SSM TCAR Exam ACTUAL EXAM
2026/2027 | Trauma Care After Resuscitation
ACS TCAR Guidelines | Verified Q&A | Pass
Guaranteed - A+ Graded
[Section 1: Shock Management & Hemodynamic Monitoring — 12 Questions]
Q1: A trauma patient arrives in the ICU after resuscitation. BP is 88/56 mmHg, HR 128 bpm, RR 26
breaths/min, SpO2 94% on 40% FiO2. The patient is cool, clammy, and confused. Which type of shock is
most likely?
A. Cardiogenic shock
B. Distributive (neurogenic) shock
C. Hypovolemic/hemorrhagic shock
D. Septic shock
Correct Answer: C
Rationale: Cool, clammy skin with tachycardia, hypotension, and confusion in a trauma patient indicates
hypovolemic/hemorrhagic shock from blood loss. Cardiogenic shock would show warm, dry skin or
pulmonary edema. Neurogenic shock presents with warm, dry skin and bradycardia. Septic shock is
unlikely in the immediate post-resuscitation period.
Q2: A trauma patient has a shock index (HR/SBP) of 1.4. What does this indicate?
A. Normal hemodynamic status
B. Hemodynamic stability
C. Significant hemorrhage requiring immediate intervention
D. Cardiogenic shock
Correct Answer: C
Rationale: A shock index > 1.0 indicates significant hemorrhage and hemodynamic compromise. Normal
shock index is 0.5-0.7. Values > 1.0 correlate with increased mortality and require immediate
hemorrhage control and resuscitation.
,Q3: A patient with a penetrating torso injury is being managed with permissive hypotension. The systolic
blood pressure is 82 mmHg. What is the target systolic BP for this patient?
A. 60-70 mmHg
B. 80-90 mmHg
C. 100-110 mmHg
D. ≥ 120 mmHg
Correct Answer: B
Rationale: Permissive hypotension for penetrating torso trauma targets SBP of 80-90 mmHg to minimize
clot disruption while maintaining perfusion. Lower targets risk cerebral and coronary hypoperfusion.
Higher targets disrupt hemostasis. Targets ≥ 100-110 mmHg are for traumatic brain injury.
Q4: A trauma patient has a lactate level of 6.2 mmol/L after initial resuscitation. What is the clinical
significance?
A. Normal post-resuscitation finding
B. Indicator of adequate tissue perfusion
C. Marker of tissue hypoperfusion and anaerobic metabolism requiring continued resuscitation
D. Expected finding after blood transfusion
Correct Answer: C
Rationale: Elevated lactate (> 2 mmol/L) indicates tissue hypoperfusion and anaerobic metabolism,
requiring continued resuscitation until normalized. Normal lactate is < 2 mmol/L. It is not a normal
finding or indicator of adequate perfusion. Blood transfusion does not cause elevated lactate.
Q5: A trauma patient is receiving massive transfusion. The patient develops hypothermia (34.5°C),
acidosis (pH 7.18), and coagulopathy (INR 2.5). What is this triad called?
A. Systemic inflammatory response syndrome
B. Lethal triad of trauma
C. Multiple organ dysfunction syndrome
D. Compensatory anti-inflammatory response syndrome
Correct Answer: B
Rationale: Hypothermia, acidosis, and coagulopathy constitute the lethal triad of trauma, which
perpetuates hemorrhage and increases mortality. SIRS is a generalized inflammatory response. MODS is
end-organ failure. CARS is an immunosuppressive response.
Q6: A trauma patient has a base deficit of -8 mEq/L. What does this indicate?
, A. Metabolic alkalosis
B. Metabolic acidosis from tissue hypoperfusion
C. Respiratory acidosis
D. Normal acid-base status
Correct Answer: B
Rationale: Base deficit of -8 indicates metabolic acidosis, typically from tissue hypoperfusion and
anaerobic metabolism in hemorrhagic shock. Positive values indicate alkalosis. Respiratory acidosis is
determined by PaCO2. Normal base deficit is -2 to +2.
Q7: A trauma patient has a cardiac output of 5 L/min and oxygen delivery (DO₂) of 400 mL O₂/min. The
oxygen consumption (VO₂) is 200 mL O₂/min. What is the oxygen extraction ratio?
A. 25%
B. 50%
C. 75%
D. 100%
Correct Answer: B
Rationale: Oxygen extraction ratio = VO₂/DO₂ = 200/400 = 0.50 or 50%. Normal extraction is 25-30%.
Elevated extraction (> 30%) indicates inadequate oxygen delivery. 25% would be normal. 75% and 100%
indicate severe shock.
Q8: A trauma patient is receiving blood products in a 1:1:1 ratio. What does this ratio represent?
A. 1 unit PRBC : 1 unit platelets : 1 unit cryoprecipitate
B. 1 unit PRBC : 1 unit FFP : 1 unit platelets
C. 1 unit PRBC : 1 unit FFP : 1 unit whole blood
D. 1 unit PRBC : 1 unit albumin : 1 unit normal saline
Correct Answer: B
Rationale: The 1:1:1 massive transfusion ratio is 1 unit packed red blood cells : 1 unit fresh frozen
plasma : 1 unit platelets, mimicking whole blood composition. Cryoprecipitate, albumin, and saline are
not part of this ratio.
Q9: A trauma patient has a central venous pressure (CVP) of 2 mmHg and a blood pressure of 78/50
mmHg. What is the most likely cause?
A. Fluid overload
B. Hypovolemia
2026/2027 | Trauma Care After Resuscitation
ACS TCAR Guidelines | Verified Q&A | Pass
Guaranteed - A+ Graded
[Section 1: Shock Management & Hemodynamic Monitoring — 12 Questions]
Q1: A trauma patient arrives in the ICU after resuscitation. BP is 88/56 mmHg, HR 128 bpm, RR 26
breaths/min, SpO2 94% on 40% FiO2. The patient is cool, clammy, and confused. Which type of shock is
most likely?
A. Cardiogenic shock
B. Distributive (neurogenic) shock
C. Hypovolemic/hemorrhagic shock
D. Septic shock
Correct Answer: C
Rationale: Cool, clammy skin with tachycardia, hypotension, and confusion in a trauma patient indicates
hypovolemic/hemorrhagic shock from blood loss. Cardiogenic shock would show warm, dry skin or
pulmonary edema. Neurogenic shock presents with warm, dry skin and bradycardia. Septic shock is
unlikely in the immediate post-resuscitation period.
Q2: A trauma patient has a shock index (HR/SBP) of 1.4. What does this indicate?
A. Normal hemodynamic status
B. Hemodynamic stability
C. Significant hemorrhage requiring immediate intervention
D. Cardiogenic shock
Correct Answer: C
Rationale: A shock index > 1.0 indicates significant hemorrhage and hemodynamic compromise. Normal
shock index is 0.5-0.7. Values > 1.0 correlate with increased mortality and require immediate
hemorrhage control and resuscitation.
,Q3: A patient with a penetrating torso injury is being managed with permissive hypotension. The systolic
blood pressure is 82 mmHg. What is the target systolic BP for this patient?
A. 60-70 mmHg
B. 80-90 mmHg
C. 100-110 mmHg
D. ≥ 120 mmHg
Correct Answer: B
Rationale: Permissive hypotension for penetrating torso trauma targets SBP of 80-90 mmHg to minimize
clot disruption while maintaining perfusion. Lower targets risk cerebral and coronary hypoperfusion.
Higher targets disrupt hemostasis. Targets ≥ 100-110 mmHg are for traumatic brain injury.
Q4: A trauma patient has a lactate level of 6.2 mmol/L after initial resuscitation. What is the clinical
significance?
A. Normal post-resuscitation finding
B. Indicator of adequate tissue perfusion
C. Marker of tissue hypoperfusion and anaerobic metabolism requiring continued resuscitation
D. Expected finding after blood transfusion
Correct Answer: C
Rationale: Elevated lactate (> 2 mmol/L) indicates tissue hypoperfusion and anaerobic metabolism,
requiring continued resuscitation until normalized. Normal lactate is < 2 mmol/L. It is not a normal
finding or indicator of adequate perfusion. Blood transfusion does not cause elevated lactate.
Q5: A trauma patient is receiving massive transfusion. The patient develops hypothermia (34.5°C),
acidosis (pH 7.18), and coagulopathy (INR 2.5). What is this triad called?
A. Systemic inflammatory response syndrome
B. Lethal triad of trauma
C. Multiple organ dysfunction syndrome
D. Compensatory anti-inflammatory response syndrome
Correct Answer: B
Rationale: Hypothermia, acidosis, and coagulopathy constitute the lethal triad of trauma, which
perpetuates hemorrhage and increases mortality. SIRS is a generalized inflammatory response. MODS is
end-organ failure. CARS is an immunosuppressive response.
Q6: A trauma patient has a base deficit of -8 mEq/L. What does this indicate?
, A. Metabolic alkalosis
B. Metabolic acidosis from tissue hypoperfusion
C. Respiratory acidosis
D. Normal acid-base status
Correct Answer: B
Rationale: Base deficit of -8 indicates metabolic acidosis, typically from tissue hypoperfusion and
anaerobic metabolism in hemorrhagic shock. Positive values indicate alkalosis. Respiratory acidosis is
determined by PaCO2. Normal base deficit is -2 to +2.
Q7: A trauma patient has a cardiac output of 5 L/min and oxygen delivery (DO₂) of 400 mL O₂/min. The
oxygen consumption (VO₂) is 200 mL O₂/min. What is the oxygen extraction ratio?
A. 25%
B. 50%
C. 75%
D. 100%
Correct Answer: B
Rationale: Oxygen extraction ratio = VO₂/DO₂ = 200/400 = 0.50 or 50%. Normal extraction is 25-30%.
Elevated extraction (> 30%) indicates inadequate oxygen delivery. 25% would be normal. 75% and 100%
indicate severe shock.
Q8: A trauma patient is receiving blood products in a 1:1:1 ratio. What does this ratio represent?
A. 1 unit PRBC : 1 unit platelets : 1 unit cryoprecipitate
B. 1 unit PRBC : 1 unit FFP : 1 unit platelets
C. 1 unit PRBC : 1 unit FFP : 1 unit whole blood
D. 1 unit PRBC : 1 unit albumin : 1 unit normal saline
Correct Answer: B
Rationale: The 1:1:1 massive transfusion ratio is 1 unit packed red blood cells : 1 unit fresh frozen
plasma : 1 unit platelets, mimicking whole blood composition. Cryoprecipitate, albumin, and saline are
not part of this ratio.
Q9: A trauma patient has a central venous pressure (CVP) of 2 mmHg and a blood pressure of 78/50
mmHg. What is the most likely cause?
A. Fluid overload
B. Hypovolemia
