NREMT trauma emergencies

Question 1

What is the difference between a hip and a pelvic fracture?

Answer 1

A hip fracture is usually a proximal femur fracture near the ball and socket hip joint. A pelvic fracture refers to a fracture in any of the pelvic bones themselves.

Question 2

Describe the appearance of arterial, venous and capillary bleeding.

Answer 2

• Arterial - spurting, brighter red blood.
• Venous - flowing, dark red blood.
• Capillary - oozing, dark red blood.

Question 3

How do you care for a patient with an impaled object?

Answer 3

First perform a primary assessment and control bleeding if necessary. Treat for shock.

The impaled object itself must be stabilized in place. This often requires creativity depending on the type of object and the location in which it is impaled. Bulky dressings are often piled on each side of the object and secured to stabilize the object in place.

Question 4

Your patient is the driver of a vehicle that was rear-ended. The classic injury pattern in this scenario is:

Answer 4

Whiplash injury to the neck caused by rapidly “whipping” the neck backward then forward. Higher headrests in cars have helped to reduce the incidence of this.

Question 5

What is exsanguination?

Answer 5

Exsanguination is “bleeding to death.”

When blood loss is more than the patient is able to overcome or survive, it is called exsanguination.

Question 6

List signs and symptoms that would make you suspect a patient had internal bleeding.

Answer 6

In all patients, signs of shock and a complaint of pain are common.

In trauma you may see outward signs of injury such as redness or bruising, have a mechanism of injury that would suggest chest or abdominal injury, or have pain and/or rigidity on palpation.

Internal bleeding can also be the result of a medical condition. Medical patients may have some of the above but can also have blood in vomit or stool (fresh, red blood or digested blood).

Question 7

What type of injury causes a fern-like pattern to appear on the skin?

Answer 7

A fern-like pattern on the skin (also known as a Lichtenberg figure) is caused by a lightning strike.

Question 8

What level of the spine provides innervation to the diaphragm?

Answer 8

The phrenic nerve provides the only motor control to the diaphragm. This derives from the C3 - C5 vertebrae.

Question 9

Which is secured to the long spine board first: head or torso?

Answer 9

The torso is secured first, then the head. Securing the head first could cause movement of the neck if the torso shifts before it is secured.

Question 10

Why does the skin become cool and clammy in shock?

Answer 10

Blood is shunted from the skin to more vital organs. This is done through vasoconstriction resulting in the cooler temperature and moisture.

Question 11

What do you check before and after splinting?

Answer 11

Distal circulation, sensation and motion

Circulation (distal pulse and skin color, temperature and condition)

Sensation (Can you tell me where I am touching?)

Motion (Can you wiggle your fingers or toes?)

Question 12

How is cardiac output calculated?

Answer 12

Cardiac output is determined by multiplying heart rate x stroke volume. It is expressed in ml/minute.

Question 13

What is the difference in concept between spinal immobilization and spinal motion restriction?

Answer 13

Spinal motion restriction is the term most commonly used for spinal care provided in the field now. Motion restriction may involve a variety of techniques including placing a c-collar on a patient and placing them on the stretcher (without a backboard). This is a concept rapidly evolving in EMS. Spinal and neurological assessment is vital in this concept. Always follow your local protocols.

Spinal immobilization involves affixing a patient to a short device or KED and/or long spine board. This may still be performed in some patients with suspected spinal injuries (again–follow your protocols). It is used less because of the discomfort and injury caused to patients after prolonged immobilization on rigid devices.

Question 14

What are the physiologic criteria for transport to a trauma center according to the Centers for Disease Control (CDC)?

Answer 14

Glasgow Coma Score less than 14

Systolic blood pressure less than 90 mmHg

Respirations less than 10 and greater than 29 (adult) and less than 20 (infant to one year)

Question 15

What is a greenstick fracture?

Answer 15

A greenstick fracture is an incomplete or partial fracture which usually occurs in children.

This occurs in children as opposed to adults because children’s bones are softer.

Question 16

What are the anatomic criteria for transport to a trauma center according to the Centers for Disease Control (CDC)?

Answer 16

All penetrating injuries to the head, neck, torso and to the extremities proximal to the elbows and knees.
- Flail chest.
- Two or more proximal long bone fractures.
- Crushed, degloved or mangled extremity.
- Amputations proximal to the wrist and ankle.
- Pelvic fractures.
- Open or depressed skull fracture.
- Paralysis.

Question 17

Why may the blood pressure differ between the two arms in an ascending aortic aneurysm?

Answer 17

The blood supply for the head and arms comes from three vessels on the aortic arch. If that vessel is damaged by an aneurysm (either spontaneously or traumatically) it may interfere with blood flow to the arms causing the difference in blood pressure (and sometimes pulse quality).

Question 18

Define: Pulse Pressure

Answer 18

The difference between the systolic and diastolic blood pressures. If a blood pressure is 120/80, the pulse pressure is 40.

Question 19

What is the “Rule of Palm” for burns?

Answer 19

The surface area of the patient’s palm is equivalent to 1% body surface area.

Question 20

Why do patients in shock sometimes experience nausea and vomiting?

Answer 20

Shock diverts blood from the abdomen and gastrointestinal system to more vital areas (e.g. brain, kidneys). This can result in the feelings of nausea and vomiting shock patients sometimes experience.

Question 21

During what portion of the assessment process would you begin c-spine stabilization?

Answer 21

C-spine stabilization is begun in the primary assessment and is performed concurrently with other assessment steps.

Question 22

How do you treat a nosebleed?

Answer 22

Pinch the nostrils together and have the patient lean forward. Do not have the patient lean back or tilt the head back which may cause blood to flow back to the throat.

Question 23

Name two traumatic injuries to the chest that will cause jugular venous distention (JVD).

Answer 23

Tension pneumothorax and cardiac tamponade

Question 24

In what situation can an impaled object be removed?

Answer 24

When an impaled object is in the cheek and is causing an airway problem the object may be removed.

Question 25

What is the difference between a pneumothorax and a tension pneumothorax?

Answer 25

A pneumothorax is a collapse of part of a lung. A tension pneumothorax begins as a pneumothorax but increasing pressure in the thorax becomes severe and causes shock by limiting circulation when compressing the heart and great vessels.

Question 26

What conditions increase the risk of intracranial bleeding?

Answer 26

Patients on blood thinners (Coumadin, warfarin) who experience a head injury have an increased risk of intracranial bleed.

Both geriatric and alcoholic patients undergo a slight shrinking (atrophy) of the brain. This stretches bridging veins that are more easily ruptured during head injury.

Question 27

What are the three components of the Glasgow Coma Score?

Answer 27

Eye opening, verbal response and best motor response.

Question 28

You are splinting a long bone fracture. What must the splint immobilize?

Answer 28

For long bone fractures a splint must immobilize the bone ends and the adjacent joints.

Question 29

List 5 components of a field spinal assessment.

Answer 29

. Assess mechanism of injury.
2. Assess for distracting injuries (e.g. extremity fracture) and intoxication.
3. Assess mental status.
4. Assess for focal neurological deficit (e.g. grip strength).
5. Assess for midline spinal tenderness along the entire length of the spine.

Question 30

Your patient does not have radial pulses but does have a carotid pulse. What is the most likely cause of this?

Answer 30

Shock. It requires more pressure to push blood out to the extremities than it does to create a carotid pulse in the neck.

Question 31

Why do the pulse and respirations increase in shock?

Answer 31

The pulse increases in an attempt to increase cardiac output.

Respirations increase to maximize the oxygenation to tissues.

Both are a result of action by the sympathetic nervous system.

Question 32

How can you tell if a splint has been applied too tightly?

Answer 32

The patient may lose distal pulses, the skin distally may become discolored or cool, and the patient may feel tingling or numbness.

You may also notice that the extremity is swollen and pushing against the straps. Swelling (as a result of the injury) may actually be a cause of the splint becoming too tight.