Chapter 12 Study Plan

Which of the following is the BEST place to check for a pulse in an unconscious​ 12-year-old patient? A. Carotid B. Radial C. Dorsalis D. Brachial

A. Carotid When assessing pulses in an unconscious​ patient, a central pulse is the best indication of cardiac output. A carotid pulse would give you an immediate assessment of central circulation and would typically not be affected by​ shunting, as peripheral pulses sometimes can be.

Which of the following phases of patient assessment would be conducted immediately after the scene​ size-up? A. Primary assessment B. Baseline vitals C. Transport decision D. Rapid trauma assessment

A. Primary assessment The primary assessment is the second major component of patient assessment after the scene​ size-up. The rapid trauma assessment would be used on critical trauma patients and would occur after the primary assessment. Transport decision and baseline vitals would also follow the primary assessment.

A​ 40-year-old male has crashed his motorcycle. Your general impression identifies that he is unconscious and that he has spurting blood pouring out of the junction between his leg and his groin. You also hear gurgling respirations. You should​ first: A. apply direct pressure to the bleeding wound. B. open the​ patient's airway using the​ jaw-thrust maneuver. C. assess for a carotid pulse. D. suction the​ patient's airway.

A. apply direct pressure to the bleeding wound. Massive hemorrhage must be addressed​ first, as it is the most​ time-sensitive life threat. In this​ patient, it is even more important than an airway obstruction. Checking a pulse would occur only after correcting the bleeding and the airway problem.

A​ 21-year-old male patient has been shot in the chest and is breathing rapidly. Law enforcement has determined that the scene is​ safe, and you have completed a scene​ size-up. You should​ NEXT: A. ensure that the patient has an open airway. B. listen to the​ patient's lung sounds. C. make a transport decision. D. check for a pulse.

A. ensure that the patient has an open airway. After the scene​ size-up, you would initiate the primary assessment. In this​ phase, you would assess the​ patient's airway​ first, then assess breathing​ (lung sounds) and circulation​ (pulse). You would make a transport decision after the primary assessment has been completed.

When you report to your partner that the patient is a​ 46-year-old male trauma patient with leg​ pain, you have provided​ the: A. general impression. B. transport priority. C. primary assessment. D. secondary assessment.

A. general impression. The general impression consists of the​ patient's age, the​ patient's sex, the chief​ complaint, whether the cause is trauma or​ medical, and identifying and managing life threats. The transport priority suggests when and how the patient should be transported. The primary and secondary assessments would include a great deal more information.

A​ 37-year-old female complains of dyspnea. You note that she has a patent airway but severe respiratory distress. She has tight wheezes and diminished air movement. She is cyanotic and confused. You should​ first: A. initiate positive pressure ventilations. B. apply supplemental oxygen. C. assess for a radial pulse. D. obtain baseline vital signs.

A. initiate positive pressure ventilations. The primary assessment of this patient identifies respiratory failure. You should first initiate positive pressure ventilations. Supplemental oxygen would not be sufficient to support this patient. Obtaining a pulse can be completed after managing the breathing​ problem, and vital signs can be obtained after completing the primary assessment.

A​ 90-year-old female is experiencing severe respiratory distress secondary to exacerbated COPD. After several minutes of treating this​ patient, you witness her stop breathing. She continues to have a pulse. You should​ NEXT: A. open the airway manually. B. Apply supplemental oxygen. C. begin chest compressions. D. deliver a positive pressure breath.

A. open the airway manually. This patient is in respiratory arrest and needs positive pressure ventilation to prevent cardiac arrest.​ However, before delivering a positive pressure​ breath, you must first open the airway manually. Supplemental oxygen would​ not, by​ itself, assist this patient. Because the patient has a​ pulse, chest compressions are not yet indicated.

When you are caring for a critical patient with distal extremity​ fractures, splinting should be​ completed: A. while transporting the patient to the hospital. B. before attempting to move the patient. C. immediately to prevent further soft tissue injury. D. once the patient has arrived in the emergency department.

A. while transporting the patient to the hospital. Any type of care that is done for the patient that is not directly supporting the​ airway, breathing, or circulation components should be delayed until the patient is en route to the hospital.

Which of the following patients would immediately require an intervention related to the circulation aspect of the primary​ assessment? A. A choking patient B. A cardiac arrest patient C. A patient with severe dyspnea D. A patient with dehydration

B. A cardiac arrest patient The circulation phase of the primary assessment addresses the movement of blood and perfusion. A cardiac arrest patient would need immediate circulatory intervention​ (chest compressions). A choking patient would need an airway​ intervention, and a dyspnea patient would need a breathing intervention. Although dehydration is a circulatory​ problem, it would not typically require immediate intervention in the primary assessment.

A​ 13-year-old male has crashed an ATV. He was not wearing a helmet and was found unconscious. His airway is​ patent, but he has crepitus and diminished lung sounds in his right chest. Which of the following destinations would be most appropriate for this​ patient? A. A community hospital 5 miles away B. A level I trauma center 14 miles away C. A level III trauma center 12 miles away D. An urgent care center 3 miles away

B. A level I trauma center 14 miles away According to the current Centers for Disease Control and Prevention Field Triage​ Guidelines, a patient with a​ high-energy mechanism and significant physical findings should be transported to the closest appropriate trauma system. In this​ case, the level I trauma center would be best equipped and staffed to manage this​ patient, even though it may be the farthest away.

A​ 22-year-old female fell 10 feet off a ladder. She is alert and oriented but has sustained bilateral ankle injuries. She has an open airway and is breathing adequately. Her blood pressure is​ 140/88. Which of the following would be the most appropriate transport destinations for this​ patient? A. A level I trauma center 15 miles away. B. A level II trauma center 5 miles away. C. A community hospital 5 miles away. D. An urgent care center 3 miles away.

B. A level II trauma center 5 miles away. According to the current Centers for Disease Control and Prevention Field Triage​ Guidelines, a patient with a GCS of​ 15, no significant derangements in​ vitals, negative serious​ injury, and absent​ high-energy impact mechanisms should be transported to the closest appropriate trauma​ system, though it need not be the​ highest-level trauma center. Because of the traumatic mechanism of this​ patient's injuries, you should consider transport to a trauma center.​ However, the level II trauma center would be sufficient.

Which of the following acronyms may be used in assessing the​ patient's level of​ consciousness? A. OPQRST B. AVPU C. SAMPLE D. ​DCAP-BTLS

B. AVPU AVPU stands for​ Alert, Verbal,​ Painful, Unresponsive. This acronym is used to determine the​ patient's level of consciousness. SAMPLE is an acronym that is used to address patient history. OPQRST helps to further describe the chief complaint.​ DCAP-BTLS is used in the physical examination.

Which of the following statements is TRUE about the primary​ assessment? A. You cannot gain enough information about the patient during the primary assessment to make a transport decision. B. Critical conditions that are identified during the primary assessment must be treated immediately as found. C. The primary assessment includes​ airway, breathing, and circulation​ (ABCs) and baseline vitals. D. The main purpose of the primary assessment is to perform a​ head-to-toe physical examination to discover injuries.

B. Critical conditions that are identified during the primary assessment must be treated immediately as found. The purpose of the primary survey is to find and treat threats to the​ airway, breathing, and circulation. These are managed immediately. A​ head-to-toe examination is not typically completed in the primary assessment. Baseline vital signs are not a component of the primary assessment.​ Generally, a transport decision is based on information that is found in the primary assessment.

Which of the following findings would address the breathing section of the primary​ assessment? A. Pale skin B. Cyanotic skin C. Capillary refill time D. Absent radial pulse

B. Cyanotic skin Cyanosis would indicate hypoxia and would be a key component of assessing a​ patient's breathing status. A radial​ pulse, capillary​ refill, and pale skin would refer to the​ patient's circulatory status.

A​ 58-year-old male crashed his vehicle at high speed. He was not wearing his seatbelt and has a deep laceration on his forehead and neck pain. It is not clear whether there was a period of unconsciousness before your arrival on the scene. Which of the following would best define the​ patient's transport​ mode, given the previous​ information? A. High priority to the nearest hospital B. High priority to the trauma center C. Low priority to the trauma center D. Low priority to the nearest hospital

B. High priority to the trauma center Because of the potential for loss of consciousness from a head injury and the significant​ MOI, this patient is a high priority and should go to the trauma center.

A​ 41-year-old male has sustained a large laceration to his leg after falling from a tree he was trimming. You identify the massive hemorrhage and apply a tourniquet. After bleeding has been​ controlled, you should​ NEXT: A. obtain baseline vital signs. B. assess the​ patient's airway. C. assess the​ patient's breathing. D. make a transport decision.

B. assess the​ patient's airway. The​ patient's most immediate life threat is bleeding. In your primary​ assessment, you identified and successfully treated this problem.​ Afterwards, you should continue on and complete the primary assessment. The next step would therefore be to assess the​ patient's airway. Transport decision and vital signs would be completed after the primary assessment is finished.

A​ 25-year-old male was shot in the leg. His bleeding has been controlled. When assessing this​ patient's circulation in the primary​ assessment, you should also​ consider: A. blood pressure. B. peripheral pulses. C. lung sounds. D. pulse oximetry reading.

B. peripheral pulses. During the primary​ assessment, the circulation is assessed for​ pulse; perfusion; skin​ color, temperature, and​ condition; and bleeding. In this​ patient, peripheral pulses can help you to identify internal bleeding and shock. Although blood pressure is​ important, it is not part of the primary assessment. Lung sounds and pulse oximetry are not circulatory assessments.

A​ 56-year-old male has fallen off a​ 12-foot ladder. After ensuring scene safety and completing the scene​ size-up, you should​ NEXT: A. assess baseline vital signs. B. take manual cervical spine precautions. C. asses the​ patient's airway. D. question bystanders.

B. take manual cervical spine precautions. The establishment of cervical immobilization of a trauma victim is commonly the first​ hands-on intervention that is done upon arrival of EMS​ (following the scene​ size-up). Airway would be assessed next. Vital signs would be obtained after the primary​ assessment, and bystanders can be questioned after life threats have been ruled out or addressed.

Forming your general impression of the patient can essentially be characterized​ as: A. your interpretation of the patient before the scene​ size-up. B. your first intuitive evaluation of the patient. C. your interpretation of the patient after the medical interview. D. your interpretation of the patient after the primary assessment.

B. your first intuitive evaluation of the patient. The general impression is the​ EMT's first intuitive evaluation of the​ patient, and it generally is part of the primary assessment that immediately follows the scene​ size-up. This is used to get a snapshot of the​ patient's stability that will be either supported or not supported by the physical assessment and patient interview.

Which of the following would be the BEST method to open the airway on an unresponsive trauma​ patient? A. Insert an oropharyngeal airway B. ​Jaw-thrust maneuver C. ​Head-tilt, chin-lift maneuver D. Place patient in a sniffing position

B. ​Jaw-thrust maneuver Use the​ jaw-thrust maneuver to open the airway in an unresponsive trauma​ patient, as it manipulates the cervical spine less than the​ head-tilt, chin-lift technique does. Although the sniffing position and adjuncts such as an OPA can be​ helpful, a manual opening maneuver is still necessary.

Which of the following acronyms is used to assess a​ patient's mental​ status? A. OPQRST B. ​AEIOU-TIPS C. AVPU D. ​DCAP-BTLS

C. AVPU To assess mental​ status, use the AVPU method​ (alert, responds to verbal​ stimulus, responds to painful​ stimulus, unresponsive).​ DCAP-BTLS is used to complete a detailed physical examination. OPQRST is used to gather additional information about a​ patient's chief complaint.​ AEIOU-TIPS is a memory aid that is used to help remember the causes of altered mental​ status, not to assess mental status.

Which one of the following terms would indicate the need for immediate transport of the patient rather than further assessment and care at the​ scene? A. Deferred priority B. Delayed C. High priority D. Secondary

C. High priority Priority is the decision about the need for immediate transport of the patient rather than further assessment and care at the scene. All of the other terms would imply that further assessment and treatment can occur.

Which of the following phases of patient interaction is most likely the phase in which the EMT will discover and deal with​ life-threatening problems? A. General impression B. Patient history C. Primary assessment D. Secondary assessment

C. Primary assessment The primary assessment includes steps that are taken for the purpose of discovering and dealing with any​ life-threatening problems, and it is the phase during which those problems are immediately dealt with. Although the secondary assessment may reveal life​ threats, they are much more commonly found in the primary assessment. The general impression can give the EMT clues about life​ threats, but they are typically confirmed with a primary assessment. The patient history is typically used to confirm findings.

How would you assess the mental status of an infant who appears​ unresponsive? A. Shake the infant and shout. B. Ask the caregiver whether the infant is alert. C. Shout as a verbal​ stimulus, and flick the feet as a painful stimulus. D. Do a light sternal rub to elicit a painful response.

C. Shout as a verbal​ stimulus, and flick the feet as a painful stimulus. If the infant is not​ alert, shout as a verbal​ stimulus, and flick the feet as a painful stimulus. Although the caregiver is typically a good source of information about a pediatric​ patient, an unresponsive patient requires more active assessment. Sternal rubs are not used in infants. Shaking is not an accepted technique and could cause injury.

A​ 65-year-old female has been found unconscious. You conduct a primary assessment. Which one of the following​ problems, if​ found, would be treated during the primary​ assessment? A. Minor bleeding B. Wheezing C. Snoring respirations D. Hypertension

C. Snoring respirations The primary assessment typically addresses massive hemorrhage and​ airway, breathing, and circulation problems. Snoring occurs as a result of a partial upper airway obstruction and should be corrected in the primary assessment. Each of the other problems would be corrected after the primary assessment.

During your assessment of a patient who is suspected of having had a​ stroke, you have to pinch his nail beds for him to respond. Which of the following would best categorize this​ patient's mental​ status? A. The patient is unresponsive. B. The patient is alert. C. The patient responds to painful stimuli. D. The patient responds to verbal stimuli.

C. The patient responds to painful stimuli. If it requires the use of painful​ (or noxious) stimuli to gain a​ response, the patient is said to respond to painful stimuli. An alert patient would respond without prompting. Verbal would indicate that the patient responds to voice. Unresponsive would imply no response.

Which of the following breathing assessments would be completed in the primary assessment of a significant trauma​ patient? A. Capillary refill time B. Pulse oximetry C. Visualization of the chest for equal rise D. Auscultation of lung sounds at eight points on the chest

C. Visualization of the chest for equal rise The breathing assessment in a significant trauma patient should include visualization of the chest. Auscultation may take​ place, but not a comprehensive assessment as an​ eight-point check would imply. Pulse oximetry is a valuable tool but would typically be completed after the primary assessment. Capillary refill time is not part of the breathing assessment.

Your general impression of the patient should be formed from which of the​ following? A. What the neighbors tell you B. The​ patient's history C. Your observations D. The medical timeline

C. Your observations Your general impression is based on your observations of both the surroundings and the patient at the time of arrival. Your general impression is also informed by what you learn from the chief complaint.

As you interview a patient with a medical​ complaint, the reason why the ambulance was called for is often called​ the: A. physical examination. B. SAMPLE history. C. chief complaint. D. mechanism of injury.

C. chief complaint. In the chief​ complaint, the patient states in her own words the reason the ambulance was called. The mechanism of injury could be a reason for calling an​ ambulance, but it is associated with trauma patients. SAMPLE history describes elements that may be involved with the reason the ambulance was called but is not necessarily the specific reason. Physical examination helps to confirm findings associated with the chief complaint.

During the primary​ assessment, an example of a life threat to circulation that must be managed right away would​ be: A. very​ cold, pale skin. B. a throbbing headache. C. external arterial bleeding. D. nausea and stomach pain.

C. external arterial bleeding. Threats to the airway​ (obstructions), breathing​ (holes in the​ chest, impaled objects in​ chest, and flail​ segments), and circulation​ (no pulse, very fast or very slow​ pulse, and severe external​ hemorrhaging) need to be found and dealt with immediately in the primary assessment. In this​ patient, the external arterial bleeding is a life threat.

The FIRST step in the primary assessment of the patient​ involves: A. assessing the airway. B. establishing patient priority. C. forming the general impression. D. assessing the circulation.

C. forming the general impression. The steps of the primary assessment include​ (1) forming a general impression of the​ patient, (2) assessing the level of consciousness​ (mental status),​ (3) assessing the​ airway, (4) assessing the​ breathing, (5) assessing the​ circulation, and​ (6) establishing patient priority.

A​ 17-year-old asthma patient has been having an attack for two hours. Her mother called EMS because the patient seemed to be deteriorating. You note that the patient is​ lethargic, pale, and diaphoretic. Her airway is​ open, and she is breathing slowly at 6 breaths per minute. You​ should: A. administer a nebulizer mask with albuterol. B. apply nonrebreather mask at 15 lpm. C. initiate​ bag-valve-mask ventilations. D. apply a nasal cannula at 6 lpm.

C. initiate​ bag-valve-mask ventilations. The slow respiratory rate coupled with altered mental status indicates respiratory failure. This patient requires immediate​ bag-valve-mask ventilations. Supplemental oxygen will not be sufficient to support this​ patient's respiratory needs. Although albuterol may be​ helpful, it is not more important than positive pressure ventilations.

During your primary​ assessment, you note blood in the​ patient's mouth and hear gurgling. You should​ NEXT: A. initiate abdominal thrusts to clear the secretions. B. proceed on to the evaluation of the​ patient's circulation. C. suction the airway and clear any secretions. D. proceed on to evaluation of the​ patient's breathing.

C. suction the airway and clear any secretions. ​Blood, secretions,​ vomitus, or other substances in the mouth and airway should be suctioned and cleared as soon as they are identified. Abdominal thrusts are not an effective way to clear secretions. Breathing and circulation can be evaluated after the airway concerns have been addressed.

You are conducting a primary assessment. You find that your patient knows his name but does not know where he is or the day of the week. You determine that his mental status​ is: A. ​"A" for alert. B. ​"U" for unresponsive. C. ​"V" for verbal. D. ​"P" for painful.

C. ​"V" for verbal. To be​ "A" for​ alert, the patient would need to know his​ name, where he​ is, and the day of the week​ (oriented to​ person, place, and​ day). In this​ case, he gets a​ "V" for responding to your verbal stimuli.​ "P" would be indicated if he responded only to painful stimuli.​ "U" would be indicated if he was completely unresponsive.

A​ 33-year-old male has been thrown from a vehicle in a​ high-speed crash. Your assessment reveals that he will respond only to painful stimuli with decorticate posturing. He has blood in the​ hypopharynx, unequal chest wall​ motion, and a penetrating injury to the leg with moderate bleeding. Which of the following priorities would best characterize this​ patient? A. Low priority B. No priority C. Medium priority D. High priority

D. High priority A​ high-priority patient is one who has a definite loss of vital function as determined by the primary assessment. In this​ instance, the change in mental​ status, the airway​ occlusion, the unequal chest wall​ motion, and the bleed all contribute to the​ high-priority designation.

In which of the following patients would you check a brachial pulse​ initially? A. Adult B. Child C. Geriatric D. Infant

D. Infant The EMT should check the brachial pulse in the​ infant, as the carotid pulse is much more difficult to identify in the less developed neck. In the other​ patients, a carotid pulse would be assessed first.

Which of the following findings would be assessed in the general impression of a​ patient? A. Vital signs B. Lung sounds C. Pulse oximetry D. Massive bleeding

D. Massive bleeding Forming a general impression involves estimating the​ patient's age, noting the​ patient's sex, identifying the complaint as trauma or​ medical, describing the chief​ complaint, and identifying and manage life threats. Massive hemorrhage would be a life threat that would be identified by observation. The other elements would be findings determined in future phases of patient assessment.

Which of the following patients might be treated with supplemental oxygen by holding an oxygen mask to his​ face? A. Unresponsive infant B. Unresponsive child C. Apneic adult D. Responsive child

D. Responsive child An oxygen mask may be held to the responsive​ child's face to reduce fear. For an unresponsive child or​ infant, the mask could be strapped directly onto the​ patient's head. This could also be done for an apneic adult.

A​ 66-year-old female has been found apneic and pulseless. You should​ immediately: A. insert an OPA. B. initiate positive pressure ventilations. C. open the​ patient's airway. D. begin chest compressions.

D. begin chest compressions. Although the primary assessment most commonly follows a stepwise​ process, the order may at times be changed. For​ example, if your patient appears to be in cardiac arrest​ (unresponsive and not​ breathing), you should first initiate chest compressions and then address airway and breathing. An OPA would be inserted after compressions were initiated.

A​ 45-year-old female is found unconscious. She is not breathing but has a pulse. You should​ NEXT: A. apply an AED. B. initiate chest compressions. C. administer supplemental oxygen. D. initiate positive pressure ventilations.

D. initiate positive pressure ventilations. If a patient has a pulse but is not​ breathing, the EMT should next administer positive pressure ventilations. Chest compressions and the application of an AED would not be indicated if the patient had a pulse. Supplemental oxygen would not be enough to support this patient if she was not breathing.

A​ 70-year-old female complains of abdominal pain and vomiting blood. She appears weak and pale. Her airway is​ patent, and her breathing is​ adequate, although fast. You attempt to find a radial pulse but cannot locate it. This finding most likely​ indicates: A. cardiac dysrhythmia. B. sepsis. C. hypothermia. D. shock.

D. shock. An absent radial pulse in the context of abdominal pain and vomiting blood would most likely indicate shock. Although septic patients can sometimes lose peripheral​ pulses, shock would be more​ likely, given the history. Hypothermia patients can also lose radial​ pulses, but there is no indication of that here. History would make dysrhythmia less likely as well.

An​ 81-year-old diabetic female has been found unconscious. You find that your patient does not respond to a sternal rub or pinching the web between the thumb and index finger. You determine that her mental status​ is: A. ​"A" for alert. B. ​"P" for painful. C. ​"V" for verbal. D. ​"U" for unresponsive.

D. ​"U" for unresponsive. To be​ "A" for​ alert, the patient would need to know his​ name, where he​ is, and the day of the week​ (oriented to​ person, place, and​ day). This patient gets a​ "U" for not responding to your painful stimuli.