BLS Trauma

Question 1

When doing your trauma exam, you assess for what? and palpate for what?

Answer 1

a. assess for:
i. contusions/colour/cyanosis/contamination,
ii. lacerations,
iii. abrasions/asymmetrical motion/abdominal breathing (diaphragmatic),
iv. penetrations/punctures/protruding objects or organs,
v. swelling/sucking wounds/subcutaneous emphysema, and
vi. distension/deformity/dried blood/diaphoresis, and
b. palpate for,
i. tenderness,
ii. instability,
iii. crepitus,
iv. swelling/subcutaneous emphysema, and
v. deformity;

Question 2

Splinting priorities are:

Answer 2

o Spine (neck, thoraco-lumbar, head)
o Pelvis
o Femurs
o Lower legs
o Upper limbs

Question 3

In pregnant patients, trauma is most often associated with?

Answer 3

domestic violence.

Question 4

In situations involving a patient with a complete or partial amputation or avulsion, the paramedic
shall:
1. consider potential life/limb/function threats, such as,

Answer 4

a. hemorrhagic shock,
b. loss of limb, and
c. loss of function;

Question 5

if patient has a partial amputation or avulsion,

Answer 5

a. assess the injury site for circulation, sensation and movement, and
b. assess distal pulses, circulation, sensation and movement;

Question 6

with respect to the injury site amputation or avulsion

Answer 6

a. control hemorrhage as per the Soft Tissue Injury Standard,
b. cleanse wound of gross surface contamination,
c. if partial amputation or avulsion, place remaining tissue or skin bridge in as nearnormal anatomical position as possible,
d. if complete amputation, cover the stump with a moist, sterile pressure dressing,
followed by a dry dressing, while taking care not to constrict or twist remaining
tissue,
e. immobilize affected extremity, and
f. if possible, elevate

Question 7

Abdominal/Pelvic Injury

1. consider potential life/limb/function threats, such as

Answer 7

a. rupture, perforation, laceration, or hemorrhage of organs and/or vessels in the
abdomen and potentially in the thorax or pelvis, and
b. spinal cord injury,
2. if the patient has evisceration of intestines,
a. make no attempt to replace intestines back into the abdomen, and
b. cover eviscerated intestines using moist, sterile large, bulky dressings; and
3. if the patient has a pelvic fracture,
a. attempt to stabilize the clinically unstable pelvis with a circumferential sheet wrap or
a commercial device,
b. secure the patient to a spinal board or adjustable break-away stretcher,
c. avoid placing spinal immobilization or stretcher straps directly over the pelvic area,
and
d. secure and immobilize lower limbs to prevent additional pelvic injury.

Question 8

Bite Injury

1. consider life/limb/function threats, such as

Answer 8

a. injuries to underlying organs, vessels, bone, and
b. specific to snake bites,
i. anaphylaxis,
ii. shock,
iii. central nervous system toxicity, and
iv. local tissue necrosis;

Question 9

if envenomation is known or suspected, how should you position the PT

Answer 9

a. position the patient supine,
b. immobilize the bite area at or slightly below heart level, and
c. not apply cold packs.

Question 10

Chest Injury

1. consider life/limb/function threats, such as,

Answer 10

a. tension pneumothorax,
b. hemothorax,
c. cardiac tamponade,
d. myocardial contusion,
e. pulmonary contusion,
f. spinal cord injury, and
g. flail chest;
2. auscultate the patient’s lungs for air entry and adventitious sounds;
3. if the patient has a penetrating chest injury,
a. assess for,
i. entry and exit wounds,
ii. tracheal deviation,
iii. jugular vein distension, and
iv. airway and/or vascular penetration (e.g. frothy/foamy hemoptysis sucking
wounds) ;

Question 11

if the patient has an open or sucking chest wound, what should you do?

Answer 11

a. seal wound with a commercial occlusive dressing with one way valve; if not possible,
utilize an occlusive dressing taped on three sides only,
b. apply dressing large enough to cover entire wound and several centimetres beyond
the edges of the wound,
c. monitor for development of tension pneumothorax, and
d. if tension pneumothorax becomes obvious or suspected (i.e. rapid deterioration in
cardiorespiratory status), release occlusive dressing and/or replace;

Question 12

for patients who have a suspected pneumothorax and require ventilations, ventilate how?

Answer 12

with a lower tidal volume and rate of delivery to prevent exacerbation of increasing intrathoracic
pressure

Question 13

what should you do with a alert PT with a avulsed tooth

Answer 13

replace a completely intact, avulsed tooth in the socket
and have the patient bite down to stabilize
• If the tooth cannot be replaced, place it in saline or milk

Question 14

Head Injury

1. consider potential life/limb/function threats, such as,

Answer 14

a. intracranial and/or intracerebral hemorrhage,
b. neck/spine injuries,
c. facial/skull fractures, and
d. concussion;
2. observe for,
a. fluid from ears/nose, e.g. cerebrospinal fluid,
b. mastoid bruising,
c. abnormal posturing,
d. periorbital ecchymosis,
e. agitation or fluctuating behaviour,
f. urinary/fecal incontinence, and
g. emesis;

Question 15

if ETCO2 monitoring is available,

i. attempt to maintain ETCO2 values of

Answer 15

35-45 mmHg,

Question 16

Neck/Back Injury

1. if the patient has a penetrating neck injury, assume what?

Answer 16

vascular and airway lacerations/tears;

2. auscultate the patient’s lungs for decreased air entry and adventitious sounds;
3. observe for,
   a. diaphragmatic breathing,
   b. neurological deficits,
   c. priapism, and
   d. urinary/fecal incontinence/retention;

Question 17

Neck/Back Injury perform, at a minimum, a secondary survey to assess,

Answer 17

a. for airway and/or vascular penetration (e.g. frothy/foamy hemoptysis),
b. lungs, for decreased air entry and adventitious sounds through auscultation,
c. head/neck, for, jugular vein distension; and tracheal deviation, and
d. chest, for subcutaneous emphysema; and
5. if the patient has a penetrating wound,
a. assess for entry and exit wounds,
b. apply pressure lateral to, but not directly over the airway, and
c. apply occlusive dressings to wounds; use non-circumferential bandaging.

Question 18

Burns (Thermal) consider life/limb/function threats, such as

Answer 18

a. airway burns,
b. asphyxia (smoke inhalation),
c. carbon monoxide/cyanide poisoning, and
d. shock

Question 19

perform, at a minimum, a secondary survey burn assessments, as follows:

Answer 19

a. estimate severity to include,
i. area burned (e.g. location, circumferential),
ii. burn depth (degree), and
iii. percentage of body surface area burned,

Question 20

if burns involve an eye and eye is swollen shut what should you do?

Answer 20

leave eye shut;

Question 21

In situations involving a patient with a cold injury, the paramedic shall:

Answer 21

remove the patient from the cold as soon as it is safe to do so after completing the
primary survey; if the patient is trapped, prevent additional heat loss (e.g. cover with a
blanket or put a blanket between the patient and ground);
2. consider life/limb/function threats, such as,
a. severe hypothermia,
b. severe frostbite, and
c. underlying disorders/precipitating factors (e.g. alcohol/drug ingestion, hypoglycemia,
trauma);

Question 22

how long should be the pulse check for hypothermia

Answer 22

For patients with known or suspected hypothermia, pulse and respirations checks should be
performed for up to ten seconds.

Question 23

Cold Injury, attempt to determine

Answer 23

a. duration of exposure, and
b. type of exposure;
4. with respect to secondary survey,
a. only expose areas that are being examined; cover the area as soon as assessment is
completed,
b. if hypothermia is known or suspected, attempt to determine the severity of
hypothermia, and
c. if frostbite is known or suspected, attempt to determine the severity of frostbite (e.g.
mild blanching of skin [frostnip]; skin waxy/white, supple [superficial frostbite]; skin
cold, hard and wooden [deep frostbite]);

Question 24

what do a pt suffering from hypothermia but is not shivering tells you?

Answer 24

The presence or absence of shivering is an important indicator of severity of hypothermia. If
shivering is minimal or absent and level of consciousness is decreased or mental status is
markedly altered, assume core temperature is below 32o
C.

Question 25

when suctioning a PT suffering from hypothermia you should be careful because?

Answer 25

it may trigger ventricular fibrillation

Question 26

Electrocution/Electrical Injury consider life/limb/function threats, such as

Answer 26

a. cardiopulmonary arrest,
b. dysrhythmias,
c. extremity neurovascular compromise,
d. multiple and/or severe trauma,
e. seizures, and
f. significant internal tissue damage;
3. attempt to determine,
a. type of current, and
b. voltage;
4. assess for signs of significant electrical injury, including,
a. burns,
b. cold/mottled/pulseless extremities,
c. dysrhythmias,
d. entry/exit wounds,
e. muscle spasms,
f. neurologic impairment, and
g. shallow/irregular respirations;

Question 27

you should re-assess neurovascular status in affected extremity approximately every __ mins?

Answer 27

re-assess distal neurovascular status in the affected extremity approximately every 10
minutes if status was compromised on initial assessment

Question 28

In situations involving a patient with an extremity injury, the paramedic shall:
1. splint injured extremities, as follows:

Answer 28

a. assess distal circulation, sensation, and movement before and after splinting,
b. splint joint injuries as found,
c. notwithstanding paragraph 1(b) above, if the distal pulse is absent or the fracture is
severely angulated, apply gentle traction; if resistance or severe pain is encountered,
splint as found,
d. if open or closed femur fractures, splint with traction splint unless limb is partially
amputated,
e. if extremity injury affects a joint, immobilize above and below the injury site,
f. if adequate circulation/sensation is absent after splinting and re-manipulation is
possible, gently re-manipulate the extremity to restore neurovascular status,
g. if it is practical to do so, elevate the affected extremity, and
h. consider application of a cold pack over the affected extremity;
2. in cases of open fractures,
a. irrigate with saline or sterile water if gross contamination, and
b. cover ends with moist, sterile dressings and/or padding

Question 29

how should you splint a fractured femur or tibia?

Answer 29

With respect to fractured femur or tibia:
o Stabilize by securing it to the uninjured leg prior to transfer to a spinal board or
adjustable break-away stretcher when utilized
o If log-rolling, log roll onto the uninjured side, if possible

Question 30

In situations involving a patient with a foreign body in his/her eye, ear or nose, the paramedic shall:

Answer 30

advise the patient not to attempt removal of the foreign body or discontinue attempts;
2. inspect the affected area for visible signs of foreign body, injury, bleeding and discharge;
3. if the foreign body is in the eye,
a. assess eye as per the Eye Injury subsection in the Blunt/Penetrating Injury Standard,
and
b. if penetration of the globe is not suspected, flush the affected eye;

Question 31

In situations involving a patient with exposure to a hazardous material, the paramedic shall:
1. consider life/limb/function threats, such as,

Answer 31

a. if chemical in eye, vision loss,
b. burns, and
c. systemic toxicity secondary to chemical absorption through the skin

Question 32

how long should you irrigate unknown chemical exposures?

Answer 32

20 minutes at scene if patient

is stable

Question 33

should you irrigate in or away the tear ducts in chemical exposures?

Answer 33

attempt to irrigate away from tear duct

Question 34

In situations involving a patient with soft tissue injuries, the paramedic shall:

Answer 34

consider underlying injuries to deep structures (e.g. nerves, vessels, bones);
2. control wound hemorrhage on the following anatomical basis,

Question 35

a. if the wound is located on an extremity

Answer 35

the wound is located on an extremity,
i. apply well-aimed, direct digital pressure at the site of bleeding,
ii. apply a tourniquet, if tourniquet fails to stop bleeding completely or cannot be
used for any reason then apply a second tourniquet, and/or,
iii. pack the wound with hemostatic dressing if appropriate and available or
standard gauze if contraindicated or unavailable, maintain pressure and secure
with a pressure dressing;

Question 36

if the wound is located in a junctional location (e.g. head, shoulders, armpit, neck,
pelvis, groin),

Answer 36

i. apply well-aimed, direct digital pressure at the site of bleeding,
ii. pack the wound with a hemostatic dressing if appropriate and available or
standard gauze if contraindicated or unavailable, maintain pressure and secure
with a pressure dressing

Question 37

if the wound is located in the hollow spaces of the skull, chest or abdomen

Answer 37

i. apply manual pressure with a flat palm and a hemostatic dressing where
available and appropriate or standard gauze if cannot use hemostatic dressing,
ii. do not pack dressings of any kind into the hollow spaces of the skull, chest or
abdomen,
iii. do not insert fingers into the hollow space of the skull, chest or abdomen;

Question 38

when applying direct pressure to soft tissue wounds you should

Answer 38

• Expose the wound cavity
• Attempt to visualize the source of bleeding inside the wound cavity
• Clear away blood, debris to better visualize source
• Be firm and aggressive in applying pressure; be prepared for local tissue destruction as
a result of applying pressure and packing
• Apply pressure as accurately, directly, firmly and with as small a surface area as
possible

Question 39

Tourniquets works best on what part of the body?

Answer 39

• Tourniquets work best when placed over large muscle mass (e.g. thigh, upper arm
muscles)
• Tourniquets work poorly when placed on joints (e.g. knee, elbow) or twinned long
bones (e.g. radius/ulna, tibia/fibula)

Question 40

In situations involving a submersion injury (including scuba-diving related disorders), the
paramedic shall:

Answer 40

1. request appropriate personnel to carry out rescue operations, if required;
2. unless authorized, make no attempt to participate in water or other types of rescue
   operations

Question 41

Submersion Injury consider life/limb/function threats, such as

Answer 41

consider life/limb/function threats, such as,
a. asphyxia,
b. aspiration,
c. hypothermia,
d. pulmonary edema,
e. underlying disorders which may have precipitated events (e.g. drug or alcohol
consumption, hypoglycemia, cardiac dysrhythmias, trauma [spinal/head injury]), and
f. specific to scuba-diving related disorders,
i. barotrauma (ears, sinuses, pneumothorax),
ii. decompression sickness, and
iii. arterial gas embolism

Question 42

Submersion Injury attempt to determine,

Answer 42

a. duration of submersion,
b. if water contains known or obvious chemicals, pollutants or other debris, and
c. water temperature

Question 43

Your PT has a suspected air embolism, what special attention with the spinal board should be made?

Answer 43

where air embolism is suspected and the patient is on a spinal board or adjustable
break-away stretcher, not elevate the head 30 degrees if level of consciousness is
decreased, and
c. prepare for tension pneumothorax.

Question 44

In situations involving a neonatal patient, the paramedic shall:

Answer 44

be aware that the mother, in addition to the neonatal patient, may require care;

2. during the primary survey,
   a. be aware of problems arising due to neonate anatomy and physiology, and
   b. determine if the neonatal patient,
   i. is term gestation,
   ii. has good tone, and
   iii. has unlaboured breathing;

Question 45

when should the apgar score be taken?

Answer 45

take an Apgar score at one and five minutes post-delivery

Question 46

In situations involving a pregnant patient, the paramedic shall:
1. consider life/limb/function threats to both the mother and fetus, such as,

Answer 46

a. pre-eclampsia/eclampsia,
b. prolapsed umbilical cord,
c. first trimester complications, including,
i. spontaneous abortion,
ii. ectopic pregnancy, and
iii. gestational trophoblastic disease, and
d. second and third trimester complications, including,
i. spontaneous abortion,
ii. placental abruption,
iii. placenta previa, and
iv. ruptured uterus;

Question 47

when should pre eclampsia be assumed with pregnant PT?

Answer 47

Pre-eclampsia should be assumed for patients beyond 20 weeks of gestation with a blood
pressure ≥140/90 (severe pre-eclampsia = diastolic BP ≥110), with:
• generalized edema (e.g. face, legs), or
• non-specific complaints of headache, nausea, abdominal pain with or without vomiting,
blurred vision, fatigue, generalized swelling or rapid weight gain.