Trauma

Question 1

In the Glasgow Coma scale what are the 3 behavioral Reponses measured?

Answer 1

Eye opening response, Verbal response and motor response

Question 2

In the Glasgow Coma scale what are the 5 responses to verbal response?

Answer 2

Oriented to person, place and time -5
Confused  -4
Inappropriate words -3
Incomprehensible sounds -2
No Response -1

Question 3

In the Glasgow Coma scale what are the 6 responses to motor response?

Answer 3

Obeys commands -6
Moves to localized pain -5
Flexion withdrawal from pain -4
Abnormal flexion (decorticate) -3
Abnormal flexion (decerabate) -2
No Response -1

Question 4

In the Glasgow Coma scale what is considered a comatose patient?

Answer 4

a score of 8 or less

Question 5

In the Glasgow Coma scale what is considered a totally unresponsive patient?

Answer 5

A score of 3

Question 6

In the Glasgow Coma scale what is considered the highest score?

Answer 6

A score of 15

Question 7

The signs of bradycardia, hypertension, and irregular breathing in a head injury is called?

Answer 7

Cushing’s Reflex

Question 8

What is a late sign of shock?

Answer 8

Decreased Blood Pressure

Question 9

What volume of blood loss is considered serious in an average adult?

Answer 9

1000cc

Question 10

What is a tension pneumothorax?

Answer 10

An accumulation of air in the pleural space under pressure, compressing the lungs and decreasing venous return to the heart. As intrathoracic pressure increases, the patient develops hypotension, tracheal deviation and neck vein distension.

Question 11

What does the pneumonic DCAP-BTLS stand for?

Answer 11

Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness Lacerations, Swelling

Question 12

What is hypovolemic shock?

Answer 12

Hypovolemic shock, also known as hemorrhagic shock, is a life-threatening condition that results when you lose more than 20 percent (one-fifth) of your body’s blood or fluid supply.

Question 13

What is the Glasgow coma scale for a patient with no eye response, incomprehensible sounds, and decorticate posturing?

Answer 13

(6) no eye response-1, Incomprehensible sounds-2, and decorticate posturing-3

Question 14

What is Decorticate posturing?

Answer 14

Decorticate posture is an abnormal posturing in which a person is stiff with bent arms, clenched fists, and legs held out straight. The arms are bent in toward the body and the wrists and fingers are bent and held on the chest. Think of de-cor-ticate as to the core!

Question 15

In a multi casualty accident with 2 vehicles how would you triage the following patients for transport, none are trapped? an 86 y.o slumped against the wheel, a 7 y.o with facial lacerations only, a 40 y.o. pregnant woman unconscious, a teenager c/o nausea with an altered level of consciousness, a second teenager who had a seizure earlier and was being transported to the doctor was belted with no sign of injury.

Answer 15

The 86 y.o. and the pregnant female should be transported first due to LOC (level of consciousness), the teenager with an altered level of consciousness should be next then the 7 y.o. and the teenager who had a seizure earlier

Question 16

You and your partner Greg are called to a hockey arena where a fan was struck in the side of the chest with a hockey puck that was hit over the protective glass and into the crowd. The man is having a painful time breathing at about 16 a minute. He says his ribs really hurt. What should your treatment include?

• A chest compression wrap while having the patient maintain his exhaled state
• Bag valve mask with oxygen attached
• Sweeping the tongue out of the way to look for airway obstructions
• High flow O2 with NRM and rapid transport

Answer 16

High flow O2 with NRM and rapid transport

Rationale: As long as the patient is able to talk and keep their respirations within range, then high flow O2 and transport would be your best choice.

Question 17

Which of the following assessment considerations should not be included for facial and eye injuries?
A. Inspection
B. Palpation of cranial bones
C. Eye examination
D. Palpation of facial bones

Answer 17

B. Palpation of cranial bones

Rationale: Assessment considerations for facial and eye injuries include: Inspection, palpation of facial bones, and eye examination.

Question 18

Where on the patient are you going to take the pulse rate via the radial artery?
A. Top of the foot
B. Thumb side of the wrist
C. Behind the ankle
D. Side of the neck

Answer 18

B. Thumb side of the wrist

Rationale: Top of the foot is the Dorsalis pedis
Behind the ankle is the posterior tibial
side of the neck is the carotid

Question 19

Unique anatomy, physiology, and pathophysiology considerations of geriatric patients include all of the following except:
A. Changes in musculoskeletal system makes older patients susceptible to trauma
B.Trauma is infrequent in the elderly due to inactivity
C. Circulation changes lead to inability to maintain normal vital signs during hemorrhage
D. Curvature of upper spine may require padding during spinal immobilization

Answer 19

B. Trauma is infrequent in the elderly due to inactivity
Rationale:
changes in pulmonary, cardiovascular, neurologic, and musculoskeletal systems make older patients susceptible to trauma; circulation changes lead to inability to maintain normal vital signs during hemorrhage and blood pressure drops sooner; multiple medications are more common and may affect assessment - especially vital signs and blood clotting; brain shrinks leading to higher risk of cerebral bleeding following head trauma; skeletal changes cause curvature of the upper spine that may require padding during spinal immobilization; loss of strength, sensory impairment, and medical illness increase risk of falls.

Question 20

When you correct a problem in the field, what is this called?
A. Blood pressure
B. Atelectasis
C. Intervention
D. Miosis

Answer 20

C. Intervention

Question 21

An unconscious male is found lying in a pool of blood with an arterial bleed on the left leg. What type of shock is this man suffering from?

Answer 21

Hypovolemic Shock

Question 22

What is Conjunctiva?

Answer 22

A thin layer of membrane that covers the eye

Question 23

Managing a burn includes all of the following except?
A. Airway management
B. Apply a Dry, sterile dressing
C. Rule of Palm
D. Prevent hypothermia

Answer 23

Rule of Palm

Rationale: Rule of palm is a way of measuring the amount of burn not a treatment

Question 24

S/S male 18 y.o. at school with glass in eye from test tube exploding in face with blood coming from the eye. What is the best treatment?
A. Bandage the eye with a pressure dressing
B. Remove the glass from the eye
C. Transport with high flow O2
D. Cover the eye with a paper cup, bandage and cover the other eye.

Answer 24

D. Cover the eye with a paper cup, bandage and cover the other eye.
Rationale: pressure dressing would cause more damage,
not supposed to remove penetrating objects, just transport would cause more discomfort for patient especially if they try to look around..

Question 25

Which of the following would be a low energy penetrating wound?
A. Stab with a knife
B. .22 Cal GSW
C. Blunt trauma with a bat
D. nail in hand from a pneumatic nail gun

Answer 25

A. Stab with a knife

Rationale: .22 Caliber bullet is low energy in a gun shot, a baseball bat is a blunt trauma not penetrating, A pneumatic nail gun is higher energy than a knife

Question 26

Your patient struck a bus with his head while on his bicycle. On Physical exam you observe unequal pupils and irregular respirations. The BP is 180/90 and a pulse rate of 60. What do these signs describe?

Answer 26

Cushing’s Triad
Rationale: High blood pressure in head trauma with a low pulse rate and irregular respirations.
brain calls for more pressure for ^O2, low pulse rate because BP too high (Aortic baroreceptors), irregular breaths -brain herniating through the foramen magnum

Question 27

The patient has pain in the chest from a baseball striking him in the chest. His pressure is 130/60 pulse of 100 and a bruise to the left lateral chest. What is the symptom?

Answer 27

Pain in the chest is a symptom

Rationale: Blood pressure- sign, Pulse- sign Bruise is a sign

Question 28

Signs and symptoms of rattlesnake bites include all of the following except: 
A. Progressive weakness
B. Hives
C. Pain at site
D. Seizures

Answer 28

Hives

Rationale: Hives is a sign of an allergic reaction which is caused by an allergen not a venomous bite.

Question 29

A primary survey is done on a patient to?

Answer 29

To reveal life threatening injuries

Question 30

What are the 2 ways needed to provide adequate C-spine stabilization with a c-collar?

Answer 30

Holding manual stabilization or securing the patient appropriately to the backboard.

Question 31

You are treating a patient who is “not feeling right”. Which of the following is considered a sign?
A. The patient shows you a contusion on their head
B. She says she is dizzy and feels like vomiting
C. She tells you she ate a whole bottle of sleeping pills
D. The patient states that she has a headache

Answer 31

A. The patient shows you a contusion on their head
Rationale:
Feeling dizzy and stating she has a headache are symptoms. Telling you she took a bunch of pills is history. The visible contusion on her head is a sign because it is objective and you can verify it’s existence visually.

Question 32

Your patient is a 14-year-old girl who is complaining of vaginal pain after falling onto the center post of her bike. She is alone and very scared. She has called the accident in on her cell phone and stated that she is bleeding very badly and feeling faint. Besides treating for shock, what other things should you consider with this patient?
A. Transport without treating patient because she is a minor
B. Inform her she is having her menstrual period
C. Have a female EMT respond for patient modesty
D. Transport in the fowlers position.

Answer 32

C. Have a female EMT respond if possible.
Rationale:
A female EMT may not always be available but a good consideration.
Heavy bleeding after an accident with a patient feeling faint would be a contraindication to sitting a patient up or transporting without direct pressure to the wound and a dressing

Question 33

What is considered a life threatening bleed?
A. Capillary bleed
B. Arterial Bleed
C. Venous bleed
D. Dark red bleed

Answer 33

B. Arterial Bleed
Rationale:
Arterial bleeds pose more of a threat to life than any of the others as they are under the most pressure and can release more blood in a shorter period of time.

Question 34

One pupil dilated and the other pupil constricted may suggest what type of injury?

Answer 34

Cerebral- head trauma (Trauma) or head bleed (CVA) are most common

Question 35

You have requested helicopter transportation of a critical burn patient. The remote nature of the accident will force the helicopter to land on an incline. What is the best way to approach the helicopter?
A. Wait for the Pilot to give direction
B. Approach from the front
C. Uphill side
D. Walk downhill to the helicopter

Answer 35

Never walk downhill toward a helicopter. Always approach from the downhill side, or on the flat ground, approaching from a 45° angle in front of the aircraft (where the pilot can see you at all times) or as directed by a helicopter crew person.
• Never approach an operating helicopter from the rear, and never go aft of the cabin doors unless directed by a helicopter crew person or the pilot.

Question 36

You arrive on the scene to find a woman who is complaining of difficulty breathing after being struck in the chest with a swing. Upon auscultation of her lungs you have clear lungs on the right and no breath sounds on the left. This woman is likely has a \_\_\_\_\_\_ and would be suffering from \_\_\_\_\_ as the collapsed lung is incapable of oxygenating the blood.
A. Flail chest / hyperventilation
B. Hemoptysis/ Hypoventilation
C. Pneumothorax/ Hypoxia
D. Cardiac contusion/ Hyperkalemia

Answer 36

C. Pneumothorax/ Hypoxia
Rationale:
Flail chest is possible but with paradoxical movement normally lungs sounds present bilaterally
Hemoptysis is coughing up of blood not listed
Cardiac contusion would present with chest pain

Question 37

Dispatch has called you to the scene of a U.S. mail truck that slid out of control on a dirt road and rolled over. Bystanders reported the truck has caught on fire and the driver is outside the truck trying to gather the dumped mail. As you arrive on scene the fire department is just getting the fire out and the driver of the truck is standing back watching the smoldering mess. You should:
A. Get a SAMPLE history on the driver
B. Do a focused assessment on the driver
C. Get the driver to sign a transport refusal form
D. Do a standing backboard technique on the driver

Answer 37

D. Do a standing backboard technique on the driver

Rationale: Given the mechanism of injury of a rollover, you should take c-spine precautions for this patient with a standing backboard technique. Adrenalin can mask serious injury and although the driver is walking around/ standing, that does not mean they are free of neck or spinal trauma.
The patient can refuse, but he will need to be informed of the possible consequences.

Question 38

For a trauma patient that is unconscious and you do not know the mechanism of injury, you should always assume the patient?

Answer 38

Has a spinal injury
Rationale: Always take c-spine precautions on a patient if you do not know the reason for the altered LOC. You should assume the patient has a spinal injury.

Question 39

You have just arrived on scene of a single vehicle accident involving a truck that has slid off the road and rolled. Your patient was driving about 40 MPH when he hit an icy spot and went off the road rolling the vehicle one time. After completing your scene size up, which of the following treatment choices would be the most appropriate?
A. Check baseline vitals, do a focused exam on the patient’s chief complaint
B. Perform a rapid trauma assessment
C.Perform a detailed physical examination to uncover any life threatening injuries
D. Get a SAMPLE history and do a focused physical examination

Answer 39

B. Perform a rapid trauma assessment
Rationale: A rapid trauma assessment should be used first with a significant method of injury suspected. Going off the road and rolling a vehicle at 40 MPH is significant. The rapid assessment will help you determine and deal with any potential life threats.

Question 40

A man has both legs burned on the front and back, along with the fronts of both arms. Approximately what percentage of his body was burned?
A. 36 percent
B. 45 percent
C. 50 percent
D. 54 percent

Answer 40

B. 45 percent

Rationale: Each leg is 18% and the front of each arm counts as 4.5 for a total of 45%.

Question 41

It’s 7:30 a.m. and you arrive on scene of a two car collision involving at least 6 patients on a foggy corner of a fairly busy country road. The fire department is not there yet and there is smoke and flames showing from both cars. You can hear people crying and cars are already driving around the wreckage to get past the scene. What steps should you take?
A. Get the fire department en route, establish a safety zone and assist in keeping traffic a safe distance away
B. Begin extrication of the patients while your partner calls for more ambulances
C. Triage the most critically injured first and then extricate them in order of severity
D. Inform the patients that you are not allowed by law to enter the zone until it is made safe by law enforcement

Answer 41

A. Get the fire department en route, establish a safety zone and assist in keeping traffic a safe distance away
Rationale: Scene safety before all else in this case. The best thing you can do for everybody is assist in keeping the accident from getting even larger with traffic and crowd control until the proper authorities get there and you can administer medical attention in a safe environment.

Question 42

Signs and symptoms of Cushing's phenomenon include all of the following except: 
A. Hypertension
B. Tachycardia
C. Biot's respirations
D. irregular respirations

Answer 42

B. Tachycardia
Rationale: Signs and symptoms of Cushing’s phenomenon include: hypertension, bradycardia, irregular respirations, central neurogenic hyperventilation, and Biot respirations. Cushing’s triad signs and symptoms are caused by a significant head trauma, also referred to as herniation syndrome. The intracranial pressure increases forcing the brain stem and the midbrain through the foramen magnum.

Question 43

A 57 year old woman is complaining of chest pain. Her blood pressure is 109/88 and her respirations are at 22 per minute. What condition does the patient’s blood pressure indicate?

A. Paradoxical pressure
B. Low Pulse pressure
C. Systolic trans cardiac ischemia
D. Biot’s sign

Answer 43

B. Low Pulse pressure

Rationale: A pulse pressure is considered abnormally low if it is less than 25% of the systolic value. In this question it is about 20% of the systolic value. The pulse pressure is the difference between the systolic and diastolic measurements of the blood pressure. 109 systolic - 88 diastolic = 21 mmHg. In trauma a low pulse pressure suggests significant blood loss. If the pulse pressure is extremely low, i.e. 25 mmHg or less, the cause may be low stroke volume, as in Congestive Heart Failure and/or shock. A low pulse pressure can also be caused by aortic valve stenosis and cardiac tamponade.

Question 44

You arrive on scene to find a 34-year-old male lying on the ground in a pool of blood. Bright, red blood is spurting from a large cut in his shirt sleeve and he is clutching a knife between his teeth. What should you do first?
A. Have your partner distract the patient while you take the knife from him
B. Inform the patient you will not hurt him and treat the injury
C. Leave the scene until police arrive to make the scene safe
D. Call for police backup and then treat the wound

Answer 44

C. Leave the scene until police arrive to make the scene safe

Rationale: Scene safety comes before all other choices and until the police arrive AND secure the scene you are to keep a safe distance and advise others to do the same. You are not in a position to render this scene safe.

Question 45

Signs and symptoms of concussion include all of the following except:
A. Delayed motor and verbal responses
B. Inappropriate emotional responses
C. Inability to recall simple concepts and words
D. Discoloration around eyes and ears

Answer 45

D. Discoloration around eyes and ears

Rationale: Signs and symptoms of concussion include: delayed motor and verbal responses, inability to focus attention, lack of coordination, disorientation, inappropriate emotional responses, memory deficit, inability to recall simple concepts and words, nausea/vomiting, and headache. Discoloration around eyes and ears are not definitive signs of a concussion

Question 46

A train derailment has caused two tanker cars to explode and several others to begin leaking an unknown gas. The size of the affected area is large and crosses several county lines. According to NIMS, this type of MCI would benefit most from a:
A. Unified Command System
B. Multiple Command System
C. Singular Command System
D. Coordinated Command System

Answer 46

A. Unified Command System

Rationale: Unified Command Systems can involve many different agencies such as EMS, Fire Departments, Law Enforcement, City Managers, County Commissioners, etc.

Question 47

What are the quadrants of the abdomen and how many?

Answer 47

four divisions of the abdomen used
to pinpoint the location of a pain or
injury:
RUQ the right upper quadrant
LUQ the left upper quadrant
RLQ the right lower quadrant
LLQ the left lower quadrant

Question 48

Also known as a scratch or scrape to the skin?

Answer 48

Abrasion