EMT Practice Exam Trauma Flashcards
You are assessing a patient who fell from a tree. The patient is conscious and complains primarily of pain to his right arm, although he admits to having dyspnea as well. You note he has an open fracture of the right humerus with moderate bleeding controlled with pressure. He also has diminished breath sounds to the right thorax, a pulse oximeter reading of 92 percent on ambient air, and a narrowing pulse pressure. Of the above findings, which is so severe that it would categorize the patient as a “high priority”?
a. Pain to the right leg
b. Open humerus fracture
c. Narrowing breath sounds
d. Diminished breath sounds
D. Rationale: The most important concern with this question is determining which finding can actually cause the patient to die if it persists or gets worse. Pain to the arm hurts, but generally broken bones with controlled bleeding don’t kill either. A narrowing pulse pressure is an indication of body compensation, not a clinical syndrome causing death. Finally, diminished breath sounds mean the patient is not going to oxygenate well; this can potentially cause death and should be treated as a high priority.
A patient has injured the index finger of her left hand while trying to drive a nail with a hammer, accidentally hitting her finger instead. Other than the soft-tissue trauma and skeletal deformity, no other signs of trauma are present. How should the secondary assessment proceed on this patient?
a. Focus on only the injury site
b. Complete a full head-to-toe assessment
c. There is no need to perform a secondary assessment
d. Assess both arms and hands but not the torso or lower extremities
A. Rationale: When a patient has a local injury with no or minimal likelihood of deterioration, the EMT can perform a focused assessment of the injury site during the secondary exam. Part of this assessment of the injury site during the secondary exam. Part of this assessment may be comparing the two hands and assessing for size and symmetry, but is would not need to include assessing the opposite arm. Likewise, it would not require assessing the body in a head-to-toe format.
While orienting a new EMT hire to your EMS system, you quiz him over general knowledge and ask him to define what the mnemonic “DCAP-BTLS” stands for. Which of the new EMTs’ answers below is incorrect?
a. Painful
b. Swelling
c. Contusions
d. Lacerations
A. Rationale : The mnemonic “DCAP-BTLS” stands for the following: Deformities, Contusions, Abrasions, Punctures/Penetrations, burns, tenderness, lacerations, swelling. Painful is not part of the mnemonic; rather, it is used in the AVPU mnemonic.
A teenage patient has sustained soft-tissue trauma while using woodworking tools in shop class. The patient, upon your arrival, has a damp cloth held over his forearm. When he removes this cloth, bright red blood comes spurting out. This would be what kind of bleeding?
a. Venous
b. Arterial
c. Capillary
d. Arteriovenule
B. Rationale: Arterial bleeding has two major characteristics: it is bright red (oxygenated blood), and it often is very heavy or sometimes spurting. Venous bleeding is typically slower and is a darker red, owing to its being deoxygenated. Capillary bleeding is typically slow and oozing. Arteriovenule bleeding is not a type of bleeding; rather, this is the point in the vascular system where the arterioles and venules interface with the capillary bed.
A patient with soft-tissue trauma has lost a significant amount of blood. If this patient enters into a hypoperfusion syndrome (shock), what is the likely etiology?
a. Neurologic
b. Distributive
c. Cardiogenic
d. Hypovolemic
D. Rationale: To maintain normal perfusion pressures, the body has to have an intact pump (heart), pipes (vascular system), and volume (blood). If the disturbance is a loss of volume, or blood, the type of shock is termed hypovolemic. Cardiogenic shock occurs when the heart fails to pump adequately. Neurologic shock occurs when the heart fails to pump adequately. Neurologic shock occurs when the pipes, or blood vessels, dilate excessively. Finally, distributive shock is also from widespread vasodilation, but it can be from blood infections, anaphylactic reactions, and other processes that result in widespread vasodilation.
You are managing an elderly patient who has sustained a deep laceration to the leg with bleeding. The patient has the following vitals: blood pressure is 80/56, heart rate is 98/min, respirations are 22/min, and the skin is cool and clammy. Which of the above findings BEST represents an advanced or decompensated shock state?
a. Heart rate
b. Skin findings
c. Blood pressure
d. Respiratory rate
C. Rationale: All the aforementioned findings indicate the development of shock. However, a low blood pressure is the one most indicative of advanced or decompensated shock.
Of the following types of soft-tissue trauma, which one could present as either an open soft-tissue injury or a closed soft-tissue injury?
a. Contusion
b. Crush injury
c. Arterial laceration
d. Superficial abrasion
B. Rationale: A crush injury is one that occurs when a region of the body is injured by a strong blunt-trauma mechanism. When the tissues and underlying structures are damaged (i.e., crushed), they can bleed internally and cause other tissue or organ dysfunctions. This injury can occur with no break in the overlying skin (open crush injury). Lacerations and abrasions are both open injuries, whereas a contusion is a closed injury.
You are treating a patient who has sustained a high-pressure injection injury to the hand while at his construction job. Prior to transport, you have immobilized the hand. As the EMT, what additional intervention should you provide en route?
a. Apply heat
b. Apply cold
c. Elevate the limb below the heart
d. Lower the limb below the heart
C. Rationale: Elevation of a high-pressure injury is considered appropriate treatment prehospitally. The application of heat may vasodilate and cause increased systemic absorption of material, and the application of cold can promote vasoconstriction, which further limits blood flow to the injured area, possibly worsening the injury. Placing the injury site below the heart will slow venous drainage, which can contribute to swelling and increased pressures in the limb (it also may change the perfusion status).
Which of the following interventions should be provided to a patient suffering from an abdominal evisceration with bowel protruding?
a. Treat for shock
b. Extremity immobilization
c. Full spinal immobilization
d. Transport the patient with lights and sirens
A. Rationale: A patient who has bowel protruding from his abdomen has a high probability of serious injury to other abdominal organs and should receive treatment for shock. This includes providing oxygen therapy, maintaining body warmth, and placing him in an appropriate position. The use of immobilization is based on need, not just because there is a soft-tissue injury to the body. Finally, transport of the patient with lights and siren should be reserved for the unstable or the potentially unstable patient, not all patients.
A child was running when she fell, and the stick she was carrying went through her cheek, becoming impaled in her hard palate. Which of the following describes the BEST means of transport?
a. Sit her up and encourage her to spit out any blood.
b. Put her on her side and let any blood drain out.
c. Position her supine and suction her airway aggressively.
d. Lay her facedown on the stretcher with a nasopharyngeal airway in place?
A. Rationale: A patient who is alert with bleeding into the mouth is best transported sitting up. You should encourage her to spit out any blood because blood irritates the stomach and may lead to vomiting. Positioning the patient on her side would be appropriate if she were drowsy enough to have difficulty maintaining her airway. One of the worst positions would be immobilized supine on a backboard, as this would limit her ability to eliminate blood from the mouth and potentially endanger the airway. One of the worst positions would be immobilized supine on a backboard, as this would limit her ability to eliminate blood from the mouth and potentially endanger the airway. A nasopharyngeal airway might promote gagging and vomiting in an alert patient as well as potentially disturb the end of the stick if it is in the nasopharynx.
A thirty-two-year-old male patient has sustained a burn to his entire left arm, the front of his chest and abdomen, and half of his right arm. What is the approximate percentage of his burned skin?
a. 18 percent
b. 30 percent
c. 32 percent
d. 36 percent
C. Rationale: Using the “rule of nines” for burn estimation, the following would apply: entire left arm = 9 %, entire front of chest and abdomen = 18%, half of right arm 4-5%. This then totals approximately 32% of the body surface area burned.
During an MCI where your equipment is limited, you are treating a chest trauma patient and you elect to apply an occlusive dressing to an open chest wound. The normal occlusive dressings for this purpose have already been used up. What other type of material could substitute for this purpose?
a. Trauma dressing
b. Sterile burn sheet
c. 4” x 4” gauze pads
d. Material such as plastic wrap
D. Rationale: The whole benefit of an occlusive dressing is the inability for air to pass through the material (the dressing needs to be nonporous). This prevents air from getting inside the body through the area of the soft-tissue trauma. If there is no commercial product available, the EMT could use material such as plastic wrap or the wrapper from a trauma pad or oxygenation device. A trauma dressing, burn sheet, and gauze pad are all porous to air and will not seal the wound they are applied upon.
A thirty-two-year-old construction worker was hit in the chest by a brick and now has paradoxical respirations over the lateral lower and middle ribs on the right. In addition to ventilating the patient with a bag-valve-mask device if necessary, which of the following is the BEST approach to treating this injury?
a. Avoid applying anything to the ribs.
b. Secure a heavy item such as a sandbag over the area.
c. Secure a bulky item such as a multitrauma dressing to the injured area.
d. Apply a circumferential bandage around the chest.
A. Rationale: In a flail segment, where multiple ribs are fractured in multiple locations, the best treatment is to ventilate if necessary without applying anything to the chest. It is extremely unlikely a conscious patient will allow you to apply either a bulky dressing or a heavy object to this very painful injury. Circling the chest with a dressing is likely to restrict breathing, an inappropriate and potentially dangerous intervention. Applying anything is unlikely to help and may make matters worse.
Of the following chest injuries, which one would have the LEAST effect on the quality of breath sounds heard with a stethoscope?
a. Hemothorax
b. Pneumothorax
c. Commotio cordis
d. Traumatic asphyxia
C. Rationale: Commotio cordis is a heart condition in which the patient may go into cardiac arrest after a sharp blow or strike to the chest. The strike causes the heart to go into ventricular fibrillation, after which the patient collapses. This condition, though, does not affect the quality of breath sounds as it does not result in lung collapse. In the other conditions, the lung tissue is collapsed due to air (pneumothorax), blood (hemothorax), or a heavy physical weight (traumatic asphyxia).
Which of the following isolated fractures would be best treated with a traction splint?
a. Tibia
b. Pelvis
c. Femur
d. Humerus
C. Rationale: A femoral fracture can be a life-threatening injury due to the concurrent vascular trauma that results in significant blood loss into the muscles surrounding the femur. To help prevent this, a traction splint will draw the broken bone ends apart from each other and help minimize additional vascular trauma. In addition, the stretching will help limit blood loss. Fractures of the tibia and humerus are managed with rigid splints, and the pelvis is commonly immobilized with a pelvic wrap or, at a minimum, by immobilization on the backboard.
