TCCC Final Review - CMS Quiz 2 Flashcards
There are no appropriate supraglottic devices for children
True
False
False
Pg 143-144
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
B. Needle thoracostomy
Pg 300-303
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. The patient has been receiving too much
oxygen, so they are breathing slower.
Pg 156
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. It is most commonly caused by blunt chest
trauma
Pg 305-6
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
False
Pg 297
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
True
Pg 134, 136-8
The Laryngeal Mask Airway prevents aspiration of gastric contents.
True
False
False
Pg 151
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
C. 500 ml
Pg 136
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.
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
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
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
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
E. A non-rebreather with reservoir and a bagmask with reservoir deliver about the same
oxygen concentration
Pg 153 Figure 7-23
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
False
Pg 144, 157
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
True
Pg 311
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. Pulsus paradoxus
Pg 306
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
E. All of the following are associated with
blunt injury to the anterior chest
Pg 304-6
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
D. Casualty who is able to protect his/her own
airway
Pg 145
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
True
Pg 139-142
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
B. Construct an occlusive dressing and
observe for signs of a tension pneumothorax
Pg 299-300
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
B. perioral cyanosis C. unresponsive (GCS of 4) D. sonorous and irregular ventilations E. requirement for frequent suctioning Pg 145
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
B. High-speed single-car motor vehicle crash into a guardrail C. Blast Injury from an IED with diffuse injuries Pg 141
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 paramedic who has been appropriately
trained for orotracheal intubation, has been
practicing for 5 years, and has performed 60
intubations on casualties.
Pg 145
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
D. ET tube placement should always be
confirmed with multiple assessments
immediately after placement
Pg 149
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. Air is sucked into and pushed out of the
pleural space with ventilatory effort
Pg 299
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
C. Aggresive IV fluid replacement is the
preferred therapy
Pg 298
