Chapter 25 - Trauma Overview

Question 1

When assessing the interior of a crashed motor vehicle for damage, you are gathering information regarding the:

Select One:

A. index of suspicion.
B. mechanism of injury.
C. kinetic energy.
D. potential energy

Answer 1

b. mechanism of injury.

Question 2

Passengers who are seated in the rear of a vehicle and are wearing only lap belts have a higher incidence of injuries to the _____________ spine during a rear-end crash.

Select One:

A. thoracic and sacral
B. lumbar and coccygeal
C. thoracic and lumbar
D. lumbar and sacral

Answer 2

c. thoracic and lumbar

Question 3

The energy of a moving object is called:

Select One:

A. latent energy.
B. kinetic energy.
C. potential energy.
D. converted energy.

Answer 3

B. kinetic energy.

Question 4

During your assessment of a patient with a head injury, you note that he opens his eyes when you pinch his trapezius muscle, is mumbling, and has his arms curled in toward his chest. You should assign him a GCS score of:

Select One:

A. 7
B. 8
C. 9
D. 10

Answer 4

A. 7

Question 5

A small compact car was involved in a rollover crash. As you are approaching the vehicle, you note that the roof is significantly collapsed. The patient, a 29-year-old male, is complaining of severe pain in his neck and to the top of his head as well as numbness and tingling in his extremities. Witnesses who removed the patient from the vehicle state that he was wearing his seatbelt.

What injury mechanism is MOST likely responsible for this patient’s condition?

Select One:

A. Compression of the head against the roof
B. Lateral bending of the neck during the crash
C. Impact of the head against the steering wheel
D. Whiplash injury to the neck during the rollover

Answer 5

A. Compression of the head against the roof

Question 6

Two of the MOST common mechanisms of injury for blunt trauma are:

Select One:

A. falls and motor vehicle collisions.
B. low-caliber gunshot wounds and falls.
C. gunshot wounds and vehicle ejections.
D. motor vehicle collisions and stabbings

Answer 6

a. falls and motor vehicle collisions.

Question 7

The driver of a sport utility vehicle lost control and struck a utility pole head-on. The driver was killed instantly. The passenger, a young female, is conscious and alert and has several small abrasions and lacerations to her left forearm.

Treatment for the passenger should include:

Select One:

A. transport to a trauma center.
B. a focused exam of her forearm.
C. transport to a community hospital.
D. a secondary assessment at the scene.

Answer 7

A. transport to a trauma center.

Question 8

When a driver is in a car equipped with an airbag but is not wearing a seatbelt, he or she will MOST likely strike the __________ when the airbag deploys upon impact.

Select One:

A. door
B. dashboard
C. windshield
D. steering wheel

Answer 8

A. door

Question 9

Evaluation of the interior of a crashed motor vehicle during extrication will allow the EMT to:

Select One:

A. determine the vehicle’s speed at the time of impact.
B. assess the severity of the third collision of the crash.
C. recognize if the driver hit the brakes before impact.
D. identify contact points and predict potential injuries.

Answer 9

D. identify contact points and predict potential injuries.

Question 10

While assessing a young male who was struck in the chest with a steel pipe, you note that his pulse is rapid and irregular. You should be MOST suspicious for:

Select One:

A. underlying cardiac disease.
B. a lacerated coronary artery.
C. bruising of the heart muscle.
D. traumatic rupture of the aorta.

Answer 10

C. bruising of the heart muscle.

Question 11

A 30-year-old male sustained a stab wound to the neck when he was attacked outside a nightclub. During your assessment, you should be MOST alert for:

Select One:

A. injury to the cervical spine.
B. potential airway compromise.
C. damage to internal structures.
D. alterations in his mental status.

Answer 11

B. potential airway compromise.

Question 12

Which of the following statements regarding low-energy penetrating injuries is correct?

Select One:

A. Internal injuries caused by low-velocity bullets are usually easy to predict.

B. Exit wounds are typically easy to locate with low-energy penetrating injuries.

C. It is usually easy to differentiate between an entrance wound and an exit wound.

D. The area of injury is usually close to the path the object took through the body.

Answer 12

D. The area of injury is usually close to the path the object took through the body.

Question 13

Which of the following patients has experienced the MOST significant fall?

Select One:

A. a 4′8″ patient who fell 12 feet
B. a 5′0″ patient who fell 13 feet
C. a 4′6″ patient who fell 13 feet
D. a 5′9″ patient who fell 14 feet

Answer 13

C. a 4′6″ patient who fell 13 feet

Question 14

When treating a patient who experienced a pulmonary blast injury, you should:

Select One:

A. use a demand valve to ventilate the patient.
B. suspect an accompanying cardiac tamponade.
C. avoid giving oxygen under positive pressure.
D. administer large amounts of intravenous fluid.

Answer 14

C. avoid giving oxygen under positive pressure.

Question 15

When evaluating the mechanism of injury of a car-versus-pedestrian collision, you should first:

Select One:

A. determine if the patient was propelled away from the vehicle.

B. approximate the speed of the vehicle that struck the pedestrian.

C. evaluate the vehicle that struck the patient for structural damage.

D. determine if the patient was struck and pulled under the vehicle.

Answer 15

B. approximate the speed of the vehicle that struck the pedestrian.

Question 16

Factors that should be considered when assessing a patient who has fallen include all of the following, EXCEPT:

Select One:

A. be involved in trauma prevention programs.
B. have general surgeons who are in-house 24 hours a day.
C. have access to an emergency physician within 30 minutes.
D. be able to stabilize patients before transferring to a higher level facility.

Answer 16

B. have general surgeons who are in-house 24 hours a day.

Question 17

Internal injuries caused by gunshot wounds are difficult to predict because:

Select One:

A. the caliber of the bullet is frequently unknown.
B. the area of damage is usually smaller than the bullet.
C. the bullet may tumble or ricochet within the body.
D. exit wounds caused by the bullet are usually small.

Answer 17

C. the bullet may tumble or ricochet within the body.

Question 18

Which of the following statements regarding the first collision that occurs during a motor vehicle crash is correct?

Select One:

A. It provides the least amount of information about the mechanism of injury.

B. It has a direct effect on patient care because of the obvious vehicular damage.

C. It is the most dramatic part of the collision and may make extrication difficult.

D. It occurs when the unrestrained occupant collides with the interior of the vehicle.

Answer 18

C. It is the most dramatic part of the collision and may make extrication difficult.

Question 19

If a person is standing near a building that explodes, which of the following injuries would he or she MOST likely experienced as a result of the pressure wave?

Select One:

A. Severe burns
B. Fractured bones
C. Stomach rupture
D. Impaled objects

Answer 19

C. Stomach rupture

Question 20

A 12-year-old male jumped approximately 12 feet from a tree and landed on his feet. He complains of pain to his lower back. What injury mechanism is MOST likely responsible for his back pain?

Select one:

A. Lateral impact to the spine
B. Secondary fall after the initial impact
C. Direct trauma to the spinal column
D. Energy transmission to the spine

Answer 20

D. Energy transmission to the spine

Question 21

A 15-year-old female was struck by a small car while riding her bicycle. She was wearing a helmet and was thrown to the ground, striking her head. In addition to managing problems associated with airway, breathing, and circulation, it is MOST important for you to:

Select one:

A. leave her bicycle helmet on.
B. obtain baseline vital signs.
C. stabilize her entire spine.
D. inspect the helmet for cracks.

Answer 21

C. stabilize her entire spine.

Question 22

A young male sustained a gunshot wound to the abdomen during an altercation. As your partner is assessing and managing his airway, you should control the obvious bleeding and then:

Select one:

A. auscultate bowel sounds.
B. assess for an exit wound.
C. apply a cervical collar.
D. obtain baseline vital signs.

Answer 22

B. assess for an exit wound.

Question 23

According to the American College of Surgeons Committee on Trauma (ACS-COT), an adult trauma patient should be transported to the highest level of trauma center if he or she:

Select one:

A. was involved in a motor vehicle crash in which another patient in the same vehicle was killed.

B. has a systolic blood pressure of less than 110 mm Hg or a heart rate greater than 110 beats/min.

C. has a bleeding disorder or takes anticoagulant medications and has any blunt or penetrating injury.

D. has a GCS score of less than or equal to 13 with a mechanism attributed to trauma.

Answer 23

D. has a GCS score of less than or equal to 13 with a mechanism attributed to trauma.

Question 24

According to the Association of Air Medical Services, you should consider air medical transport of a trauma patient if:

Select one:

A. the patient requires advanced life support care and stabilization, and the nearest ALS-ground ambulance is more than 5 to 10 minutes away.

B. traffic conditions hamper the ability to get the patient to a trauma center by ground within the ideal time frame for the best clinical outcome.

C. ground transport will take your ambulance out of service for an extended period of time, regardless of the severity of the patient’s injuries.

D. he or she was involved in a motor vehicle crash in which another occupant in the same vehicle was killed, even if your patient’s injuries are minor.

Answer 24

B. traffic conditions hamper the ability to get the patient to a trauma center by ground within the ideal time frame for the best clinical outcome.

Question 25

Approximately 25% of severe injuries to the aorta occur during:

Select one:

A. frontal collisions.
B. rollover collisions.
C. rear-end collisions.
D. lateral collisions.

Answer 25

D. lateral collisions.

Question 26

Following a blunt injury to the head, a 22-year-old female is confused and complains of a severe headache and nausea. On the basis of these signs and symptoms, you should be MOST concerned with the possibility of:

Select one:

A. a fracture of the skull.
B. airway compromise.
C. intracranial bleeding.
D. spinal cord injury.

Answer 26

C. intracranial bleeding.

Question 27

Force acting over a distance is the definition of:

Select one:

A. work.
B. latent energy.
C. kinetic energy.
D. potential energy.

Answer 27

A. work.

Explanation:

W = (Fd)
W = m*a*d
W = m*a*cosθ [cosθ = angle of displacement]

Question 28

The index of suspicion is MOST accurately defined as:

Select one:

A. the detection of less obvious life-threatening injuries.
B. a predictable pattern that leads to serious injuries.
C. your awareness and concern for potentially serious underlying injuries.
D. the way in which traumatic injuries occur.

Answer 28

C. your awareness and concern for potentially serious underlying injuries.

Question 29

When assessing a patient who experienced a blast injury, it is important to remember that:

Select one:

A. solid organs usually rupture from the pressure wave.
B. secondary blast injuries are usually the least obvious.
C. primary blast injuries are the most easily overlooked.
D. primary blast injuries are typically the most obvious.

Answer 29

C. primary blast injuries are the most easily overlooked.

Explanation: Types of Blast Injuries

1. Primary blast injury: Primary blast injury is due to the supersonic over-pressurization blast wave unique to high-order (HE) explosives. HE devices involve a detonation or the nearly instantaneous transformation of solid or liquid into a gas state. When this blast over-pressure wave strikes body surfaces, it can cause pulmonary barotrauma, rupture of the eardrum, perforation of gas-filled structures like the intestines or gallbladder, ocular rupture and concussion – even in the absence of obvious physical head injury.
2. Secondary blast injury: Low-order (LE) explosions are typically deflagrations whose exothermic wave is subsonic and isn’t nearly as powerful. By definition, LE explosions are unable to cause primary blast injury. However, they may cause injury resulting from flying debris, bomb fragments and projectiles causing blunt and penetrating trauma known as secondary blast injury.

When documenting injury from pieces of a device itself, it is more correct to use the term “fragmentation” as opposed to “shrapnel.” Shrapnel injury technically can only come from actual shrapnel shells where relatively low velocity lead balls are ejected from a casing that remains intact.

3. Tertiary blast injuries: Tertiary blast injury results from the human body actually being thrown by the blast wind and may manifest as fractures, traumatic amputations and brain injuries.
4. Quaternary blast injuries: Quaternary blast injury is everything else not caused by primary, secondary or tertiary mechanisms. Examples include burns, angina, crush injuries, asthma or COPD exacerbations due to dust, smoke or toxic fumes.

Question 30

When assessing an elderly patient who fell, it is important to remember that:

Select one:

A. any fall in the elderly is considered to be high-energy trauma.
B. osteoporosis can cause a fracture as a result of a fall from a standing position.
C. bilateral hip fractures usually occur when an elderly person falls.
D. elderly patients who fall usually have a secondary head injury.

Answer 30

B. osteoporosis can cause a fracture as a result of a fall from a standing position.

Question 31

When the speed of a motor vehicle doubles, the amount of kinetic energy:

Select one:

A. quadruples.
B. is not affected.
C. triples.
D. doubles.

Answer 31

A. quadruples.

Question 32

Which of the following destinations is most appropriate for a 41-year-old male patient who was involved in a rollover motor vehicle collision and is unconscious and unresponsive, assuming that travel times to each is equal?

Select one:

A. A Level I or Level II trauma center
B. Only a Level I trauma center
C. A Level IV or Level III trauma center
D. Any designated trauma center is acceptable.

Answer 32

A. A Level I or Level II trauma center

Question 33

Which of the following findings would be LEAST suggestive of the presence of high-energy trauma?

Select one:

A. Intrusion into the vehicle
B. Dismounted seats
C. Steering wheel deformity
D. Deployment of the airbag

Answer 33

D. Deployment of the airbag

Question 34

Which of the following injuries would MOST likely occur as a direct result of the third collision in a motor vehicle crash?

Select one:

A. Flail chest
B. Forehead lacerations
C. Aortic rupture
D. Extremity fractures

Answer 34

C. Aortic rupture

Question 35

Which of the following interventions is the MOST critical to the outcome of a patient with multisystem trauma?

Select one:

A. Intravenous fluid administration
B. Early administration of oxygen
C. Rapid transport to a trauma center
D. Elevation of the lower extremities

Answer 35

C. Rapid transport to a trauma center

Question 36

Which of the following statements regarding gunshot wounds is correct?

Select one:

A. The size of a bullet has the greatest impact on the injury produced.

B. High-velocity bullets will cause less severe internal injuries.

C. The speed of a bullet has the greatest impact on the injury produced.

D. Low-velocity bullets will cause the greatest amount of trauma.

Answer 36

C. The speed of a bullet has the greatest impact on the injury produced.

Question 37

Which types of motor vehicle collisions present the greatest potential for multiple impacts?

Select one:

A. Lateral and rollover
B. Frontal and rotational
C. Rotational and rollover
D. Rear-end and rotational

Answer 37

C. Rotational and rollover

Question 38

When is the only time an EMT can remove an object from the patient?

Select One:

A. To treat the massive hemorrhage
B. When it interferes with CPR
C. When it doesn’t involve a hollow organ
C. When it doesn’t involve a solid organ

Answer 38

B. When it interferes with CPR

Question 39

While en route to a major motor vehicle crash, an on-scene police officer advises you that a 6-year-old male who was riding in the front seat is involved. He further states that the child was only wearing a lap belt and that the airbag deployed. On the basis of this information, you should be MOST suspicious that the child has experienced:

Select one:

A. lower extremity fractures.
B. neck and facial injuries.
C. blunt trauma to the head.
D. open abdominal trauma.

Answer 39

B. neck and facial injuries.

Question 40

Your patient has a Glasgow Coma Scale (GCS) score of 13, a systolic blood pressure of 80 mm Hg, and a respiratory rate of 8 breaths/min. His Revised Trauma Score (RTS) is:

Select one:

A. 10.
B. 11.
C. 9.
D. 8.

Answer 40

C. 9.

Question 41

What are the DCAP-BTLS (say them quickly)

Answer 41

Deformities
Contusions
Abrasions
Punctures/penetrations
-
-
Burns
Tenderness
Lacerations
Swelling.