Trauma

Question 1

You arrive on the scene of a patient who fell from a ladder. What information is NOT important in the care of the patient?

Answer 1

Height of the ladder

Question 2

You are at the scene of an MVA, in which there are three patients, all of which have minor visible injuries. Two are refusing treatment and the last is complaining of neck and back pain. How should you proceed?

Answer 2

Have your partner obtain refusals from the two patients who refused treatment, while you treat the last patient.

Question 3

Your patient is a 17 year old male found face down in a swimming pool. He is currently being held face up at the surface of the water. He is unconscious but breathing and has a pulse. What is the best course of action for this patient?

Answer 3

Apply cervical and spinal immobilization while the patient is still in the pool

Question 4

A laceration, spurting bright red blood, most likely means what type of injury?

Answer 4

Arterial

Question 5

Your patient has a laceration to the right leg which has intersected the femoral artery. You have applied direct pressure to the wound, but it continues to soak through the bandages. What should you do next?

Answer 5

Apply a tourniquet

Question 6

Of the two types of energy transfer, which type of energy transfer is a MVC with frontal impact, non-restrained driver with bent steering wheel, and spidered windshield?

Answer 6

Blunt

Question 7

Any penetrating missile traveling over 2,000 ft/sec would be classified as?

Answer 7

High velocity

Question 8

When there is penetrating trauma there is a permanent cavity which is formed by the projectile contacting the tissues. How is a temporary cavity formed?

Answer 8

The energy scrubbing off of the projectile

Question 9

The way a patient is injured is often referred to as the _______________?

Answer 9

Mechanism of injury

Question 10

When approaching a scene of trauma incident, what is your first order of business?

Answer 10

Scene safety

Question 11

A large collection of blood under the skin is known as?

Answer 11

Hematoma

Question 12

Your trauma patient has her left hand caught between rollers on a conveyor belt. Extrication takes 30 minutes. Evaluation of the injury during extrication showed delayed capillary refill distal to the injury. Post extrication shows rapid capillary refill distal to the injury deformity mid-palm. There are no obvious fractures, no lacerations, and minor swelling. Knowing that crush injuries can cause many other problems, name one of those potential problems.

Answer 12

Compression of tissues
Fractures
Compartment syndrome
Internal bleeding
Rupture of internal organs
Shock

Question 13

Loss of tissue in a traumatic event can be: just soft tissue, a portion of an extremity, or an entire extremity. If your patient has lost the distal one-third of a lower extremity, what would that injury be called?

Answer 13

Amputation

Question 14

In any traumatic event where there is tissue damage that caused bleeding, the bleeding needs to be controlled. What are the proper steps to bleeding control?

Answer 14

Direct pressure, application of tourniquet

Question 15

Your 16 year old trauma patient has what appears to be a mid-shaft femur fracture. You notice that there is a laceration directly over the suspected fracture. Bleeding is controlled. What type of fracture would this be?

Answer 15

Open

Question 16

En route to the hospital, your partner intubates the patient. During your assessment of tube placement, you hear wheezing in the upper lung fields. What is most likely causing this wheezing?

Answer 16

Inhalation injury

An inhalation injury inferior to the glottis can result in wheezing and bronchospasm. An inhalation injury superior to the glottis can cause a hoarse voice and stridor. Inhalation of the byproducts of combustion can cause wheezing but this would still be classified as an inhalation injury to the lower airway.

Question 17

Following the immobilization of an extremity fracture to the lower right arm, the EMT should perform what step last?

Answer 17

Assessing presence of distal motor, sensory, and perfusion.

The last part of immobilizing the arm fracture (or any suspected fracture for that matter), is the assessment of distal motor, sensory, and perfusion status. This is done to assure there was no additional trauma from the immobilization process, and to assure the splint was not put on incorrectly (for example an air splint inflated too high). If there is a loss in the motor, sensory, perfusion findings following immobilization, the paramedic should immediately reassess the splinting process and correct any errors.

Question 18

You are treating a 24-year-old female with a gunshot wound to the right side of the back. No exit wound is visible. She is awake but confused. Her skin is pale and diaphoretic with cyanosis noted to the oral mucosa. Breath sounds are clear and equal bilaterally. Jugular vein distention is present. Blood pressure is 90/78 mmHg, heart rate is 124 beats per minute, and respiratory rate is 28 per minute and labored. Sinus tachycardia is seen on the cardiac monitor. What condition do you think is most likely present with this patient?

Answer 18

Pericardial Tamponade

Pericardial tamponade causes decreased cardiac output as seen by pale skin and hypotension. In addition, jugular vein distention may be seen along with a narrowed pulse pressure. Other signs and symptoms include tachycardia, respiratory difficulties, and cyanosis of the face, neck, and arms. With tension pneumothorax or a significant hemothorax, decreased or absent breath sounds will be present.

Question 19

You are treating a 24-year-old female with a gunshot wound to the right side of the back. No exit wound is visible. She is awake but confused. Her skin is pale and diaphoretic with cyanosis noted to the oral mucosa. Breath sounds are clear and equal bilaterally. Jugular vein distention is present. Blood pressure is 90/78 mmHg, heart rate is 124 beats per minute, and respiratory rate is 28 per minute and labored. Sinus tachycardia is seen on the cardiac monitor. What would be the most appropriate treatment for this patient?

Answer 19

High flow oxygen, spinal precautions, occlusive dressing over entrance wound, rapid transport.

Treatment of a gunshot wound to the thorax would include taking necessary spinal precautions. The open wound should be covered with an occlusive dressing. The respiratory distress should be treated with high flow oxygen with consideration of positive pressure ventilation and possible intubation. In addition, an IV should be started for a fluid route if hypotension worsens. Rapid transport is indicated for pericardiocentesis and possible surgery.

Question 20

You are treating a 12-year-old male patient who was hit in the nose with a baseball. His nose is deviated to the left with moderate epistaxis. He is complaining of severe pain to his nose. He is alert and oriented with no loss of consciousness. What is the best treatment sequences to best manage this patient?

Answer 20

Have patient sit upright and lean forward while holding pressure to nares.

Holding pressure on the nares is the proper technique to control epistaxis while leaning the patient forward to prevent blood from draining down the throat. Leaning the patient forward should not be performed if spinal precautions are necessary.

Question 21

You are called for an elderly female that fell down and hurt her knee. When you find the patient, she tells you she tripped and fell, and landed on her left knee. She denies any loss of consciousness or trauma to her head. The patient is only complaining of pain to the distal portion of her femur. During your assessment, you notice deformity and swelling to the femur, proximal to the knee. The patient has good distal pulses, motor function, and sensation. What would be the most appropriate treatment for this patient?

Answer 21

Secure to a backboard and pad appropriately

The patient with a femur fracture should be secured to a backboard and padded appropriately. Traction splinting is only appropriate if the femur fracture is mid shaft. Padded board splints may or may not provide sufficient stabilization.

Question 22

Which of the following patients would be most appropriate for triage to a non-trauma center?

a) 67-year-old female who was electrocuted by a 220 volt electrical outlet
b) 19-year-old male involved in a single car MVC at a rate of 25 miles per hour
c) 25-year-old female with a 1-inch laceration on her thigh
d) 14-year-old male who fell 11 feet out of a tree, landing on his back

Answer 22

25-year-old female with a 1-inch laceration on her thigh

Question 23

You have responded to a local residence of a 37-year-old male who had lacerated his leg while using a chainsaw in the back of his house. Prior to your arrival, the patient’s wife, who is a nurse, applied pressure to the wound and has the patient in a Trendelenburg position. Your assessment of the patient reveals him to be responsive to painful stimuli with a weak carotid pulse and the blood pressure unobtainable. There is a massive amount of blood surrounding the patient on the ground. The wife tells you that the wound is arterial and the injury occurred about 10 to 15 minutes ago. In addition to oxygen therapy, what are your treatment priorities for this patient?

Answer 23

25-year-old female with a 1-inch laceration on her thigh

Direct pressure and fluids are this patient’s best chance for survival and prevention of decompensated shock. ALS should be activated to administer fluids as soon as possible. If bleeding continues, apply a tourniquet.

Question 24

Which of the following findings in a crush injury is typically the earliest and most prominent?

a) Pain
b) Pulselessness
c) Paresthesia
d) Paralysis

Answer 24

Pain

Pain is generally the most obvious sign of a crush injury and tends to present earliest out of all of the other associated signs and symptoms.

Question 25

Your 26-year-old female patient has been pulled out of a house fire. Her chest and arms have been burned. The area is charred and the patient states she has little pain in the burned area. What is the most likely classification of this patient’s burns?

Answer 25

Full Thickness

The patient is most likely experiencing a full thickness burn with disruption of the soft tissue through the nerve root. They are typically painless, with the exception of the penumbra, because of the lack of nerve stimulation.

Question 26

You have responded for a 43-year-old male who was involved in an altercation. The patient was reportedly beaten about the face and head with a baseball bat. The patient is unresponsive. Evaluation of the patient’s face reveals instability from the orbits to the mandible. Based on this information, how would you definitively manage this patient’s airway?

Answer 26

Orally intubate the patient and assist ventilations with a Bag-Valve-Mask.

This patient has an unstable face and an unstable airway. Ultimately, this patient needs to have his airway protected as quickly as possible with an endotracheal tube. With facial instability, it is imperative that an adjunct be placed to ensure that the airway is not occluded by the pressure on the jaw created with the application of the Bag-Valve-Mask.

Question 27

When managing an open fracture, you should do which of the following?

Answer 27

Cover the exposed bone ends with a moist sterile dressing

When bone is exposed, care must be taken to prevent further injury and infection. A good rule of thumb for the use of moist, sterile dressings is as follows: If the protruding part is normally on the inside of the body, cover it with a moist sterile dressing. Do not attempt to reinsert or reduce the exposed bone back into the body.

Question 28

What is the most common spinal injury associated with improper lifting techniques?

Answer 28

Lumbar

The most common spinal injury is injury to the cervical spine. Improper lifting techniques, however, often result in lumbar injuries. Common lumbar injures are bulging and/or compressed vertebra. You must remember to lift with your legs and knees and not your back.

Question 29

You respond to the scene of a residential natural gas explosion to find a 36-year-old male patient complaining of a diminished ability to hear, moderate dyspnea, and acute abdominal pain. These symptoms are likely due to what mechanism?

Answer 29

Primary blast injury

Primary Blast Injuries are caused by the compression of air filled organs by an overpressure wave, typically affecting the tympanic membranes, lungs, stomach, intestines, and sinuses.

Question 30

While assessing the carotid and radial pulse in your unresponsive patient, you determine that the carotid pulse is weak and rapid, and the peripheral pulses are absent. What other clinical assessment finding would you expect to be present?

Answer 30

Cool and pale skin

Checking the central and peripheral pulses in the unresponsive patient will give the paramedic a rough estimate of peripheral perfusion. In this instance, where there is no peripheral pulse and a weak central pulse, the inference can be made that there is poor peripheral perfusion. Another expected finding in this patient then would be cool and pale skin from the diminished peripheral blood flow.