Penetrating Trauma-Table 1

Question 1

Which of the following statements about low-velocity penetrating trauma is TRUE?

Answer 1

Knives, arrows, ice picks, and similar weapons cause damage only in their direct path.

Question 2

Your patient is an eight-year-old male with a pencil impaled 2 centimeters inferior to the xiphoid process. You note that the pencil is pulsating. Which of the following is the best action?

Answer 2

Stabilize the pencil in place and transport to a trauma center.

Question 3

The pathway of injury left in the wake of a penetrating mechanism of injury is called:

Answer 3

Cavitation

Question 4

The passage through tissue of a high-energy bullet creates a temporary cavity and a permanent cavity. Which of the following statements is TRUE of the permanent cavity created by penetrating trauma?

Answer 4

It is filled with disrupted tissues, some air, fluid, and debris.

Question 5

Which of the following is TRUE of the pressure wave that accompanies high-velocity penetrating trauma?

Answer 5

The pressure wave may be transmitted through blood, resulting in damage to blood vessels some distance from the primary wound.

Question 6

Your patient is a 50-year-old male with a gunshot wound to the right anterior chest. He is unresponsive. Which of the following should you do first?

Answer 6

Check for breathing.

Question 7

Your patient is a 30-year-old female with a stab wound to the neck. She is sitting up and appears very anxious and short of breath. There is minimal external bleeding noted, but there is bubbling from the wound. Which of the following should you suspect, based on the mechanism of injury and assessment findings?

Answer 7

laceration of the trachea

Question 8

If you were to design a bullet to have the highest energy exchange, what would you do?

Answer 8

Design the bullet to become more unstable

Question 9

Which of the following is most important when assessing the damage done by a gunshot?

Answer 9

The distance from the shooter

Question 10

A penetrating injury to which of the following organs is LEAST likely to result in severe hemorrhage?

Answer 10

Ureter

Question 11

Which of the following is TRUE of shotgun ammunition?

Answer 11

A shotgun may either fire one slug or use ammunition with multiple pellets.

Question 12

Which of the following abdominal organs is the least affected by the pressure wave associated with penetrating trauma?

Answer 12

Bowel

Question 13

The study of the characteristics of projectiles in motion and their effects on the objects they impact is called:

Answer 13

Ballistics

Question 14

You have arrived on the scene of a 17-year-old male with a gunshot wound to the thigh. Police are on the scene. There is significant ongoing hemorrhage from the wound. The patient is screaming for someone to help him. Which of the following should you do first?

Answer 14

Ask the police if they have searched the patient for weapons yet.

Question 15

As a bullet tumbles, its potential to inflict damage:

Answer 15

Increases

Question 16

The path a projectile follows during a flight is called its:

Answer 16

Trajectory

Question 17

Which of the following is TRUE of body armor use?

Answer 17

Blunt trauma may be significant, but the potential for life-threatening injury is less than if armor had not been worn.

Question 18

Which of the following is most susceptible to damage from the pressure wave when a bullet enters it?

Answer 18

Liver

Question 19

Which of the following is TRUE about determining the pathway of the bullet when assessing a patient with a gunshot wound?

Answer 19

A. You should try to determine the bullet’s pathway. B. The purpose of determining the bullet’s pathway is to anticipate which organs may have been affected, which will help to guide your priorities for on-scene care or rapid transport. C. It is difficult to determine the pathway of a bullet because it may not travel in a straight line, possibly being deflected by structures in its path or being shifted by natural movements of the diaphragm and other organs and structures of the body. D. ALL OF THE ABOVE

Question 20

Which statement about ballistics is TRUE?

Answer 20

When a bullet yaws, it increases the damage.

Question 21

When you are assessing someone with a gunshot wound from a rifle, which of the following is important to remember?

Answer 21

The zone of injury is larger than that expected with other types of weapons.

Question 22

Which of the following is typical of the trajectory of a knife when a female assailant stabs someone?

Answer 22

The movement is downward as the assailant raises the knife and swings downward.



Question 23

Greater velocity of a bullet will cause a ________ path of travel and a ________ trajectory.

Answer 23

Flatter, straighter

Question 24

Which of the following is TRUE of the temporary cavity formed by penetrating trauma?

Answer 24

It is a space indirectly created by a projectile as tissue moves rapidly away from its path.

Question 25

Which of the following is TRUE of defense wounds in the victim of a knife attack?

Answer 25

They usually occur to the hands and arms as the victim raises them to ward off the attacker.

Question 26

To gain an appreciation for the potential for trauma from high-velocity projectiles, it is important to remember that the shock wave produced can exceed atmospheric pressure by up to ________ times.

Answer 26

100

Question 27

Which of the following is associated with assault rifle wounds but not hunting rifle wounds?

Answer 27

Multiple wounds

Question 28

Which of the following statements about bullets is TRUE?

Answer 28

A small, light bullet does the most harm.

Question 29

During the scene size-up on a call for a patient with penetrating trauma due to a stab wound, which of the following should you do?

Answer 29

Check for weapons on or near the patient.

Question 30

Which of the following statements about stab wounds is true?

Answer 30

Damage is usually limited to physical injury caused by direct contact between the blade and the victim’s tissue.

Question 31

Which of the following statements about entrance and exit wounds is TRUE?

Answer 31

Only a thorough forensic examination by a qualified expert can determine with certainty whether a given wound is an entrance wound or an exit wound.

Question 32

Which of the following organs would be most likely to be injured by a stab wound to the sixth intercostal space in the midaxillary line on the right side?

Answer 32

Liver, diaphragm, lung, kidney

Question 33

Which of the following is best described as “the area of contused tissue resulting from penetrating trauma that may be slow to heal due to disrupted blood flow and tissue damage”?

Answer 33

Zone of injury

Question 34

Penetrating trauma to the face can complicate airway management by which of the following mechanisms?

Answer 34

Both: B. Airway obstruction and C. Destruction of anatomical landmarks

Question 35

The initial assessment of a patient with a gunshot wound to the chest should focus on detecting which of the following?

Answer 35

Tension pneumothorax

Question 36

Which two factors related to kinetic energy proportionately affect the damage a projectile will do?

Answer 36

Velocity and mass

Question 37

Which type of firearm usually limits trauma to direct injury?

Answer 37

Handgun

Question 38

Your patient is a construction worker who fell 15 feet and has a 3-foot metal concrete reinforcement bar (rebar) impaled in his right thigh. Which of the following is the best action?

Answer 38

If the proper tools and personnel are present, have rescuers cut the rebar to a manageable length.

Question 39

Which of the following bullet characteristics would create the most damage?

Answer 39

“Mushrooming” or flattening on impact

Question 40

As the mass of an object increases, which of the following occurs?

Answer 40

The amount of energy increases.

Question 41

Your patient is a 60-year-old male with a gunshot wound in the second intercostal space anteriorly on the left. You note that he has frothy blood coming from his mouth. For which of the following must you have the highest index of suspicion?

Answer 41

Tension pneumothorax

Question 42

Which of the following statements about rifles is TRUE?

Answer 42

Assault rifles generally increase the number of wounds the victim sustains.

Question 43

Your patient has a gunshot wound to the left posterior thorax. Which of the following is NOT appropriate in initial assessment?

Answer 43

Auscultating breath sounds bilaterally in six places, anteriorly and posteriorly

Question 44

Which of the following is NOT considered penetrating trauma?

Answer 44

A laceration on the forehead as a result of being struck with a metal pipe

Question 45

Which of the following increases a bullet’s profile?

Answer 45

A and C: Mushrooming on impact and tumbling 180 degrees on impact

Question 46

As the energy from a medium- or high-velocity projectile pushes tissue from its path, which of the following occurs?

Answer 46

Negative pressure is generated inside the cavity, drawing debris into the wound.

Question 47

Which of the following is most likely to occur when military ammunition is used?

Answer 47

It will remain intact.

Question 48

Which of the following is considered a high-velocity weapon?

Answer 48

Rifle