CH. 40

Question 1

Answers to Assessment in Action Questions

Answer 1

Answers to Assessment in Action Questions

1. Answer: A Upwind and uphill from the incident
2. Answer: A The incident commander best understands incident needs.
3. Answer: B Potential permanent hearing loss
4. Answer: D Pulmonary blast injury
5. Answer: A Hollow organ injury
6. Answer: B Head and neck
7. Answer: B Solid organ
8. Answer: Primary blast injury (shockwave) is due to the direct effects of the pressure wave on the body seen almost exclusively in the hollow organs of the body—lungs, intestines, and inner ears. Lung injury causes the greatest morbidity and mortality. Secondary blast injury causes penetrating or blunt injury that results from being struck by flying debris set in motion by the explosion. Tertiary blast injury occurs when there is traumatic impact with environmental objects (often when a body propelled into the air comes to rest.)
9. Answer: Try to get a history on how close the patient was to the blast and what happened. Was there a collapse of a structure that could have caused a crush injury? The patient’s proximity to the blast will help determine whether he or she suffered from primary, secondary, or tertiary blast trauma. Were there toxic effects from the inhalation of combustion gases? Are there baseline mentation or communication problems that should be factored in? Is age an issue that may make injury more serious or recovery more difficult? Good patient care will also take into consideration the psychological effects of being a victim of a WMD, witnessing trauma to others, or perhaps losing a loved one.
10. Answer: Pulmonary agents, such as chlorine and phosgene, cause immediate damage because they are inhaled by the victims. Once exposed to the chemical, lung tissue is damaged and fluid is allowed to enter. This results in the acute onset of pulmonary edema. Patients exposed to a pulmonary agent will present with an increased work of breathing demonstrated by tachypnea, tachycardia, and anxiety.