TCCC Final Review - CMS Quiz 4 Flashcards by Krista Moore

A patient is found down after being hit in the head with a baseball bat; he has limited
responsiveness and the on-site EMS team tells you he has been having DECEREBRATE
posturing. On exam, you would expect him to be exhibiting?
A. Flexion of upper extremities
B. Weak upper extremities but strong lower
extremities
C. Focal seizure activity of one extremity
D. Extension of upper extremities

D. Extension of upper extremities

Pg 225

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The leading cause of traumatic brain injury (TBI) in those under 65 years old is \_\_\_\_\_; in the
elderly, the leading cause is \_\_\_\_\_.
A. MVC; Falls 
B. Falls; MVC 
C. MVC; MVC
D. Gunshot wounds; Gunshot wounds 
E. Falls;Falls

A. MVC; Falls

Pg 218

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You are caring for an aviator who was playing baseball and was hit in the head by a line
drive. Bystanders noted that he did NOT lose consciousness, but was reported to have been
“dazed”. On examination, the pilot tells you he cannot recall any of the events from the
accident and doesn’t even remember coming to the hospital. His squadron commander
wants to know if he has had a concussion. You inform him that the HALLMARK finding for
the diagnosis of concussion is?
A. Loss of consciousness
B. Disorientation
C. Post-traumatic amnesia
D. Confusion

C. Post-traumatic amnesia

Pg 233

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A patient must have a loss of consciousness to be diagnosed with a concussion?
True
False

False

Pg 233

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You are a GMO physician caring for a 22 year-old soldier injured by an IED blast. The
helicopters are en route to transfer the patient from your Battalion Aid Station to a level III
facility in theater. You suspect severe traumatic brain injury. He begins having changes to his
physical exam. Which of the following physical findings are associated with herniation (check
all that apply):
A. Cheyne-Stokes ventilation
B. Consistently rapid, deep breaths
C. Decorticate posturing
D. A unilateral enlarged pupil
E. Increased verbalizations
F. Greatly increased blood pressure with
bradycardia

A,B,C,D,F

Pg 225

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How does hyperventilating a patient reduce intracranial pressure?
A. Decreases arterial O2 levels: reducing free
radical production and apoptosis
B. Decreases arterial CO2 levels; leading to
cerebral artery vasoconstriction
C. Decreases arterial CO2; leading to
cerebral artery vasodilatation
D. Increases arterial O2 levels; leading to
increased oxygen supply to the brain

B. Decreases arterial CO2 levels; leading to
cerebral artery vasoconstriction
Pg 222-223

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According to the national Traumatic Brain Injury (TBI) database, the two most significant
predictors of poor outcome from TBI are the amount of time spent with an ICP greater than
20mmHg, and hypotension. A single episode of a Systolic Blood Pressure (SBP) less than
________ mmHg significantly increases the likelihood of a poor outcome in a TBI patient.
A. 110 mmHg
B. 90 mmHg
C. 80 mmHg
D. 100 mmHg

B. 90 mmHg

Pg 226

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A bicycle rider cutting through a neighbor’s back yard ran into a clothes line, which struck him in the neck. The patient arrives complaining of dyspnea and difficulty speaking (and a lower tone of his voice). On exam you note prominent neck contusion and subcutaneous emphysema. The patient now begins to have further deterioration in their respiratory status.
True/False: The most appropriate airway intervention at this time would be immediate endotracheal intubation; you want to definitively secure the airway before they develop frank respiratory failure.
True
False

False

Pg 32

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Which of the following are neurologic changes associated with concussion? (check all that
apply)
A. delayed verbal and motor responses 
B. slurred or incoherent speech
C. disorientation
D. Vomiting
E. inability to memorize and recall 
F. post-traumatic amnesia

A,B,C,D,E,F

Pg 233

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You are dispatched to the scene of an accident. A teenager fell out of a second story
townhouse window; he had been drinking (alcohol) and lost his balance. He landed on a
concrete sidewalk. Bystanders noted a 10-minute loss of consciousness, but he was awake by the time you arrived and had a GCS of 14 (some confusion as he attempts to answer
questions). His heart rate is 120 bpm, vital signs otherwise normal. He has a 10-cm laceration to the right side of his scalp; bleeding is controlled with direct pressure. He follows commands, but does not recall the events leading up to the fall. You place him in spinal immobilization (C-collar and backboard). En-route to the ER, he has a decline in his mental status and level of responsiveness – now he is only speaking incomprehensible words, opens his eyes spontaneously, and withdraws from pain. What injury is most likely given the casualty’s presenting signs?
A. cerebral concussion
B. acute alcohol intoxication
C. cervical spine fracture
D. epidural hematoma
E. brain death
F. subdural hematoma

D. epidural hematoma

Pg 218, 233-241

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An intubated TBI casualty has a blood pressure of 100/50, HR 110, oxygen saturation of
100%, and temperature of 96.9. They withdraw from pain and have no eye opening. How
would you report their GCS score?
A. 5 
B. 5T
C. 6 
D. 6T
E. 7 
F. 7T
G. 8 
H. 8T

B. 5T

Pg 228

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You are dispatched to the scene of an accident. A teenager fell out of a second story
townhouse window; he had been drinking and lost his balance. He landed on a concrete
sidewalk. Bystanders noted a 10-minute loss of consciousness, but he was awake by the
time you arrived and had a GCS of 14 (some confusion as he attempts to answer questions).
His heart rate is 120 bpm, vital signs otherwise normal. He has a 10-cm laceration to the right
side of his scalp; bleeding is controlled with direct pressure. He follows commands, but does
not recall the events leading up to the fall. You place him in spinal immobilization (C-collar
and backboard). En-route to the ER, he has a decline in his mental status and level of
responsiveness – now he is only making incomprehensible noises, opens his eyes only to
painful stimuli, and withdraws from pain. What is his current GCS?
A. 3
B. 4
C. 5
D. 6
E. 7
F. 8
G. 9
H. 10
I. 11
J. 12
K. 13
L. 14
M. 15

F. 8

Pg 228

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Possible interventions that may help acutely control/manage increased intracranial pressure
include the following: (check all that apply)
A. chemical paralysis
B. sedation 
C. controlled hyperventilation
D. controlled hypoglycemia 
E. application of PASG/MAST trousers 
F. osmotherapy (such as mannitol)

A,B,C,F

Pg 238

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In the casualty with traumatic brain injury, which of the following can contribute to secondary
brain injury? (check all that apply)
A. hematoma
B. hypoxia 
C. hypotension
D. cerebral edema
E. hypoglycemia

A,B,C,D,E

Pg 223-27

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Which of the following is NOT considered to increase risk for secondary brain injury?
A. Hypothermia 
B. Hypotension
C. Hematoma
D. Hypoxia

A. Hypothermia

Pg 223

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A patient’s blood pressure is 150/90. Their intracranial pressure is elevated at 30 mmHg.
Their cerebral perfusion pressure (CPP) is ____.

80
Pg 222
BP 150/90, so MAP is 110.
CPP = MAP - ICP = 110 - 30 = 80

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According to the Trauma Coma Data Bank, the presence of which of the following types of
intracranial hemorrhage DOUBLES the incidence of death in Traumatic Brain Injury patients?
A. Intracerebral hemorrhage
B. Subarachnoid hemorrhage
C. Subdural hemorrhage
D. Epidural hemorrhage

B. Subarachnoid hemorrhage

Pg 235

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Use of Positive End Expiratory Pressure (PEEP) valves on patients with Traumatic Brain
Injury (TBI) has been proven to be helpful in maintaining oxygenation. However, PEEP
greater than ________ can cause a dangerous raise in intracranial pressure.
A. 20 cmH20
B. 15 cmH20
C. 5 cmH20
D. 10 cmH20

B. 15 cmH20

Pg 236

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Intubation should be considered in TBI casualties with a GCS of 8 or less.
True
False

True

Pg 236

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You are examining a 22-year-old man who just had a serious fall onto his face. While
examining
him, it is difficult to palpate his jaw secondary to his severe pain and swelling. Which of the
following is the most common complaint of patient’s with a mandibular fracture?
A. Epistaxis (nose bleed)
B. Dyspnea (difficulty breathing)
C. Malocclusion of the teeth
D. Lost teeth

C. Malocclusion of the teeth

Pg 232

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An 82 y.o male presents to your clinic with his wife because she fears he has had a stroke.
On history you note that he complains of a worsening headache and blurred vision; on exam his is lethargic and has weakness on his right side. In discussion with his wife, you find he had a fall 10 days ago and hit his head. She says he did not lose consciousness and was
“OK” after the fall. Which of the following is the MOST likely diagnosis?
A. Epidural hemorrhage
B. Subdural hemorrhage
C. Intracerebral hemorrhage
D. Subarachnoid hemorrhage

B. Subdural hemorrhage

Pg 234-5

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Match the area of the brain with its function:

Frontal
Parietal
Temporal
Occipital
Brainstem
Cerebellum F. vision

A. sensory function and spatial orientation
B. coordination and balance
C. cardiorespiratory; reticular activating system
D. certain memory functions; speech reception and integration
E. emotions, motor function, expression of
speech on the dominant side

1:E, 2:A, 3:D, 4:F, 5:C, 6:B

Pg 220

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You are caring for a sailor who was playing baseball and was hit in the head by a line
drive. Bystanders noted helost consciousness for a few minutes. On your arrival he is alert
and lucid, and simply reports to “feeling dazed.” During transport, he becomes less
responsive and his Glasgow Coma Scale score is dropping. You suspect the underlying
pathology is a pure space-occupying lesion. When you radio theEmergency Department,
the receiving nurse asks which injury you think he has. While the patient’s exact diagnosis
cannot be known without imaging, what is most likely based on this classic history.
A. Subdural hemorrhage
B. Epidural hemorrhage
C. Subarachnoid hemorrhage
D. Intracerebral hemorrhage

B. Epidural hemorrhage

Pg 233-34

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While transporting a patient who was involved in an aircraft crash, you notice he is beginning
to develop stridorous respirations and respiratory distress. A quick re-examination reveals he
has a neck contusion, loss of the prominence of the thyroid cartilage, and subcutaneous
emphysema (air under the skin) in his neck. Fearing your patient is near respiratory arrest,
which of the following would be the BEST way to secure and protect his airway?
A. Cricothyrotomy
B. oropharyngeal airway
C. Allow the patient to sit in the position of
comfort
D. Endotracheal intubation

A. Cricothyrotomy

Pg 232

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``` While rounding on the Trauma Service as a fourth year medical student, the surgery resident attempts to throw you off by stating “this patient has a craniofacial dysjunction injury”. Being a superior USUHS student, you astutely inform him the eponym is a _____? A. Salter-Harris III fracture B. LeFort III fracture C. Jeffersonian fracture D. Lis-Franc fracture ```

B. LeFort III fracture | Pg 231-2

You are taking care of a patient who fell from wing of a C-130 to the tarmac below. He was not wearing a helmet and has signs of a head injury. You visit the patient a few hours later in the hospital. Which of the following physical findings indicate he suffered a basilar skull fracture? (check all that apply) A. Periorbital eccymosis B. A palpable depression at his R frontal skull C. Nasal fracture D. Bruising to his mastoid areas E. CSF draining from his ear canals

A. Periorbital eccymosis D. Bruising to his mastoid areas E. CSF draining from his ear canals Pg 230

``` What type of posturing does this drawing demonstrate? A. demobilized B. demotion C. decorticate D. decerebrate ```

C. decorticate | Pg 225

You are caring for a 23-year-old woman who was struck in the orbit by a line-drive at a squadron softball game. Her left eye is injured. You consider a differential of possible eye injuries. While you should always treat eye injuries gently, which of the following injury descriptions mandates that you do NOT apply any pressure to the globe? A. She has a disruption of the corneal epithelium that is very painful B. She has blood in the anterior chamber of her globe between her iris and cornea C. She has a scleral defect with expulsion of a small amount of intraocular contents D. She has a laceration through the tarsal plate of her left upper eyelid

C. She has a scleral defect with expulsion of a small amount of intraocular contents Pg 230-1

Match the term with its most appropriate description/definition: A. flexion of the upper extremities, and rigidity and extension of the lower extremities B. all extremities are extended, and arching of the spine may occur C. a repeating cycle of slow, shallow breaths that become deeper and more rapid, then return to slow, shallow breaths; brief periods of apnea may occur between cycles D. erratic ventilatory efforts that lack any discernible pattern E. consistently rapid, deep breaths F. greatly increased arterial blood pressure and bradycardia 1. Cheyne-Stokes ventilations 2. Central neurogenic hyperventilation 3. Ataxic breathing 4. Cushing's phenomenon 5. Decorticate posturing 6. Decerebrate posturing

1:C, 2:E, 3:D, 4:F, 5:A, 6:B | Pg 224-5

Your blood pressure is 150/90. What is your mean arterial pressure (MAP)? ____

110 Pg 222 If BP is 150/90; MAP = 90 + 1/3[150-90] = 90 + 1/3[60] = 90 + 20 = 110

You are called to the scene of a gunshot victim; he is alert but in pain, complaining he has been shot in the thigh. Primary survey reveals a GCS of 14, airway and breathing intact, HR is 144 and thready. Your secondary exam is significant only for a penetration wound of the proximal thigh with arterial bleeding. On obtaining vitals, you note his pulse pressure is 20. Pulse Pressure is determined by: A. Systolic Blood Pressure + 1/3 Diastolic Pressure B. Systolic Blood Pressure – Diastolic Pressure C. Diastolic Blood Pressure + 1/3 Systolic Pressure D. Systolic Blood Pressure - Mean Arterial Pressure

B. Systolic Blood Pressure – Diastolic Pressure Pg 222

During transport of a head trauma patient, you notice his respiratory rate becomes 35 per minute and is very deep, then drops to 6 per minute and very shallow. This continues in a repeating cycle. What would you call this type of respiration? A. Cushing's Respiration B. Ataxic Respiration C. Cheyne-Stokes Respiration D. Neurogenic Hyperventilation

C. Cheyne-Stokes Respiration | Pg 225

``` The Monro-Kelly doctrine helps explain complex changes in intracranial pressure (ICP). Which of the following components contribute to ICP in a normal (healthy) state? (check all that apply) A. Blood volume B. Mass C. Cerebrospinal fluid (CSF) D. Air volume E. Brain tissue F. Bone volume (skull) ```

A. Blood volume C. Cerebrospinal fluid (CSF) E. Brain tissue Pg 223-4

A TBI casualty has a decreased level of consciousness and left-sided hemiplegia. The right pupil is 6 mm, and the left is 2 mm. What side of the skull/brain (right or left) is most likely to have an intracranial hematoma? A. Left B. Right C. Neither right nor left -- this is most likely a brainstem lesion

B. Right | Pg 225

A 22 y.o male is found down outside his apartment building and 911 called. On arrival, you find that he is having a generalized (grand mal) seizure. You suspect traumatic brain injury as the cause, but generate a quick differential of other reversible causes of seizure. Which of the following would you include as the MOST likely cause of his seizure? A. Acute Alcohol Intoxication B. Hyperglycemia C. Hypoglycemia D. Tachycardia

C. Hypoglycemia | Pg 227

Best evidence suggests that (at a minimum) a SBP greater than ____ is desirable for neurologically injured casualties.

90 | Pg 222

Warning signs of possible increased intracranial pressure and herniation include: (check all that apply) A. Fever B. Precipitous drop in blood sugar level C. Development of hemiplegia or hemiparesis D. Development of a sluggish or nonreactive pupil E. Decline in GCS score by two points or more F. Cushing's phenomenon

C,D,E,F | Pg 238

``` Acutely elevated Intracranial Pressure (ICP) can lead to a Cushing’s Response, which is best described as? A. Hypertension and Bradycardia B. Hypotension and Tachycardia C. Hypertension and Tachycardia D. Hypotension and Bradycardia ```

A. Hypertension and Bradycardia | Pg 225

``` What type of posturing does this drawing demonstrate? A. decorticate B. demonic C. demotion D. decerebrate ```

D. decerebrate | Pg 225

Which of the following describes the neurological findings of Brown-Sequard Syndrome? A. Weakness or paresthesia in the upper extremities with normal strength in the lower extremities B. Loss of motor function and pain, temperature and light touch sensation below the level of the spinal cord injury. Motion, vibration, and position sense is spared. C. None of the listed answers D. Complete loss of function on the affected side (including motor, vibration, motion, and position sense) with loss of pain and temperature on the opposite side.

D. Complete loss of function on the affected side (including motor, vibration, motion, and position sense) with loss of pain and temperature on the opposite side. Pg 254

Casualties who have cervical spine injuries also have a ____% chance of having another spinal fracture. Therefore, the entire spine must be immobolized in casualties who have indications for cervical spine immobilization.

10 | Pg 252

A casualty with spinal cord injury requires both acute and long-term care. The average lifetime cost of care for a permanent spinal cord injury is estimated at: A. $250,000 B. $1,350,000 C. $2,250,000 D. $3,250,000

B. $1,350,000 | Pg 246

Steroids should routinely be administered to all patients with presumptive spinal cord injury. They should be administered as early as possible (preferably by medics in the field) True False

False | Pg 264

You are on the scene of a motorcycle crash on a local freeway. The motorcycle driver is being prepared for transport. An EMT with you on-scene asks for advice about the best way to immobilize the patient's c-spine. Which of the following are true (select all that apply)? A. The unique primary purpose of a cervical collar is to protect the cervical spine from compression B. A rigid collar provides definitive immobilization of the c-spine. No additional stabilization or immobilization is needed C. Cervical collars are designed to be "onesize fits all" D. Blankets, towels and tape can be used as alternative methods to immobilize a c-spine when a collar cannot be used E. A soft cervical collar is of no use as an adjunct to spinal immobilization in the field

A, D, E | Pg 259

You are evaluating a 19 y.o. male who jumped off a third story balcony (20 feet high) during a party. He tells you he was “just showing off”, and states his only injury is a sprained ankle. His primary survey is unremarkable, and his secondary survey reveals a deformed and obviously broken left ankle. X-rays reveal he has a shattered calcaneus. What other fracture would be MOST likely in this patient? A. Thoracic Spine B. Cervical Spine C. Lumbar Spine

C. Lumbar Spine | Pg 253

A dermatome is the sensory area on the body for which a nerve root is responsible. Dermatomes help determine the level of a spinal cord injury. The nipple level is the T ____ dermatome

4 | Pg 252

Which of the following describes the neurological findings of Central Cord Syndrome? A. Loss of motor function and pain, temperature and light touch sensation below the level of the spinal cord injury. Motion, vibration, and position sense is spared. B. Weakness or paresthesia in the upper extremities with normal strength in the lower extremities. C. Complete loss of function on the affected side including motor, vibration, motion, and position sense with loss of pain and temperature on the opposite side. D. None of the listed answers

B. Weakness or paresthesia in the upper extremities with normal strength in the lower extremities. Pg 253-4

An 82 y.o male presents to your clinic with his wife because she fears he has had a stroke. She tells you that he has been complaining of weakness and burning in his hands; on exam he is slow to move and has bilateral weakness of his grips and flexion/extension at the elbow. The rest of his physical exam is unremarkable except for a slow and deliberate, but otherwise normal gate. In discussion with his wife, you find he had a fall 10 days ago and hit his head. She says he did not lose consciousness and was “OK” after the fall. Of the following, which is the MOST likely diagnosis? A. Anterior Cord Syndrome B. Central Cord Syndrome C. Brown-Sequard Syndrome D. Posterior Cord syndrome

B. Central Cord Syndrome | Pg 253-4

A 25 year old male was involved in a motorcycle accident. He was wearing a full-face helmet. What is the most appropriate management strategy concerning his helmet? A. Leave the helmet in place. A properly-fitted helmet provides better C-spine immobilization than the rigid C-collars used by medical providers. B. Remove the helmet so that you can completely evaluate the head and neck region. C. Leave the helmet in place. Attempting to remove the helmet would cause flexion and extension of his cervical spine, which may exacerbate a C-spine injury.

B. Remove the helmet so that you can completely evaluate the head and neck region. Pg 288-89

Match the incomplete cord injury with its most appropriate description: 1. Central cord syndrome 2. Anterior cord syndrome 3. Brown-Sequard syndrome A. An 18 year old football player is struck in the upper abdomen/low chest during a game; below the T8 level he has loss of motor function and pain, temperature, and light touch sensations. B. An elderly male fell forward into the trunk of his car, hyperextending his neck. Later that day he walks into the ER (normal leg strength) complaining of bilateral arm weakness. C. A 28 y/o drug dealer is stabbed in the back; he has complete loss of motor, vibration, motion, and position sense on his right side from T10 down, and loss of pain and temperature sensation on the left.

1:B, 2:A, 3:C | Pg 253-254

Which of the following describes the neurological findings of Anterior Cord Syndrome? A. Weakness or paresthesia in the upper extremities with normal strength in the lower extremities B. Complete loss of function on the affected side including motor, vibration, motion, and position sense with loss of pain and temperature on the opposite side. C. Loss of motor function and pain, temperature and light touch sensation below the level of the spinal cord injury. Motion, vibration, and position sense is spared. D. None of the listed answers

C. Loss of motor function and pain, temperature and light touch sensation below the level of the spinal cord injury. Motion, vibration, and position sense is spared. Pg 253

Which of the following patients does NOT require hard cervical collar and spine board immobilization? A. Patient with a 20 foot fall with a brief loss of consciousness, but now has a GCS of 15 and denies any neck pain. B. Patient found walking around complaining of pain in the side of his face after being shot in the neck by an pistol. No neurologic deficits or complaints are found on your secondary survey. C. 22 y.o. male brought to you immediately after being involved in a bar fight. He ambulates (walks) into the clinic. He has significant swelling and contusions to the face, and abrasions and contusions on his back. He smells strongly of alcohol. D. 17 y.o. female is brought to E.R. after a role-over car crash in which she was wearing her seat belt and her airbag deployed; she complains of hip pain and you note an open femur fracture. Her cervical spine has no pain on palpation, and she denies other injury/complaint.

B. Patient found walking around complaining of pain in the side of his face after being shot in the neck by an pistol. No neurologic deficits or complaints are found on your secondary survey. Pg 256

``` What percentage of significant falls (from a height of >15 feet) have an associated lumbar spine fracture? A. 10% B. 20% C. 30% D. 40% E. 50% F. 60% ```

B. 20% | Pg 253

When considering penetrating injury to the neck or torso, spinal immobilization is generally NOT indicated unless a neurologic deficit or complaint is identified. True False

True | Pg 256

About 32 people per 1 million of population will sustain some type of spinal cord injury annually. An estimated 250,000 to 400,000 people live with spinal cord injuries in the US. The most common age group involved is 16 to 35 years old; this age group is involved in the most violent and high-risk activities. What is the most common cause of spinal cord injury? A. penetrating injuries B. motor vehicle crashes C. falls D. sports injuries

B. motor vehicle crashes | Pg 246

You are called to the scene of a multi-car accident. You find one of the victims walking around at the accident scene. Although he was involved in the MVC, he got out of his car to check on other injured people. True/false: Since he is already walking around, you do not need to apply a cervical spine collar to this patient. True False

False | Pg 255

Which of the following patients/casualties should be placed in spinal immobilization? (check all that apply) A. A 20 year old male was out drinking (alcohol) and then crashed his motorcycle on the expressway (60 mph); he has no complaint of neck pain. B. A teenager who dove head-first into a shallow pond; he was pulled by friends to shore and is unresponsive. C. A 20 year old college student trips and falls forward while walking to class, landing on their outstretched hand. She has pain and an obvious deformity of her wrist. She denies neck pain, and has no tenderness to palpation. D. A 35 year old woman who was struck by a car while crossing the street. She has an obvious left femur and left tibia/fibula fractures, but no other complaint and no neck pain. E. A 25 year old male was stabbed in the left neck; pulsatile bleeding from an apparent carotid artery injury is controlled by direct pressure. He has severe neck pain at the site of injury, but no neurologic deficit or complaint. F. A 35 year old woman was involved in a single-car accident -- while driving ~50 mph, she reached into the back seat to adjust her baby's car seat. She ran off the road into a telephone pole. She was wearing her seatbelt; her airbags deployed; there is significant damage to the vehicle. She got out of her car and walked around at the scene to care for her infant. She is very worried about her child, but has no specific complaints of her own. G. A 23 year old Marine who was shot in the arm by a sniper in Afghanistan. Bleeding is controlled by direct pressure

A,B,D,F | Pg 256

You are examining a Navy Captain (O-6) after he fell off the top of his aircraft (~15 feet) onto the hanger deck during a pre-flight inspection. On your arrival he is walking around the hanger deck and is complaining of abdominal pain. He has no obvious external injury. On Primary Survey, you find he is alert, speaks full sentences, has clear breath sounds and a strong radial pulse. His vitals reveal a GCS of 15, HR 122, BP 105/70, RR22, Oxygen Sat 98%. During secondary survey you find he is moving all extremities easily and has no bony tenderness, but his abdomen is diffusely tender. He is reluctant to go the Emergency Department for evaluation, stating 'he feels fine' and 'just needs to walk it off.' What is the BEST way to transport this patient? A. In position of comfort; the patient will know best how to protect his spine B. Cervical hard collar and spine board to protect him from any spine injury he obtained C. Sitting up to allow for decrease in abdominal pressure from possible intraabdominal injury D. Allow his co-pilot to drive him in the command's duty vehicle, as he is ambulating without spine pain or neurologic deficit

B. Cervical hard collar and spine board to protect him from any spine injury he obtained Pg 253, 256

Pain out of proportion to visible injury is the most characteristic sign of compartment syndrome True False

True | Pg 698

A survivor of a terrorist attack on a federal facility presents to your Emergency Department. He has signs and symptoms consistent with blast lung. All of the following management strategies should be used EXCEPT A. Push IV fluids. Patients with blast lung will generally require significantly greater doses of fluids than burn patients B. Use supplemental oxygen C. Monitor hemodynamic parameters D. Use tube thoracostomy for a pnuemothorax, and consider empiric tube thoracostomies if the patient will require transport via air for higher level of care

A. Push IV fluids. Patients with blast lung will generally require significantly greater doses of fluids than burn patients Pg 694

Match each of the phases of a blast injury with the appropriate description 1. Primary injuries 2. Secondary injuries 3. Tertiary injuries 4. Quaternary injuries 5. Quinary injuries A. Injuries caused by radiation, chemicals or biological agents B. Injuries caused by propulsion of casualties into the ground or into solid objects C. Injuries resulting from the blast wave or overpressure which causes direct tissue damage D. Injuries from ballistic wounds produced by fragments from exploding weapons E. Injuries from burns and toxicities in the blast environment

1:C, 2:D, 3:B, 4:E, 5:A | Pg 689

Regarding the epidemiology of injured patients after a blast, which of the following would you most likely expect to see A. Small numbers of minimally wounded and dead patients with a large number of critically ill patients (50%) who may be saved B. Large numbers of dead and minimally wounded patients with a small number of critically injured patients (10-15%) who may be saved C. Large numbers of dead, large numbers of critically injured patients (50%) who may be saved, and a small number of minimally wounded patients D. An equal distribution of dead, critically injured patients who may be saved, and minimally injured patients

``` B. Large numbers of dead and minimally wounded patients with a small number of critically injured patients (10-15%) who may be saved Pg 686-7 ```

A Navy Explosive Ordnance Disposal Diver is brought to your emergency department after a weapon inadvertently exploded underwater. The patient has blast injuries. Given that he was underwater when the blast occurred, he will have milder injuries than if he were subjected to an equivalent blast on land. True False

False | Pg 692

All of the following are primary blast injuries EXCEPT? A. Tympanic membrane rupture B. Blast lung C. Ruptured globe (eye) from a flying piece of glass D. Traumatic brain injury

C. Ruptured globe (eye) from a flying piece of glass Pg 693-98

You are working at a combat support hospital in Afghanistan when casualties from an explosion begin arriving. The on-scene medics report the patients have symptoms consistent with nerve agent exposure. You are concerned about exposing the hospital staff to the nerve agent. Your colleague tells you that, "removing the patients' shoes and clothing will reduce contamination by about 90%." Is this true? True False

True | Pg 700

A 22 year-old soldier is brought to your Air Force Theater Hospital after he was injured performing a dismounted patrol. He has bilateral amputations of his lower extremities, hemoptysis, ruptured tympanic membranes and evidence of TBI. Based on his injury pattern, what can you conclude about the type of explosives used in the attack? A. Most likely a low explosive, like a Molotov cocktail B. Most likely a high explosive, like TNT C. Most likely a medium explosive, like a Molotov cocktail D. The wounds appear more consistent with a blunt assault, rather than an explosion

B. Most likely a high explosive, like TNT | Pg 682-3, 690-94

You are assigned to a special operations unit conducting a raid in Afghanistan. A powerful explosion occurs as the assault force breaches the door of a two-story concrete building. A 28 year-old soldier is knocked down by the blast wave, screaming in pain from what appears to be an obvious R femur fracture, and complaining that he has something stuck in his right side. He is laying on his left side. You see an object protruding from his right flank (see attached). Which of the following are true regarding his management (select all that apply)? A. Since he experienced a blunt/blast injury, he should be moved into a supine position on a spine board for transport B. If this patient goes into cardiac arrest, defibrillation is an acceptable treatment option C. Physicians should not use electrocautery or ultrasound when treating this patient D. This patient should be treated in a protected area away from the main hospital E. This patient would likely be a top priority in a mass-casualty incident

C, D | Pg 701-702

You are called to the flight line to evaluate a 21 year-old airman. She took off her safety goggles for a moment, and felt something hit her R eye. She has intense pain, and complete vision loss in that eye. The eye appears grossly deformed on initial inspection. Which of the following treatment principles should be followed (select all that apply) A. Cover the eye with a protective shield B. Promptly remove any penetrating object that is graspable at the scene C. Do not place pressure on the eye D. Place a moistened gauze on her eye with light pressure to facilitate pain relief

A, C | Pg 698

Only a minority of casualties from an explosion sustain psychological damage True False

False | Pg 702

Which of the following is true regarding the epidemiology of battlefield casualties? A. Explosives are the predominant cause of combat injury and death B. Explosives used in modern combat tend to cause injuries, but rarely cause deaths C. While explosives are an important aspect of modern warfare, they are responsible for far fewer fatalities than small arms fire D. While explosives have been used extensively in combat, they are a rare occurrence in the "civilian" world and typically cause about 100 deaths per year worldwide

A. Explosives are the predominant cause of combat injury and death Pg 680