CH 15 Secondary Assessment

Question 1

Medical Patient

Answer 1

A patient with one or more medical diseases or conditions

Question 2

Trauma Patient

Answer 2

A patient suffering from one or more physical injuries

Question 3

History of Present Illness or Injury (HPI)

Answer 3

Information gathered regarding the symptoms and nature of patient’s current concern

Question 4

Past Medical History

Answer 4

Information gathered regarding the patient’s health problems in the past

Question 5

Symptom

Answer 5

Something regarding the patient’s condition that the patient tells you

Question 6

Reassessment

Answer 6

A procedure for detecting changes in a patient’s condition. It involves four steps; 1. Repeating the primary assessment 2. Repeating and recording VS 3. Repeating the physical exam 4. Checking interventions

Question 7

Rapid Trauma Assessment

Answer 7

A rapid assessment of the head, neck, chest, abdomen, pelvis, extremities, and posterior of the body to detect signs and symptoms of injury

Question 8

Stoma

Answer 8

A permanent surgical opening in the neck through which the patient breathes

Question 9

Tracheostomy

Answer 9

A surgical incision held open by a metal or plastic tube

Question 10

Paradoxical Motion

Answer 10

Movement of a part of the chest in the opposite direction to the rest of the chest during respiration

Question 11

Distention

Answer 11

A condition of being stretched, inflated, or larger than normal

Question 12

Priapism

Answer 12

Persistent erection of the penis that may result from spinal injury and some medical problems

Question 13

Detailed Physical Exam

Answer 13

An assessment of the head, neck, chest, abdomen, pelvis, extremities, and posterior of the body to detect signs and symptoms of injury. It differs from the Rapid Trauma Assessment only in that it also includes examination of the face, ears, eyes, nose, and mouth during the examination of the head

Question 14

The history will provide the most relevant information for: 1. a responsive medical patient 2. an unresponsive trauma patient 3. an unresponsive medical patient 4. a responsive trauma patient

Answer 14

1. a responsive medical patient The history requires a patient to be responsive with an unaltered mental status. If a patient is a trauma patient, while their medical history is important later on, right now, you have been called out there due to a traumatic condition, so medical hx generally does not have a bearing on it One medical hx that COULD affect the trauma patient, is a medical patient who is on blood thinners. Since this will create issues with controlling their external bleeding and can lead to internal hemorrhaging. So, it is important to get this information, however, the most RELEVANT information is gathered in the hx on a medical patient.

Question 15

For critical patients, the secondary assessment will often be conducted: 1. before transport 2. at the scene 3. in the ambulance 4. at the hospital

Answer 15

3. in the ambulance The reason that this is the case, is that you have labeled them as a priority transport, have initiated the transport and then you are actually enroute when you start the secondary assessment

Question 16

Your patient is unresponsive, has an unusual odor on his breath, and is incontinent of urine. You should suspect: 1. an endocrine emergency 2. a neurological emergency 3. a cardiac emergency 4. a respiratory emergency

Answer 16

1. an endocrine emergency Altered mental status, unusual breath odor, incontinence, excessive hunger, excessive thirst, urination indicate a diabetic emergency. Insulin is produce in the pancreas which is part of the Endocrine system. This COULD be a cardiac complaint This COULD be a neurologic complaint However, what pushes you more to the Diabetic/Endocrine emergency is the unusual order on breath. That is a tell-tale sx of a diabetic emergency None of the sx point to a respiratory emergency

Question 17

For a responsive medical patient, the hx indicates 1. whether to check VS 2. which medications to prescribe 3. which body systems to examine 4. whether to perform a reassessment

Answer 17

3. which body systems to examine For the responsive medical patient, the hx indicates which body systems are relevant to examine. An EMT does not prescribe medications Reassessing the patient at certain intervals as well as Taking VS are routine parts of assessing a patient

Question 18

What are the the categorization types based on the nature of the patients underlying complaint?

Answer 18

1. Medical patient - a patient with one or more medical diseases or conditions 2. Trauma patient - a patient suffering from one or more physical injuries 3. Unknown Patient - A patient with a problem of an undetermined nature

Question 19

FAST

Answer 19

Face Arm Speech Test

Question 20

For which type of of complaint should you conduct a FAST physical examination? 1. Mental status changes or neurologic complaints 2. Shortness of breath 3. Chest Pain or discomfort 4. Altered mental status with a diabetic hx

Answer 20

1. Mental status changes or neurologic complaints A Face-Arm-Speech Test (FAST) would be appropriate for patients with complaints of mental status changes or neurologic complaints

Question 21

Which of the following additional hx components would best assist you in the evaluation of a conscious medical patient with SOB from an allergic reaction? 1. Time of exposure to the allergen 2. Cough 3. Dyspnea on exertion 4. Excessive hunger or thirst

Answer 21

1. Time of exposure to the allergen For an allergic reaction, inquiring about exposure to an allergen would be most appropriate Dyspnea on exertion typically associated with cardiovascular complaints Cough typically associated with cardiovascular complaints Hunger and Thirst are generally associated with endocrine emergencies

Question 22

For an unresponsive medical patient 1. speak to family members of the patient or bystanders to gather the hx before conducting any physical examination 2. it is not necessary to attempt to gather the patients hx 3. you should gather as much of the patients hx as you can 4. ignore any information regarding the patient that does not come from a close family member

Answer 22

3. You should gather as much of the patients hx as you can For an unresponsive medical patient, you should gather as much of the patient’s hx as you can by speaking to any family members or bystanders who may be able to provide pertinent information. Taking this hx should follow a rapid physical examination

Question 23

Which of the following should you do first when examining an unresponsive medical patient? 1. obtain a past medical hx 2. perform a rapid physical examination 3. assess baseline VS 4. transport

Answer 23

2. perform a rapid physical examination The rapid physical examination would be most important because with an unresponsive medical patient, communication will be impossible. VS will be important, but the physical examination will help you differentiate the patient into the proper category immediately. Transport will also be important, but not more important than a rapid physical examination. Past medical hx may be impossible to obtain.

Question 24

Which of the following questions might you ask a bystander when you are attempting to obtain the hx of an unresponsive patient? 1. What interventions have you performed if any? 2. How long have you been on scene? 3. What is the patients name? 4. What were you doing when the the incident occured?

Answer 24

3. What is the patients name? Bystanders may not know the patients name, but asking them is they know it, is pertinent to obtaining the hx of an unresponsive patient. The other questions are irrelevant to obtaining the patients HX

Question 25

Which of the following is a term that means rapid assessment of the head, neck, chest, abdomen, pelvis, extremities, and posterior of the body to detect sx of the injury? 1. HX of present illness 2. Pas medical HX 3. Rapid trauma assessment 4. SAMPLE

Answer 25

3. Rapid trauma assessment

Question 26

A 14 y/o F is complaining of knee pain after a fall on the playground. Witnesses state that she had no unconsciousness and stood immediately after falling. She is now alert and complaining of no other pain or injury. After completing a primary assessment, you should next: 1. assess the patients knee and leg 2. obtain a SAMPLE hx 3. apply a C-collar 4. complete a rapid trauma assessment

Answer 26

1. assess the patients knee and leg This patient likely has only an isolated traumatic injury. She does not have a significant MOI and has no sx of spinal involvement. Therefore, you should next assess her knee and leg, performing a physical exam based on the CC and MOI. Mobilization of the neck with a C-Collar would not be necessary based on the MOI. A rapid trauma assessment would be reserved for a severe trauma patient. The SAMPLE hx would be obtained after assessment of the likely injury

Question 27

Your patient fell from the roof of a house. What action would you take before assessing the ABCs? 1. take baseline VS 2. perform a rapid trauma assessment 3. obtain a past medical hx 4. manually stabilize the head and neck

Answer 27

4. manually stabilize the head and neck On the basis of the MOI, you should provide manual C-Spine stabilization before assessing the ABCs and -before taking baseline VS -before obtaining a past medical hx -before performing a rapid trauma assessment All of the above ARE parts of the secondary assessment you would perform after assessing the ABCs for this patient

Question 28

Which of the following statements is true of the rapid trauma assessment 1. the rapid trauma assessment should be performed at the scene 2. the rapid trauma assessment is for patients without a significant MOI 3. do not delay transport to conduct the rapid trauma assessment 4. limit the rapid trauma assessment to a visual inspection only

Answer 28

1. the rapid trauma assessment should be performed at the scene The rapid trauma assessment is for patients with a significant MOI. It only takes a few moments, includes inspection and palpation, and should be conducted before transport

Question 29

When assessing the head during a rapid trauma assessment, you would check for wounds, tenderness, deformities and what else? 1. Distention 2. Paradoxical motion 3. Crepitation 4. Tenderness

Answer 29

3. Crepitation When assessing the head during a rapid trauma assessment, you would check for wounds, tenderness, deformities, and crepitation, which is grating sound or a feeling of bones being rubbed together. Distention is assessed in the neck and abdomen Tenderness is assessed in the pelvis Paradoxical motion is assessed in the chest

Question 30

Which of the following patients has a significant MOI and would therefore be considered unstable? 1. Patient who fell from <6 feet 2. Pedestrian hit by an automobile 3. Patient who fell from a bicycle 4. Patient with superficial burns over 2% of the body

Answer 30

2. Pedestrian hit by an automobile There is a significant MOI. The other MOI’s would be minor MOI In the case of the falls, there may be no injury at all

Question 31

An assessment of the head, neck, chest, abdomen, pelvis, extremities, and posterior of the body to detect signs and symptoms of an injury is a: 1. detailed physical exam 2. past medical hx 3. differential diagnosis 4. reassessment

Answer 31

1. Detailed physical exam

Question 32

During which of the following would EMTs rely most on their own physical senses? 1. Past medical hx 2. Interviewing bystanders for additional information 3. Detailed physical examination 4. HX of the present illness

Answer 32

3. Detailed physical examination This is where you will use your senses to examine the patient. You may feel (palpate) for injuries, listen (auscultate) for abnormal breathing sounds, and look for swelling. It is important to use your senses to their fullest to get the most relevant information. When interviewing bystanders or conducting a hx of the present illness or a past medical hx, the physical senses would be involved but not as completely, and the EMT would be asking numerous questions and assessing the answers to them, which isn’t primarily a physical exercise

Question 33

Secondary Assessment - RESPONSIVE PATIENT - MEDICAL - Step 1

Answer 33

1. Gather the chief complaint and the hx of the present illness using a body system approach. Use mnemonics such as OPQRST to help get detailed information from the patient

Question 34

Secondary Assessment - RESPONSIVE PATIENT - MEDICAL PATIENT - OPQRST - DEFINED

Answer 34

O - Onset - When did this start? P - Provocation - What makes it worse, what makes it better? Q - Quality - Can you DESCRIBE the pain for me? (do not give them suggestions, we tend to want to say, does it feel like an Elephant sitting on your chest? Because this is what we have heard for years and years when we have dealt with cardiac patients. We have then done a reverse Confirmation Bias, or we have convinced THEM to HELP OUR confirmation bias R - Radiation (Region) - Is the pain anywhere else? Does it stay where you are feeling it? Again, do not SUGGEST anything, we will tend to steer them to does it go down your arm, leg, into your back etc. Let THEM answer your question. S - Severity - 0-10 (O being NO pain, and 10 being the worst pain you have ever felt. Rate you pain for me) T - Time - When did this pain start?

Question 35

Secondary Assessment - RESPONSIVE PATIENT MEDICAL PATIENT - Step 2

Answer 35

Gather a past medical hx from the patient. Use SAMPLE to ensure a comprehensive hx

Question 36

Secondary Assessment - RESPONSIVE PATIENT MEDICAL PATIENT - Step 2 - SAMPLE Defined

Answer 36

S - Signs and Symptoms - What’s wrong? This is something that you have most likely already have attained in the OPQRST or SHOULD HAVE. If not, this is your back-up A - Allergies - Are they allergic to any medications? They may tell you that they are allergic to shrimp and strawberries. OK, take it, do not tell them that you do not care about it. Just say, ok cool, what about medications? Give examples, Penicillin, that is the biggest usual one. M - Medications - What medications are they on? What medications are they SUPPOSED to be on and maybe have not taken? Are they supposed to be on Warfarin, are they supposed to be on Levetiracetam? Those two will tell you that they have some kind of cardiac issues (Warfarin - blood thinner) or they have a seizure disorder (Levetiracetam - anti-seizure medication). If they ARE on medications, you want to know the last time that they took them. P - Past medical hx - You want to know what medical hx that they have had. If they tell you about all kinds of hx that have NOTHING to do with current situation, then ask them if they have ever experienced the current situation before. Do NOT dismiss their PMH. L - Last Oral Intake - When was the last time that they had anything to eat or drink E - Events leading up to the injury or illness - What were they doing prior to the chest pains (CP)? Were they sleeping? Were they arguing with their significant other (maybe it is a stress related incident, maybe it is legitimate cardiac), Were they running 10 miles in 90 degree weather with 97% humidity?

Question 37

Secondary Assessment - RESPONSIVE PATIENT - MEDICAL PATIENT - Step 3

Answer 37

Conduct a physical exam (focusing on the area the patient is complaining about, and the related body systems)

Question 38

Secondary Assessment - RESPONSIVE PATIENT - MEDICAL PATIENT - Step 4

Answer 38

Obtain Baseline Vital Sx: Respirations Pulse Skin Temperature, Color, Dry/Moist Pupils Blood Pressure SpO2 (Blood Oxygen Saturation)

Question 39

Secondary Assessment - UNRESPONSIVE PATIENT - MEDICAL - Step 1

Answer 39

Conduct a rapid physical exam. Focus on body systems and areas related to the suspected condition (if known) Head Neck Chest Abdomen Pelvis Extremities Posterior

Question 40

Secondary Assessment - UNRESPONSIVE PATIENT - MEDICAL PATIENT - Step 2

Answer 40

Obtain baseline Vital Sx Respirations Pulse Skin Pupils Blood Pressure SpO2 (Blood O2 Saturation)

Question 41

Secondary Assessment - UNRESPONSIVE PATIENT - MEDICAL PATIENT - Step 3

Answer 41

Gather the hx of the present illness (OPQRST) from family or bystanders: O - Onset - Do they know when it started prior to when the patient went unresponsive? P - Provocation - Did they mention anything that made it worse or better? Q - Quality - Did they tell the family or bystanders what the pain felt like? R - Radiation - Did they mention if the pain stayed in one place or if it went anywhere else? S - Severity - Did they mention how bad the pain was? T - Time - When did the illness start?

Question 42

Secondary Assessment - UNRESPONSIVE PATIENT - MEDICAL PATIENT - Step 4

Answer 42

Gather a past medical hx (SAMPLE) from bystanders or family if possible: S - Signs and Symptoms - Again this is your fail safe to remember to get the “what’s wrong” with the patient (besides them being unresponsive. What LEAD UP TO them being unresponsive? A - Allergies - Do they know if the patient is allergic to any medications? M - Medications - What medications is the patient on? P - Past Medical Hx - Is there any relevant past medical hx? Hs anything like this happened before? L - Last oral intake - Do they know when the patient ate or drank anything? E - Events leading to the illness - Do they know what the patient was doing PRIOR to the onset of the illness?

Question 43

Specific Medical Complaints: Shortness of Breath Additional Hx Physical Exam

Answer 43

Additional HX: - Cough - Fever or Chills - Dyspnea on exertion - Weight gain (indicates fluid) - Has prescribed bronchodilator? Physical Exam - Lung Sounds (presence and equality) - Wheezing - Work of breathing and positioning (Tripod example) - SpO2 (Oxygen Saturation) - Pedal or sacral edema

Question 44

Specific Medical Complaints Chest Pain or Discomfort Additional Hx Physical Exam

Answer 44

Additional Hx - Has prescribed nitroglycerin? - Taking aspirin Physical Exam - Skin color, temperature, and condition - Blood pressure - Pulse (including strength and regularity)

Question 45

Specific Medical Complaints: Mental Status Changes or Neurologic Complaints Additional Hx Physical Exam

Answer 45

Additional Hx - Headache - Seizure Physical Exam - FAST - (Face - Arm - Speech - Time) - Face - Does one side of the face droop? Ask patient to smile - Is the smile “normal” looking? Does one side of the smile look like a smile, and the other side stay straight (equates to a droop) Arms - Can Pt hold arms in front on them (does one arm droop?) If the patient has an unequal smile, and they have an arms that they cannot lift the Arms the same (it SHOULD be on the same side) S - Speech - Is their speech clear and understandable? T - Time - Time is critical, need to make sure that you get them to the hospital, get them packaged and to advanced care ASAP

Question 46

Specific Medical Complaints Allergic (involved components of the cardiovascular and respiratory systems) Additional Hx Physical Exam

Answer 46

Additional Hx - Time of Exposure - Time of symptoms onset Physical Exam - Stinger present? - Rash/hives (urticaria) - Lung Sounds (present and equal)? - Face and Neck Edema - SpO2 - Oxygen Saturation

Question 47

Specific Medical Complaints Abdominal Pain Additional Hx Physical Exam

Answer 47

Additional Hx - Fever - Nausea and Vomiting - Diarrhea or Constipation - Blood in Vomit or Feces; may be bright red (fresh) or dark (digested) Menstrual Hx Physical Exam Inspect and palpate all four quadrants of the abdomen

Question 48

Specific Medical Complaints Altered Mental Status with a Diabetic Hx Additional Hx Physical Exam

Answer 48

Additional Hx - Oral intake - Medication Hx - Hx of recent illness - Excessive hunger, thirst, urination

Question 49

Secondary Assessment - TRAUMA NOT SERIOUSLY INJURED 1. AFTER SCENE SIZE UP 2. AFTER PRIMARY ASSESSMENT

Answer 49

1. Determine the CC and elicit information about how the patient was injured (hx of the present injury) 2. Perform the physical exam based on the chief complaint and MOI 3. Assess baseline VS 4. Obtain a past medical HX

Question 50

Secondary Assessment - TRAUMA SERIOUSLY INJURED 1. AFTER SCENE SIZE UP 2. AFTER PRIMARY ASSESSMENT

Answer 50

1. Determine the chief complaint and rapidly elicit information about how the patient was injured (hx of the present injury) 2. Continue spinal precautions if indicated 3. Consider requesting ALS 4. Perform rapid trauma assessment 5. Assess baseline VA 6. Obtain a patient hx

Question 51

Trauma Patient Assessment

Answer 51

1. Scene Size-Up - Provide c-spine stabilization based on severity of injury or MOI and/or complaints of pain 2. Primary Assessment - Massive hemorrhage - Airway - Breathing - Circulation * Maintain patent airway * Assess for injuries that could affect breathing; * Listen for and compare lung sounds bilaterally * Check for sx of shock 3. Priority Determination - Does my patient have serious injury requiring prompt transport from the scene? OR Does patient have minor and/or isolated non-life-threatening injury? 4. On scene Examination ** Serious or multiple injuries - Rapid head-ti-toe exam; - head, neck, chest, abdomen, pelvis, extremities, posterior ***Minor or Isolated Injury - Slower, focused exam 5. Transport 6. Perform detailed Assessment and reassessments enroute (remember if unstable patient, reassessments are every 5 minutes) 7. Notify receiving hospital

Question 52

C - Collar Sizing

Answer 52

Using your fingers, measure from the tip of the patient’s chin to the top of the sternum Then you will take that measurement and compare it to your C-Collars that you have.

Question 53

When applying the C-Collar what should you be careful about?

Answer 53

Ensure that the collar is not too small or big. Too small and the collar can create a danger to the patient by prohibiting the patient’s breathing. If too big, then the patients chin can actually slip down inside the collar and the collar is not maintaining the stabilization

Question 54

Steps to applying a C-Collar to a seated patient

Answer 54

1. Stabilize the head and neck from the rear 2. Size the C-Collar for correct fit of the collar 3. Properly angle the collar for placement 4. Position the collar 5. Begin to secure the collar 6. Complete securing the collar 7. Maintain manual stabilization of the head and neck ****NOTE - ensure that the patient does not have jewelry on, make sure that the patient does not have hair that is getting in the way of the Velcro fasteners****

Question 55

Steps to applying a C-Collar to a Supine Patient

Answer 55

1. Kneel at the patients head to get manual stabilization. 2. Measure the patient for the correct collar selection 3. Set the collar in place 4. Secure the collar 5. Continue to manually stabilize the head and neck ***NOTE - Ensure that there is no jewelry on the patient (around the neck). Ensure that the patient’s hair does not get in the way of the Velcro fasteners

Question 56

Guidelines for Field Triage of Injured Patients -Transport to a hospital that provides trauma care if any of the following are identified

Answer 56

* Falls - Adults with a fall of > 20 feet - Children age < 15 y/o: falls > 10 feet, or 2-3 times the child’s height * High Risk Auto Crash - Intrusion: > 12” to the occupant side, or > 18” to any site - Ejection (partial or complete from automobile - Death of someone else in the same passenger compartment - Vehicle telemetry data consistent with high risk of injury - Auto versus pedestrian/bicyclist thrown, run over, or with significant ( > 20 mph), impact or motorcycle crash (> 20 mph)

Question 57

Physical Examination of the Trauma Patient - Steps STEP 1

Answer 57

1. Reassess the MOI and actual injury. If the MOI is not significant (i.e. patient has a cut on their finger), focus the examination on only the injured part. If the MOI is significant: - Continue spinal precautions - Consider requesting ALS intercept (if not on ALS truck) - Reconsider transport decision (Ground vs Air) - Reassess mental status - Perform a rapid trauma assessment

Question 58

Physical Examination of the Trauma Patient - Steps STEP 2

Answer 58

2. Hx of the present illness Rapid determination of what happened to the patient to cause the injury

Question 59

Physical Examination of the Trauma Patient - Steps STEP 3 RAPID TRAUMA ASSESSMENT

Answer 59

3. Rapidly assess each part of the body HEAD : Check for wounds, tenderness, and deformities plus crepitation FACE : Check for wounds, tenderness, and deformities EARS : Check for wounds, tenderness, and deformities, plus drainage of blood or clear fluid EYES : Check for wounds, tenderness, and deformities, plus discoloration, unequal pupils, foreign bodies, and blood in the anterior chamber NOSE : Check for wounds, tenderness, and deformities, plus drainage of blood or clear fluid MOUTH : Check for wounds, tenderness, and deformities, plus loose or broken teeth, objects that can cause obstruction, swelling, or laceration of the tongue; unusual breath odor, or discoloration NECK : Check for wounds, tenderness, and deformities, plus JVD and crepitation APPLICATION OF COLLAR : Once the neck has been examined, apply the C-Collar CHEST : Inspect and palpate for wounds, tenderness, and deformities, plus crepitation and paradoxical motion CHEST : Auscultate for breath sounds (presence, absence, equality) ABDOMEN : Check for wounds, tenderness, and deformities, plus firm, soft, and distended areas PELVIS : Check for wounds, tenderness, and deformities using gentle compression for tenderness and gentle motion UPPER EXTREMITIES : Check for wounds, tenderness, and deformities Check for circulation, sensation and motor function LOWER EXTREMTIES : Check for wounds, tenderness, and deformities Check for circulation, sensation, and motor function POSTERIOR : Check for wounds, tenderness and deformities (Need to log roll patient, maintaining C-Spine control throughout)

Question 60

Physical Examination of the Trauma Patient - Steps STEP 4 - VS Patient Hx Interventions and Transport

Answer 60

Vital Sx Assess the patient’s baseline VS - Respirations - Pulse - Skin color, temperature, condition (capillary refill in infants and children) - Pupils - Blood Pressure SpO2 Obtain Patient Hx (if Possible) Interview patient if possible. If patient is unresponsive, interview family and bystanders to gain as much information as possible about the patient’s problem (SAMPLE) - Signs and Symptoms - Allergies - Medications - Pertinent past hx - Last oral intake - Events leading to the problem Interventions and Transport - Contact on-line medical direction, and perform interventions as needed - Package and transport the patient

Question 61

When you are looking for a sign, you would: 1. examine the patient 2. ask the patient about allergies and past illnesses 3. ask the patient about the symptoms the patient is experiencing 4. ask the patient about the onset of the present illness

Answer 61

1. Examine the patient - A sign is something that you can SEE vs A symptom which is something the patient TELLS you

Question 62

An 81 y/o F is complaining of CP. After asking her to describe the current problem and hx of the present illness, you should next: 1. obtain baseline vital signs 2. ask the patient about her past medical history 3. perform a rapid trauma assessment 4. physically examine the patient

Answer 62

2. ask the patient about her past medical history You have completed the OPQRST (PRESENT condition) Now you move into medical hx (SAMPLE) Then you move to assessment of the relevant body systems Then you get VS

Question 63

The basic components of a secondary assessment are 1. scene size-up, general impression, and determination of priority for transport 2. airway, breathing, and circulation 3. physical examination, patient hx, and vital sx 4. hx of the present illness, past medical hx, and rapid trauma assessment

Answer 63

3. physical examination, patient hx and vital sx

Question 64

You are caring for a patient who was in a MVA and who has significant injuries to the chest, abdomen, head and lower extremities. She is unstable and requires artificial ventilation. Her VS have not yet stabilized, but you feel that her best chance of survival is rapid transport to the nearest trauma facility. While in the ambulance, you should: 1. measure VS every 15 minutes 2. perform a detailed physical examination 3. continue interventions to maintain airway, breathing and circulation 4. ask the patient for her PMH

Answer 64

3. Continue interventions to maintain airway, breathing and circulation

Question 65

Which of the following is done immediately after scene size-up, regardless of whether a trauma patient has a significant MOI? 1. primary assessment 2. baseline vital signs 3. secondary assessment 4. rapid trauma assessment

Answer 65

1. primary assessment You always have Scene Size up, PPE, Primary Assessment, and General Impression to set the scene. THEN Secondary assessment is performed after this which is more tailored to the incident.

Question 66

For the physical examination of a responsive medical patient, you would focus on: 1. the endocrine and immune systems first 2. completing a full head to toe examination 3. examining body systems related to the chief complain 4. the respiratory and cardiovascular systems first

Answer 66

3. examining body systems related to the chief complaint

Question 67

When questioning bystanders about an unresponsive patient’s medications, what is the best word to use when asking them? 1. substances 2. drugs 3. medicines 4. pills

Answer 67

3. medicines The reason for this is if you use “substances, drugs, or pills”, bystanders may not answer you truthfully because they may feel that they would be getting the patient in trouble by doing so

Question 68

Why should you check baseline VS in the unresponsive medical patient? 1. to provide a place from which to compare later VS 2. because the physical examination is unnecessary 3. because taking the patient’s hx is impossible 4. because it is local protocol

Answer 68

1. to provide a place from which to compare later VS

Question 69

During the rapid trauma assessment of the victim of a boating accident, you note that part of the patients chest wall is moving in the direction opposite that of the rest of the chest. What is the cause of this movement? 1. two or more ribs are broken at two or more places, causing a floating segment of ribs 2. the patient’s collarbone is broken, causing the chest to move paradoxically 3. cardiac tamponade restricts the movement of the chest 4. the patient is having severe difficulty breathing, causing retractions

Answer 69

1. two or more ribs are broken at two or more places, causing a floating segment of ribs

Question 70

When should you obtain a set of baseline VS on an unresponsive pediatric medical patient? 1. after assessing the past medical hx 2. during transport 3. after the rapid physical examination 4. immediately on arrival at the scene

Answer 70

3. After a rapid physical assessment

Question 71

Which of the following terms describes a condition of being stretched, inflated, or larger than normal? 1. Distention 2. Priapism 3. Crepitation 4. Paradoxical Motion

Answer 71

1. Distention

Question 72

What action should be taken immediately after determining the chief complaint and eliciting information about how the patient was injured for a trauma patient with no significant MOI? 1. Obtaining a PMH 2. Reassessment 3. Rapid Trauma Assessment 4. Physical Examination

Answer 72

4. Physical examination Since the MOI is not significant, the patient is A&O and able to tell you what hurts, where and how bad, you can focus on that area

Question 73

A 32 y/o M was rescued from a burning building. He was unconscious when he was rescued, and the firefighters advise you that there was evidence of illegal drugs in the room with the patient. When assessing this patient, you would assume that the patient may have: 1. medical issues only 2. neither medical nor trauma issues 3. both medical and trauma issues 4. trauma issues only

Answer 73

3. both medical and trauma issues

Question 74

Which of the following should you consider when deciding whether ALS personnel should be requested? 1. is the call to a rural area? 2. does a nearby clinic provide advanced care? 3. would ALS-level care benefit the patient? 4. are you in an urban or suburban area?

Answer 74

3. would ALS-level care benefit the patient

Question 75

Your truck is called for an assault patient. While transporting the patient to the hospital, the EMT noted that the patient’s jugular veins are flat (nondistended). Which of the following are most likely the cause of the finding> 1. Closed head injury 2. Blood collecting around the heart in the pericardial sac 3. Blood loss 4. HBP

Answer 75

3. Blood Loss (page 437) Flat neck veins in a patient who is lying down in a horizontal position may be a sign of blood loss, because there is not enough blood to fill them

Question 76

In medical terms, bruises are known as which of the following? 1. Contusion 2. Laceration 3. Deformity 4. Abrasion

Answer 76

1. Contusion

Question 77

What term describes a permanent surgical opening in the neck through which a patient breathes? 1. Tracheostomy 2. Stoma 3. Crepitation 4. Pneumothorax

Answer 77

2. Stoma

Question 78

Your patient is a 14 y/o M who was run over by a tractor and is now unresponsive. During the rapid assessment, you should look for clear drainage from the patients _________ indicating a serious injury 1. mouth 2. rectum 3. eyes 4. ears

Answer 78

4. ears Fluid coming from the ears shows a skull FX allowing CSF to leak.

Question 79

What term describes a surgical incision in the neck that is held open by a metal or plastic tube through which a patient can breath or be placed on a ventilator 1. Priapism 2. Distension 3. Tracheostomy 4. Stoma

Answer 79

3. Tracheostomy

Question 80

In the assessment of a responsive medical patient, which of the following will provide you with the most important information? 1. Baseline VS 2. Patient’s medical HX 3. Detailed Physical Exam 4. Focused Physical Exam

Answer 80

2. Patient’s medical hx

Question 81

In which of the following patients should you check for the possibility of spinal injury? 1. An unresponsive diabetic who appears to have fallen down 2. A responsive patient with no hx of injury who is complaining of a headache and neck pain 3. An unresponsive patient found in her bed with no obvious injury 4. All of the above

Answer 81

1. An unresponsive diabetic, who appears to have fallen down

Question 82

Your patient is the 18 y/o M driver of a vehicle that struck a tree. He is conscious and complaining of neck pain. The passenger is obviously dead. You have performed your primary assessment. Which of the following is the next step: 1. Perform a tertiary assessment 2. Immobilize the patient on a long backboard and perform a detailed examination in the ambulance 3. Rule out the possibility of cervical injury before moving the patient 4. Perform a rapid trauma assessment

Answer 82

4. Perform a rapid trauma assessment

Question 83

You are performing a rapid trauma assessment on an unresponsive 30 y/o M/ As you evaluate his head, which of the follow should you check for? 1. Unequal facial muscles 2. Crepitation 3. Whether the patient can follow your finger with his eyes 4. Function of the cranial nerves

Answer 83

2. Crepitation

Question 84

You respond to the scene of a MVA to find a middle aged man on a long spine board being cared for by first responding firefighters. He appears to be bleeding from his head and is unconscious. You should check the car for: 1. personal items too valuable to leave on-scene 2. a bent steering wheel or starred windshield 3. Insurance information or identification 4. a deployed passenger-side air bag

Answer 84

2. A bent steering wheel or starred windshield

Question 85

Which of the following situations is most likely to result in hidden or unsuspected injury? 1. A vehicle without injuries 2. Seatbelt used by the vehicle occupants 3. Collisions that occur at night 4. Deformity of the interior compartment of the vehicle

Answer 85

2. Seat belt used by the vehicle occupants

Question 86

For which of the following is a focused physical examination appropriate 1. A 30 y/o M with a hx of diabetes and who is found unresponsive by his son 2. A 19 y/o F with a hx of epilepsy and who is found only responsive to painful stimuli by her roommate 3. A 70 y/o M with deformities whose caretaker called because he “didn’t seem like himself today.” 4. A 25 y/o F with a hx of asthma and who is complaining of difficulty breathing

Answer 86

4. A 25 y/o F with a hx of asthma and who is complaining of difficulty breathing

Question 87

If a patient complains of abdominal pain localized to a specific area of the abdomen, which of the following techniques should be used to assess the abdomen 1. Palpate the area last 2. Palpate the area at the beginning and end of the exam 3. Palpate the painful area first 4. Do not palpate the painful area

Answer 87

1. Palpate the area last

Question 88

Your patient is a 45 y/o F who complains of “twisting her ankle” when she slipped on a patch of ice. Which of the following is NOT appropriate 1. Questioning about other complaints or areas of pain 2. Detailed physical exam 3. Providing emotional support if necessary 4. Secondary Assessment

Answer 88

2. Detailed physical exam

Question 89

Your patient is an unresponsive 40 y/o F. Which of the following should you do first 1. take her BP 2. perform a rapid physical exam 3. ask her husband if she has AKA 4. Immediately request ALS

Answer 89

2. perform a rapid physical exam

Question 90

When assessing a patient who has been stabbed, which of the following information should the EMT gain first? 1. Angle at which the knife entered the patient 2. Size and type of the knife 3. Owner of the knife 4. Make and model of the knife

Answer 90

1. Angle at which the knife entered the patient

Question 91

An unconscious trauma patient should always be assumed to have which of the following types of injuries 1. Cardiac 2. Spine 3. Skull 4. Abdominal

Answer 91

2. Spine

Question 92

When checking breath sounds in a trauma patient, what should the EMT assess for first? 1. Presence and equality 2. Rate and SpO2 3. Wheezing and Stridor 4. Edema and rhonchi

Answer 92

1. Presence and equality

Question 93

You are assessing a patient who has been involved in a motor vehicle crash. Which of the following questions would be the most important to ask him? 1. Have you been in a crash before? 2. How fast was the vehicle going? 3. Why were you in such a hurry? 4. How much fuel is in your car?

Answer 93

2. How fast was the vehicle going?

Question 94

You are assessing a 21 y/o F who was assaulted by an unknown person. She is complaining of abdominal pain. As you perform a rapid assessment of her abdomen, you should check for all of the following except: 1. contusions 2. firmness 3. distension 4. bowel sounds

Answer 94

4. bowel sounds

Question 95

You respond to a MVA and find a patient with an altered mental status and an angulated left femur. The other driver is deceased. Your closest trauma center is 45 minutes away. Which of the following would you do next? 1. Perform s detailed physical exam 2. Transport the patient to a local medical clinic for evaluation by a physician 3. Request ALS 4. Apply a traction splint

Answer 95

3. Request ALS

Question 96

When a patient describes how he feels, he is telling you which of the following; 1. His signs 2. His syndrome 3. His symptoms 4. His diagnosis

Answer 96

3. His symptoms

Question 97

When assessing a 14 y/o M patient that has been involved a bicycle accident, you notice that he has a small amount of blood come from his L forearm. This observation is known as which of the following? 1. Clue 2. Sign 3. Indication 4. Symptom

Answer 97

2. Sign

Question 98

You have performed a rapid trauma assessment on a patient with multiple long-bone injuries. Your next assessment step should be which of the following 1. Perform a detailed physical exam 2. Obtain baseline VS and past medical hx 3. Transport the patient to the hospital and perform a detailed physical exam 4. Call the ALS unit to determine their ETA before deciding their ETA before deciding your next step

Answer 98

2. Obtain baseline VS and past medical hx

Question 99

You are called for a patient who was discovered unconscious in his bed this morning. You immediately complete a primary assessment and determine that he is breathing and has a good pulse. What should you do next? 1. Try to locate all of his medication 2. Begin transport immediately 3. Ask the family what happened 4. Complete a rapid physical examination

Answer 99

4. Complete a rapid physical examination

Question 100

What is a surgical opening in the wall of the abdomen with a plastic bag to collect digestive waste? 1. Stoma 2. Colostomy 3. Tracheostomy 4. Priapism

Answer 100

2. Colostomy

Question 101

Your patient was struck in the chest with a baseball bat during a bar fight. A crackling or crunching sensation that is felt when air escapes from its normal passageways and is trapped under the skin 1. tension pneumothorax 2. subcutaneous emphysema 3. distension 4. crepitation

Answer 101

1. tension pneumothorax

Question 102

You are assessing a 76 y/o M, patient who has fallen from a standing position. You have completed the scene size up and primary assessment. What should you do next? 1. Focused hx assessment 2. Ongoing assessment 3. Reassessment 4. Secondary assessment

Answer 102

4. Secondary assessment

Question 103

Immediately following a rapid physical exam on an unresponsive patient, which of the following should you do next? 1. Obtain baseline VS 2. Check the scene for medications 3. Perform a focused physical exam 4. Find out who the patient’s doctor is

Answer 103

1. Obtain baseline VS

Question 104

You are called for a patient who is complaining of being weak and dizzy. He reports that he does not have enough money to pay for his medications so he has not gotten them refilled. Your service has an automatic blood pressure machine and you use it to measure the​ patient’s blood pressure while you count his respirations. The blood pressure machine reports a blood pressure of​ 280/140. What should you do​ next? 1. Take a Manual BP 2. Calle immediately for ALS response 3. Begin transport immediately 4. Continue with VS assessment

Answer 104

1. Take a Manual BP

Question 105

Your patient is a​ 24-year-old female who swallowed a handful of pills of unknown type. Although she was initially alert and oriented with no​ complaints, you note that she is now beginning to slur her words and is becoming progressively lethargic. What is the highest priority in dealing with this​ patient? 1. Notifying receiving facility of the change in mental status 2. checking the patients pupil size and reactivity to light 3. Maintaining an open airway 4. Finding out exactly what she took

Answer 105

3. Maintaining an open airway

Question 106

The patient was a driver in a lateral impact motor vehicle collision. During the assessment of his​ chest, the EMT notes a segment of the chest wall moving in the opposite direction from the rest of the chest. Which of the following best describes this​ finding? 1. Intercostal retractions 2. Paradoxical motion 3. Flutter segment 4. Tension pneumothorax

Answer 106

2. Paradoxical motion

Question 107

Which of the following is another term for​ trauma? 1. Medical Problem 2. Suffering 3. Injury 4. Illness

Answer 107

3. Injury

Question 108

The term priapism means​ ________ and may be found in injuries of the​ ________. 1. unequal pupils; brain 2. a persistent penile; erection 3. a painful muscle spasm; spine 4. abnormal pulsation; abdomen

Answer 108

2. a persistent penile; erection

Question 109

Which of the following is not a purpose of a rapid trauma​ assessment? 1. To assess the extent of injuries 2. To focus care on specific injuries 3. To detect injuries that may become life threatening 4. To provide a basis for care during transport

Answer 109

2. To focus care on specific injuries

Question 110

What does distention refer to when describing your​ patient’s abdomen? 1. Harder than normal 2. Larger than normal 3. Softer than normal 4. Having a sunken-in appearance

Answer 110

2. Larger than normal

Question 111

Where might you find a​ patient’s medical alert identification​ jewelry? 1. Necklace 2. Bracelet 3. Ankle bracelet 4. All of the above

Answer 111

4. All of the above

Question 112

Your patient has been hit in the arm with a baseball during practice. He is alert and​ oriented, complaining of pain to his left arm with obvious black discoloration of the skin. What type of assessment is called for in this​ situation? 1. Area exam 2. Focused exam 3. Rapid Trauma Assessment 4. Detailed physical exam

Answer 112

2. Focused exam

Question 113

What does DCAP-BTLS Stand for? When it is used?

Answer 113

D - Deformities - parts of the body that no longer have the normal shape C - Contusions - Bruising A - Abrasions - Abrasions and Scrapes are some of the most common injuries you will see P - Punctures or Penetrations - Holes in the body, gunshot, stabbing wounds B - Burns - Are they reddened, blistered, charred looking? T - Tenderness - an area that hurts when you palpate it (Pain and tenderness frequently, but not always go together. Additionally, Pain can be present without palpation) L - Lacerations - cuts - open wounds, that sometimes cause significant blood loss S - Swelling - Very common result of injured capillaries bleeding under the skin Used for trauma patient