Page 40 - JSOM Fall 2025

APPENDIX 2: REBOA POST-TRAINING TEST

Thank you for what you do!
REBOA Theater Post-Test
1. Where is the correct location to place a femoral arterial sheath that could be used for REBOA placement?
A) Common femoral artery, 2 cm below the inguinal ligament
B) Confluence of superficial femoral and profunda arteries
C) Superficial femoral artery
D) Profunda femoral artery
E) Common femoral vein, 2 cm below the inguinal ligament
2. You are evaluating an unstable blunt trauma patient with a negative FAST and normal chest x-ray in a pelvic binder who meets clinical
criteria for REBOA placement for an open book pelvic fracture. A femoral arterial line is upsized to a 7 French sheath without difficulty.
While inserting the REBOA catheter you feel resistance. All of the following are acceptable management options EXCEPT:
A) Retract the catheter several inches and try again, advancing slowly
B) Retract and advance under fluoroscopic guidance
C) Keep advancing the catheter despite resistance
D) Abort the procedure and proceed to the OR
3. What is the maximum diameter of the ER-REBOA balloon?
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A) 3 cm
B) 3.2 cm
C) 4 cm
D) 4.2 cm
4. Zone 1 for REBOA placement is defined as the segment of aorta between the:
A) Left subclavian and celiac arteries
B) Innominate and celiac arteries
C) Celiac and renal arteries
D) Innominate and left subclavian arteries
5. Zone 3 for REBOA placement is defined as the segment of aorta between the:
A) Lowest renal artery to the highest hypogastric artery
B) Aortic bifurcation and the common femoral arteries
C) Celiac and lowest renal artery
D) Lowest renal artery to the aortic bifurcation
6. Which of the following is the smallest sheath size that will accommodate the ER-REBOA catheter?
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A) 2 mm
B) 7 French
C) 12 French
D) 18 French
7. A 30 year old female presents with a penetrating left upper quadrant abdominal injury. The chest x-ray is normal but the patient is
profoundly hypotensive and does not respond to resuscitation with blood products. Because an OR was not immediately available, an ER-
REBOA catheter is being placed. Which zone of the aorta should be targeted for balloon inflation in this case?
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A) Zone 1
B) Zone 2
C) Zone 3
D) Zone 4
8. A 35 year old male status post dismounted IED blast presents with a severe pelvic fracture and a left lower extremity traumatic amputation
with a tourniquet in place without any active extremity bleeding. His chest x-ray is normal and his FAST is negative, but he remains
hypotensive and does not respond to resuscitation with blood products. A ER-REBOA catheter is inserted without complication. Which
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zone of the aorta should be targeted for balloon inflation in this case?
A) Zone 1
B) Zone 2
C) Zone 3
D) Zone 4
9. Insertion of an arterial access sheath which can be used to place a REBOA catheter can be accomplished by which of the following
techniques?
A) “Up-sizing” a femoral arterial line to a larger (i.e. 7Fr) access sheath
B) Direct insertion of 14 French access sheath
C) Use of an Amplatz SuperStiff guide wire and serial dilators to achieve appropriate arteriotomy for sheath insertion.
D) REBOA does not require an access sheath for insertion.
10. After successful placement and inflation of a REBOA catheter in the emergency department for hemorrhage control in severe hemorrhagic
shock, what is the most appropriate next step in the management of this patient?
A) Continue blood product resuscitation in the ED with a 1:1:1 ratio and re-assess response
B) Continue resuscitation while proceeding immediately to the OR/IR for definitive hemorrhage control
C) Transient deflation of the REBOA balloon to test for hemodynamic stability; continue this maneuver in the ED until the patient’s blood
pressure normalizes
D) Resuscitative thoracotomy to define the injury
E) Admission to the ICU for warming and resuscitation
11. The ideal duration of aortic balloon occlusion in the unstable trauma patient is:
A) Maintain occlusion until major truncal hemorrhage is controlled, and then deflate the balloon
B) Maintain occlusion until all injuries are identified and repairs are completed, and then deflate the balloon
C) Maintain occlusion during initial resuscitation, and then deflate the balloon on arrival to the operating room
D) Maintain occlusion until systolic blood pressure > 90 mmHg achieved, and then deflate the balloon
12. Which of the following should be assessed after femoral sheath removal to aid in the early identification of a common serious complication?
A) Pulse distal to the access site
B) Lactate level
C) D-dimer level

38 | JSOM Volume 25, Edition 3 / Fall 2025