Mass Casualty Management — MCQs
Patients who need surgery within 24 hours are categorized under which color category in a disaster management triage?
Patients are categorized on the basis of chances of survival in Disaster management:
In a patient with multiple fractures, what is the most important initial management step?
What is the correct sequence of management in a patient who presents to the casualty with an RTA? 1. Cervical spine stabilization 2. Intubation 3. IV cannulation 4. CECT
In the damage control resuscitation protocol, which location is primarily focused on correcting physiological derangements after initial hemorrhage control?
Which intravenous anaesthetic agent has analgesic effect also
What is the dose of adrenaline given intravenously in a cardiac arrest victim?
What is the alternative drug for epinephrine in Advanced Cardiac Life Support (ACLS)?
A 19-year-old boy requires emergency repair of a ruptured globe. The patient had their last meal 5 hours ago. Which of the following is the anesthetic technique of choice in this patient?
Rapid Sequence Induction is indicated in:
Mass Casualty Management Indian Medical PG Practice Questions and MCQs
Question 1: Patients who need surgery within 24 hours are categorized under which color category in a disaster management triage?
- A. Green
- B. Yellow (Correct Answer)
- C. Blue
- D. Black
Explanation: ***Yellow*** - Patients in the **yellow category** are those who require **significant medical attention** and intervention, such as surgery, but whose condition is stable enough to withstand a delay of a few hours up to 24 hours without immediate threat to life or limb. - This category indicates a **delayed but urgent need** for treatment, distinguishing them from immediate (red) or minor (green) cases. *Blue* - The color **blue** is generally **not a standard triage category** in most commonly used disaster protocols (e.g., START, JumpSTART). - Triage systems typically use red, yellow, green, and black to prioritize patients based on immediate medical need and prognosis. *Green* - The **green category** is for patients with **minor injuries** who are considered "walking wounded" and can often wait for treatment for several hours, sometimes up to a few days. - These individuals are **stable** and do not require immediate intervention to preserve life or limb. *Black* - The **black category** is reserved for individuals who are **deceased** or have injuries so severe that survival is unlikely given the available resources, often implying **palliative care** rather than active life-saving interventions in a mass casualty event. - This category signifies that resources would be better allocated to patients with a higher chance of survival.
Question 2: Patients are categorized on the basis of chances of survival in Disaster management:
- A. Tagging
- B. Triage (Correct Answer)
- C. Mitigation
- D. Surge capacity
Explanation: ***Triage*** - **Triage** is the process of sorting and prioritizing patients based on the severity of their injuries and their chances of survival, especially in mass casualty incidents or disasters. - This system ensures that limited resources are allocated to maximize the number of survivors and provide the most effective care. *Tagging* - **Tagging** refers to the physical labeling of patients after they have been triaged, using color-coded tags (e.g., red for immediate, yellow for delayed, green for minor, black for expectant). - It is a result of the triage process, not the process of categorization itself. *Mitigation* - **Mitigation** involves measures taken to reduce the impact of a disaster or emergency, such as constructing earthquake-resistant buildings or developing flood control systems. - It focuses on preventing or lessening the severity of a disaster before it occurs, rather than categorizing patients. *Surge capacity* - **Surge capacity** is the ability of a healthcare system to expand its services and resources in response to an unexpected influx of patients, such as during a pandemic or mass casualty event. - It refers to the operational capability of the system, not the method of patient categorization.
Question 3: In a patient with multiple fractures, what is the most important initial management step?
- A. Intravenous fluids
- B. Open reduction of fractures
- C. Blood transfusion
- D. Airway maintenance (Correct Answer)
Explanation: ***Airway maintenance*** - In any trauma patient, ensuring a **patent airway** is the absolute priority to prevent hypoxia and brain damage. - This is part of the primary survey (**ABCDE**) in trauma management, where life-threatening issues are addressed first. *Intravenous fluids* - While essential for managing **hypovolemia** due to blood loss in polytrauma, fluid resuscitation comes after securing the airway and ensuring adequate breathing. - Administering fluids to a patient who cannot breathe effectively will not resolve the primary issue. *Blood transfusion* - **Blood transfusion** is necessary for significant hemorrhage and can be life-saving, but it is not the *initial* management step. - Airway, breathing, and circulation (which includes addressing significant hemorrhage) collectively precede the decision and initiation of blood transfusions. *Open reduction of fractures* - **Open reduction of fractures** is a definitive treatment for musculoskeletal injuries that is performed much later, after the patient has been stabilized. - It is an elective procedure in the context of initial trauma management and is not a life-saving measure in the acute phase.
Question 4: What is the correct sequence of management in a patient who presents to the casualty with an RTA? 1. Cervical spine stabilization 2. Intubation 3. IV cannulation 4. CECT
- A. 2,1,4,3
- B. 1,3,2,4
- C. 2,1,3,4
- D. 1,2,3,4 (Correct Answer)
Explanation: ***1,2,3,4*** - This sequence follows the **ATLS (Advanced Trauma Life Support)** protocol, prioritizing immediate life threats in order. - **Cervical spine stabilization** is the **first action upon patient contact** to prevent secondary neurological injury in any trauma patient. - **Airway management (intubation)** is then performed **with maintained in-line c-spine stabilization** - these occur nearly simultaneously but c-spine protection is instituted first. - **IV cannulation (circulation)** follows to establish vascular access for resuscitation and medications. - **CECT (imaging)** is performed last, once the patient is stabilized after addressing immediate life threats. - This follows the **ATLS Primary Survey: Airway (with c-spine protection) → Breathing → Circulation → Disability → Exposure**. *2,1,4,3* - This incorrectly places intubation **before** cervical spine stabilization is initiated. - In ATLS, **c-spine protection must be applied immediately upon patient contact** before any airway manipulation. - Delaying IV cannulation until after CECT is inappropriate as circulatory access is critical for early resuscitation. *1,3,2,4* - While this correctly starts with cervical spine stabilization, it incorrectly places **IV cannulation before intubation**. - In the ATLS primary survey, **Airway comes before Circulation** - securing the airway takes priority over establishing IV access. - This sequence could delay critical airway management in a patient with respiratory compromise. *2,1,3,4* - This sequence places **intubation before cervical spine stabilization**, which violates ATLS principles. - **C-spine stabilization must be the first action** upon approaching any trauma patient to prevent secondary spinal cord injury. - While intubation with in-line stabilization is possible, the c-spine protection must be instituted first, not after beginning airway manipulation.
Question 5: In the damage control resuscitation protocol, which location is primarily focused on correcting physiological derangements after initial hemorrhage control?
- A. In OT
- B. Prehospital resuscitation
- C. In emergency
- D. In ICU (Correct Answer)
Explanation: ***In ICU*** - The **Intensive Care Unit (ICU)** is the primary location for correcting physiological derangements in the damage control resuscitation protocol after initial hemorrhage control. - This phase focuses on addressing the **"deadly triad"** of **acidosis**, **hypothermia**, and **coagulopathy** to stabilize the patient before definitive surgical repair. - The ICU provides the controlled environment and resources needed for prolonged resuscitation and physiological optimization. *In OT* - The **Operating Theater (OT)** is where initial hemorrhage control and damage control surgery are performed. - While some resuscitation occurs here, the main focus is on stopping bleeding and controlling contamination, not prolonged physiological correction. - The goal is rapid surgical intervention followed by transfer to ICU. *Prehospital resuscitation* - **Prehospital resuscitation** involves immediate life-saving interventions and rapid transport. - It prioritizes hemorrhage control, airway management, and preventing hypothermia, but lacks the resources for comprehensive physiological correction. - The focus is on rapid transport to definitive care. *In emergency* - The **Emergency Department (ED)** is crucial for initial assessment, rapid transfusion, and preparing the patient for surgery. - However, the ED phase is typically focused on rapid stabilization and transfer for definitive care rather than protracted physiological correction. - It serves as a bridge between prehospital care and the operating room.
Question 6: Which intravenous anaesthetic agent has analgesic effect also
- A. Thiopentone
- B. Ketamine (Correct Answer)
- C. Propofol
- D. Etomidate
Explanation: ***Ketamine*** - Ketamine acts as an **N-methyl-D-aspartate (NMDA) receptor antagonist**, providing significant **analgesia** in addition to its anaesthetic effects. - It induces a state of **dissociative anaesthesia**, where the patient appears awake but is unresponsive to pain, making it unique among intravenous anaesthetics. *Thiopentone* - Thiopentone is a **barbiturate** that acts as a potent hypnotic and anaesthetic but provides no significant analgesic properties. - It can even cause **anti-analgesia** (hyperalgesia) at sub-hypnotic doses, increasing sensitivity to pain. *Propofol* - Propofol is a potent intravenous anaesthetic that works primarily as a **GABA-A receptor agonist**, but it lacks intrinsic analgesic properties. - While it can cause some sedation and reduced pain perception due to CNS depression, it does not directly modulate pain pathways in the way an analgesic would. *Etomidate* - Etomidate is a hypnotic agent highly valued for its **cardiovascular stability**, making it suitable for patients with compromised cardiac function. - Like propofol and thiopentone, etomidate primarily acts on **GABA-A receptors** to induce unconsciousness and offers no significant analgesic effects.
Question 7: What is the dose of adrenaline given intravenously in a cardiac arrest victim?
- A. 10 ml of 1 in 10,000 solution (Correct Answer)
- B. 1 ml of 1 in 10,000 solution
- C. 2 ml of 1 in 1000 solution
- D. 10 ml of 1 in 1000 solution
Explanation: **Explanation:** In the management of cardiac arrest (as per ACLS guidelines), the standard intravenous dose of Adrenaline (Epinephrine) is **1 mg every 3–5 minutes**. To ensure rapid systemic distribution and minimize local irritation during emergency administration, a dilute concentration is used. **Why Option A is correct:** Adrenaline is available in two standard strengths: 1:1,000 and 1:10,000. * **1:10,000 concentration** means 1 gram in 10,000 ml, which equals **0.1 mg/ml**. * Therefore, **10 ml** of a 1:10,000 solution provides exactly **1 mg** of Adrenaline, which is the gold-standard dose for Advanced Cardiac Life Support (ACLS). **Analysis of Incorrect Options:** * **Option B (1 ml of 1:10,000):** This provides only 0.1 mg, which is a sub-therapeutic dose for cardiac arrest (though sometimes used in pediatric cases or for severe anaphylaxis). * **Option C (2 ml of 1:1,000):** This provides 2 mg. While the 1:1,000 concentration is used for IM injections in anaphylaxis, giving it IV in this volume is incorrect and potentially arrhythmogenic. * **Option D (10 ml of 1:1,000):** This provides 10 mg, which is a massive overdose and can cause severe hypertension and fatal arrhythmias post-resuscitation. **High-Yield Clinical Pearls for NEET-PG:** * **Route:** IV/IO is preferred. If given via **Endotracheal tube**, the dose is doubled (2–2.5 mg). * **Mechanism:** Its primary benefit in arrest is **$\alpha$-1 agonist** activity, which causes vasoconstriction, increasing coronary and cerebral perfusion pressure. * **Anaphylaxis Dose:** 0.5 mg (0.5 ml of 1:1,000) **Intramuscularly**. * **Shockable vs. Non-shockable:** In VF/pVT, give after the 2nd shock. In PEA/Asystole, give as soon as possible.
Question 8: What is the alternative drug for epinephrine in Advanced Cardiac Life Support (ACLS)?
- A. Amiodarone infusion
- B. Atropine
- C. High dose vasopressin (Correct Answer)
- D. Adenosine
Explanation: **Explanation:** In the management of cardiac arrest (VF, pulseless VT, Asystole, or PEA), **Epinephrine** is the primary vasopressor used for its $\alpha$-adrenergic effects, which increase coronary and cerebral perfusion pressure. According to ACLS guidelines, **Vasopressin (40 units IV/IO)** can be used as an alternative to the first or second dose of Epinephrine. **Why Vasopressin?** Vasopressin is a potent non-adrenergic peripheral vasoconstrictor that acts on $V_1$ receptors. Unlike Epinephrine, it remains effective in the presence of metabolic acidosis (common during prolonged arrest) and does not increase myocardial oxygen consumption, as it lacks $\beta$-adrenergic effects. **Analysis of Incorrect Options:** * **A. Amiodarone:** This is an anti-arrhythmic drug, not a vasopressor. It is indicated for shock-refractory VF or pulseless VT, but it does not replace Epinephrine. * **B. Atropine:** Previously used for asystole/PEA, it has been removed from the routine ACLS cardiac arrest algorithm because it showed no therapeutic benefit in these scenarios. * **D. Adenosine:** This is the drug of choice for stable Supraventricular Tachycardia (SVT). It causes a transient AV nodal block and has no role in the management of cardiac arrest. **High-Yield Pearls for NEET-PG:** * **Dose:** Vasopressin is given as a single one-time dose of **40 units** (High dose). * **Half-life:** Vasopressin has a longer half-life (10–20 mins) compared to Epinephrine (3–5 mins). * **Current Status:** While the 2015/2020 AHA updates simplified the algorithm by focusing primarily on Epinephrine to reduce complexity, Vasopressin remains the classic "textbook" alternative in exam questions. * **Endotracheal Route:** If IV/IO access is unavailable, drugs like **L**idocaine, **E**pinephrine, **A**tropine, and **N**aloxone (**LEAN**) can be given via the ET tube at 2–2.5 times the IV dose.
Question 9: A 19-year-old boy requires emergency repair of a ruptured globe. The patient had their last meal 5 hours ago. Which of the following is the anesthetic technique of choice in this patient?
- A. Retrobulbar block
- B. Subtenon block
- C. General anesthesia (Correct Answer)
- D. Peribulbar block
Explanation: **Explanation:** The primary goal in managing a **ruptured globe** (open eye injury) is to prevent any increase in **Intraocular Pressure (IOP)**, which could lead to the extrusion of intraocular contents (vitreous or iris) and permanent blindness. **Why General Anesthesia (GA) is the correct choice:** 1. **Airway Protection:** The patient had a meal 5 hours ago. In emergency surgery, any patient who has not met the fasting guidelines (6 hours for solids) is considered to have a **"full stomach."** GA with **Rapid Sequence Induction (RSI)** and endotracheal intubation is mandatory to protect the airway from aspiration. 2. **IOP Control:** GA provides a controlled environment where coughing, straining, or movement—all of which acutely spike IOP—can be prevented through the use of muscle relaxants and deep anesthesia. **Why the other options are incorrect:** * **Retrobulbar, Peribulbar, and Subtenon Blocks (A, B, D):** These regional techniques are **contraindicated** in an open globe injury. Injecting local anesthetic into the confined orbital space increases the volume and pressure behind the eye. This external pressure can squeeze the globe, causing the expulsion of intraocular contents through the rupture site. Additionally, these blocks do not address the aspiration risk associated with the patient's "full stomach" status. **High-Yield Clinical Pearls for NEET-PG:** * **Succinylcholine Controversy:** While Succinylcholine can slightly increase IOP, the priority in a full-stomach emergency is securing the airway. If a difficult airway is anticipated, Succinylcholine is still used, though **Rocuronium** is often preferred if a rapid-acting alternative is available. * **Pre-medication:** Avoid morphine (causes vomiting) and use IV Ondansetron to prevent postoperative nausea/vomiting (PONV), which can cause wound dehiscence. * **Induction:** Use a smooth induction; avoid Ketamine as it may increase IOP and cause blepharospasm.
Question 10: Rapid Sequence Induction is indicated in:
- A. Emergency surgery for intestinal obstruction (Correct Answer)
- B. Cardiopulmonary bypass surgery
- C. Elective open hernia surgery
- D. Elective laparoscopic surgery
Explanation: ***Emergency surgery for intestinal obstruction*** - Rapid Sequence Induction (RSI) is indicated in situations where there is a high risk of **pulmonary aspiration** of gastric contents, such as in **intestinal obstruction**, due to a full stomach or impaired gastric emptying. - The goal of RSI is to achieve rapid intubation while minimizing the risk of aspiration by using a specific sequence of medications and techniques (e.g., cricoid pressure). *Cardiopulmonary bypass surgery* - This is an **elective procedure** where patients are typically fasted and have time for a thorough pre-operative assessment and standard induction. - While significant, it does not inherently carry the same immediate high risk of aspiration as an emergency with a full stomach. *Elective open hernia surgery* - This is an **elective procedure** where the patient can be properly fasted, significantly reducing the risk of a full stomach. - A standard, controlled anesthetic induction is generally preferred, allowing for gradual intubation and ventilation. *Elective laparoscopic surgery* - Similar to elective open surgery, patients undergoing **elective laparoscopic procedures** are properly fasted. - The primary concern in laparoscopic surgery is often related to pneumoperitoneum and its effects, rather than a high aspiration risk during induction if fasting guidelines are followed.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free