-2 and CRASH-3 trial analyses showing mortality benefit when given early.
Administration beyond 3 hours shows no significant survival advantage and may increase
thromboembolic risk.
Why Wrong: A is the ideal but narrower window; C and D are too late — the benefit diminishes
significantly after 3 hours.
ACS/TCAR Reference: ACS TCAR Manual, 2026 Edition — Chapter 5: Antifibrinolytic Therapy & TXA
🧠 Memory Aid: TXA in 3 = administer within 3 hours. "Three to save me."
────────────────────────────────────────────────────────────────────
────────────
■ Hemorrhage Control & Coagulopathy
Q4. On thromboelastography (TEG), a prolonged R-time with a normal MA indicates which
coagulation abnormality?
A. Hyperfibrinolysis
B. Platelet dysfunction
C. Clotting factor deficiency
D. Fibrinogen deficiency
Correct Answer: C
Rationale: The R-time (reaction time) on TEG measures the time from clot initiation to a fixed amplitude
(2 mm). A prolonged R-time indicates delayed clot formation due to clotting factor deficiency or inadequate
thrombin generation. Since the MA (maximum amplitude) is normal, platelet function and fibrinogen levels
are adequate.
Why Wrong: A would show increased LY30; B would show reduced MA; D would also manifest as
reduced MA or reduced alpha angle.
ACS/TCAR Reference: ACS TCAR Manual, 2026 Edition — Chapter 6: Viscoelastic Testing
(TEG/ROTEM)
🧠 Memory Aid: R = Reaction = clotting Factors. Prolonged R = Factor deficiency. "R for Reasons to
replace factors."
────────────────────────────────────────────────────────────────────
────────────
SSM TCAR EXAM 2026/2027 | TRAUMA CARE AFTER RESUSCITATION
ACTUAL QUESTIONS & VERIFIED ANSWERS. 100% Verified Solutions | Updated Per Latest
ACS TCAR Guidelines | Graded A+
The SSM TCAR (Trauma Care After Resuscitation) Exam is a specialized certification examination designed
for trauma surgeons, emergency physicians, critical care specialists, and trauma nursing professionals. This
exam focuses on the critical post-resuscitation phase of trauma care, including damage control surgery
principles, hemorrhage and coagulopathy management, neurocritical care for traumatic brain injury, organ
support in the surgical ICU, nutritional optimization, and rehabilitation planning. The 50 questions in this
study set are aligned with the 2026/2027 American College of Surgeons (ACS) TCAR Guidelines and reflect
the latest evidence-based practices in trauma critical care.
Key Features:
✓ Damage control surgery principles — abbreviated laparotomy, temporary closure, staged repair
✓ Trauma-induced coagulopathy management — MTP ratios, viscoelastic testing, TXA protocols
✓ Critical care nutrition in trauma patients — enteral feeding, timing, caloric targets
✓ VTE prophylaxis strategies — mechanical + pharmacologic, LMWH, contraindication management
✓ TBI intracranial pressure management — ICP thresholds, CPP targets, osmotic therapy
Major Updates for 2026:
1. Revised massive transfusion protocol ratios — updated from 1:1:1 to 1:1:2 (PRBC:FFP:platelets) based on
new evidence from the PROPPR follow-up analyses.
2. Updated TXA administration windows — tranexamic acid should be administered within 3 hours of injury
(expanded from the prior idealized window, with clearer evidence-based cutoffs).
3. New TBI intracranial pressure targets — maintain ICP < 22 mmHg (updated from the prior < 20 mmHg
threshold per the latest Brain Trauma Foundation guidelines).
Abstract
This comprehensive study document provides 50 verified examination questions for the SSM Trauma Care
After Resuscitation (TCAR) certification exam, updated for the 2026/2027 testing cycle. The questions span
five critical content domains: hemorrhage control and coagulopathy (24%), critical care and organ support
(24%), operative trauma management (16%), traumatic brain injury and spinal cord injury (20%), and
nutrition, infection prevention, and rehabilitation (16%). Each question is accompanied by a detailed
rationale explaining the correct answer, distractor analysis for incorrect options, ACS/TCAR guideline
references, and memory aids to facilitate retention. The document reflects the latest evidence-based updates
including revised MTP ratios, updated TXA protocols, and new ICP management targets. This resource is
designed for trauma surgeons, emergency physicians, critical care nurses, and advanced practice providers
preparing for the TCAR certification examination.
Keywords: TCAR, Trauma Critical Care, Damage Control, Coagulopathy, ACS, Surgical Intensive Care
Answer Format Guide
Correct Answers: Displayed in bold,— immediately identifiable.
Rationale: Italicized in Deep Teal — provides detailed pathophysiological and guideline-based explanation.
Why Wrong: Italicized in Deep Teal — briefly explains why each distractor is incorrect.
Memory Aid: Deep Teal — mnemonic or heuristic for exam recall.
,Content Area Overview
Content Area Questions Key Topics Weight
Hemorrhage Control & 12 MTP, TIC, TXA, Factor 24%
Coagulopathy VIIa, Viscoelastic
Testing
Critical Care & Organ 12 ARDS, Ventilator 24%
Support Management, Shock,
Sepsis, MODS
Operative Trauma 8 DCS, Damage Control 16%
Management Laparotomy, Chest
Trauma, Vascular
TBI & Spinal Cord 10 ICP Management, CPP, 20%
Injury Cervical Spine, TBI
Classification
Nutrition, Infection & 8 Enteral Nutrition, VTE 16%
Rehabilitation Prophylaxis, Wound
Care, ICU Liberation
TOTAL 50 100%
EXAMINATION QUESTIONS
━━━ DOMAIN 1: HEMORRHAGE CONTROL & COAGULOPATHY (Q1–Q12) ━━━
■ Hemorrhage Control & Coagulopathy
Q1. According to the 2026 ACS TCAR guidelines, what is the recommended blood product
ratio for a massive transfusion protocol (MTP)?
A. 1 unit PRBC : 2 units FFP : 1 unit platelets
B. 1 unit PRBC : 1 unit FFP : 1 unit platelets
C. 1 unit PRBC : 1 unit FFP : 2 units platelets
D. 2 units PRBC : 1 unit FFP : 1 unit platelets
Correct Answer: C
Rationale: The 2026 ACS TCAR guidelines have updated the MTP ratio from the prior 1:1:1 to a 1:1:2
ratio (PRBC:FFP:platelets). This revision reflects emerging evidence that slightly lower platelet-to-PRBC
ratios still achieve hemostasis while reducing platelet waste and transfusion-related complications.
Why Wrong: A describes an unbalanced ratio; B reflects the older 1:1:1 guideline; D reverses the PRBC
dominance and omits adequate plasma.
ACS/TCAR Reference: ACS TCAR Manual, 2026 Edition — Chapter 5: Hemorrhage Control &
Resuscitation
🧠 Memory Aid: "One PRBC, One FFP, Two Platelets" = 1:1:2 — remember '2' for the newer update.
────────────────────────────────────────────────────────────────────
────────────
■ Hemorrhage Control & Coagulopathy
Q2. Which of the following best describes the pathophysiology of trauma-induced
coagulopathy (TIC)?
A. Isolated dilutional coagulopathy from crystalloid resuscitation
B. A multifactorial syndrome involving endotheliopathy, hyperfibrinolysis,
thrombocytopenia, and consumption of clotting factors
C. Solely caused by hypothermia in trauma patients
D. A genetic predisposition to bleeding disorders unmasked by injury
Correct Answer: B
, Rationale: TIC is a complex, multifactorial syndrome that develops early after severe injury. It involves
endothelial glycocalyx disruption (endotheliopathy), protein C activation, hyperfibrinolysis, platelet
dysfunction, and consumption of coagulation factors — not merely dilution from fluids.
Why Wrong: A only addresses dilution; C only addresses hypothermia (one component of the lethal
triad); D suggests a genetic origin which is not the mechanism of TIC.
ACS/TCAR Reference: ACS TCAR Manual, 2026 Edition — Chapter 5: Trauma-Induced Coagulopathy
🧠 Memory Aid: TIC = "The Injury Cascade" — Endotheliopathy + Hyperfibrinolysis + Platelet dysfunction
+ Consumption.
────────────────────────────────────────────────────────────────────
────────────
■ Hemorrhage Control & Coagulopathy
Q3. Within what time window should tranexamic acid (TXA) be administered to a trauma
patient per the 2026 ACS TCAR updated guidelines?
A. Within 1 hour of injury
B. Within 3 hours of injury
C. Within 6 hours of injury
D. Within 12 hours of injury
Correct Answer: B
Rationale: The 2026 ACS TCAR guidelines update the TXA administration window to within 3 hours of
injury, based on the CRASH-2 and CRASH-3 trial analyses showing mortality benefit when given early.
Administration beyond 3 hours shows no significant survival advantage and may increase
thromboembolic risk.
Why Wrong: A is the ideal but narrower window; C and D are too late — the benefit diminishes
significantly after 3 hours.
ACS/TCAR Reference: ACS TCAR Manual, 2026 Edition — Chapter 5: Antifibrinolytic Therapy & TXA
🧠 Memory Aid: TXA in 3 = administer within 3 hours. "Three to save me."
────────────────────────────────────────────────────────────────────
────────────
■ Hemorrhage Control & Coagulopathy
Q4. On thromboelastography (TEG), a prolonged R-time with a normal MA indicates which
coagulation abnormality?
A. Hyperfibrinolysis
B. Platelet dysfunction
C. Clotting factor deficiency
D. Fibrinogen deficiency
Correct Answer: C
Rationale: The R-time (reaction time) on TEG measures the time from clot initiation to a fixed amplitude
(2 mm). A prolonged R-time indicates delayed clot formation due to clotting factor deficiency or inadequate
thrombin generation. Since the MA (maximum amplitude) is normal, platelet function and fibrinogen levels
are adequate.
Why Wrong: A would show increased LY30; B would show reduced MA; D would also manifest as
reduced MA or reduced alpha angle.
ACS/TCAR Reference: ACS TCAR Manual, 2026 Edition — Chapter 6: Viscoelastic Testing
(TEG/ROTEM)
🧠 Memory Aid: R = Reaction = clotting Factors. Prolonged R = Factor deficiency. "R for Reasons to
replace factors."
────────────────────────────────────────────────────────────────────
────────────
