Chapter 34 | Multisystem Trauma

Question 1

Define:

multiple trauma patient

Answer 1

patient with more than one serious injury

Question 2

Define:

multisystem trauma patient

Answer 2

patient with one or more injuries serious enough to affect more than one body system

Question 3

List:

criteria to determine trauma patient severity

3 points

Answer 3

1. function: physiologic criteria
2. structure: anatomic criteia
3. MOI: mechanism of injury

(in that order)

Question 4

Define:

RTS

(abbreviation)

Answer 4

revised trauma score

Question 5

List:

components of RTS

3 points (and maximum point values)

Answer 5

• Glasgow coma scale
• systolic BP
• RR

(4 points each)

Question 6

List

most critical decisions in treating a trauma patient

3 points

Answer 6

• patient priority/severity
• when to transport (whether or not to limit scene time)
• where to transport

Question 7

Answer:

Up to how many points are assigned to each element of the revised trauma score?

Answer 7

4

Question 8

Choose:

Your adult trauma patient has a score of 14 on the Glasgow Coma Scale, a systolic blood pressure of 90 mm Hg, and a respiratory rate of 10.

You should:

A. package the patient for immediate transport to a trauma center.

B. decide whether the mechanism of injury is significant enough to merit transport to a trauma center.

C. address whether the patient meets the anatomic criteria for transport to a trauma center.

D. reassess blood pressure and respiratory rate.

Answer 8

C

each of the criteria for determining trauma transport — physiologic criteria, anatomic criteria, and mechanism of injury — should be considered separately and in sequence

if you encountered a patient who is physiologically unstable, he would be transported to a trauma center — however, if your patient were physiologically stable, you would move on to consider the anatomic criteria (and so on)

this patient is barely stable enough to not require transport to a trauma center based on physiological criteria, so you would move on to the anatomic criteria

Question 9

Choose:

Your patient was involved in a motor vehicle collision. You have decided to transport him to a trauma center because another occupant in the same vehicle died.

Your decision is based on:

A. mechanism of injury.

B. anatomical findings.

C. physiological findings.

D. pathophysiological findings.

Answer 9

A

A patient with no anatomical or physiological abnormalities may be classified as a high-priority patient on the basis of the mechanism of injury. If someone in the same compartment died, it heightens the suspicion of MOI.

Question 10

Choose:

According to CDC trauma triage guidelines, special patient or system considerations include age, burns, pregnancy, and:

A. clinical depression.

B. anticoagulants and bleeding disorders.

C. belligerent behavior.

D. medication use.

Answer 10

B

According to CDC trauma triage guidelines, anticoagulants and bleeding disorders are a special patient or system consideration.

Question 11

Choose:

You are caring for an elderly trauma patient. The mechanism of injury is not remarkable, but your instincts tell you that something is wrong.

You should:

A. delay your transport decision and further evaluate the patient.

B. wait for ALS personnel to arrive.

C. ignore your instincts until you have evidence.

D. trust your judgment.

Answer 11

D

When in doubt, trust your instincts and err on behalf of the patient’s best interests. A special consideration according to the CDC trauma triage guidelines is EMS provider judgment.

Question 12

Choose:

You arrive on scene to a patient with an arterial bleed from his right lower leg. The patient is lethargic, and has many other injuries.

What should you do first?

A. Call for air medical evacuation

B. Administer 100% high-flow oxygen via nonrebreather mask

C. Open the patient’s airway and ensure that it is patent

D. Stop the hemorrhage with direct pressure

Answer 12

D

Question 13

Choose:

Which of the following patients is the most critical, based on trauma triage guidelines?

A. 16-year-old male driver with neck and back pain following a motor vehicle collision

B. 26-year-old assault victim with multiple self-controlled lacerations across the face and neck, with a systolic blood pressure of 110

C. 46-year-old car crash victim with possible right ankle fracture

D. 31-year-old male construction-site fall victim who fell approximately two stories and who demonstrates signs and symptoms of shock

Answer 13

D

fall greater than 20 feet is trauma indicator

besides: what’s worse than shock?

Question 14

Choose:

Timing in multisystem trauma management involves:

A. the amount of time it takes a paramedic team to stabilize a patient on scene.

B. taking no more than 10 seconds to perform any single task involved in the patient’s care.

C. an awareness that time on scene must be efficiently managed in order to expedite transport.

D. arriving at a definitive diagnosis of each patient’s condition in the first 5 minutes of every call.

Answer 14

C

Question 15

Choose:

You respond to a 32-year-old male who fell 20 feet off a ladder. He is responsive to painful stimuli. He has snoring respirations at 20 a minute with decent chest rise and fall. He has a broken femur, a broken wrist, and a lacerated radial artery that is bleeding profusely.

Which of these injuries is the highest priority?

A. Snoring respirations

B. Arterial bleed

C. Broken wrist

D. Femur fracture

Answer 15

B

Question 16

Choose:

Which patient is the highest priority?

A. Patient with a penetrating chest injury

B. Patient with a Glasgow Coma Scale of 15

C. Patient with a Revised Trauma Score of 12

D. Patient with a broken femur

Answer 16

A

Question 17

Choose:

Which of the following choices is not a justifiable reason for delaying transport of a critical trauma patient?

A. Immobilizing the patient to a long spine board

B. Suctioning the airway

C. Ventilating a patient in respiratory distress

D. Awaiting arrival of police on scene

Answer 17

D

Question 18

Choose:

Which one of the following patients would justify the need to directly transport to a trauma center based on special patient considerations?

A. An elderly patient who slipped out of her wheelchair and is complaining of pelvic pain

B. An end-stage renal disease (ERSD) patient who tripped and fell and is complaining of shoulder pain on the same side as his shunt

C. An unlicensed teenage driver who has a pulse rate of 120 after a MVC and a 4 minute EMS response

D. A pregnant female in the third trimester who is spotting (showing small amounts of vaginal bleeding) following a low mechanism of injury MVC

Answer 18

D

Question 19

Choose:

You are transporting a stable patient who was involved in a minor fall from a ladder at a height of about 10 feet to a local community hospital. You assumed full spinal precautions not only because the patient has midline back pain in the sacrum, but also because he was knocked unconscious. While transporting, the patient begins to become increasingly confused, develop an irregular respiratory rate, and experience a drop in heart rate with an increase in blood pressure. You just called in a radio report and are about 7 minutes from the hospital. A trauma center is about 10 minutes away.

Which of the following is the best transport decision?

A. Continue transporting to the local hospital because it’s the closest facility.

B. Call medical control for advice from the trauma center.

C. Continue transporting to the local hospital because you’ve already given your report and they accepted the patient.

D. Divert to the trauma center because the patient is becoming symptomatic.

Answer 19

D

symptoms of irregular RR, low HR, and high BP are synonymous with Cushing’s Triad (indicating increased ICP)

patient with increased ICP is a huge deal— take them to the big boy hospital

Question 20

Choose:

You respond to a 22-year-old male patient who fell while exiting the local bar. Bystanders state he drank at least 10 beers and could not keep his balance. Physical exam reveals that the patient is alert to verbal stimuli only. He has Glasgow Coma Scale scores of 3, 4, and 6; slurred speech; and an obvious scalp laceration to the back of his head. He is refusing treatment and transport and wants his friends to drive him home. The nearest hospital is 5 minutes away, a Level II Trauma Center is 10 minutes away, and a Level I Full Service Trauma Center is 30 minutes away.

Which of these is the most appropriate facility for the patient?

A. The nearest community facility

B. Level I Trauma Center

C. Nowhere, because the patient is an adult and refusing care

D. Level II Trauma Center

Answer 20

D

Question 21

Choose:

You encounter an accident on a busy intercity street while on duty. Calling into dispatch, you make note that the occupants of both vehicles are outside, and you request additional units to proceed non-emergently. You approach an elderly male who is rubbing his back and left shoulder. During secondary assessment of past medical history, you make note of several important details: the patient is on high blood pressure medications and has had a heart attack in the past. He is complaining of midline thoracic pain on palpation of his spine and left shoulder pain, which may have been from the seat belt, but is refusing care and transport. The patient did not lose consciousness.

Based on this information, which transport decision would be most appropriate for this patient?

A. Have the patient to sign a refusal form.

B. Call for ALS intercept.

C. Take the patient to a trauma center.

D. Explain to the patient the need for transport to a local community hospital.

Answer 21

D

Question 22

Fill in the blank:

Sometimes a [BLANK] can act as a full-body splint when the critical patient must be immobilized quickly.

Answer 22

Sometimes a long backboard can act as a full-body splint when the critical patient must be immobilized quickly.

Question 23

Choose:

Your 39-year-old male patient was changing his tire on a major highway ramp when another vehicle ran into him and his vehicle. He has two fractured femurs, a crushed pelvis, and a possible abdominal injury.

You should:

A. not apply a traction splint.

B. move the patient with the scoop stretcher.

C. set up an ALS intercept en route to the hospital.

D. do all of these.

Answer 23

D

When a patient has two fractured femurs, a crushed pelvis, and a possible abdominal injury, you should not apply a traction splint. Do consider moving with the scoop stretcher, and request an ALS intercept enroute to the hospital.

Question 24

Choose:

Your 39-year-old male patient was changing his tire on a major highway ramp when another vehicle ran into him and his vehicle. He has two fractured femurs, a crushed pelvis, and a possible abdominal injury. You have decided that it is appropriate to minimize your scene care in accordance with your established multisystem trauma protocols.

You will most likely perform any or all of the following except:

A. suctioning the airway.

B. ventilating with a BVM.

C. bandaging all of the lacerations.

D. immobilizing the cervical spine.

Answer 24

C

When trying to minimize the on-scene care of a multiple-trauma patient, do not take the time to bandage all lacerations.

Question 25

Choose

Even when you are trying to limit on-scene time for a multiple-trauma patient, the one thing that you do not leave out is:

A. applying traction splints if needed.

B. the secondary assessment.

C. ensuring scene safety.

D. immobilization to a long backboard.

Answer 25

C

Even when you are trying to minimize scene time for a multiple-trauma patient, the one thing that you do not cut out is scene safety, no matter how serious the patient is.

Question 26

Choose:

An example of a patient who requires triage to a higher level of care would be the:

A. child who has a headache after being struck by a golf ball.

B. geriatric patient who fell and is on anticoagulant medications.

C. adolescent with a femur fracture from playing basketball.

D. middle-aged man who may have fractured his forearm.

Answer 26

B

The geriatric patient who fell and is on anticoagulant medications should be a higher priority because of the potential for serious life-threatening internal hemorrhaging.

Question 27

Choose:

In some EMS systems, the EMTs are asked to assign a number to the severity of the trauma patient, using the trauma score.

A trauma score will help in determining where the patient should be transported in addition to:

A. allow the trauma centers to evaluate themselves.

B. determine which steps in the primary survey come first.

C. determine whether a patient should go to a trauma center.

D. all of these.

Answer 27

A

The scoring system for trauma patients also helps to allow the trauma centers to evaluate themselves as well as determine where the patient should be transported.

Question 28

Choose:

You are on the scene of a one-vehicle MVC with entrapment. The patient is a 16-year-old female who states that she hydroplaned and then hit a tree impacting at the driver’s door side.

Which of the following contributes to a greater degree of injury in a lateral-impact motor vehicle collision?

A. The force of a side-impact air bag deployment

B. Taking the up-and-over pathway

C. Lack of a crumple zone

D. Increased gravitational forces due to multiple changes in direction and velocity

Answer 28

C

The entire kinetics of forces involved will change based on absorption of impact that a crumple zone creates. Crumple zones significantly decrease the kinetics of injury.

side impact air deployment would create a “crumple zone” or sortes

up-and-over is more typical of head-on crashes

multiple changes in direction and velocity are typical of roll-overs