Chapter 6 extended Flashcards
Which of the following best describes the effect of hyperventilation in the brain-injured
patient?
A) It is beneficial, because vasodilation results in increased cerebral blood flow.
B) It is detrimental, because vasodilation causes an increase in tissue edema.
C) It is beneficial, because vasoconstriction results in decreased tissue edema.
D) It is detrimental, because vasoconstriction results in decreased cerebral perfusion
it is detrimental because vasoconstriction results in decreased cerebral perfusion
Your patient is a 45-year-old man with extensive blunt trauma to the face. He has decorticate
posturing in response to pain; weak, irregular respiratory effort at 6 per minute; and a heart rate
of 50 with a good radial pulse. The patient appears to have nasal and mandibular fractures, and
an oropharyngeal airway is insufficient to keep the tongue from the posterior pharynx. Which of
the following has the most potential to negatively impact the patient?
A) Retrograde intubation
B) Oral intubation under direct laryngoscopy
C) Nasotracheal intubation
D) A non-visualized dual-lumen airway
nasotracheal intubation
Which of the following medications may be indicated in the prehospital management of the patient with traumatic brain injury? A) Methylprednisolone B) Diazoxide C) Mannitol D) Furosemide
mannitol
Circulation to the face is provided by the \_\_\_\_\_\_\_\_ artery. A) external carotid B) internal carotid C) midfacial D) mandibular
external carotid
Which of the following correctly describes the impact of motorcycle helmet use?
A) Helmet usage is associated with a 10 percent reduction in serious head injuries.
B) There have been no reported fatalities from motorcycle collisions in which the riders were
wearing helmets.
C) Helmet usage decreases the risk of serious head injuries but increases the risk of cervical-
spine injuries.
D) Helmet usage results in a more than 50 percent reduction in serious head injuries.
helmet usage results in a more than 50 percent reduction in serious head injuries
Which of the following parameters should be used to guide the oxygenation and ventilation of
the patient with a traumatic brain injury?
A) Maintain an oxygen saturation level of at least 96 percent and a capnography reading between
35 and 40 mmHg.
B) Maintain an oxygen saturation level of at least 90 percent and a capnography level < 45
mmHg.
C) Maintain an oxygen saturation level of at least 98 percent and a capnography reading > 45
mmHg.
D) Maintain an oxygen saturation level of at least 90 percent and a capnography reading < 35
mmHg
maintain an oxygen saturation of at least 96 percent and a capnography level between 35 and 40 mmHg
You are caring for a 22-year-old amateur boxer who complained of a sudden obstruction of
part of his visual field. This complaint is most consistent with which of the following conditions?
A) Extrusion of the eyeball
B) Subconjunctival hemorrhage
C) Hyphema
D) Retinal detachment
retinal detachment
Regarding the primary assessment of the patient with suspected traumatic brain injury, which
of the following describes the best approach to assessing the patient’s neurological functioning?
A) The use of AVPU
B) Assessing the patient for level of consciousness and orientation to person, place, and time
C) Assessing a revised trauma score
D) Assessing a Champion trauma scale scor
assessing the patient for level of consciousness and orientation to person place and time
Which of the following best describes the percentage of mortality from penetrating gunshot wounds to the cranium? A) 35 to 50 B) 75 to 80 C) 90 to 95 D) 10 to 15
which of the following best describes the percentage of mortality from penetrating gunshot wounds to the cranium
Your patient has received blunt facial trauma due to an assault. For which of the following
injuries should you maintain a high index of suspicion?
A) Airway obstruction
B) Hypoxia due to aspiration of blood
C) Basilar skull fracture
D) Lumbar spine trauma
basilar skull fracture
The \_\_\_\_\_\_\_\_ is one of the thinnest and most frequently fractured cranial bones. A) temporal B) ethmoid C) parietal D) occipita
temporal
Which of the following patients fit the criteria for application of spinal precautions in the
prehospital setting?
A) An 85-year-old man who has fallen down three steps and has a large laceration to the occipital
region of the skull, but no complaints of pain
B) A 21-year-old man who was diving into a pool and states he hit his head, but is out of the pool
and ambulatory upon your arrival with no complaint of neck or back pain
C) A 36-year-old woman who was involved in a minor motor vehicle crash with an obvious
closed tibia fracture
D) None of the above
none of the above
During the early care for a patient with a basilar skull fracture in the prehospital setting,
which of the following would be an unexpected finding?
A) Periorbital ecchymoses or “raccoon eyes”
B) CSF otorrhea
C) Blood mixed with cerebral spinal fluid flowing from the mouth
D) CSF rhinorrhea
periorbital ecchymoses or racoon eyes
Which of the following skull fractures is most common? A) Linear B) Basilar C) Depressed D) Comminuted
linear
Which of the following features of the cranium exacerbates the severity of intracranial
trauma?
A) It is rigid.
B) It is formed of dense, heavy bone.
C) It is relatively thin in the frontal region.
D) The sutures allow for separation of the bones
it is rigid
Your patient is a 7-year-old male pedestrian who was struck by a vehicle. Your assessment
reveals bleeding from the right auditory canal. Which of the following describes the most
appropriate way to manage this?
A) Determining the presence or absence of cerebrospinal fluid is a low priority. Pack the auditory
canal with sterile gauze to control bleeding.
B) Use a “halo” test to determine whether cerebrospinal fluid is in the blood. If it is, loosely
cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely
from the ear. If cerebrospinal fluid is not present, pack the ear canal with sterile gauze to control
bleeding.
C) Determining the presence or absence of cerebrospinal fluid in the blood is a low priority.
Loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to
flow freely from the ear.
D) Check the glucose level in the blood draining from the ear. If it is less than the patient’s blood
glucose level, there is cerebrospinal fluid present. Cover the ear loosely with a sterile dressing to
prevent contamination while allowing blood to flow freely from the ear. If the glucose level of
the blood from the ear is the same as the patient’s blood glucose level, pack the auditory canal
with sterile gauze to control bleeding.
determining the presence of absence of cerebrospinal fluid in the blood is a low priority, loosely cover the ear with a sterile dressing to prevent contamination while letting the blood flow freely from the ear
When developing a spinal clearance policy, age:
A) should never be considered, as age does not matter.
B) should be considered only when the patient is a man between the ages of 21 and 35.
C) should be considered, as the very old may not be able to describe their symptoms accurately.
D) should be considered only if the patient is a minor.
should be considered as the very old may not be able to describe their symptoms accurately
Your patient is a 22-year-old female assault victim. She has blunt trauma to the face with
swelling around the right eye and zygomatic area. Upon assessing her eye movement, you note
that the right eye cannot follow your finger and does not move. Which of the following MOST
likely explains this finding?
A) She has a fracture of the orbit that has trapped the optic nerve, thereby paralyzing her gaze.
B) She has direct trauma to the eyeball that has damaged the intrinsic muscles of the eye.
C) She has a fracture of the orbit that has trapped the extrinsic eye muscles.
D) She has direct trauma to the eyeball that has damaged the optic nerve, thereby paralyzing her
gaze
she has a fracture of the orbit that has trapped the extrinsic eye muscles
Which of the following groups is NOT among those with the highest incidence of serious head trauma? A) The elderly B) Young men C) Middle-aged men D) Infants
middle aged men
For the head injury patient without signs of herniation, adjust ventilation rates to maintain a capnography reading of between: A) 15 and 20 mmHg. B) 25 and 30 mmHg. C) 45 and 50 mmHg. D) 35 and 40 mmHg.
35 and 40 mmHg
Your patient is a 37-year-old male unrestrained driver of a vehicle. You find him with his
upper body across the console and his head hanging down into the passenger’s side floorboard
area. You note pooled blood from a scalp wound. After immobilizing him and loading him into
the ambulance, where you have more light for your examination, you note that he has a large,
full-thickness avulsion of the scalp. The patient’s heart rate is 112, respirations are 20, and blood
pressure is 82/50. Which of the following statements about this patient are TRUE?
1. The scalp wound itself cannot account for the patient’s vital signs.
2. The scalp wound itself may account for the patient’s vital signs.
3. The patient’s vital signs are consistent with increasing intracranial pressure.
4. Nothing about the vital signs indicates increased intracranial pressure.
A) 1 and 4
B) 2 and 3
C) 1 and 3
D) 2 and 4
2 and 4
When palpating the spine of a patient during your assessment, you are feeling the: A) spinous processes. B) vertebral bodies. C) transverse vertebral processes. D) vertebral pedicles.
spinous process
) A patient who has dived into a shallow pool and hit his head on the bottom is MOST likely to
have which of the following types of injuries?
A) Cervical hyperextension
B) Cervical hyperflexion
C) Axial distraction
D) Axial loading
axial loading
Recent research has provided evidence of which of the following regarding spinal injury
assessment?
A) Only trauma patients with signs and symptoms of neurological deficit need to receive spinal
immobilization.
B) Paramedics cannot reliably identify patients who are likely to have spinal injuries.
C) All trauma patients should be assumed to have spinal injuries.
D) There are reliable criteria for determining the likelihood of spinal injury.
there are reliable criteria for determining the likelihood of spinal injury
Which of the following is a common mechanism of injury associated with spinal cord injuries? A) Falls greater than 20 feet B) Bungee jumping C) Shallow water diving D) All of the above
all of the above
Which of the following best describes the goals of manual cervical spine stabilization?
A) Preventing movement of the head in any direction; prevent any flexion/extension, rotation, or
lateral bending
B) Keeping the head in an “eyes forward” position; applying enough traction to cause axial
unloading, which is 18 to 22 pounds in the average adult
C) Preventing rotation of the head; avoiding any upward lifting or downward pressure on the
cervical spine
D) Preventing movement of the head in any direction; applying gentle axial pressure to stabilize
the vertebral column
preventing movement of the head in any direction, prevent any flexion/extension, rotation, or lateral bending
Which of the following statements about the administration of dextrose to the patient with a
traumatic brain injury is TRUE?
A) Hypoglycemia is associated with a poorer neurologic outcome; if the blood glucose level is
less than 60 mg/dL, administer 25 grams of dextrose.
B) Hypoglycemia is inconsequential to neurologic outcome; assessing the blood glucose level is
not a priority.
C) Hyperglycemia is associated with a poorer neurologic outcome; never administer dextrose to
a patient with traumatic brain injury.
D) Hypoglycemia is associated with a poorer neurologic outcome. All patients with suspected
traumatic brain injury who have an altered mental status should receive 25 grams of dextrose
intravenously
hypoglycemia is associated with a poorer neurological outcome, if the blood glucose level is less than 60 mg/dL administer 25 grams of dextrose
You are caring for a 20-year-old skateboarder who crashed into a brick retaining wall at the
bottom of a steep hill. He has blunt trauma to his face with nose deformity, loose teeth, and
bleeding from the nose and mouth. Although you have answered him several times, he keeps
repeating to you, “What happened? It seems like I’m having a bad day.” This is most indicative of
which of the following?
A) Aphasia
B) Retrograde amnesia
C) Decorticate disorientation
D) Anterograde amnesia
anterograde amnesia
Which of the following are the two most important prehospital considerations for head injury
patients?
A) Cervical spine immobilization and ventilation
B) ICP monitoring and administering corticosteroids
C) Ventilation and administering corticosteroids
D) Ventilation and maintaining adequate blood pressure
ventilation and maintaining adequate blood pressure
