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Paramedic Trauma Emergencies > Chapter 1 extended > Flashcards

Chapter 1 extended Flashcards

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1
Q

You are called to a commercial creamery where an employee got his arm trapped in the ice cream-mixing machinery. You note that the skin has been pulled off his hand and arm from the midforearm down. The patient’s muscles, tendons, and bones are exposed. This type of injury is a(n):

A

degloving injury

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2
Q

You are assessing an assault victim and note a contusion over the abdomen. Which of the following should you remember while caring for this patient?

a. Unless the contusion is over a critical area, such as the spleen or liver, the likelihood of serious injury is minimal.
b. A contusion to the abdomen should always increase your index of suspicion for underlying injury.
c. If there is no rigidity or distension of the abdomen, serious injury is unlikely.
d. The significance of the trauma is related to the amount of pain the patient experiences on palpation.

A

a contusion to the abdomen should always increase your index of suspicion for underlying injury

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3
Q

A nonpenetrating injury caused by blunt trauma that damages blood vessels, causing pain and discoloration, is a(n):

A

contusion

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4
Q

You have responded for an injured person at an address you know to be a motorcycle clubhouse. Your patient was attacked by another party with a broken beer bottle. Your patient has a large laceration on her neck with moderate bleeding. Which property of your dressing material is most important in caring for this patient?

a. Occlusive
b. Sterile
c. Absorbent
d. Adherent

A

occlusive

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5
Q

The tough, fibrous sheaths that bundle skeletal muscle are called:

a. Tendons
b. Fibers
c. Sarcolemma
d. Fascia

A

fascia

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6
Q

Which of the following statements about crush injuries is most accurate?

a. Only closed injuries can be classified as crush injuries.
b. The actual source of bleeding in crush injuries may be hard to identify.
c. A spongy sensation on palpation of the injured area indicates crush injury.
d. Crush injuries are easily identifiable because they invariably result in deformity.

A

the actual source of bleeding in crush injuries may be hard to identify

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7
Q

Which of the following is best described as the accumulation of a pocket of blood in the tissues?

a. Hematoma
b. Abrasion
c. Compartment syndrome
d. Contusion

A

hematoma

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8
Q

The acute breakdown of muscle fibers in crushing injury is called:

a. Myoglobinemia
b. Sarcoidosis
c. Rouleaux formation
d. Rhabdomyolysis

A

rhabdomyolysis

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9
Q

When caring for an amputated part, which of the following principles apply?
Place the unwrapped part in a dry plastic bag, and seal it.

Place the part in a plastic bag with the part wrapped in gauze moistened with lactated Ringer’s solution or normal saline, and seal it.

Always transport the part with the patient.

Keep the part moist, and place it in a container of cold water.

Keep the part dry, and place it in an ice-filled container.

a. 2, 4
b. 2, 3, 4
c. 1, 3, 5
d. 2, 5

A

2,4

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10
Q

You arrive on the scene of a patient with severe blunt trauma to the face. You hear gurgling as you approach the patient. After opening the airway with a manual maneuver, what should your next action be?

a. Ventilate
b. Apply a cervical collar
c. Control the source of hemorrhage
d. Suction

A

suction

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11
Q

Which of the following are likely to accumulate in the bloodstream following a large crush injury?

a. Myoglobin
b. Potassium
c. Lactic acid
d. All of the above

A

all of the above

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12
Q

Your patient is an 18-year-old male who stepped on a nail in the barnyard. The nail penetrated his tennis shoe and punctured his foot. On your arrival, the patient has removed the nail and the shoe. The wound is about 2 mm in diameter with minor bleeding that has been controlled. The skin around the wound is red. The patient does not want to be transported but asks if you can give him “some ointment and a Band-Aid.” You should explain to the patient that this type of injury is associated with an increased risk of:

a. Infection
b. Delayed bleeding
c. Scarring
d. Nerve damage

A

infection

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13
Q

In which of the following ways does the integumentary system prevent pathogens from entering the body?

a. Via humoral immunity
b. Via cell-mediated immunity
c. Secretes chemotactic factors
d. Provides a barrier to the environment

A

provides a barrier to the environment

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14
Q

In which type of soft-tissue injury is the skin cut or torn, leaving a flap of skin attached?

a. Avulsion
b. Laceration
c. Amputation
d. Abrasion

A

avulsion

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15
Q

Your patient is a 35-year-old male who has his leg trapped under a section of concrete from an industrial accident. While awaiting removal of the concrete, which type of IV fluid is indicated for administration to this patient?

a. Five percent dextrose in water
b. Normal saline
c. Lactated Ringer’s
d. Whole blood

A

normal saline

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16
Q

The layer of skin that contains adipose tissue is the ________ layer.

a. Dermal
b. Connective
c. Epidermal
d. Subcutaneous

A

subcutaneous

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17
Q

Which of the following medications may be indicated in the treatment of a patient with a crush injury?

a. Mannitol
b. Potassium chloride
c. Lactated Ringer’s solution
d. Furosemide

A

mannitol

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18
Q

For most open, soft-tissue wounds managed by the paramedic in the prehospital setting, which of the following is a desirable characteristic of the dressing applied?

a. Occlusive
b. Dry
c. Adherent
d. Nonabsorbent

A

dry

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19
Q

Your patient is a 19-year-old male who received a penetrating knife wound to his chest. On your arrival he is lying supine with a visible chest wound that is bleeding slightly. You can hear the sucking sound of air moving in and out of the wound. This wound is best managed with:

a. A bulky dressing held in place with adhesive strips
b. An occlusive bandage sealed on three sides, open on the fourth side
c. A dry dressing covered by an adherent bandage
d. A sterile, wet dressing held in place with an elastic bandage

A

an occlusive bandage sealed on three sides open on the fourth side

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20
Q

The first stage of wound healing is:

a. Hemostasis
b. Neovascularization
c. Inflammation
d. Epithelialization

A

hemostasis

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21
Q

A laceration that is perpendicular to the tension lines of the body is more likely to:

a. Become infected
b. Heal without a scar
c. Be caused by blunt trauma
d. Leave a noticeable scar

A

leave a noticeable scar

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22
Q

Your patient is a 30-year-old machinist who had his right hand caught in a press. Upon extrication there is no evidence of significant trauma. You should:

a. Splint the hand in the position found, elevate above the heart, apply ice
b. Splint in position of function, start an IV of normal saline, consider morphine for analgesia
c. Wrap the hand in a bulky dressing held in place by an elastic bandage
d. Apply oxygen by nonrebreather, splint using a sling and swath, insert a large-bore IV of lactated Ringer’s

A

splint in position of function start an IV of normal saline consider morphine for analgesia

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23
Q

Which of the following most accurately describes the bleeding you would expect from an abrasion?

a. Bright red, steady flow
b. Dark red, steady flow
c. Dark red, oozing
d. Bright red, oozing

A

bright red oozing

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24
Q

Which of the following is a principle that should be used when considering application of a tourniquet to control bleeding?

a. A tourniquet should be used for severe bleeding that cannot be controlled by any other means.
b. Every 15 minutes the tourniquet will need to be removed for 5 minutes, then reapplied.
c. A narrow, nonelastic material is best for generating the pressure needed to stop bleeding.
d. A blood pressure cuff used as a tourniquet will maintain its pressure if it has been properly applied.

A

a tourniquet should be used for severe bleeding that cannot be controlled by other means

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25
Q

Your patient is a 15-year-old soccer player who was kicked in the calf by another player. She has a contusion on her calf, but the amount of pain she is experiencing seems out of proportion to the apparent injury. You note that, although you can palpate a pedal pulse, there is swelling in the foot and ankle, and the skin is cool to the touch. You should suspect which of the following at this time?

a. Compartment syndrome
b. Volkmann’s ischemic contracture
c. Crush syndrome
d. Degloving injury

A

compartment syndrome

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26
Q

The bacteria most often associated with infection of open soft-tissue injury is:

a. Streptococcus
b. Pseudomonas aeruginosa
c. Staphylococcus
d. Clostridium tetani

A

staphylococcus

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27
Q

Your patient is a three-year-old male who has struck his head on a concrete patio. He has a linear wound that penetrates the dermis and is approximately 2 cm long. This wound would be best described as a(n):

a. Contusion
b. Puncture
c. Avulsion
d. Laceration

A

laceration

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28
Q

Your patient is a 45-year-old type II diabetic who has a nonhealing wound on his right foot. You note that the right leg is discolored and edematous and has subcutaneous emphysema and a foul odor. Which of the following should you suspect?

a. MRSA
b. Gangrene
c. Tetanus
d. Compartment syndrome

A

gangrene

29
Q

The three primary factors that determine the severity of radiation are:

a. distance, shielding, and symptoms.
b. duration, shielding, and dose.
c. duration, distance, and shielding.
d. dose, symptoms, and shielding.

A

duration, distance and shielding

30
Q

Which of the following has contributed most significantly to the decline in U.S. burn mortality?

a. Public service announcements on radio, television, and billboards
b. Paramedic involvement in public education
c. Visits to elementary schools by firefighters
d. Improved building codes and construction and sprinkler and smoke detector use

A

improved building codes and construction and sprinkler and smoke detector use

31
Q

Which classification of burn is characterized mainly by blisters?

a. Full thickness
b. Superficial
c. Partial thickness
d. Minor

A

partial thickness

32
Q

Based on total body surface area and burn depth, you have determined that an 88-year-old woman has a moderate burn. Considering the age of the patient, this burn is classified as:

a. critical.
b. significant.
c. fatal.
d. moderate.

A

critical

33
Q

An area of burned tissue that is not painful is MOST likely a ________ burn injury.

a. second-degree
b. full thickness
c. superficial
d. partial thickness

A

full thickness

34
Q

You have been dispatched to a call for a burn patient. Upon arriving, you find a 23-year-old woman who was sunbathing and fell asleep. She is alert and oriented and in moderate pain. She has blisters covering her extremities, abdomen, face, and chest. This patient’s burns fall into which one of the following categories?

a. Superficial
b. Critical
c. Minor
d. Moderate

A

critical

35
Q

Which of the following stages of burn injury is best described as including a pain response, an outpouring of catecholamines, tachycardia, tachypnea, mild hypertension, and anxiety?

a. Resolution
b. Emergent
c. Fluid shift
d. Hypermetabolic

A

emergent

36
Q

Which tissue layer(s) is (are) affected by partial thickness burns?

  1. Epidermis
  2. Dermis
  3. Subcutaneous
  4. Muscle

Select one:

a. 1, 2, 3, and 4
b. 1 and 2
c. 1, 2, and 3
d. 1

A

1 and 2

37
Q

Contact with strong alkalis results in burns involving ________ necrosis of the tissue.

Select one:

a. coagulation
b. liquefaction
c. thermal
d. ischemic

A

liquefaction

38
Q

Your patient has circumferential full thickness burns of the thorax. He is intubated, and you have noticed an increase in resistance as you bag him. His skin is very tight and inflexible as you try to ventilate. Which of the following is required to improve this patient’s ventilatory status?

Select one:

a. IV sedation
b. Needle thoracostomy
c. Escharotomy
d. Fasciotomy

A

escharotomy

39
Q

Which of the following body areas warrant special attention when burned?

a. Legs
b. Arms
c. Abdomen
d. Feet

A

feet

40
Q

Which of the following patient factors increases the criticality of the patient’s burn injuries?

Select one:
a. Taking antidepressants
b. Male gender
c. Prior history of burns
d. Being in the geriatric age group
Feedbackd
A

being in the geriatric age group feed back

41
Q

You are dispatched to a structure fire at which there is a report of a burned person. Your patient is a 32-year-old man with blisters on his anterior chest and circumferential superficial burns to both lower extremities. Using the “rule of nines,” the percentage of burn is:

Select one:

a. 54.
b. 27.
c. 36.
d. 45.

A

45

42
Q

Which of the following agents is the best choice for analgesia in a patient with 9 percent partial thickness burns involving the right lower extremity?

Select one:

a. Naproxen sodium
b. Ketorolac
c. Acetaminophen
d. Fentanyl

A

fentanyl

43
Q

The type of electricity supplied to homes is ________ current. Contact with this type of current may result in ________.

Select one:

a. indirect; rhabdomyolysis
b. direct; rhabdomyolysis
c. direct; muscle tetany
d. alternating; muscle immobolization

A

alternating muscle immobilization

44
Q

You are caring for a patient with 30 percent full and partial thickness burns. He is an 80 kg man. According to the Parkland formula, he should receive ________ liters of fluid over 24 hours, with ________ liters infused in the first 8 hours.

Select one:

a. 9.6; 4.8
b. 5; 3
c. 8.2; 2
d. 4.5; 1.25

A

9.6; 4.8

45
Q

According to Jackson’s theory of thermal wounds, which of the following zones has suffered the greatest damage?

a. Coagulation
b. Hyperemia
c. Stasis
d. Disintegration

A

coagulation

46
Q

Which type of radiation particle can travel through 6 to 10 feet of air, penetrate a few layers of clothing, and cause external and internal injuries?

Select one:

a. Gamma
b. Alpha
c. Neutron
d. Beta

A

beta

47
Q

Which of the following accounts for the most severe thermal burns of the airway?

Select one:

a. Inhalation of toxic gases
b. Inhalation of radioactive particles in smoke
c. Inhalation of superheated steam
d. Inhalation of superheated air

A

inhalation of super heated steam

48
Q

Which of the following may occur from watching arc welding without proper protection?

Select one:
a. Hyphema
b. Retinal detachment
c. Ultraviolet keratitis
d. Radial keratotomy
Feedback
A

ultraviolet keratitis

49
Q

For which of the following burn patients could you use local cooling?

Select one:

a. An 18-month-old child with partial and full thickness scald burns on the lower extremities, buttocks, genitalia, and lower abdomen
b. A 19-year-old woman with approximately 40 percent superficial and 45 percent partial thickness burns from sunbathing
c. A 15-year-old man with partial thickness burns of his left upper extremity, anterior chest, and neck resulting from playing with gasoline and matches
d. A 52-year-old man with a 1-inch-wide full thickness burn across the entire width of the palm of his right hand resulting from picking up a hot grate from a barbecue grill

A

a 53 year old man with a 1 inch wide full thickness burn across the entire width of the palm of his right hand resulting from picking up a hot grate from a barbecue grill

50
Q

For which of the following burn patients could you use local cooling?

Select one:

a. An 18-month-old child with partial and full thickness scald burns on the lower extremities, buttocks, genitalia, and lower abdomen
b. A 19-year-old woman with approximately 40 percent superficial and 45 percent partial thickness burns from sunbathing
c. A 15-year-old man with partial thickness burns of his left upper extremity, anterior chest, and neck resulting from playing with gasoline and matches
d. A 52-year-old man with a 1-inch-wide full thickness burn across the entire width of the palm of his right hand resulting from picking up a hot grate from a barbecue grill

A

critical

51
Q

You are assessing a 17-year-old male patient with a burn on the lateral aspect of his thigh. Which of the following guidelines is most helpful when estimating the percentage of total body surface area involved?

a. The rule of palms
b. The Parkland formula
c. The rule of nines
d. The modified pediatric rule of nines

A

the rule of palms

52
Q

Which of the following is TRUE of the heat generated when electricity flows through the body?

a. Dry skin offers less resistance to electricity, generating more heat.
b. Wet skin offers less resistance to electricity, generating more heat.
c. Wet skin offers greater resistance to electricity, generating more heat.
d. Dry skin offers more resistance to electricity, generating more heat.

A

dry skin offers more resistance to electricity generating more heat

53
Q

Cool-water immersion of a burned part effectively reduces burning only when done within which of the following time frames?

a. The first 24 hours
b. The first 10 to 15 minutes
c. The first 1 to 2 minutes
d. The first hour

A

the first 1 to 2 min

54
Q

Paralysis of the muscles of respiration may occur when there is body contact with electrical currents as low as ________ mA.

a. 60
b. 100
c. 20
d. 5

A

20

55
Q

The first step for treating a patient who has been contaminated with dry lime is to:

a. neutralize the lime with a mild acidic solution, such as vinegar and water.
b. brush away as much of the powder as possible.
c. flush the skin with large amounts of isopropyl alcohol.
d. flush with copious amounts of tepid water.

A

brush away as much of the powder as possible

56
Q

Which of the following best describes the pathophysiology of most burns to the human body?

a. Heat causes evaporation of water and denatures protein.
b. Radiation, including solar radiation and radiant heat, alters cell structures.
c. Chemicals cause an endothermic reaction that destroys tissue.
d. The skin, and sometimes deeper tissues, are destroyed through combustion.

A

heat causes evaporation of water and denatures protein

57
Q

Which of the following represents the modified body surface area percentages in the “rule of nines” for pediatric patients?

a. Posterior chest is 7 percent.
b. Upper extremities are 13.5 percent each.
c. External genitalia is 1 percent.
d. Lower extremities are 13.5 percent each.

A

lower extremities are 13.5 percent each

58
Q

The voltage of a bolt of lightning may be as much as ________ volts, and its temperature may reach ________ degrees Fahrenheit.

a. 5,000; 150,000
b. 150,000; 5,000
c. 50,000; 100,000
d. 100,000; 50,000

A

100,000; 50,000

59
Q

Most inhalation injuries in burn patients are due to which of the following?

a. Toxic inhalation
b. Radiation burns of the airway
c. Thermal burns of the lower airway
d. Thermal burns of the upper airway

A

toxic inhalation

60
Q

During which phase of a burn injury does extravasation of proteins, water, and electrolytes occur, resulting in edema and potential hypovolemia?

a. Emergent
b. Hyperemia
c. Hypermetabolic
d. Fluid shift

A

fluid shift

61
Q

Your patient is a 23-year-old woman who was rescued from a burning house. She was asleep in a back bedroom when the fire started, and there was no smoke alarm. She has a pulse oximetry reading of 99 percent after receiving oxygen by nonrebreather mask. What is the most appropriate interpretation of this finding?

a. Effects of smoke inhalation have been resolved by oxygen administration.
b. You cannot rely on this alone to assess oxygenation.
c. There was minimal smoke inhalation.
d. Carboxyhemoglobin is less than 1 percent.

A

you cannot rely on this alone to assess oxygenation

62
Q

Which of the following body structures is the best electricity conductor?

a. Bones
b. Nerves
c. Muscle
d. Skin

A

nerves

63
Q

Which of the following burns would be classified as moderate?

a. Superficial < 50 percent BSA
b. Full thickness < 2 percent BSA
c. Partial thickness < 30 percent BSA
d. Partial thickness > 30 percent BSA

A

partial thickness <30 percent BSA

64
Q

Patients who survive the first several days of a moderate to critical burn are MOST likely to die from which of the following complications?

Select one:

a. Hypovolemia
b. Organ failure
c. Infection
d. Hypothermia

A

infection

65
Q

Flash burns associated with electricity occur because:

a. air is a moderately good conductor of electricity, generating moderate heat.
b. air is an excellent conductor of electricity, generating moderate heat.
c. air is mildly resistant to the passage of electricity, generating only enough heat to cause superficial burns.
d. air is highly resistant to the passage of electricity, generating intense heat.

A

air is highly resistant to the passage of electricity generating intense heat

66
Q

You are assessing a 37-year-old woman who was rescued from an apartment fire. She has a harsh, stridorous, “brassy”-sounding cough productive of sooty sputum. Her eyebrows and the hair around her face are singed. Respirations = 28, heart rate = 108, and blood pressure = 124/84. You have a 30-minute transport time. Which of the following is the best intervention for this patient?

a. One hundred percent oxygen by nonrebreather mask
b. Sedation and cricothyrotomy
c. A nebulized albuterol treatment
d. Rapid sequence intubation and endotracheal intubation

A

rapid sequence intubation and endotracheal intubation

67
Q

The seriousness of burns in the pediatric population is put into perspective by realizing that burns are the ________ leading cause of death in children under age 12 years.

a. first
b. second
c. third
d. fourth

A

second

68
Q

Which of the following chemicals must be brushed off the skin, then covered with oil?

a. Phenol
b. Sodium metal
c. Oleoresin capsicum
d. Dry lime

A

sodium metal

Paramedic Trauma Emergencies (23 decks)

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