Chapter 27: Trauma

QUESTION: A "whiplash"-type neck injury is most often observed with which type of collision? A) Rear-end impact B) Rollover C) Frontal impact D) Ejection

A

QUESTION: A teenage female patient was ejected from a car as it rolled down a hill after she ran off the road. She is responsive, but with signs of early shock and respiratory distress. She has bruising to her anterior abdomen and chest, a laceration to her left temple, and deformity to her left wrist. At which point should the wrist injury be splinted? A) Before transferring the patient to the stretcher B) En route to the hospital C) Just before leaving the scene D) Prior to full spinal motion restriction precautions being provided

B

QUESTION: A 49-year-old male has been stabbed in the lower right chest. Police tell you that the patient got into an argument with an unidentified man, who then stabbed him before fleeing the scene. After assessing the patient, you are suspicious that the knife punctured the lung and is causing internal bleeding. In this situation, the mechanism of injury would be: A) Stab wound to the right chest B) Assailant with a knife C) Internal hemorrhage D) Penetrating trauma to the lungs

A

QUESTION: A car, driven by an unrestrained male, strikes a utility pole at 35 mph. Given this scenario, which would be true? A) The internal organs struck the inside of the body at a speed of 35 mph B) The energy transferred to the body is increased by a factor of 2 C) The patient struck the steering wheel at a combined speed of 70 mph D) The utility pole absorbed half of the kinetic energy, so that the body collision occurred at a speed of 17.5 mph

A

QUESTION: A patient, who was constructing a bomb in his basement, has sustained a secondary-phase blast injury. Which presentation would the EMT most likely observe from this blast phase? A) Screwdriver impaled in the thorax B) Burns to the head, neck, and chest C) Complaint of nausea after inhaling fumes D) Headache and shortness of breath

A

QUESTION: An 8-year-old boy fell forward off of a swing onto outstretched arms. He did not hit his head or lose consciousness and is complaining of left forearm pain. There is deformity to the left wrist, but no other injuries or life threats. His vital signs are pulse 132 beats/min, respirations 20 breaths/min, blood pressure 108/62 mmHg, and SpO2 100%. The proper care of this patient would be to: A) Secure the forearm to a padded board splint and apply a cold pack to the injury site before transporting the patient nonemergently B) Call ALS so that the patient can be given intravenous pain medications before splinting the forearm C) Immediately load and transport the patient, splinting the injury en route D) Apply supplemental oxygen and anatomically splint the forearm when the patient is placed on a long backboard

A

QUESTION: An unrestrained driver of a car that has struck a tree at 45 mph has suffered a contusion to his heart. The EMT would recognize that this injury occurred during which impact of the collision? A) Organ collision B) Body collision C) Vehicle collision D) Physiological collision

A

QUESTION: During an in-service program focusing on care of the trauma patient, the medical director asks if anyone can correctly describe the "platinum 10 minutes." What statement by a participant is the best response? A) "EMS should initiate transport of the critically injured trauma patient to the hospital within 10 minutes of arriving on scene." B) "EMS systems should be designed so that it takes an ambulance no longer than 10 minutes to respond to a trauma call." C) "EMS should spend 10 minutes assessing the patient for life-threatening injuries prior to initiating transport to the emergency department." D) "If the transport to a trauma center will exceed 10 minutes, EMS should strongly consider the use of an aeromedical helicopter."

A

QUESTION: What is the best description of the goal of a trauma system? A) Getting the right patient to the right facility in the right amount of time B) Providing all trauma patients with a complete battery of diagnostic tests and access to specialists C) Providing the highest level of care possible within a 10-minute transport time frame for all patients D) Transporting as many patients as possible by air medical transportation

A

QUESTION: When teaching Emergency Medical Responders about air bags, which point would you emphasize? A) The benefit of air bags is lessened in a multiple-vehicle collision impact B) Properly placed air bags eliminate the need for seat belts C) Air bags are effective in decreasing injury in a rollover-type collision D) Air bags prevent broken glass from striking the occupant

A

QUESTION: You are assessing a patient who was involved in a motorcycle accident. He states that he saw an oncoming car and "laid the bike down" to avoid an outright collision. He was wearing a helmet. Which injury pattern would make sense given the action of the motorcyclist? A) Burn to the inside of the leg from the motorcycle exhaust pipe B) "Road rash" to the entire body surface C) Bilateral broken forearms with upper extremity trauma D) Angulation to both femurs with protrusion

A

QUESTION: You are responding to a call for a 4-year-old child hit by a car. When assessing this child, which injury patterns would you recognize as typical based on the child's age and mechanism of injury? A) Deformed femurs, bruises to the chest and abdomen, and head injury B) Bilateral ankle deformity, contusions to the back, and face trauma C) Head injury with deformities to both upper arms and neck trauma D) Left arm and leg deformities, and head injury

A

QUESTION: A 23-year-old roofer has fallen 20 feet from the roof of a house into shrubs below. Aside from superficial abrasions and complaint of soreness, you detect no obvious injuries. Consequently, the patient states that as long as his legs are not broken, he does not see the need to go to the hospital. As a knowledgeable EMT, your best response would be: A) "Since you did not lose consciousness, I feel better about having you refuse. Just keep an eye on your feet and watch for swelling." B) "In a fall from this height, you may have hurt some internal organs. You really need to be examined." C) "Although you feel okay now, you will most likely be sore later on. Why don't we go to the hospital and ask about some medications for pain?" D) "Since this is a work-related injury, you should really be evaluated in the hospital. Worker's compensation may not cover you if you do not."

B

QUESTION: A patient who was involved in a motor vehicle collision is complaining of neck pain. Which piece of information would most contribute to the EMT's high index of suspicion that the patient may have suffered more significant injuries beyond isolated neck pain? A) Lack of air bags in the car B) Death of the car's driver C) Difficulty turning is head to the right D) External damage to the car is significant

B

QUESTION: A young female wears her lap belt too low, over her upper thighs, because the belt is uncomfortable when worn properly. If she is involved in a head-on "up and over" type of collision, to which injury is she most prone, given the position of her lap belt? A) Tibia-fibula fractures B) Dislocated hips C) Bilateral arm fractures D) Internal abdominal injury

B

QUESTION: After assessing these patients, which would the EMT identify as suffering from multisystem trauma? A) An 89-year-old female who fell in a nursing home and has a hematoma to the back of her head B) A 61-year-old male who became dizzy and fell down five stairs, and who has a laceration to the head and open fracture of the left lower leg C) A 24-year-old male who slipped on ice and has tenderness to the right shoulder D) A 31-year-old female who has a large laceration to her leg from a hunting knife, with bleeding controlled

B

QUESTION: An unrestrained female driving a small car is involved in a rollover-type collision. Why is her risk for serious injury or death significantly increased? A) The risk for ejection is lessened, increasing injuries suffered in the car B) There are more impacts in a rollover causing injury C) Smaller and lighter cars tend to roll multiple times D) Rollovers are the result of high speeds

B

QUESTION: As part of your service to the community, you are certified as a car seat specialist and provide monthly classes on the safe transport of infants and children. Over the course of one day, several cars have pulled into your EMS station and asked you to look at their car seats. Which car seat position would indicate that the parent is safely transporting his or her infant (younger than 1 year old)? A) Facing forward in the back seat in a reclined position (60 degrees) B) Facing backward in the back seat in a reclined position (45 degrees) C) Facing backward in an upright position in the front seat (45 degrees) D) Facing forward in the back seat in an upright position (60 degrees) 31)

B

QUESTION: Emergency Medical Responders have removed an intoxicated and confused patient from a car that struck another vehicle at a high rate of speed. The patient was unrestrained and his car did not have air bags. Assessment reveals deformity bilaterally to the hips and femurs and bruising to the knees. Based on this injury pattern, the EMT would recognize which type of injury mechanism? A) Up and over B) Down and under C) High velocity D) Lateral impact

B

QUESTION: The EMT understands the importance of evaluating the mechanism of injury when he states: A) "The mechanism of injury is a useful tool in determining whether the patient's outcome will be good or bad." B) "The mechanism of injury can be used to guide the EMT's injury assessment and treatment of the patient." C) "The mechanism of injury is useful in determining the exact injuries the patient has sustained." D) "Evaluating the mechanism of injury is important because it determines whether emergency transport to the hospital is needed."

B

QUESTION: Two cars have collided head-on. One car was traveling at a speed of 55 mph and the other at 35 mph. The total speed of impact would be: A) 55 mph B) 90 mph C) 20 mph D) 35 mph

B

QUESTION: Which of the statements concerning trauma is most accurate? A) The mechanism of injury is the best predictor of patient outcome B) Multisystem trauma has a higher mortality rate than single-system injuries C) A "spider web" or "star" pattern of cracks on the windshield means the patient impacted the windshield with his head D) Falls are the leading cause of trauma deaths

B

QUESTION: Which of these is a high-velocity wound that carries the greatest risk for death when considering the concept of cavitation? A) Stab wound to the liver B) Gunshot wound to the spleen C) Gunshot wound to the stomach D) Shotgun wound to the lung

B

QUESTION: Which piece of information would you provide to a group of young teenage drivers to decrease their chance of suffering a "whiplash"-type injury if involved in a motor vehicle collision? A) Make sure the car has side-door air bags B) Ensure that the head rest is properly positioned C) Position the car's seats in a full upright position D) Properly wear seat belts with a headrest in the down position

B

QUESTION: You have arrived on the scene of an explosion in a warehouse used to store fertilizers. A paramedic, who has already triaged the nine patients involved, directs you to a young man sitting under a tree. The man states that he is having excruciating ear pain. The initial assessment and rapid trauma assessment reveal no obvious injuries. Given this presentation, the EMT would recognize the injury was likely sustained: A) After the secondary blast phase B) During the primary blast phase C) From the noise of the explosion D) As a result of exposure to superheated air

B

QUESTION: A car has been hit head-on by another vehicle at a moderate rate of speed. Seat belts were in place and the air bags deployed. The patient complains of chest pain. Quick observation reveals a bruise to his sternum. The EMT should immediately: A) Suspect an injury related to the air bag B) Check the windshield for starring C) Lift the air bag and check for steering wheel deformity D) Deflate the air bag to get breath sounds

C

QUESTION: A male patient has sustained gunshot wounds to the neck and abdomen. He is unresponsive and has gurgling respirations. Your immediate action would be to: A) Start positive pressure ventilation and then place a cervical collar and maintain manual spine motion restriction B) Insert a nasal airway and place the patient on a long backboard C) Suction the airway while providing manual spine motion restriction D) Place a cervical collar and position the patient on a long board

C

QUESTION: A patient with severe head and neck pain states that he was properly wearing his seat belt when another car struck him from behind. As a knowledgeable EMT, you would realize that the complaint of: A) Head and neck pain indicates that the lap belt was worn without the shoulder harness B) Head pain suggests that he was not wearing the seat belt properly C) Head and neck pain could occur even when the seat belt is properly worn D) Head and neck pain indicates that he was not wearing his seat belt

C

QUESTION: Which injury is most serious, warranting immediate and rapid transport to the local trauma center? A) Deformity to the right ankle with pain rated as a 10/10 B) Large, deep laceration to the arm with bone visible C) Instability and crepitus to the left lateral chest wall D) Open fracture to the left lower leg

C

QUESTION: Which statement best characterizes the capabilities of a Level III trauma center? A) The hospital can manage all trauma patients and injuries, 24 hours a day, 7 days a week B) The hospital can handle most trauma patients, but will transfer those who require specialty care for specific injuries such as neurologic trauma C) The hospital has some surgical capabilities to help trauma patients, but will generally stabilize and them and still arrange transfer D) The hospital will provide any emergency surgical services to a trauma patient and then transfer the patient once stable

C

QUESTION: You are assessing a male patient who was stabbed three times in the chest and abdomen. As you begin your primary assessment, you note the patient to have a decreased level of consciousness and gurgling respirations. Your next action would be to: A) Apply a cervical collar B) Check his pulse C) Suction the airway D) Obtain an SpO 2 reading

C

QUESTION: You are first on the scene of a two-car motor vehicle collision. Two patients are entrapped in one vehicle. In the other vehicle, there is a male driver complaining of chest pain. During this time, your primary concern is: A) Triaging the patients B) Calling for additional help C) Ensuring personal safety D) Determining severity of injuries

C

QUESTION: A 27-year-old male was involved in an altercation and was struck in the ribs with a baseball bat. Assessment reveals intact skin with bruising to the right lateral chest. When palpating this area, pain, instability, and crepitus are all observed. The patient also complains of difficult and painful breathing. The EMT would recognize: A) Chest wall injury caused by acceleration forces B) Pulmonary injury caused by penetrating trauma C) Thoracic injury secondary to penetrating trauma D) Chest injury caused by blunt trauma

D

QUESTION: A bullet fired from a gun at close range passes through the patient's liver. However, on autopsy, the coroner discovers that the man's pancreas, stomach, and gallbladder were also injured, even though not in direct contact with the bullet. As a knowledgeable EMT, you would recognize that which mechanism is responsible for injuries to these additional organs? A) Blunt injury B) Drag force C) Profile impact D) Cavitation

D

QUESTION: A patient has been critically hurt in a nighttime motor vehicle collision. She was wearing a seat belt and hit a tree at 70 mph. The car she was driving weighed 2 tons and was equipped with air bags that did deploy. Which factor had the greatest impact on the injuries she sustained? A) Weight of the vehicle B) Deployment of air bags C) Nighttime conditions D) Speed of the vehicle at impact

D

QUESTION: A patient has been stabbed with a knife at the fifth intercostal space on the right side of the chest in an attempted suicide. Assessment reveals him to be short of breath and coughing. Which question is it most important for the EMT to ask regarding the weapon? A) "Did you push the knife in slowly or quickly?" B) "Did the knife penetrate your chest easily?" C) "Was the knife clean or dirty?" D) "How long was the knife blade?"

D

QUESTION: As you pull up to a motor vehicle collision, you quickly scan the scene for clues as to the type and severity of injuries. Which observation would best indicate that a patient may have a head injury? A) Frontal-type collision B) Air bag deployment C) Blood on a patient's clothing D) Starburst on the windshield

D

QUESTION: Assessment of a patient involved in a motor vehicle accident reveals him to have crepitus to the left humerus, instability to the left lateral chest wall and flank, and pain on palpation to left hip region. The patient also complains of pain to the right side of the neck. Based on this injury pattern, the EMT would recognize the patient was: A) An unrestrained rear seat occupant in a car struck from the right side B) The passenger in a car hit from behind C) An unrestrained driver involved in a head-on collision D) The driver of a car hit on the driver's side

D

QUESTION: Regarding the field triage of injured patients, which of these patients is NOT a member of a special patient population that would necessitate transport to a trauma center? A) A female patient with a suspected brain injury from a fall who also takes prescribed anticoagulants B) A male patient with a broken femur and burns to 25 percent of his body after jumping from a second-story window of a house that was on fire C) A 70-year-old male patient with a systolic blood pressure of 104 mmHg after wrecking his car into a tree D) A female patient who is 12 weeks pregnant and who fell on the sidewalk, injuring her hip and wrist

D

QUESTION: What is the best description of the "platinum 10 minutes" as it applies to care of the trauma patient? A) The time it should take the transporting ambulance to get the trauma patient to the closest medical facility B) The target maximum time that the multisystem trauma patient should spend in the emergency department before being transferred to surgery C) The goal for total amount of time from the actual injury to arrival of EMS at the scene D) The target maximum scene time for EMS as it applies to the seriously injured trauma patient

D

QUESTION: You are hosting a discussion on injury prevention when a participant asks you if you believe that helmets for motorcyclists truly make a difference. You would respond by saying: A) "Helmets have been shown to prevent motorcycle accidents." B) "A motorcycle helmet decreases the chance of permanent spinal injury." C) "Wearing a helmet decreases the chance of being ejected from a motorcycle." D) "Motorcycle helmets decrease the risk of death when the rider is involved in a collision."

D

QUESTION: You arrive at the scene where a young male patient fell out of a tree he was climbing. Although he fell from a lower branch, he was still reportedly 10-12 feet in the air when he fell. The patient landed on his side on the ground. Which element of the kinematics of trauma would explain the mechanism of any injuries he may have sustained? A) Terminal velocity B) Rapid acceleration C) Terminal mass D) Rapid deceleration

D

QUESTION: You arrive on the scene of a motorcycle accident and find an unresponsive male patient lying in the middle of the road with blood coming from his ears and nose. He was not wearing a helmet and has snoring respirations. Which sequence of events would be most appropriate in the care of this patient? A) Primary assessment, oxygen administration, transfer to stretcher, transport within 5 minutes of arriving on scene with spine motion restriction precautions done en route B) Primary assessment, spine motion restriction, transfer to the ambulance after 8 minutes of scene time, all other care provided en route C) Full spine motion restriction procedures, transfer to the ambulance, provide all assessment and care en route to the hospital, with total scene time of 7 minutes D) Primary assessment, airway and ventilatory management, oxygen administration, spine motion restriction precautions, transport within 10 minutes of arriving on scene

D