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MFP102 > TCCC Final Review - CMS Quiz 2 > Flashcards

TCCC Final Review - CMS Quiz 2 Flashcards

1
Q

There are no appropriate supraglottic devices for children
True
False

A

False

Pg 143-144

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2
Q

A patient with chest trauma is hypotensive on presentation and c/o shortness of breath
(SOB). Exam reveals jugular venous distension (JVD), tracheal deviation, and decreased
breath sounds associated with hyperresonance to percussion on one side of his chest. Other
than providing O2, starting IVs, and placing the patient on a cardiac monitor, what is the most
appropriate initial therapy for this patient?
A. Tube thoracostomy
B. Needle thoracostomy
C. Intubation
D. Pericardiocentesis

A

B. Needle thoracostomy

Pg 300-303

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3
Q

You have intubated a casualty and are transporting them to the hospital. You have been using continuous capnography, and note that the patient has a sudden drop in their expired CO2. All of the following are possible causes of this EXCEPT:
A. The patient has been receiving too much
oxygen, so they are breathing slower.
B. The endotracheal tube has become
dislodged from the casualty’s airway.
C. The ventilator circuit has become
disconnected from the patient.
D. The casualty’s perfusion has decreased
significantly.

A

A. The patient has been receiving too much
oxygen, so they are breathing slower.
Pg 156

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4
Q

Which of the following statements regarding cardiac tamponade is inaccurate?
A. It is most commonly caused by blunt chest
trauma
B. It can manifest as PEA (Pulseless Electrical Activity)
C. Initial therapy is with IV fluids and pericardiocentesis
D. Clinical findings include hypotension,
jugular venous distension (JVD), pulsus
paradoxis, and muffled heart tones

A

A. It is most commonly caused by blunt chest
trauma
Pg 305-6

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5
Q

Splinting and immobilization of bone fractures reduces pain and promotes healing. While
immobilization of long-bone fractures (ie, femur, tibia, humerus) are relatively straightforward,
immobilization of rib fractures is difficult. A tight ACE-wrap around the chest or firm tight
taping is the best treatment of rib fractures.
True
False

A

False

Pg 297

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6
Q

Airway and ventilation are among the most important components of prehospital casualty
care. Even if oxygenation is adequate (i.e. pulse oximetry reading of 100% with supplemental
oxygen), failure to address ventilation [eg, removal of carbon dioxide] can lead to death.
True
False

A

True

Pg 134, 136-8

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7
Q

The Laryngeal Mask Airway prevents aspiration of gastric contents.
True
False

A

False

Pg 151

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8
Q 
In an average adult during resting ventilation, what is the average tidal volume?
A. 150 ml 
B. 1000 ml
C. 500 ml 
D. 7000 ml
A

C. 500 ml

Pg 136

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9
Q

Flail chest occurs when two or more adjacent ribs are fractured in more than one place along
their length. All of the following are appropriate management strategies except:
A. Pain relief with IV morphine; an
appropriate initial dose would be 5-10 mg IV.
B. Administration of supplemental oxygen
C. Close monitoring of respiratory status, with
consideration of BVM assistance or
endotracheal intubation should respiratory
distress develop.
D. Emperic bolus of IV fluids, since the force
necessary to produce such a lesion is
typically associated with other significant
injuries.

A

D. Emperic bolus of IV fluids, since the force
necessary to produce such a lesion is
typically associated with other significant
injuries.
Pg 297-8

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10
Q 
Which is true regarding the "sniffing position" to facilitate endotracheal intubation?
A. It is used exclusively for awake
nasotracheal intubations
B. It has been repeatedly shown to be
ineffective for non-trauma patients
C. It hyperextends the neck at C1-C2, and
hyperflexes it at C5-C6 (both common
fracture sites) and should not be used for
trauma patients
D. It improves anatomic alignment, and
should be used for all rapid sequence
intubations
A

C. It hyperextends the neck at C1-C2, and
hyperflexes it at C5-C6 (both common
fracture sites) and should not be used for
trauma patients
Pg 145-6, 148

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11
Q

Which of the following devices delivers the highest concentration of oxygen to a patient?
A. Simple face mask
B. Bag-mask with reservoir
C. Nasal cannula
D. Non-rebreather mask with reservoir
E. A non-rebreather with reservoir and a bagmask with reservoir deliver about the same
oxygen concentration

A

E. A non-rebreather with reservoir and a bagmask with reservoir deliver about the same
oxygen concentration
Pg 153 Figure 7-23

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12
Q

In a civilian urban environment, endotracheal intubation has been the preferred method for
achieving maximum control of the airway in trauma casualties who are either apneic or
require assisted ventilations. Critically injured trauma casualties have a better outcome with
endotracheal intubation by prehospital providers, when compared to those who are
transported with only BVM (bag-valve-mask) and OPA (oropharyngeal airway).
True
False

A

False

Pg 144, 157

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13
Q

Casualties with suspected intrathoracic, intraabdominal, or retroperitoneal hemorrhage
should be maintained with SBP in the range of 80 to 90 mmHg during prehospital transport.
Overaggressive volume resuscitation may significantly worsen pulmonary contusions, as well as lead to recurrent internal hemorrhage.
True
False

A

True

Pg 311

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14
Q 
The components of Beck's Triad include all of the following except?
A. Pulsus paradoxus
B. Hypotension
C. Jugular Venous Distension (JVD) 
D. Muffled heart tones
A

A. Pulsus paradoxus

Pg 306

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15
Q

All of the following cardiac injuries are associated with blunt force to the anterior chest EXCEPT?
A. blunt cardiac rupture
B. valvular rupture
C. commotio cordis
D. cardiac contusion
E. All of the following are associated with
blunt injury to the anterior chest

A

E. All of the following are associated with
blunt injury to the anterior chest
Pg 304-6

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16
Q

Which of the following is NOT an indication for intubation?
A. Casualty requiring assisted ventilation
B. Casualty with significant oxygenation problem
C. Severely depressed level of consciousness
D. Casualty who is able to protect his/her own
airway

A

D. Casualty who is able to protect his/her own
airway
Pg 145

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17
Q

Management of the airway in civilian trauma casualties takes precedence over all other
procedures because without an adequate airway, a positive outcome cannot be achieved.
Advanced airway interventions such as intubation or cricothyrotomy may not always be
immediately required or necessary, though – in most casualties, basic-level procedures may
be sufficient initially [i.e. manual clearing of foreign bodies from the airway, jaw thrust, chin
lift, suctioning, oropharyngeal or nasopharyngeal airways].
True
False

A

True

Pg 139-142

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18
Q

A patient has sustained a penetrating chest wound to the anterior right chest. It is
approximately 2 cm in diameter. There is moderate bleeding that does not appear to be
arterial. There are also air bubbles coming from the wound when the patient exhales. The
most appropriate immediate course of action is to:
A. Insert a chest tube in the 2nd intercostal
space, anterior axillary line
B. Construct an occlusive dressing and
observe for signs of a tension pneumothorax
C. Apply a pressure dressing over the wound
D. Perform a needle decompression on the
posterior left chest
E. Insert a chest tube through the wound

A

B. Construct an occlusive dressing and
observe for signs of a tension pneumothorax
Pg 299-300

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19
Q

You are dispatched to a motor vehicle crash. On arrival, you observe that an SUV truck has
struck a tree on the driver’s side, which has sustained substantial damage. The driver of the
SUV, a 30 y/o male, is unresponsive (GCS=4) and has periorbital ecchymosis. You observe
bleeding from both nares and the right ear. Frequent suctioning is required to maintain a
patent airway, and no gag reflex is noted. Ventilations are irregular, and snoring sounds are audible. The patient’s skin is pale, and cyanosis is present around the lips. What indicators for endotracheal intubation are evident in this patient? [check all that apply]
A. physical exam findings that suggest a
basilar skull fracture
B. perioral cyanosis
C. unresponsive (GCS of 4)
D. sonorous and irregular ventilations
E. requirement for frequent suctioning

A 
B. perioral cyanosis 
C. unresponsive (GCS of 4)
D. sonorous and irregular ventilations 
E. requirement for frequent suctioning
Pg 145
20
Q 
In which of the following patients is a head-tilt chin-lift NOT an acceptable maneuver to open
the airway (choose all that apply)?
A. Single gunshot wound to the thigh 
B. High-speed single-car motor vehicle crash
into a guardrail
C. Blast Injury from an IED with diffuse
injuries
D. Stab wound to the left flan
A 
B. High-speed single-car motor vehicle crash
into a guardrail
C. Blast Injury from an IED with diffuse
injuries
Pg 141
21
Q

Who is statistically more likely to successfully perform an orotracheal intubation?
A. A paramedic who has been appropriately
trained for orotracheal intubation, has been
practicing for 5 years, and has performed 60
intubations on casualties.
B. An MS-1 USU student who has completed
the Combat Medical Skills course and has
intubated 5 mannequins.
C. A paramedic who has been appropriately
trained for orotracheal intubation, has been
practicing for 10 years, and has performed 40
intubations on casualties.

A

A. A paramedic who has been appropriately
trained for orotracheal intubation, has been
practicing for 5 years, and has performed 60
intubations on casualties.
Pg 145

22
Q

You are on the scene of a motor vehicle collision where a colleague intubates a critically ill patient. She asks about confirming endotracheal tube placement. Which of the following is the most appropriate advice?
A. No confirmation of placement is required
for patients less than 50 years old with no
known cardiac disease
B. When the provider is pretty sure she saw
the ET tube pass through the vocal cords, no
further confirmation is necessary
C. For unstable patients, it is okay to wait to
confirm ET tube placement until the patient
has been transferred to a higher level of care
D. ET tube placement should always be
confirmed with multiple assessments
immediately after placement

A

D. ET tube placement should always be
confirmed with multiple assessments
immediately after placement
Pg 149

23
Q

A penetrating chest wound is called a “sucking chest wound” when:
A. Air is sucked into and pushed out of the
pleural space with ventilatory effort
B. Air leaks out of the lung into the pleural
space during inspiration causing a sucking
sound
C. The patient makes a sucking sound with
his mouth while trying to breathe following a
chest injury
D. All of the above
E. None of the above

A

A. Air is sucked into and pushed out of the
pleural space with ventilatory effort
Pg 299

24
Q

All of the following statements regarding pulmonary contusions are accurate except:
A. Support of ventilation with BVM and
endotracheal intubation may be necessary
B. Associated rib fractures may be present
C. Aggresive IV fluid replacement is the
preferred therapy
D. It is almost always present with a flail
segment
E. Blood and edema fluid interfere with gas
exchange

A

C. Aggresive IV fluid replacement is the
preferred therapy
Pg 298

25
Q

What is the preferred method for determining the proper size for an oro-pharyngeal airway
(OPA)?
A. Use the diameter of the casualty’s little
finger
B. Distance from the corner of the casualty’s
mouth to the ear lobe
C. Use an age chart to determine the best
size
D. Distance from the casualty’s nose to his
ear lobe
E. Distance from front teeth to the mentum

A

B. Distance from the corner of the casualty’s
mouth to the ear lobe
Pg 160

26
Q

All of the following are contraindications to placement of a supraglottic airway EXCEPT:
A. Recent ingestion of caustic substances
B. Known esophageal disease
C. Intact gag reflex
D. Hypoxia

A

D. Hypoxia

Pg 144

27
Q

Considering blind nasotracheal intubation (BNTI), which of the following is false?
A. Midface trauma has been suggested as a
contraindication to BNTI in many texts
B. No stylet is used when BNTI is performed.
C. Blind nasotracheal intubation (BNTI) is
more difficult to perform than orotracheal
intubation.
D. BNTI is especially effective in apneic
patients

A

D. BNTI is especially effective in apneic
patients
Pg 146-7

28
Q

A patient with a gunshot wound to the chest is anxious, hypotensive, and breathing rapidly.
When you listen to his chest you hear breath sounds on the right but not on the left. Your
immediate course of action is to:
A. Start two large-bore IVs of Lactated
Ringers
B. Perform needle decompression at the
second intercostal space on the affected side
C. Apply an occlusive dressing over the
wound
D. Determine the severity of the injury by
evacuating the casualty for a chest x-ray
E. Look for other injuries

A

B. Perform needle decompression at the
second intercostal space on the affected side
Pg 300-302

29
Q 
Which of the following medications should be considered for young children, but not adults,
during rapid-sequence intubation?
A. Etomidate
B. Atropine
C. Midazolam 
D. Succinycholine
A

B. Atropine

Pg 141

30
Q 
Which of the following would be MOST likely to cause erroneous SpO2 measurements when
using a pulse oximeter?
A. Sensor placement on an extremity 
B. Poor casualty perfusion
C. Vasoconstriction from a hyperthermic
patient
D. Elevated PaCO2 levels
A

B. Poor casualty perfusion

Pg 154-55

31
Q

What is the preferred method to determine the proper size for a nasopharyngeal airway
(NPA)?
A. Use the diameter of the casualty’s index
finger
B. Distance from the casualty’s nose to his
ear lobe
C. Distance from the corner of the casualty’s
mouth to the ear lobe
D. Use an age chart
E. Distance from front teeth to the mentum

A

B. Distance from the casualty’s nose to his
ear lobe
Pg 162

32
Q

Once intubation has been performed, you take measures to ensure that the tube has been
properly placed in the trachea. Which of the following assessments indicate the tube is in
place? (check all that apply)
A. Fogging in the tube
B. You directly visualized the ET tube passing
through the vocal cords
C. End-tidal CO2 monitor/colorimetric CO2
indicator
D. Presence of breath sounds over the
epigastrium
E. Visualization of the chest rising and falling

A

A, B, C, E

Pg 148-50

33
Q

Which of the following is a contraindication to placement of an oropharyngeal airway?
A. Significant facial trauma
B. Significant blood in oropharynx preventing
direct visualization
C. The patient is semi-conscious
D. The patient already has an endotracheal
airway

A

C. The patient is semi-conscious

Pg 143

34
Q

Which of the following injury mechanisms is most likely to result in a traumatic aortic
disruption?
A. A single stab wound to the right, upper
chest
B. A motor vehicle collision, in which the
patient’s vehicle was struck by another
vehicle perpendicularly on the passenger’s
door (T-bone)
C. A high-speed MVC in which the patient’s
vehicle hits a bus in a head-on collision
D. A stab wound to the left upper back

A

C. A high-speed MVC in which the patient’s
vehicle hits a bus in a head-on collision
Pg 307

35
Q

Which of the following is NOT a potential complication of Positive End-Expiratory Pressure (PEEP)?
A. Decrease in ability to provide adequate
oxygenation
B. Decrease in cardiac pre-load (blood
returning to heart)
C. Decrease blood pressure
D. Elevation of intracranial pressure

A

A. Decrease in ability to provide adequate
oxygenation
Pg 153-54

36
Q

Penetrating trauma to the chest may result in hemothorax. Each pleural space can
accommodate approximately what volume of blood?
A. 3,000 ml
B. 4,000 ml
C. 1,000 ml
D. 2,000 ml

A

D. 2,000 ml

Pg 137-38, 150

37
Q 
In a pre-hospital setting, effective ventilation of a patient is BEST monitored by:
A. Pulse Oximetry 
B. Arterial oxygen levels
C. Venous CO2 levels 
D. Respiratory Capnography
A

D. Respiratory Capnography

Pg 137-38, 150

38
Q

Match the type of pneumothorax with its description:
1. Simple pneumothorax
2. Open pneumothorax
3. Tension pneumothorax
A. A defect in the chest wall that allows air to
enter and exit the pleural space from the
outside without ventilatory effort.
B. Air entering the pleural space has no
avenue for egress, resulting in increasing
pressure within the pleural space and
compromising circulatory function.
C. Presence of air within the pleural space.
As the amount of air in the pleural space
increases, the lung on that side collapses.

A

1:C, 2:A, 3:B

39
Q

Treatment options for a pneumothorax may include all of the following (choose all that apply):
A. needle decompression
B. tube thoracostomy
C. supplemental oxygen
D. rapid transport to receiving emergency
department; if you are functioning at the
Basic Life Support (BLS) level, consider
rendezvous with an Advanced Life Support
(ALS) unit

A

A,B,C,D

Pg 299-303

40
Q

What are the critical steps and sequence in performing Rapid Sequence Intubation in an
adult?
A. Pre-oxygenate with 100% O2, administer a
sedative, administer a paralytic agent, Insert
ET tube
B. Pre-oxygenate with 100% O2, administer a
sedative, administer a paralytic agent, Insert
ET tube, confirm ET tube placement
C. Pre-oxygenate with 100% O2, administer
an analgesic, administer atropine, Insert ET
tube, confirm ET tube placement
D. Pre-oxygenate with 100% O2, administer a
paralytic agent, Insert ET tube, confirm ET
tube placement, administer a sedative agent

A

B. Pre-oxygenate with 100% O2, administer a
sedative, administer a paralytic agent, Insert
ET tube, confirm ET tube placement
Pg 149

41
Q 
Beck's triad is a constellation of findings that suggest cardiac tamponade. Which of the
following is NOT part of Beck's triad?
A. Muffled heart sounds
B. Altered mental status
C. Hypotension
D. Jugular venous distention
A

B. Altered mental status

Pg 306

42
Q

The most correct location to insert a needle (or catheter over needle) to relieve a tension
pneumothorax is:
A. 2nd intercostal space, anterior axillary line
B. 2nd intercostal space, mid-clavicular line
C. 4th intercostal space, mid-clavicular line
D. 5th intercostal space, anterior axillary line
E. 5th intercostal space, mid-clavicular line

A

B. 2nd intercostal space, mid-clavicular line

Pg 315

43
Q 
A patient with decreased minute-volume during respiration will initially develop?
A. Anoxia 
B. Hypercarbia
C. Hypocarbia
D. Hypoxia
A

B. Hypercarbia

Pg 136-37

44
Q 
Extended suctioning in a patient with significant secretions can lead to which complication?
A. Bradycardia 
B. Pneumothorax
C. Alkalosis 
D. Decreased intracranial pressure (ICP)
A

A. Bradycardia

Pg 141

45
Q

In the civilian prehospital setting, if there is an anticipated difficult airway (such as massive
midface trauma), surgical cricothyrotomy should be the initial airway control method.
True
False

A

False

Pg 152

46
Q

For a pre-hospital provider who does not have adequate advanced airway skills [i.e. s/he
does not know how to intubate], what is the preferred airway management methodology IAW the PHTLS airway protocols for a casualty that requires advanced airway management?
A. Orotracheal intubation
B. Laryngeal Mask Airway
C. Nasotracheal intubation
D. Bag-valve mask assisted ventilation
E. Cricothyroidotomy

A

D. Bag-valve mask assisted ventilation

Pg 140

47
Q

Which of the following is considered the “gold standard” for determining ET tube placement in
a casualty with a perfusing cardiac rhythm?
A. Presence of bilateral breath sounds
(auscultate laterally below the axilla) and
absence of air sounds over the epigastrium.
B. Fogging (water vapor condensation) in the
ET tube on expiration
C. Visualization of the chest rising and falling
during ventilation.
D. Direct visualization of the ET tube passing
through the vocal cords.
E. End-tidal CO2 monitoring (capnography).

A

E. End-tidal CO2 monitoring (capnography).

Pg 150

MFP102 (5 decks)

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