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Section 7 Trauma > Chapter 29 Trauma Systems and Mechanism of Injury > Flashcards

Chapter 29 Trauma Systems and Mechanism of Injury Flashcards

1
Q

 The acute physiologic and structural change that occurs in a patient’s body when an external source of energy dissipates faster than the body’s ability to sustain and dissipate it is called: A) injury. B) trauma. C) deceleration. D) kinematics.

A
  • B) trauma. Page: 1483
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2
Q

The energy stored in an object, such as a bridge pillar, is called __________ energy, and the energy from motion is called __________ energy. A) kinetic, potential B) barometric, kinetic C) potential, kinetic D) chemical, potential

A
  • C) potential, kinetic Page 1484
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3
Q

Knowledge of kinetics can help the paramedic: A) predict injury patterns found in a patient. B) determine which organs have been injured. C) quantify how much blood a patient has lost. D) differentiate between medical and trauma patients.

A
  • A) predict injury patterns found in a patient. Page: 1484
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4
Q

The primary determinants of the extent of trauma a patient sustains are the: A) type of object that strikes a patient and the part of the body that sustains the most impact. B) amount of energy in the object and the mechanism by which the object is delivered to the body. C) size of the object that strikes the body and any secondary injuries that occur if the patient falls. D) physical size of the patient and the part of the body that sustains direct impact from an object.

A
  • B) amount of energy in the object and the mechanism by which the object is delivered to the body. Page: 1484
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5
Q

Which of the following general statements regarding trauma is correct? A) Bullet impact is less if the energy in the bullet is applied to a small area. B) The position of the patient at the time of the event is considered to be an internal factor. C) Blunt trauma is difficult to diagnose by paramedics in the field and is often more lethal than penetrating trauma. D) Rapidly applied amounts of energy are better tolerated than a similar amount of energy applied over a longer period.

A
  • C) Blunt trauma is difficult to diagnose by paramedics in the field and is often more lethal than penetrating trauma. Page: 1484
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6
Q

Which of the following will be of MOST benefit in helping the paramedic predict the type of injuries that a patient experienced? A) Index of suspicion B) Past medical history C) Age of the patient D) Mechanism of injury

A
  • D) Mechanism of injury Page: 1484-1485
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7
Q

According to the American College of Surgeons, an injured patient should be transported to a Level I trauma center if his or her: A) heart rate is greater than 100 beats/min. B) systolic blood pressure is less than 90 mm Hg. C) respiratory rate is less than 14 breaths/min. D) Glasgow Coma Scale score is less than 15.

A
  • B) systolic blood pressure is less than 90 mm Hg. Page: 1507-1508
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8
Q

Which of the following mechanisms of injury poses the LEAST threat for significant injury? A) Rear-end collision with restrained driver B) Death of an occupant in the same vehicle C) Motorcycle crash at greater than 20 mph D) Vehicular intrusion of greater than 12 inches

A
  • A) Rear-end collision with restrained driver Page: 1509
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9
Q

Which of the following injuries would MOST likely require transport to a Level I trauma center? A) Two or more proximal long bone fractures B) Superficial burns to an entire lower extremity C) Lateral neck pain following a motor vehicle crash D) Penetrating injury that is distal to the elbow or knee

A
  • A) Two or more proximal long bone fractures Page: 1507
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10
Q

If the mechanism of injury does not appear to be significant, you should consider transporting an injured patient to a Level I trauma center if he or she: A) is older than 45 years of age. B) takes any kind of medication. C) is emotionally upset or angry. D) has a known bleeding disorder.

A
  • D) has a known bleeding disorder. Page: 1509
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11
Q

A specific attribute of a Level I trauma center is that it: A) is involved in an injury prevention program. B) can initiate definitive care for all injured patients. C) has 24-hour in-house coverage by general surgeons. D) has rapid access to an off-site anesthesiologist.

A
  • C) has 24-hour in-house coverage by general surgeons. Page: 1510
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12
Q

At a minimum, a Level II trauma center should: A) have an in-house neurosurgeon 24 hours a day. B) be able to initiate definitive care for all injured patients. C) have access to an emergency physician within 20 minutes. D) provide total care for every aspect of a patient’s injuries.

A
  • B) be able to initiate definitive care for all injured patients. Page: 1510
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13
Q

If a Level I trauma center is 30 miles away, and a Level II trauma center is 10 miles away, it would be MOST appropriate to transport a patient with a severe traumatic brain injury: A) by ground to the Level I trauma center. B) to the closest hospital for stabilization. C) via air transport to the Level I trauma center. D) by ground to the Level II trauma center.

A
  • C) via air transport to the Level I trauma center. Page: 1509-1511
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14
Q

Which of the following is NOT a factor when considering transport of a trauma patient via helicopter? A) The need for definitive airway management B) Distance from the scene to the landing zone C) Time it will take the aircraft to reach the scene D) Type of terrain on which the helicopter will land

A
  • A) The need for definitive airway management Page: 1511
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15
Q

When summoning an air transport service to transport a critically injured patient, it is MOST important to: A) determine the flight crew’s credentials. B) ensure that the fire department is present. C) predetermine the destination facility. D) activate the service as soon as possible.

A
  • D) activate the service as soon as possible. Page: 1511
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16
Q

The “platinum 10 minutes” refers to the: A) maximum amount of time to extricate a patient. B) maximum time spent at a scene for a trauma patient. C) amount of time before decompensated shock occurs. D) amount of time taken to perform a rapid assessment.

A
  • B) maximum time spent at a scene for a trauma patient. Page: 1505
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17
Q

An object increases its kinetic energy more by: A) decreasing its speed than by increasing its mass. B) increasing its velocity than by increasing its mass. C) decreasing its velocity than by decreasing its mass. D) increasing its mass than by increasing its velocity.

A
  • B) increasing its velocity than by increasing its mass. Page: 1485
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18
Q

The greatest amount of kinetic energy would be created if a ____-pound driver struck a tree while traveling at ____ mph. A) 140, 50 B) 160, 30 C) 150, 40 D) 170, 30

A
  • A) 140, 50 Page: 1484-1486
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19
Q

The law of conservation of energy states that: A) kinetic energy can be converted only to thermal or chemical energy. B) the force that an object can exert is the product of its mass multiplied by its acceleration. C) energy can be neither created nor destroyed; it can only change form. D) a body at rest will remain at rest unless acted upon by an outside force.

A
  • C) energy can be neither created nor destroyed; it can only change form. Page: 1486
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20
Q

Sudden deceleration of a motor vehicle that is traveling at 60 mph: A) typically generates forces of up to 10 to 20 g. B) initially causes whiplash injuries to the patient’s neck. C) dissipates tremendous forces and causes major injuries. D) causes the driver’s body to stop moving at the same time.

A
  • C) dissipates tremendous forces and causes major injuries. Page: 1486
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21
Q

Which of the following injury mechanisms would MOST likely result in blunt trauma? A) Small-caliber gunshot wound B) Explosion involving shards of glass C) Falling from a tree onto a fence D) The pressure wave caused by a blast

A
  • D) The pressure wave caused by a blast Page: 1486
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22
Q

Penetrating trauma occurs when: A) internal organs are lacerated and bleed profusely. B) tissues are penetrated by single or multiple objects. C) blunt force trauma causes explosive open injuries. D) a fractured rib perforates the parenchyma of a lung.

A
  • B) tissues are penetrated by single or multiple objects. Page: 1497
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23
Q

During abrupt deceleration: A) shearing or rupturing of internal organs can occur. B) the neck commonly sustains hyperextension injuries. C) the skull provides excellent protection for the brain. D) supporting structures of the aorta keep it attached.

A
  • A) shearing or rupturing of internal organs can occur. Page: 1487, 1489
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24
Q

Unlike deceleration injuries, crush and compression injuries occur: A) at the time of impact. B) before impact occurs. C) after the initial impact. D) from penetrating mechanisms.

A
  • A) at the time of impact. Page: 1489
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25
Q

The MOST common site of deceleration injury in the chest is the: A) heart. B) esophagus. C) aorta. D) vena cava.

A
  • C) aorta. Page: 1489
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26
Q

The third phase of a motor vehicle accident involves: A) crush injuries to the body. B) impact by another vehicle. C) deceleration of internal organs. D) injuries caused by flying debris.

A
  • C) deceleration of internal organs. Page: 1487
27
Q

If the windshield of a wrecked vehicle is cracked or broken: A) you should assume that the driver has a severe intracerebral hemorrhage. B) the front seat occupant has a cervical spine injury until proven otherwise. C) the rear seat passenger was likely thrust from the seat into the windshield. D) it is likely that the vehicle was traveling at least 55 mph at the time of impact.

A
  • B) the front seat occupant has a cervical spine injury until proven otherwise. Page: 1488
28
Q

The MOST reliable indicator that significant energy was dissipated by braking before a motor vehicle collision is: A) deformity to the driver’s brake pedal. B) severe damage to the front rims of the tires. C) a trail of debris leading to the site of impact. D) the presence of tire skid marks at the scene.

A
  • D) the presence of tire skid marks at the scene. Page: 1488-1489
29
Q

The forces applied to the driver during a frontal vehicle collision will differ based on all of the following factors, EXCEPT: A) objects inside the vehicle. B) the physical size of the patient. C) the design of the motor vehicle. D) safety features of the motor vehicle.

A
  • B) the physical size of the patient. Page: 1489
30
Q

The initial point of bodily impact when an unrestrained passenger takes the “down and under” pathway during a frontal collision is the: A) knees. B) pelvis. C) femurs. D) abdomen.

A
  • A) knees. Page: 1489-1490
31
Q

When a patient takes the “up and over” pathway during a head-on collision: A) the head takes a higher trajectory, striking the windshield and causing stretching injuries to the neck. B) secondary injuries as the patient is ejected are often less severe than the primary injuries. C) the anterior part of the neck may strike the steering wheel, resulting in a fractured larynx. D) injuries to the parietal aspect of the skull are common as the head strikes the side window.

A
  • C) the anterior part of the neck may strike the steering wheel, resulting in a fractured larynx. Page: 1490
32
Q

During a frontal collision, MOST pneumothoraces occur when: A) the patient takes a deep breath just before impact and the lungs rapidly decompress at the time of impact. B) the diaphragm rapidly ascends into the chest cavity during impact, causing an increase in intrathoracic pressure. C) the chest strikes the steering wheel, which fractures one or more ribs and causes a perforation injury to one of the lungs. D) the patient is ejected through the windshield, and his or her chest collides with a secondary object outside the vehicle.

A
  • A) the patient takes a deep breath just before impact and the lungs rapidly decompress at the time of impact. Page: 1490-1491
33
Q

During a lateral impact collision: A) the far-side occupant, even if properly restrained, experiences double the amount of force as the driver. B) the patient’s head moves away from the object causing the impact, resulting in stretching injuries. C) properly worn seat belts protect the passenger from pelvic trauma at the time of impact. D) trauma to the upper extremities depends on the spatial orientation of the arms upon impact.

A
  • D) trauma to the upper extremities depends on the spatial orientation of the arms upon impact. Page: 1490-1491
34
Q

The severity of hyperextension injuries to the neck following a rear-end collision depends MOSTLY on: A) the proper use of seat belts. B) the position of the headrest. C) proper deployment of the air bags. D) whether the driver tenses up.

A
  • B) the position of the headrest. Page: 1492
35
Q

Following a rotational impact, the MOST severely injured patient(s. will likely be found at the point of: A) least deceleration. B) greatest deceleration. C) secondary impact. D) greatest acceleration.

A
  • B) greatest deceleration. Page: 1492
36
Q

Which of the following statements regarding rollover motor vehicle crashes is correct? A) Injuries to the passengers are usually not serious if seat belts are worn properly. B) Ejection of the patient from the vehicle increases the chance of death by 5 times. C) Unrestrained passengers are struck with each change in direction the car makes. D) The restrained occupant’s head and neck usually remain stationary during a rollover.

A
  • C) Unrestrained passengers are struck with each change in direction the car makes. Page: 1492-1493
37
Q

Which of the following is NOT a benefit of a properly worn seat belt? A) Minimal risk of whiplash injuries after a rear-end collision B) Prevention of partial or complete ejection from the vehicle C) Prevention of occupants from violently contacting each other D) Distribution of deceleration energy over a greater surface area

A
  • A) Minimal risk of whiplash injuries after a rear-end collision Page: 1493
38
Q

What type of injuries will MOST likely occur if a passenger is wearing his or her lap belt above the pelvic bone during a frontal impact? A) Pelvic and lumbar spine B) Femur and thoracic spine C) Kidney and thoracic spine D) Abdominal and lumbar spine

A
  • D) Abdominal and lumbar spine Page: 1493
39
Q

All of the following statements regarding front air bags are correct, EXCEPT: A) Small children riding in the front seat can be killed when the air bag deploys. B) Air bags will provide protection from both initial and secondary impacts. C) Without the use of a seat belt, front air bags are insufficient in preventing ejection. D) Front air bags will not activate in side impacts or impacts to the front quarter panel.

A
  • B) Air bags will provide protection from both initial and secondary impacts. Page: 1493
40
Q

Common air bag-related injuries include: A) spinal fractures. B) minor skin burns. C) hyperflexion injuries. D) abdominal abrasions.

A
  • B) minor skin burns. Page: 1493
41
Q

Lap belts that are worn alone and too high by a pregnant woman: A) usually do not injure the fetus because the uterus is a highly muscular organ. B) will provide adequate protection for the uterus if the air bag properly deploys. C) allow enough forward flexion and subsequent compression to rupture the uterus. D) will provide equal distribution of forces and prevent forward flexion of the mother.

A
  • C) allow enough forward flexion and subsequent compression to rupture the uterus. Page: 1494
42
Q

Structural protection afforded to a motorcycle rider during a crash comes from: A) protective gear worn by the rider. B) the main frame of the motorcycle. C) side foot pedals and the handlebars. D) the handlebars and large engine block.

A
  • A) protective gear worn by the rider. Page: 1494
43
Q

A properly worn motorcycle helmet will: A) not protect the cervical spine. B) eliminate the risk of head trauma. C) decrease the risk of a spinal injury. D) minimize the trauma caused by secondary impacts.

A
  • A) not protect the cervical spine. Page: 1494
44
Q

Following a head-on collision of a motorcycle and a truck, the motorcyclist would MOST likely experience initial injury to the: A) cervical spine. B) chest and abdomen. C) wrists and forearms. D) femurs and tibias.

A
  • D) femurs and tibias. Page: 1495
45
Q

After a motorcyclist is ejected from his or her motorcycle, secondary collisions: A) most commonly involve a stationary object. B) cause an unpredictable combination of blunt injuries. C) typically cause bilateral fractures of the femurs and tibias. D) result in less severe injuries if the rider is wearing leather.

A
  • B) cause an unpredictable combination of blunt injuries. Page: 1495
46
Q

When an adult pedestrian is struck by a motor vehicle, lateral and posterior injuries are most common because: A) the patient is thrust onto the hood of the vehicle. B) adults tend to turn to the side or away from the impact. C) the patient is thrown and lands on his or her side or back. D) the initial impact by the bumper spins the patient to the side.

A
  • B) adults tend to turn to the side or away from the impact. Page: 1495
47
Q

The second impact that occurs when an adult pedestrian is struck by a motor vehicle would MOST likely result in injuries to the: A) head and neck. B) hips and knees. C) pelvis and chest. D) lower extremities.

A
  • C) pelvis and chest. Page: 1496
48
Q

According to the Waddell triad, the second impact from a motor vehicle occurs when the: A) head strikes the ground, resulting in skull and facial fractures. B) car’s bumper strikes the pelvis and femurs instead of the knees. C) child is run over by the car as he or she is propelled to the ground. D) chest and abdomen strike the grille or low on the hood of the car.

A
  • D) chest and abdomen strike the grille or low on the hood of the car. Page: 1496
49
Q

When a person falls from a significant height and lands on his or her feet, axial loading results in: A) compression or burst fractures to the lumbar spine. B) shearing injuries to the liver, spleen, and aorta. C) crushing injuries to the heels and hip dislocations. D) disc injuries to the lower cervical and upper thoracic spine.

A
  • A) compression or burst fractures to the lumbar spine. Page: 1497
50
Q

The MOST significant fall occurs from a height greater than: A) 10 feet. B) 15 feet. C) 1.5 times the patient’s height. D) 2 times the patient’s height.

A
  • B) 15 feet. Page: 1496
51
Q

Unlike blunt trauma, penetrating trauma: A) is especially common during the primary blast injury following an explosion. B) often causes damage to a large body surface area, even from a single projectile. C) involves a disruption of the skin and underlying tissues in a small, focused area. D) is usually more fatal because of the severe external bleeding that accompanies it.

A
  • C) involves a disruption of the skin and underlying tissues in a small, focused area. Page: 1497
52
Q

Which of the following factors is the LEAST influential in the severity of a stab wound? A) The size of the attacker B) The anatomic area involved C) The length of the knife blade D) The angle of penetration

A
  • A) The size of the attacker Page: 1498
53
Q

Compared to stab wounds to the posterior part of the body, stab wounds to the anterior part of the body are generally: A) downward. B) single. C) multiple. D) upward.

A
  • D) upward. Page: 1498
54
Q

If a person survives the initial trauma from a shotgun wound at close range: A) nervous system damage is likely due to the internal dispersal of the pellets. B) contaminants that were driven into the wound can cause a severe infection. C) he or she typically dies within 24 hours secondary to liver or renal failure. D) it is likely that only soft tissue was injured and major organs were spared.

A
  • B) contaminants that were driven into the wound can cause a severe infection. Page: 1498
55
Q

Compared to a handgun, a rifle: A) is less accurate. B) fires a single projectile. C) fires at a higher velocity. D) has less powerful ammunition.

A
  • C) fires at a higher velocity. Page: 1498
56
Q

Which of the following general statements regarding gunshot wounds is correct? A) The most important factor for the seriousness of a gunshot wound is the type of tissue through which the projectile passes. B) Injuries from a shotgun blast are most devastating when the distance between the gun and the target is less than 100 yards. C) Wounds to lower extremities that are not associated with a fracture or neurovascular compromise are always explored surgically. D) Tissue of high elasticity, such as muscle, is less able to tolerate temporary cavitation than tissue of low elasticity, such as the liver.

A
  • A) The most important factor for the seriousness of a gunshot wound is the type of tissue through which the projectile passes. Page: 1498
57
Q

Which of the following characteristics of an entry wound indicates that the weapon was fired at close range? A) Abrasions around the wound B) Indentation of cutaneous tissues C) Severe bleeding from the wound D) Tattoo marks from powder burns

A
  • D) Tattoo marks from powder burns Page: 1498
58
Q

Which of the following statements regarding exit wounds is correct? A) Exit wounds occur when the projectile’s energy is not entirely dissipated along its trajectory through the body. B) Compared to entrance wounds, exit wounds are generally much smaller and typically have regular edges. C) Despite fragmentation of the projectile, there is usually only one exit wound for each round that is fired. D) With low-velocity gunshot wounds, the exit wound is always a mirror image of the entrance wound.

A
  • A) Exit wounds occur when the projectile’s energy is not entirely dissipated along its trajectory through the body. Page: 1499
59
Q

During an explosion, secondary blast injuries occur when: A) hollow organs rupture due to the pressure wave. B) the patient is thrown against a stationary object. C) the patient sustains severe burns from the intense heat. D) the patient is struck by flying debris, such as shrapnel.

A
  • D) the patient is struck by flying debris, such as shrapnel. Page: 1500
60
Q

Which of the following statements regarding primary blast injuries is correct? A) Primary blast injuries are typically the most obvious injuries. B) Primary blast injuries are the most easily overlooked. C) Primary blast injuries are the result of flying glass or shrapnel. D) Primary blast injuries are due entirely to intense heat.

A
  • B) Primary blast injuries are the most easily overlooked. Page: 1501
61
Q

The peak magnitude of the pressure wave experienced by a person: A) causes secondary and tertiary injuries as a result of the explosion. B) will cause less severe trauma if the person is standing beside a solid object. C) lessens as the person is farther away from the center of the explosion. D) causes more severe trauma if the person is in an open area during the explosion.

A
  • C) lessens as the person is farther away from the center of the explosion. Page: 1501
62
Q

The shock wave velocity from an explosion is slower and its duration is longer if a person is: A) closer to the explosion. B) standing behind a solid object. C) farther from the explosion. D) standing beside a solid object.

A
  • C) farther from the explosion. Page: 1501
63
Q

Which of the following organs is LEAST susceptible to pressure changes caused by an explosion? A) Liver B) Lungs C) Tympanic membrane D) Gastrointestinal tract

A
  • A) Liver Page: 1502
64
Q

A vagus nerve-mediated form of cardiogenic shock without compensatory vasoconstriction that may be seen following a blast injury would MOST likely present with: A) syncope and hypertension. B) hypertension and bradycardia. C) hypotension and tachycardia. D) bradycardia and hypotension.

A
  • D) bradycardia and hypotension. Page: 1502

Section 7 Trauma (10 decks)

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