Midterm 3 trauma Flashcards
During transport of a patient with a head injury, which of the following will provide you with the MOST information regarding the patient’s condition?
A: Heart rate
B: Mental status
C: Pupil size
D: Blood pressure
B: Mental status
Which of the following sets of vital signs is MOST suggestive of increased intracranial pressure in a patient who has experienced a traumatic brain injury?
A: BP, 176/98 mm Hg; pulse, 50 beats/min; respirations, 10 breaths/min
B: BP, 84/42 mm Hg; pulse, 60 beats/min; respirations, 32 breaths/min
C: BP, 92/60 mm Hg; pulse, 120 beats/min; respirations, 24 breaths/min
D: BP, 160/72 mm Hg; pulse, 100 beats/min; respirations, 12 breaths/min
A: BP, 176/98 mm Hg; pulse, 50 beats/min; respirations, 10 breaths/min
When caring for a trauma patient with signs of intraabdominal bleeding, it is MOST important for the EMT to:
A: apply and inflate the pneumatic antishock garment.
B: transport rapidly to an appropriate medical facility.
C: perform an in-depth abdominal assessment.
D: auscultate bowel sounds for at least 2 minutes.
B: transport rapidly to an appropriate medical facility.
A man was struck in the side of the head with a steel pipe. Blood-tinged fluid is draining from the ear and bruising appears behind the ear. The MOST appropriate treatment for this patient includes:
A: controlling the drainage from the ear and immobilizing the entire spine.
B: elevating the lower extremities and providing immediate transport.
C: applying high-flow oxygen and packing the ear with sterile gauze pads.
D: immobilizing the spine, administering oxygen, and monitoring for vomiting.
D: immobilizing the spine, administering oxygen, and monitoring for vomiting.
A 40-year-old man has burns to the entire head, anterior chest, and both anterior upper extremities. Using the adult Rule of Nines, what percentage of his total body surface area has been burned?
A: 45%
B: 27%
C: 36%
D: 18%
B: 27%
Reason:
Using the adult Rule of Nines, the head accounts for 9% of the total body surface area (TBSA), the anterior chest for 9% (the entire anterior trunk [chest and abdomen] accounts for 18%), and the anterior upper extremities for 4.5% each (each entire upper extremity is 9% of the TBSA). On the basis of this, the patient has sustained 27% TBSA burns.
During your assessment of a patient who experienced blunt facial trauma, you note the presence of a hyphema. This indicates:
A: a fracture of the nasal bone.
B: an orbital blowout fracture.
C: that the pupils are unequal.
D: direct trauma to the eyeball.
D: direct trauma to the eyeball.
Reason:
Some patients with blunt trauma to the eyeball (globe) may present with a hyphema, or bleeding into the anterior chamber of the eye, that obscures a portion of or the entire iris. This condition may seriously impair vision and should be considered a sight-threatening emergency. A fracture of the orbital floor (blowout fracture) is characterized by double vision and an inability of the patient to move his or her eyes above the midline (paralysis of an upward gaze) following blunt facial trauma. In an orbital blowout fracture, fragments of fractured bone can entrap some of the muscles that control eye movement. Anisocoria is the term used to describe unequal pupils. Unequal pupils following head trauma indicates increased intracranial pressure.
A 19-year-old female has a closed, swollen deformity to her left forearm. You are unable to palpate a radial pulse and the skin distal to the injury is cold and pale. Several attempts to contact medical control have failed and you are approximately 45 miles away from the closest hospital. You should:
A: begin transport at once, gently manipulate her arm en route until distal circulation is restored, and apply an air splint.
B: make one attempt to restore distal circulation by applying gentle manual traction in line with the long axis of the limb.
C: apply an air splint to her forearm, keep her arm below the level of her heart, place an icepack over the injury, and transport.
D: splint her entire arm with rigid board splints, elevate the limb above the level of her heart, and transport immediately.
B: make one attempt to restore distal circulation by applying gentle manual traction in line with the long axis of the limb.
Cold, pale skin and an absent distal pulse indicates that blood flow distal to the injury is compromised. You should notify medical control, who will likely direct you to attempt to restore distal circulation. However, if you are unable to contact medical control and your transport time will be lengthy, you should make ONE attempt to restore distal circulation by applying gentle manual traction in line with the long axis of the limb. Be careful, as excessive manipulation can worsen the vascular problem. If you are unsuccessful after one attempt, splint the limb in the most comfortable position for the patient and transport at once. If distal circulation is restored, splint the limb in whatever position allows the strongest distal pulse. You should elevate the limb above the level of the heart to help minimize swelling. An icepack may also help reduce pain and swelling.
A woman stabbed her boyfriend in the cheek with a dinner fork during an argument. Police have the woman in custody. The patient still has the fork impaled in his cheek. He is conscious and alert, breathing adequately, and has blood in his oropharynx. You should:
A: suction his oropharynx, carefully cut the fork to make it shorter, control any external bleeding, and secure the fork in place.
B: apply high-flow oxygen via a nonrebreathing mask, carefully remove the fork, and control any external bleeding.
C: carefully remove the fork, suction his oropharynx as needed, and pack the inside of his cheek with sterile gauze pads.
D: suction his oropharynx, control any external bleeding, stabilize the fork in place, and protect it with bulky dressings.
D: suction his oropharynx, control any external bleeding, stabilize the fork in place, and protect it with bulky dressings.
Upon discovering an open chest wound, you should:
A: immediately reassess the patient’s ventilatory status.
B: quickly cover the wound with a porous trauma dressing.
C: begin assisted ventilation and prepare for transport.
D: prevent air from entering the open wound.
D: prevent air from entering the open wound.
A patient with a closed head injury opens his eyes in response to pain, is mumbling words that you cannot understand, and pushes your hand away when you apply a painful stimulus. His Glasgow Coma Scale (GCS) score is:
A: 7
B: 8
C: 9
D: 6
C: 9
Reason:
The Glasgow Coma Scale (GCS) is a valuable tool used when assessing patients with a neurological injury. It assesses three parameters: eye opening, verbal response, and motor response. A minimum score on the GCS is 3 and a maximum score is 15. A patient who opens his or her eyes in response to pain would receive a score of 2. Mumbling speech, moaning, or incomprehensible words equate to a score of 2 for verbal response. Localization of a painful stimulus, such as pushing your hand away from the source of pain, equates to a score of 5. Therefore, the patient has a GCS score of 9. It is important to note that a patient’s GCS score should be reassessed frequently. Review the entire GCS in your EMT text and commit it to memory.
During a soccer game, an 18-year-old woman injured her knee. Her knee is in a flexed position and is obviously deformed. You should:
A: assess circulatory function distal to her injury.
B: immobilize the knee in the position in which it was found.
C: straighten the knee to facilitate immobilization.
D: manually stabilize the leg above and below the knee.
D: manually stabilize the leg above and below the knee.
A high-school student was splashed in the eyes with a strong acid chemical during a lab experiment. He is in severe pain and is unable to open his eyes. You should:
A: cover both of his eyes with sterile gauze and transport at once.
B: flush both eyes with sterile water for no more than 5 minutes.
C: force his eyes open and assess for the presence of severe burns.
D: continuously flush his eyes with saline for at least 20 minutes.
D: continuously flush his eyes with saline for at least 20 minutes.
When applying a vest-style spinal immobilization device to a patient with traumatic neck pain, you should:
A: ask the patient to fully exhale as you secure the torso.
B: secure the torso section prior to immobilizing the head.
C: immobilize the head prior to securing the torso straps.
D: gently flex the head forward as you position the device.
B: secure the torso section prior to immobilizing the head.
A young male has trauma to multiple body systems after he fell approximately 35 feet. He is semiconscious, has an unstable chest wall, numerous long bone fractures, and a large hematoma to his head. He will have the GREATEST chance for survival if you:
A: request an ALS ambulance.
B: keep him warm and elevate his legs.
C: give him high-flow oxygen early.
D: rapidly transport him to a trauma center.
D: rapidly transport him to a trauma center.
A 23-year-old male was struck across the face with a baseball bat. His eyes are swollen shut, he has massive facial bruising and deformities, and has blood in his mouth. Your MOST immediate concern should be:
A: spinal trauma.
B: airway compromise.
C: permanent vision loss.
D: intracranial bleeding.
B: airway compromise.
Displaced fractures of the proximal femur are characterized by:
A: lengthening and internal rotation of the leg.
B: a flexed hip joint and inward thigh rotation.
C: shortening and external rotation of the leg.
D: hip joint extension and external leg rotation.
C: shortening and external rotation of the leg.
Fractures of the proximal (upper) part of the femur are especially common in older people, particularly those with osteoporosis, but may also occur as a result of high-energy trauma in younger patients. Although they are usually called hip fractures, they rarely involve the hip joint. Instead, the break goes through the neck of the femur, the middle region, or across the proximal shaft. Patients with displaced fractures of the proximal femur display a very characteristic deformity. They lie with the leg externally rotated, and the injured leg is usually shorter than the uninjured leg. If the fracture is not displaced, this deformity is not present. A flexed hip joint and internal rotation of the thigh are characteristic of a posterior hip dislocation. With the less common anterior hip dislocation, the limb is in the opposite position, extended straight out, externally rotated, and pointing away from the midline of the body.
After stopping the burning process, emergency care for a 68-year-old male with partial- and full-thickness burns to his chest and upper extremities includes all of the following, EXCEPT:
A: covering the burns with dry, sterile dressings.
B: avoiding the use of burn ointments or antiseptics.
C: flushing the burns with cool water for 10 minutes.
D: preparing to assist the patient’s ventilations.
C: flushing the burns with cool water for 10 minutes.
Reason:
Unless the patient is on fire, do not apply water to a full-thickness (third-degree) burn, especially if the patient is already prone to hypothermia and infection (ie, older adults, small children). Cover the burns with dry, sterile dressings or a sterile burn sheet. The use of burn creams, ointments, or antiseptics should be avoided; these increase the risk of infection and will only need to be removed at the hospital. Apply high-flow oxygen, treat any associated injuries, and rapidly transport the patient. If the patient is breathing inadequately (eg, fast or slow rate, shallow breathing [reduced tidal volume]), assist ventilations with a bag-mask device.
General care for an amputated body part includes:
A: wrapping the amputated part in a moist, sterile dressing and keeping it warm.
B: immersing the amputated part in ice cold water to prevent further damage.
C: wrapping the amputated part in a moist, sterile dressing and placing it on ice.
D: thoroughly cleaning the amputated part and wrapping it in a sterile dressing.
C: wrapping the amputated part in a moist, sterile dressing and placing it on ice.
When assessing and treating a patient with a gunshot wound, you should routinely:
A: determine why the patient was shot.
B: evaluate the pulses proximal to the wound.
C: look for the presence of an exit wound.
D: apply ice directly to the wound.
C: look for the presence of an exit wound.
Despite direct pressure, a large laceration continues to spurt large amounts of bright red blood. You should:
A: apply a tourniquet proximal to the injury until the bleeding stops.
B: elevate the extremity and apply a tight pressure dressing.
C: place additional dressings on the wound until the bleeding stops.
D: apply pressure to the pulse point that is proximal to the injury.
A: apply a tourniquet proximal to the injury until the bleeding stops.
Shock following major trauma is MOST often the result of:
A: head injury.
B: spinal injury.
C: hemorrhage.
D: long bone fractures.
C: hemorrhage
A young man fell and landed on his outstretched hand, resulting in pain and deformity to the left midshaft forearm. Distal circulation should be assessed at which of the following pulse locations?
A: Pedal
B: Radial
C: Popliteal
D: Brachial
B: Radial
A 44-year-old male experienced burns to his anterior trunk and both arms. He is conscious and alert, but is in extreme pain. Assessment of the burns reveals reddening and blisters. This patient has ________________ burns that cover _____ of his total body surface area.
A: full-thickness, 18%
B: partial-thickness, 36%
C: first-degree, 27%
D: second-degree, 45%
B: partial-thickness, 36%
You are assessing a young male who was stabbed in the right lower chest. He is semiconscious and has labored breathing, collapsed jugular veins, and absent breath sounds on the right side of his chest. This patient MOST likely has a:
A: ruptured spleen.
B: liver laceration.
C: hemothorax.
D: pneumothorax.
C: hemothorax
Patients with significant closed head injuries often have pupillary abnormalities and:
A: tachycardia.
B: paralysis.
C: hypertension.
D: paresthesia.
C: hypertension
You are called to a local nightclub for an injured patient. Law enforcement personnel have secured the scene. Upon arrival, you see a young man who is lying on the ground screaming in pain; bright red blood is spurting from an apparent stab wound to his groin area. You should:
A: apply 100% oxygen.
B: prevent hypothermia.
C: control the bleeding.
D: ensure an open airway.
C: control the bleeding.
Which of the following mechanisms of injury would necessitate performing a rapid head-to-toe assessment?
A: An impaled object in the patient’s lower extremity with minimal venous bleeding
B: A 5 foot, 9 inch tall adult who fell 12 feet from a roof and landed on his side
C: A stable patient involved in a motor-vehicle crash, whose passenger was killed
D: Amputation of three toes from the patient’s left foot with controlled bleeding
C: A stable patient involved in a motor-vehicle crash, whose passenger was killed
A gang member was cut on the left side of the neck during a fight and is bleeding heavily from the wound. His airway is patent and his breathing is adequate. You should immediately:
A: apply high-flow oxygen via a nonrebreathing mask at 15 L/min.
B: cover the wound with an occlusive dressing and apply direct pressure.
C: apply a tight pressure dressing and secure it in place with tape.
D: perform a head-to-toe assessment to find and treat other injuries.
B: cover the wound with an occlusive dressing and apply direct pressure.
A 42-year-old man was ejected from his car after it struck a bridge pillar at a high rate of speed. You find him in a prone position approximately 50 feet from his car. He is not moving and does not appear to be breathing. You should:
A: use the jaw-thrust maneuver.
B: administer high-flow oxygen.
C: assess his breathing effort.
D: manually stabilize his head.
D: manually stabilize his head.
The presence of subcutaneous emphysema following blunt trauma to the anterior neck should make you MOST suspicious for a:
A: ruptured esophagus.
B: fractured larynx.
C: pneumothorax.
D: carotid artery injury.
B: fractured larynx.
Following blunt trauma to the chest, a 33-year-old male has shallow, painful breathing. On assessment, you note that an area to the left side of his chest collapses during inhalation and bulges during exhalation. These are signs of a/an:
A: pneumothorax.
B: flail chest.
C: isolated rib fracture.
D: pulmonary contusion.
B: flail chest
In which of the following circumstances would external bleeding be the LEAST difficult to control?
A: Lacerated jugular vein; BP of 100/60 mm Hg
B: Lacerated brachial artery; BP of 140/90 mm Hg
C: Lacerated carotid artery; BP of 90/50 mm Hg
D: Lacerated femoral vein; BP of 70/40 mm Hg
D: Lacerated femoral vein; BP of 70/40 mm Hg
Which of the following signs would you expect to see in the early stages of shock?
A: Restlessness
B: Unconsciousness
C: Hypotension
D: Thready pulses
A: Restlessness
Which of the following injury mechanisms is associated with hangings?
A: Subluxation
B: Distraction
C: Axial loading
D: Hyperextension
B: Distraction
A 45-year-old male was stabbed in the left anterior chest. He is conscious, but restless. His skin is cool and clammy, his blood pressure is 90/60 mm Hg, his respirations are rapid and shallow, and his heart rate is 120 beats/min and weak. Further assessment reveals that his breath sounds are clear and equal bilaterally and his jugular veins are distended. In addition to giving him high-flow oxygen, you should:
A: perform a detailed physical exam at the scene to ensure that you locate and treat less obvious injuries.
B: suspect that the patient has a tension pneumothorax and notify the trauma center as soon as possible.
C: control the bleeding from the stab wound with a sterile porous dressing and reassess his vital signs.
D: cover the stab wound with an occlusive dressing, support ventilation as needed, and transport rapidly.
D: cover the stab wound with an occlusive dressing, support ventilation as needed, and transport rapidly
Which of the following patients would be MOST in need of a rapid head-to-toe assessment?
A: A 60-year-old man who fell from a standing position and has small abrasions on his cheek
B: A 43-year-old woman with a unilaterally swollen, painful deformity of the midshaft femur
C: A responsive 25-year-old woman who fell 9 feet from a roof and landed on her side
D: A responsive 22-year-old man with a small caliber gunshot wound to the abdomen
D: A responsive 22-year-old man with a small caliber gunshot wound to the abdomen
Which of the following BEST describes the mechanism of injury?
A: The energy of an object in motion
B: The product of mass, force of gravity, and height
C: Your concern for potentially serious injuries
D: The way in which traumatic injuries occur
D: The way in which traumatic injuries occur
Appropriate care for an amputated body part includes all of the following, EXCEPT:
A: placing it directly on ice to prevent tissue damage.
B: keeping the part cool, but not allowing it to freeze.
C: laying the wrapped body part on a bed of ice.
D: wrapping it in a sterile dressing and placing it in a plastic bag.
A: placing it directly on ice to prevent tissue damage.
A 40-year-old man has burns to the entire head, anterior chest, and both anterior upper extremities. Using the adult Rule of Nines, what percentage of his total body surface area has been burned?
A: 18%
B: 45%
C: 27%
D: 36%
C: 27%
Which of the following is MOST indicative of decompensated shock in a trauma patient with internal bleeding?
A: Tachycardia
B: Hypotension
C: Restlessness
D: Clammy skin
B: Hypotension
A 44-year-old man has a traumatic leg amputation just below the knee. He is unresponsive; is breathing rapidly and shallowly; and has pale, cool, clammy skin. He is lying in a large pool of blood and the wound is bleeding profusely. To control this bleeding, you should:
A: cover the wound with a trauma dressing and apply a proximal tourniquet.
B: apply an icepack to the wound to constrict the vessels and stop the bleeding.
C: apply a pressure dressing and elevate the injured extremity at least 12 inches.
D: locate the femoral artery and apply pressure to it until the bleeding stops.
A: cover the wound with a trauma dressing and apply a proximal tourniquet.
A 33-year-old factory worker was pinned between two pieces of machinery. When you arrive at the scene, you find him lying supine on the ground complaining of severe pain to his pelvis. He is restless, diaphoretic, and tachycardic. After performing a rapid head-to-toe assessment, you should:
A: carefully log roll him to check his back.
B: palpate his pelvis to assess for crepitus.
C: perform a detailed secondary exam.
D: prepare for immediate transport.
D: prepare for immediate transport.
If a vehicle strikes a tree at 60 MPH, the unrestrained driver would likely experience the MOST severe injuries during the:
A: second collision.
B: third collision.
C: first collision.
D: fourth collision.
B: third collision.
Following blunt injury to the anterior torso, a patient is coughing up bright red blood. You should be MOST suspicious of:
A: bleeding within the lungs.
B: intraabdominal bleeding.
C: gastrointestinal bleeding.
D: severe myocardial damage.
A: bleeding within the lungs.
A 22-year-old man was stabbed in the chest with a large knife. The patient is pulseless and apneic, and the knife is impaled in the center of his chest. Treatment should include:
A: stabilizing the knife, applying an occlusive dressing, and providing rapid transport.
B: stabilizing the knife, starting CPR, and providing rapid transport.
C: removing the knife, applying an occlusive dressing, and providing rapid transport.
D: removing the knife, starting CPR, and providing rapid transport.
D: removing the knife, starting CPR, and providing rapid transport.
You arrive at a residence where you find a man lying unresponsive in his front yard. There were no witnesses to the event. In assessing this man, you should assume that he:
A: is having a heart attack.
B: has a heat-related emergency.
C: has sustained an injury.
D: is having a diabetic reaction.
C: has sustained an injury.
You are performing a secondary assessment on a severely injured patient while en route to a trauma center. During the assessment, you note that the patient’s respiratory rate has increased. You should:
A: count the number of respirations per minute.
B: immediately notify the receiving facility.
C: repeat the primary assessment and treat as needed.
D: assess his oxygen saturation with a pulse oximeter.
C: repeat the primary assessment and treat as needed.
A 21-year-old man partially amputated his right arm when the chainsaw he was using to trim trees slipped. You can feel a weak radial pulse and his arm is cool to the touch. Dark red blood is flowing heavily from the wound. You should:
A: carefully pack sterile dressings into the wound and fully splint the extremity.
B: apply a tourniquet proximal to the injury and tighten it until the bleeding stops.
C: apply bulky compression dressings to the wound and splint the extremity.
D: control the bleeding, manipulate the arm to improve circulation, and apply a splint.
C: apply bulky compression dressings to the wound and splint the extremity.
If a passenger strikes his or her head on the windshield during a motor-vehicle crash:
A: the anterior part of the brain sustains a compression injury, while the posterior part sustains a stretching injury.
B: the posterior portion of the brain will receive the initial impact, resulting in severe intracerebral hemorrhage.
C: you will always see a starburst fracture of the windshield at the location where the patient struck his or her head.
D: he or she will likely experience a hyperflexion injury, resulting in fractures of the vertebrae in the cervical spine.
A: the anterior part of the brain sustains a compression injury, while the posterior part sustains a stretching injury.
A 21-year-old male was bitten on the left forearm by a dog. He is conscious and alert and denies any other injuries. An animal control officer is at the scene and has contained the dog. Your assessment of the patient’s arm reveals a large avulsion with a peeled back flap of skin. Distal circulation is adequate and the patient is able to feel and move his fingers. In addition to bleeding control, you should:
A: irrigate the wound for at least 15 minutes.
B: perform a rapid head-to-toe assessment.
C: apply oxygen via a nonrebreathing mask.
D: replace the avulsed flap to its original position.
D: replace the avulsed flap to its original position.
Which of the following is the MOST reliable indicator of a fracture to a spinal vertebra?
A: Decreased grip strength in the upper extremities
B: Lack of pain at the site of the injury
C: Decreased movement on one side of the body
D: Palpable pain at the site of the injury
D: Palpable pain at the site of the injury
An elderly woman, who was removed from her burning house by firefighters, has full-thickness burns to approximately 50% of her body. Appropriate treatment for this patient should include:
A: peeling burned clothing from the skin and removing all rings, necklaces, and bracelets.
B: cooling the burns with sterile saline and covering them with dry, sterile burn pads.
C: covering the burns with dry, sterile dressings and preventing further loss of body heat.
D: applying moist, sterile dressings to the burned areas and preventing hypothermia.
C: covering the burns with dry, sterile dressings and preventing further loss of body heat.
During the rapid head-to-toe assessment of a patient with multiple injuries, you expose the chest and find an open wound with blood bubbling from it. You should:
A: prevent air from entering the wound.
B: apply high-flow supplemental oxygen.
C: place a porous dressing over the wound.
D: stop your assessment and transport.
A: prevent air from entering the wound.
Which of the following assessment parameters is the MOST reliable when determining if a patient with a head injury is improving or deteriorating?
A: rate and depth of breathing.
B: pupillary reaction.
C: systolic blood pressure.
D: level of consciousness.
D: level of consciousness.
A 22-year-old female woman was shot by her husband. Law enforcement is at the scene and has the husband in custody. The patient is conscious, but extremely restless, and is pale and diaphoretic. As your partner administers high-flow oxygen, you should:
A: take her BP to detect hypotension.
B: look for and control any bleeding.
C: compare her carotid and radial pulses.
D: keep her warm by applying blankets.
B: look for and control any bleeding.
Internal or external bleeding would be especially severe in a patient:
A: who takes aspirin.
B: with heart disease.
C: with hemophilia.
D: who is hypotensive.
C: with hemophilia
Despite direct pressure, a large laceration to the medial aspect of the arm continues to bleed profusely. You should:
A: pack the inside of the laceration with sterile gauze.
B: quickly apply a tourniquet proximal to the injury.
C: continue direct pressure and elevate the extremity.
D: locate and apply pressure to the brachial artery.
B: quickly apply a tourniquet proximal to the injury.
Priority treatment for a large avulsion includes:
A: cleaning the wound.
B: assessing distal circulation.
C: controlling any bleeding.
D: immobilizing the injured area.
C: controlling any bleeding.
Firefighters have rescued a man from his burning house. He is conscious and alert, but is experiencing significant respiratory distress. He has a brassy cough and singed nasal hairs. The MOST immediate threat to this patient’s life is:
A: severe burns.
B: hypothermia.
C: severe infection.
D: airway swelling.
D: airway swelling.
A 56-year-old man was the unrestrained driver of a small passenger car that rolled over twice after he rounded a corner too fast. He is unresponsive; has rapid, shallow respirations; and has a rapid, weak pulse. His left arm is completely amputated just below the elbow. As you and your partner are treating the patient, other responders are trying to find the amputated arm. Which of the following statements regarding this scenario is correct?
A: Quickly move the patient to the ambulance, continue treatment, and wait for the other responders to recover his arm.
B: You should transport the patient immediately, even if the other responders recover his arm before you depart the scene.
C: If the patient’s arm has not been recovered by the time you are ready to transport, you should transport without delay.
D: Your priority should be to recover the man’s arm because a vascular surgeon may be able to successfully reattach it.
C: If the patient’s arm has not been recovered by the time you are ready to transport, you should transport without delay.
A young male has a large laceration to his lateral neck, directly over his jugular vein. His airway is patent and his breathing is adequate. Your MOST immediate priority should be to:
A: obtain vital signs to determine if he is hypotensive.
B: perform a rapid assessment to detect other injuries.
C: apply high-flow oxygen via a nonrebreathing mask.
D: keep air out of the wound and control the bleeding.
D: keep air out of the wound and control the bleeding.
An adult patient opens his eyes in response to a painful stimulus, moans when you ask him questions, and pulls his arm away when you palpate it. What is his Glasgow Coma Scale (GCS) score?
A: 6
B: 7
C: 9
D: 8
D: 8
Reason:
The Glasgow Coma Score (GCS) assesses three neurologic parameters: eye opening, verbal response, and motor response. Your patient’s GCS score is 8. For eye opening, he receives 2 points for opening his eyes in response to pain. For verbal response, he receives 2 points for moaning or making unintelligible sounds. For motor response, he receives 4 points for withdrawing to pain. The GCS is a valuable neurologic assessment tool; it should be reassessed frequently in seriously injured patients—especially patients with a head injury.
Which of the following is MOST indicative of decompensated shock in a trauma patient with internal bleeding?
A: Restlessness
B: Clammy skin
C: Tachycardia
D: Hypotension
D: Hypotension
A soft-tissue injury that results in a flap of torn skin is called a/an:
A: abrasion.
B: avulsion.
C: incision.
D: laceration.
B: avulsion
Initial treatment for a patient with external blood loss depends upon:
A: his or her signs and symptoms.
B: the amount of estimated blood loss.
C: whether or not hypotension is present.
D: his or her past medical history.
A: his or her signs and symptoms.
A 40-year-old man was hit in the nose during a fight. He has bruising under his left eye and a nosebleed. After taking standard precautions, you should:
ensure that he is sitting up and leaning forward
Prior to your arrival at the scene, a young female was removed from the water after being submerged for an unknown period of time. You should manage her airway appropriately while considering the possibility of:
A: spinal injury.
B: hyperthermia.
C: airway obstruction.
D: internal bleeding.
A: spinal injury.
In addition to high-flow oxygen, the MOST appropriate treatment for a patient with widespread full-thickness burns should include:
A: moist; sterile dressings; burn ointment; and rapid transport.
B: dry; sterile dressings; burn ointment; and rapid transport.
C: dry, sterile dressings; warmth; and rapid transport.
D: moist; sterile dressings; warmth; and rapid transport.
C: dry, sterile dressings; warmth; and rapid transport.
Following a head injury, a young female is semiconscious and is bleeding from the nose and left ear. You should:
A: control the bleeding from her nose by pinching her nostrils closed.
B: place a pressure dressing over her ear to prevent blood loss.
C: insert a nasal airway to keep her tongue from blocking the airway.
D: cover her ear and nose with a loose gauze pad to collect the blood.
D: cover her ear and nose with a loose gauze pad to collect the blood
Which of the following actions is MOST important when immobilizing a patient with a suspected spinal injury?
A: Select and apply the appropriate size of extrication collar.
B: Secure the patient’s head prior to immobilizing the torso.
C: Check range of motion by asking the patient to move the head.
D: A vest-style immobilization device should routinely be used.
A: Select and apply the appropriate size of extrication collar.
Basic shock treatment includes:
A: applying oxygen, elevating the lower extremities per protocol, and providing warmth.
B: applying and inflating the PASG, applying oxygen, and thermal management.
C: elevating the lower extremities, applying and inflating the PASG, and applying oxygen.
D: applying oxygen, elevating the upper body, and taking measures to prevent hypothermia.
A: applying oxygen, elevating the lower extremities per protocol, and providing warmth.
When assessing distal circulation in a patient with a swollen deformed femur, you should:
A: ask the patient to wiggle his toes.
B: touch his foot with a blunt object.
C: assess the pulse behind the knee.
D: palpate for a dorsalis pedis pulse.
D: palpate for a dorsalis pedis pulse.
During a soccer game, a 20-year-old man collided shoulder-to-shoulder with another player. He has pain and a noticeable anterior bulge to the left shoulder. Which of the following is the MOST effective method of immobilizing this injury?
A: A sling to support the left arm and swathes to maintain downward traction
B: A long board splint with the left arm immobilized in the extended position
C: An air-inflatable splint with the left arm immobilized in the flexed position
D: A sling to support the left arm and swathes to secure the arm to the body
D: A sling to support the left arm and swathes to secure the arm to the body
A 22-year-old female fell on her knee and is in severe pain. Her knee is flexed and severely deformed. Her leg is cold to the touch and you are unable to palpate a distal pulse. You should:
A: apply gentle longitudinal traction as you straighten her leg and then apply a traction splint.
B: manually stabilize her injury and contact medical control for further stabilization instructions.
C: place a pillow behind her knee and stabilize the injury by applying padded board splints.
D: carefully straighten her leg until you restore a distal pulse and then apply padded board splints.
B: manually stabilize her injury and contact medical control for further stabilization instructions.
Following penetrating trauma to the abdomen, a 50-year-old woman has a large laceration with a loop of protruding bowel. How should you manage this injury?
A: Apply a tight pressure dressing to control any external bleeding.
B: Apply a moist, sterile dressing covered by a dry, sterile dressing.
C: Carefully replace the bowel and apply an occlusive dressing.
D: Apply a dry, sterile dressing covered by an occlusive dressing.
B: Apply a moist, sterile dressing covered by a dry, sterile dressing
Which of the following is the MOST reliable indicator of a fracture to a spinal vertebra?
A: Decreased grip strength in the upper extremities
B: Lack of pain at the site of the injury
C: Palpable pain at the site of the injury
D: Decreased movement on one side of the body
C: Palpable pain at the site of the injury
In which of the following circumstances would external bleeding be the LEAST difficult to control?
A: Lacerated brachial artery; BP of 140/90 mm Hg
B: Lacerated carotid artery; BP of 90/50 mm Hg
C: Lacerated jugular vein; BP of 100/60 mm Hg
D: Lacerated femoral vein; BP of 70/40 mm Hg
D: Lacerated femoral vein; BP of 70/40 mm Hg
The pneumatic antishock garment may be indicated for patients with:
A: pelvic instability and signs of shock.
B: blunt chest trauma and hypotension.
C: any severe injury above the nipple line.
D: femur fractures and crackles in the lungs.
A: pelvic instability and signs of shock.
A 33-year-old male struck a parked car with his motorcycle and was ejected from the motorcycle. He was not wearing a helmet. He is unresponsive, has a depressed area to his forehead, bilaterally deformed femurs, and widespread abrasions with capillary bleeding. Which of the following statements regarding this patient is false?
A: Internal hemorrhage cannot be controlled in the field and requires prompt surgical intervention.
B: You must stop the bleeding from his abrasions immediately or he will die from hypovolemic shock.
C: Femur fractures are a common injury when a motorcyclist is ejected from his or her motorcycle.
D: You should suspect that the patient has a skull fracture and increased intracranial pressure.
B: You must stop the bleeding from his abrasions immediately or he will die from hypovolemic shock.
An unresponsive patient with multi-systems trauma has slow, shallow breathing; weak radial pulses; and severe bleeding from a lower extremity wound. You should direct your partner to:
A: radio for a paramedic ambulance to respond to the scene.
B: apply oxygen via nonrebreathing mask while you control the bleeding.
C: assist the patient’s ventilations while you control the bleeding.
D: prepare the long spine board and straps for rapid spinal immobilization.
C: assist the patient’s ventilations while you control the bleeding.
A 23-year-old unrestrained female struck the steering wheel with her chest when her passenger car collided with a tree at a high rate of speed. Your assessment reveals that she is conscious, but has signs of shock and an irregular pulse. The MOST appropriate treatment for this patient includes:
A: applying an AED in case she develops cardiac arrest, high-flow oxygen, full spinal precautions, and rapid transport.
B: high-flow oxygen or assisted ventilations as needed, full spinal precautions, blankets to keep her warm, and rapid transport.
C: insertion of an oral airway, assisted ventilations with a bag-mask device, full spinal precautions, and rapid transport.
D: high-flow oxygen, summoning a paramedic unit to the scene to assess her cardiac rhythm, a cervical collar, and transport as soon as possible.
B: high-flow oxygen or assisted ventilations as needed, full spinal precautions, blankets to keep her warm, and rapid transport.
A 19-year-old male was assaulted and has trauma to multiple body systems. After performing your primary assessment and treating any immediate life-threatening injuries, you should:
A: transport at once and intercept with ALS.
B: obtain a full set of baseline vital signs.
C: perform a rapid head-to-toe assessment.
D: fully immobilize his spine and transport.
C: perform a rapid head-to-toe assessment.
When caring for a critically injured patient, it is MOST appropriate to perform your secondary assessment:
A: while you are en route to the hospital.
B: immediately after taking baseline vital signs.
C: after all life threats have been ruled out.
D: immediately following the primary assessment.
A: while you are en route to the hospital.
Rapid extrication of a patient from an automobile should be performed by:
A: maintaining support of the head, grasping the patient by the clothing, and rapidly removing the patient from the car.
B: applying a vest-style extrication device and sliding the patient out of the car onto a long spine board for full immobilization.
C: applying a cervical collar and removing the patient from the car using the direct carry method.
D: applying a cervical collar, sliding a long spine board under the patient’s buttocks, and removing the patient from the car.
D: applying a cervical collar, sliding a long spine board under the patient’s buttocks, and removing the patient from the car.
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During your rapid assessment of a critically-injured patient, you should assess the chest for:
A: crepitus and distention.
B: symmetry and pain.
C: rigidity and guarding.
D: distention and guarding.
B: symmetry and pain.
Priority treatment for a large avulsion includes:
A: cleaning the wound.
B: immobilizing the injured area.
C: assessing distal circulation.
D: controlling any bleeding.
D: controlling any bleeding.
A gang member was cut on the left side of the neck during a fight and is bleeding heavily from the wound. His airway is patent and his breathing is adequate. You should immediately:
A: apply high-flow oxygen via a nonrebreathing mask at 15 L/min.
B: apply a tight pressure dressing and secure it in place with tape.
C: perform a head-to-toe assessment to find and treat other injuries.
D: cover the wound with an occlusive dressing and apply direct pressure.
D: cover the wound with an occlusive dressing and apply direct pressure.
A football player complains of severe neck pain and tingling in his arms and legs after being tackled. He is conscious and alert, has a patent airway, and is breathing adequately. He is in a supine position and is still wearing his helmet, which is tight-fitting. The MOST appropriate treatment for this patient includes:
A: manually stabilizing his head, carefully removing his helmet, administering high-flow oxygen, applying a cervical collar, placing him onto a long backboard, and restricting spinal motion with straps and a lateral head stabilizer.
B: manually stabilizing his head with his helmet still on, removing the face mask, administering high-flow oxygen, placing him onto a long backboard, and restricting spinal motion with straps and a lateral head stabilizer.
C: carefully removing his helmet, manually stabilizing his head, applying a cervical collar, administering high-flow oxygen, placing him onto a long backboard, and restricting spinal motion with straps and a lateral head stabilizer.
D: manually stabilizing his head, leaving his helmet on, applying a vest-style spinal immobilization device, placing him onto a long backboard, and restricting spinal motion with straps and a lateral head stabilizer.
B: manually stabilizing his head with his helmet still on, removing the face mask, administering high-flow oxygen, placing him onto a long backboard, and restricting spinal motion with straps and a lateral head stabilizer.
Which of the following indicates that a patient is in decompensated shock?
A: Tachycardia and tachypnea
B: Diaphoresis and pallor
C: Restlessness and anxiety
D: Falling blood pressure
D: Falling blood pressure
During which part of your assessment would you MOST likely discover a small caliber gunshot wound to the back with minimal bleeding?
A: Primary assessment
B: General impression
C: Rapid head-to-toe assessment
D: Detailed secondary assessment
C: Rapid head-to-toe assessment
You are assessing a young male who was stabbed in the right lower chest. He is semiconscious and has labored breathing, collapsed jugular veins, and absent breath sounds on the right side of his chest. This patient MOST likely has a:
A: ruptured spleen.
B: pneumothorax.
C: hemothorax.
D: liver laceration.
C: hemothorax
Reason:
You should suspect a hemothorax if a patient with chest trauma presents with shock, especially if the injury was caused by penetrating trauma. Hemothorax occurs when blood collects in the pleural space and compresses the lung, resulting in shock and respiratory compromise. Other signs include collapsed jugular veins (due to low blood volume), labored breathing, and decreased or absent breath sounds on the side of the injury. A pneumothorax (air in the pleural space) is also associated with difficulty breathing and unilaterally decreased or absent breath sounds; however, the jugular veins are usually not collapsed. If excessive air accumulates within the pleural space, however, pressure will shift across the mediastinum and affect the uninjured lung (tension pneumothorax); if this occurs, the jugular veins may become engorged (distended). Splenic injury is unlikely; the patient’s injury is on the right side and the spleen is on the left. A liver laceration can cause severe shock; however, it is not associated with unilaterally decreased breath sounds or labored breathing.
Which of the following is MOST indicative of decompensated shock in a trauma patient with internal bleeding?
A: Clammy skin
B: Tachycardia
C: Restlessness
D: Hypotension
D: Hypotension
A young male has an open abdominal wound through which a small loop of bowel is protruding. There is minimal bleeding. The BEST way to treat his injury is to:
A: gently clean the exposed loop of bowel with warm sterile saline, carefully replace it back into the wound, and cover it with a dry sterile dressing.
B: apply a sterile trauma dressing moistened with sterile saline directly to the wound and secure the moist dressing in place with a dry sterile dressing.
C: apply dry sterile gauze pads to the wound and then keep them continuously moist by pouring sterile saline or water on them throughout transport.
D: cover the wound with a dry sterile trauma dressing and tightly secure it in place by circumferentially wrapping roller gauze around the abdomen.
B: apply a sterile trauma dressing moistened with sterile saline directly to the wound and secure the moist dressing in place with a dry sterile dressing.
Which of the following is MOST indicative of compensated shock in an adult?
A: Unresponsive, pallor, absent radial pulses, tachypnea
B: Weak carotid pulse, cool skin, increased respiratory rate
C: Restless, diaphoresis, tachypnea, BP of 104/64 mm Hg
D: Confusion, mottling, tachycardia, BP of 88/60 mm Hg
C: Restless, diaphoresis, tachypnea, BP of 104/64 mm Hg
In contrast to an incision, a laceration:
A: bleeds more severely.
B: is a jagged cut.
C: usually involves an artery.
D: is a superficial injury.
B: is a jagged cut.
Damaged small blood vessels beneath the skin following blunt trauma causes:
A: ecchymosis.
B: cyanosis.
C: mottling.
D: hematoma.
A: ecchymosis
A patient experienced blunt chest trauma and has asymmetrical chest wall movement. This MOST likely indicates:
A: decreased air movement into one lung.
B: shallow breathing secondary to severe pain.
C: accumulation of blood in both of the lungs.
D: several ribs broken in numerous places.
A: decreased air movement into one lung.
A young male experienced a syncopal episode after working in the heat for several hours. He is conscious and alert; has cool, clammy skin; and complains of nausea and lightheadedness. You should:
A: advise him to go home and rest.
B: provide rapid cooling.
C: transport him on his side.
D: give him cold water to drink.
C: transport him on his side.
Which of the following devices is contraindicated in patients with blunt chest trauma?
A: Oral airway
B: Nasal airway
C: Bag-mask device
D: Oxygen-powered ventilator
D: Oxygen-powered ventilator
Hypoxia-induced unresponsiveness during a submersion injury is usually the result of:
A: associated hypothermia.
B: laryngospasm.
C: water in the lungs.
D: a cardiac dysrhythmia.
B: laryngospasm
A 5-year-old child in compensated shock secondary to severe vomiting and diarrhea would be expected to have:
A: a weakly palpable carotid pulse.
B: strong, bounding radial pulses.
C: a slow capillary refill time.
D: slow, shallow respirations.
C: a slow capillary refill time.
Xxxxx
In order to maintain neutral alignment of an 18-month-old child’s airway, you should:
A: hyperextend the head.
B: place a rolled towel behind the head.
C: pad in between the shoulder blades.
D: ensure that the head is slightly flexed.
C: pad in between the shoulder blades.
A 5-year-old boy was struck by a car when he ran out into the street. When you arrive at the scene and approach the child, you see him lying supine approximately 15 feet from the car. Based on the child’s age and mechanism of injury, which of the following should you suspect to be his PRIMARY injury?
A: Upper thorax injury
B: Lower leg injury
C: Pelvic injury
D: Head injury
C: Pelvic injury
Which of the following is the MOST common cause of shock in infants and children?
A: Dehydration
B: Cardiac failure
C: Accidental poisoning
D: Severe allergic reaction
A: Dehydration
After attaching the AED to a 7-year-old child in cardiac arrest, you push the analyze button and receive a shock advised message. After delivering the shock, you should:
A: assess for a carotid pulse.
B: immediately perform CPR.
C: open the airway and ventilate.
D: reanalyze the cardiac rhythm.
B: immediately perform CPR.
You receive a call for a 3-year-old girl with respiratory distress. When you enter her residence, you see the mother holding the child, who does not acknowledge your presence. This finding indicates that the child:
A: is afraid of your presence.
B: probably is sleeping.
C: is reacting normally for her age.
D: has severe hypoxia.
D: has severe hypoxia.
You are responding to a call for a 2-year-old child who fell from a second-story window. With the mechanism of injury and the age of the patient in mind, you should suspect that the primary injury occurred to the child’s:
A: abdomen.
B: lower extremities.
C: chest.
D: head.
D: head
Immediately upon delivery of a newborn’s head, you should:
A: suction the nose.
B: suction the mouth.
C: cover the eyes.
D: dry the face.
B: suction the mouth
The MAIN reason why small children should ride in the backseat of a vehicle is because:
A: the back of the front seat will provide a cushion during a crash.
B: they are much less likely to be ejected from the vehicle.
C: they can experience severe injury or death if the airbag deploys.
D: their legs are highly prone to injury from striking the dashboard.
C: they can experience severe injury or death if the airbag deploys.
Appropriate treatment for an 18-year-old woman with severe vaginal bleeding may include all of the following, EXCEPT:
A: high concentrations of oxygen.
B: placing sterile dressings into the vagina.
C: keeping her warm with blankets.
D: covering the vagina with a trauma dressing.
B: placing sterile dressings into the vagina.
You arrive at a residence shortly after a 4-year-old boy experienced an apparent febrile seizure. The child is alert and crying. His skin is flushed, hot, and moist. His mother tells you that the seizure lasted about 2 minutes. You should:
A: begin rapid cooling measures at once.
B: allow the mother to take her child to the doctor.
C: provide supportive care and transport.
D: give him acetaminophen or ibuprofen.
C: provide supportive care and transport.
The appropriate technique for performing two-rescuer CPR on a 4-year-old child includes:
A: 15 compressions to 2 ventilations, compressing the sternum with your thumbs, and delivering at least 100 compressions per minute.
B: 15 compressions to 2 ventilations, compressing the sternum with the heel of your hand, and ventilating until visible chest rise occurs.
C: 30 compressions to 2 ventilations, compressing the sternum with the heel of both hands, and delivering each breath over 1 to 2 seconds.
D: 30 compressions to 2 ventilations, compressing the chest one third the depth of the chest, and delivering each breath over 1 second.
B: 15 compressions to 2 ventilations, compressing the sternum with the heel of your hand, and ventilating until visible chest rise occurs.
Which of the following would MOST likely occur in conjunction with a breech presentation?
A: Prolapsed umbilical cord
B: Maternal hypertension
C: Premature rupture of the amniotic sac
D: Vertex presentation
A: Prolapsed umbilical cord
You should suspect physical abuse of a 4-year-old child if you observe:
A: that the child clings to his or her parent.
B: bruises to the anterior tibial area.
C: purple and yellow bruises to the thighs.
D: curious siblings who are watching you.
C: purple and yellow bruises to the thighs.
You are treating a 5-year-old child who has had severe diarrhea and vomiting for 3 days and is now showing signs of shock. Supplemental oxygen has been given and you have elevated his lower extremities. En route to the hospital, you note that his work of breathing has increased. You should:
A: insert a nasopharyngeal airway and increase the oxygen flow.
B: begin positive-pressure ventilations and reassess the child.
C: lower the extremities and reassess the child.
D: listen to the lungs with a stethoscope for abnormal breath sounds.
C: lower the extremities and reassess the child.
Which artery should you palpate when assessing for a pulse in an unresponsive 6-month-old patient?
A: Femoral
B: Radial
C: Brachial
D: Carotid
C: Brachial
Upon assessing a newborn immediately after delivery, you note that the infant is breathing spontaneously and has a heart rate of 80 beats/min. What is the MOST appropriate initial management for this newborn?
A: Initiate positive-pressure ventilations.
B: Provide blow-by oxygen with oxygen tubing.
C: Assess the newborn’s skin condition and color.
D: Start chest compressions and contact medical control.
A: Initiate positive-pressure ventilations.
A 30-year-old woman has severe lower abdominal pain and light vaginal bleeding. She tells you that her last menstrual period was 2 months ago. On the basis of these findings, you should suspect:
A: a ruptured ovarian cyst.
B: a spontaneous abortion.
C: an ectopic pregnancy.
D: a normal pregnancy.
C: an ectopic pregnancy.