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Flashcards in Midterm 3 trauma Deck (298)
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1

During transport of a patient with a head injury, which of the following will provide you with the MOST information regarding the patient's condition?

A: Heart rate
B: Mental status
C: Pupil size
D: Blood pressure

B: Mental status

2

Which of the following sets of vital signs is MOST suggestive of increased intracranial pressure in a patient who has experienced a traumatic brain injury?

A: BP, 176/98 mm Hg; pulse, 50 beats/min; respirations, 10 breaths/min
B: BP, 84/42 mm Hg; pulse, 60 beats/min; respirations, 32 breaths/min
C: BP, 92/60 mm Hg; pulse, 120 beats/min; respirations, 24 breaths/min
D: BP, 160/72 mm Hg; pulse, 100 beats/min; respirations, 12 breaths/min

A: BP, 176/98 mm Hg; pulse, 50 beats/min; respirations, 10 breaths/min

3

When caring for a trauma patient with signs of intraabdominal bleeding, it is MOST important for the EMT to:

A: apply and inflate the pneumatic antishock garment.
B: transport rapidly to an appropriate medical facility.
C: perform an in-depth abdominal assessment.
D: auscultate bowel sounds for at least 2 minutes.

B: transport rapidly to an appropriate medical facility.

4

A man was struck in the side of the head with a steel pipe. Blood-tinged fluid is draining from the ear and bruising appears behind the ear. The MOST appropriate treatment for this patient includes:

A: controlling the drainage from the ear and immobilizing the entire spine.
B: elevating the lower extremities and providing immediate transport.
C: applying high-flow oxygen and packing the ear with sterile gauze pads.
D: immobilizing the spine, administering oxygen, and monitoring for vomiting.

D: immobilizing the spine, administering oxygen, and monitoring for vomiting.

5

A 40-year-old man has burns to the entire head, anterior chest, and both anterior upper extremities. Using the adult Rule of Nines, what percentage of his total body surface area has been burned?

A: 45%
B: 27%
C: 36%
D: 18%

B: 27%

Reason:

Using the adult Rule of Nines, the head accounts for 9% of the total body surface area (TBSA), the anterior chest for 9% (the entire anterior trunk [chest and abdomen] accounts for 18%), and the anterior upper extremities for 4.5% each (each entire upper extremity is 9% of the TBSA). On the basis of this, the patient has sustained 27% TBSA burns.

6

During your assessment of a patient who experienced blunt facial trauma, you note the presence of a hyphema. This indicates:

A: a fracture of the nasal bone.
B: an orbital blowout fracture.
C: that the pupils are unequal.
D: direct trauma to the eyeball.

D: direct trauma to the eyeball.

Reason:

Some patients with blunt trauma to the eyeball (globe) may present with a hyphema, or bleeding into the anterior chamber of the eye, that obscures a portion of or the entire iris. This condition may seriously impair vision and should be considered a sight-threatening emergency. A fracture of the orbital floor (blowout fracture) is characterized by double vision and an inability of the patient to move his or her eyes above the midline (paralysis of an upward gaze) following blunt facial trauma. In an orbital blowout fracture, fragments of fractured bone can entrap some of the muscles that control eye movement. Anisocoria is the term used to describe unequal pupils. Unequal pupils following head trauma indicates increased intracranial pressure.

7

A 19-year-old female has a closed, swollen deformity to her left forearm. You are unable to palpate a radial pulse and the skin distal to the injury is cold and pale. Several attempts to contact medical control have failed and you are approximately 45 miles away from the closest hospital. You should:

A: begin transport at once, gently manipulate her arm en route until distal circulation is restored, and apply an air splint.
B: make one attempt to restore distal circulation by applying gentle manual traction in line with the long axis of the limb.
C: apply an air splint to her forearm, keep her arm below the level of her heart, place an icepack over the injury, and transport.
D: splint her entire arm with rigid board splints, elevate the limb above the level of her heart, and transport immediately.

B: make one attempt to restore distal circulation by applying gentle manual traction in line with the long axis of the limb.

Cold, pale skin and an absent distal pulse indicates that blood flow distal to the injury is compromised. You should notify medical control, who will likely direct you to attempt to restore distal circulation. However, if you are unable to contact medical control and your transport time will be lengthy, you should make ONE attempt to restore distal circulation by applying gentle manual traction in line with the long axis of the limb. Be careful, as excessive manipulation can worsen the vascular problem. If you are unsuccessful after one attempt, splint the limb in the most comfortable position for the patient and transport at once. If distal circulation is restored, splint the limb in whatever position allows the strongest distal pulse. You should elevate the limb above the level of the heart to help minimize swelling. An icepack may also help reduce pain and swelling.

8

A woman stabbed her boyfriend in the cheek with a dinner fork during an argument. Police have the woman in custody. The patient still has the fork impaled in his cheek. He is conscious and alert, breathing adequately, and has blood in his oropharynx. You should:

A: suction his oropharynx, carefully cut the fork to make it shorter, control any external bleeding, and secure the fork in place.
B: apply high-flow oxygen via a nonrebreathing mask, carefully remove the fork, and control any external bleeding.
C: carefully remove the fork, suction his oropharynx as needed, and pack the inside of his cheek with sterile gauze pads.
D: suction his oropharynx, control any external bleeding, stabilize the fork in place, and protect it with bulky dressings.

D: suction his oropharynx, control any external bleeding, stabilize the fork in place, and protect it with bulky dressings.

9

Upon discovering an open chest wound, you should:

A: immediately reassess the patient’s ventilatory status.
B: quickly cover the wound with a porous trauma dressing.
C: begin assisted ventilation and prepare for transport.
D: prevent air from entering the open wound.

D: prevent air from entering the open wound.

10

A patient with a closed head injury opens his eyes in response to pain, is mumbling words that you cannot understand, and pushes your hand away when you apply a painful stimulus. His Glasgow Coma Scale (GCS) score is:

A: 7
B: 8
C: 9
D: 6

C: 9
Reason:

The Glasgow Coma Scale (GCS) is a valuable tool used when assessing patients with a neurological injury. It assesses three parameters: eye opening, verbal response, and motor response. A minimum score on the GCS is 3 and a maximum score is 15. A patient who opens his or her eyes in response to pain would receive a score of 2. Mumbling speech, moaning, or incomprehensible words equate to a score of 2 for verbal response. Localization of a painful stimulus, such as pushing your hand away from the source of pain, equates to a score of 5. Therefore, the patient has a GCS score of 9. It is important to note that a patient's GCS score should be reassessed frequently. Review the entire GCS in your EMT text and commit it to memory.

11

During a soccer game, an 18-year-old woman injured her knee. Her knee is in a flexed position and is obviously deformed. You should:

A: assess circulatory function distal to her injury.
B: immobilize the knee in the position in which it was found.
C: straighten the knee to facilitate immobilization.
D: manually stabilize the leg above and below the knee.

D: manually stabilize the leg above and below the knee.

12

A high-school student was splashed in the eyes with a strong acid chemical during a lab experiment. He is in severe pain and is unable to open his eyes. You should:

A: cover both of his eyes with sterile gauze and transport at once.
B: flush both eyes with sterile water for no more than 5 minutes.
C: force his eyes open and assess for the presence of severe burns.
D: continuously flush his eyes with saline for at least 20 minutes.

D: continuously flush his eyes with saline for at least 20 minutes.

13

When applying a vest-style spinal immobilization device to a patient with traumatic neck pain, you should:

A: ask the patient to fully exhale as you secure the torso.
B: secure the torso section prior to immobilizing the head.
C: immobilize the head prior to securing the torso straps.
D: gently flex the head forward as you position the device.

B: secure the torso section prior to immobilizing the head.

14

A young male has trauma to multiple body systems after he fell approximately 35 feet. He is semiconscious, has an unstable chest wall, numerous long bone fractures, and a large hematoma to his head. He will have the GREATEST chance for survival if you:

A: request an ALS ambulance.
B: keep him warm and elevate his legs.
C: give him high-flow oxygen early.
D: rapidly transport him to a trauma center.

D: rapidly transport him to a trauma center.

15

A 23-year-old male was struck across the face with a baseball bat. His eyes are swollen shut, he has massive facial bruising and deformities, and has blood in his mouth. Your MOST immediate concern should be:

A: spinal trauma.
B: airway compromise.
C: permanent vision loss.
D: intracranial bleeding.

B: airway compromise.

16

Displaced fractures of the proximal femur are characterized by:

A: lengthening and internal rotation of the leg.
B: a flexed hip joint and inward thigh rotation.
C: shortening and external rotation of the leg.
D: hip joint extension and external leg rotation.

C: shortening and external rotation of the leg.

Fractures of the proximal (upper) part of the femur are especially common in older people, particularly those with osteoporosis, but may also occur as a result of high-energy trauma in younger patients. Although they are usually called hip fractures, they rarely involve the hip joint. Instead, the break goes through the neck of the femur, the middle region, or across the proximal shaft. Patients with displaced fractures of the proximal femur display a very characteristic deformity. They lie with the leg externally rotated, and the injured leg is usually shorter than the uninjured leg. If the fracture is not displaced, this deformity is not present. A flexed hip joint and internal rotation of the thigh are characteristic of a posterior hip dislocation. With the less common anterior hip dislocation, the limb is in the opposite position, extended straight out, externally rotated, and pointing away from the midline of the body.

17

After stopping the burning process, emergency care for a 68-year-old male with partial- and full-thickness burns to his chest and upper extremities includes all of the following, EXCEPT:

A: covering the burns with dry, sterile dressings.
B: avoiding the use of burn ointments or antiseptics.
C: flushing the burns with cool water for 10 minutes.
D: preparing to assist the patient’s ventilations.

C: flushing the burns with cool water for 10 minutes.

Reason:
Unless the patient is on fire, do not apply water to a full-thickness (third-degree) burn, especially if the patient is already prone to hypothermia and infection (ie, older adults, small children). Cover the burns with dry, sterile dressings or a sterile burn sheet. The use of burn creams, ointments, or antiseptics should be avoided; these increase the risk of infection and will only need to be removed at the hospital. Apply high-flow oxygen, treat any associated injuries, and rapidly transport the patient. If the patient is breathing inadequately (eg, fast or slow rate, shallow breathing [reduced tidal volume]), assist ventilations with a bag-mask device.

18

General care for an amputated body part includes:

A: wrapping the amputated part in a moist, sterile dressing and keeping it warm.
B: immersing the amputated part in ice cold water to prevent further damage.
C: wrapping the amputated part in a moist, sterile dressing and placing it on ice.
D: thoroughly cleaning the amputated part and wrapping it in a sterile dressing.

C: wrapping the amputated part in a moist, sterile dressing and placing it on ice.

19

When assessing and treating a patient with a gunshot wound, you should routinely:

A: determine why the patient was shot.
B: evaluate the pulses proximal to the wound.
C: look for the presence of an exit wound.
D: apply ice directly to the wound.

C: look for the presence of an exit wound.

20

Despite direct pressure, a large laceration continues to spurt large amounts of bright red blood. You should:

A: apply a tourniquet proximal to the injury until the bleeding stops.
B: elevate the extremity and apply a tight pressure dressing.
C: place additional dressings on the wound until the bleeding stops.
D: apply pressure to the pulse point that is proximal to the injury.

A: apply a tourniquet proximal to the injury until the bleeding stops.

21

Shock following major trauma is MOST often the result of:

A: head injury.
B: spinal injury.
C: hemorrhage.
D: long bone fractures.

C: hemorrhage

22

A young man fell and landed on his outstretched hand, resulting in pain and deformity to the left midshaft forearm. Distal circulation should be assessed at which of the following pulse locations?

A: Pedal
B: Radial
C: Popliteal
D: Brachial

B: Radial

23

A 44-year-old male experienced burns to his anterior trunk and both arms. He is conscious and alert, but is in extreme pain. Assessment of the burns reveals reddening and blisters. This patient has ________________ burns that cover _____ of his total body surface area.

A: full-thickness, 18%
B: partial-thickness, 36%
C: first-degree, 27%
D: second-degree, 45%

B: partial-thickness, 36%

24

You are assessing a young male who was stabbed in the right lower chest. He is semiconscious and has labored breathing, collapsed jugular veins, and absent breath sounds on the right side of his chest. This patient MOST likely has a:

A: ruptured spleen.
B: liver laceration.
C: hemothorax.
D: pneumothorax.

C: hemothorax

25

Patients with significant closed head injuries often have pupillary abnormalities and:

A: tachycardia.
B: paralysis.
C: hypertension.
D: paresthesia.

C: hypertension

26

You are called to a local nightclub for an injured patient. Law enforcement personnel have secured the scene. Upon arrival, you see a young man who is lying on the ground screaming in pain; bright red blood is spurting from an apparent stab wound to his groin area. You should:

A: apply 100% oxygen.
B: prevent hypothermia.
C: control the bleeding.
D: ensure an open airway.

C: control the bleeding.

27

Which of the following mechanisms of injury would necessitate performing a rapid head-to-toe assessment?

A: An impaled object in the patient’s lower extremity with minimal venous bleeding
B: A 5 foot, 9 inch tall adult who fell 12 feet from a roof and landed on his side
C: A stable patient involved in a motor-vehicle crash, whose passenger was killed
D: Amputation of three toes from the patient’s left foot with controlled bleeding

C: A stable patient involved in a motor-vehicle crash, whose passenger was killed

28

A gang member was cut on the left side of the neck during a fight and is bleeding heavily from the wound. His airway is patent and his breathing is adequate. You should immediately:

A: apply high-flow oxygen via a nonrebreathing mask at 15 L/min.
B: cover the wound with an occlusive dressing and apply direct pressure.
C: apply a tight pressure dressing and secure it in place with tape.
D: perform a head-to-toe assessment to find and treat other injuries.

B: cover the wound with an occlusive dressing and apply direct pressure.

29

A 42-year-old man was ejected from his car after it struck a bridge pillar at a high rate of speed. You find him in a prone position approximately 50 feet from his car. He is not moving and does not appear to be breathing. You should:

A: use the jaw-thrust maneuver.
B: administer high-flow oxygen.
C: assess his breathing effort.
D: manually stabilize his head.

D: manually stabilize his head.

30

The presence of subcutaneous emphysema following blunt trauma to the anterior neck should make you MOST suspicious for a:

A: ruptured esophagus.
B: fractured larynx.
C: pneumothorax.
D: carotid artery injury.

B: fractured larynx.