Chapter 29 Trauma Systems and Mechanism of Injury

C) via air transport to the Level I trauma center.

13. If a Level I trauma center is 30 miles away, and a Level II trauma center is 10 miles away, it would be MOST appropriate to transport a patient with a severe traumatic brain injury: A) by ground to the Level I trauma center. B) to the closest hospital for stabilization. C) via air transport to the Level I trauma center. D) by ground to the Level II trauma center.

A) The need for definitive airway management

14. Which of the following is NOT a factor when considering transport of a trauma patient via helicopter? A) The need for definitive airway management B) Distance from the scene to the landing zone C) Time it will take the aircraft to reach the scene D) Type of terrain on which the helicopter will land

D) activate the service as soon as possible.

15. When summoning an air transport service to transport a critically injured patient, it is MOST important to: A) determine the flight crew's credentials. B) ensure that the fire department is present. C) predetermine the destination facility. D) activate the service as soon as possible

B) increasing its velocity than by increasing its mass

17. An object increases its kinetic energy more by: A) decreasing its speed than by increasing its mass. B) increasing its velocity than by increasing its mass. C) decreasing its velocity than by decreasing its mass. D) increasing its mass than by increasing its velocity.

A) 140, 50

18. The greatest amount of kinetic energy would be created if a ____-pound driver struck a tree while traveling at ____ mph. A) 140, 50 B) 160, 30 C) 150, 40 D) 170, 30

C) energy can be neither created nor destroyed; it can only change form.

19. The law of conservation of energy states that: A) kinetic energy can be converted only to thermal or chemical energy. B) the force that an object can exert is the product of its mass multiplied by its acceleration. C) energy can be neither created nor destroyed; it can only change form. D) a body at rest will remain at rest unless acted upon by an outside force.

C) potential, kinetic

2. The energy stored in an object, such as a bridge pillar, is called __________ energy, and the energy from motion is called __________ energy. A) kinetic, potential B) barometric, kinetic C) potential, kinetic D) chemical, potential

C) dissipates tremendous forces and causes major injuries

20. Sudden deceleration of a motor vehicle that is traveling at 60 mph: A) typically generates forces of up to 10 to 20 g. B) initially causes whiplash injuries to the patient's neck. C) dissipates tremendous forces and causes major injuries. D) causes the driver's body to stop moving at the same time.

D) The pressure wave caused by a blast

21. Which of the following injury mechanisms would MOST likely result in blunt trauma? A) Small-caliber gunshot wound B) Explosion involving shards of glass C) Falling from a tree onto a fence D) The pressure wave caused by a blast

B) tissues are penetrated by single or multiple objects

22. Penetrating trauma occurs when: A) internal organs are lacerated and bleed profusely. B) tissues are penetrated by single or multiple objects. C) blunt force trauma causes explosive open injuries. D) a fractured rib perforates the parenchyma of a lung.

A) shearing or rupturing of internal organs can occur.

23. During abrupt deceleration: A) shearing or rupturing of internal organs can occur. B) the neck commonly sustains hyperextension injuries. C) the skull provides excellent protection for the brain. D) supporting structures of the aorta keep it attached.

A) at the time of impact.

24. Unlike deceleration injuries, crush and compression injuries occur: A) at the time of impact. B) before impact occurs. C) after the initial impact. D) from penetrating mechanisms.

C) deceleration of internal organs.

26. The third phase of a motor vehicle accident involves: A) crush injuries to the body. B) impact by another vehicle. C) deceleration of internal organs. D) injuries caused by flying debris.

B) the front seat occupant has a cervical spine injury until proven otherwise.

27. If the windshield of a wrecked vehicle is cracked or broken: A) you should assume that the driver has a severe intracerebral hemorrhage. B) the front seat occupant has a cervical spine injury until proven otherwise. C) the rear seat passenger was likely thrust from the seat into the windshield. D) it is likely that the vehicle was traveling at least 55 mph at the time of impact.

D) the presence of tire skid marks at the scene.

28. The MOST reliable indicator that significant energy was dissipated by braking before a motor vehicle collision is: A) deformity to the driver's brake pedal. B) severe damage to the front rims of the tires. C) a trail of debris leading to the site of impact. D) the presence of tire skid marks at the scene.

B) the physical size of the patient

29. The forces applied to the driver during a frontal vehicle collision will differ based on all of the following factors, EXCEPT: A) objects inside the vehicle. B) the physical size of the patient. C) the design of the motor vehicle. D) safety features of the motor vehicle

A) predict injury patterns found in a patient

3. Knowledge of kinetics can help the paramedic: A) predict injury patterns found in a patient. B) determine which organs have been injured. C) quantify how much blood a patient has lost.

A) knees.

30. The initial point of bodily impact when an unrestrained passenger takes the "down and under" pathway during a frontal collision is the: A) knees. B) pelvis. C) femurs. D) abdomen.

C) the anterior part of the neck may strike the steering wheel, resulting in a fractured larynx.

31. When a patient takes the "up and over" pathway during a head-on collision: A) the head takes a higher trajectory, striking the windshield and causing stretching injuries to the neck. B) secondary injuries as the patient is ejected are often less severe than the primary injuries. C) the anterior part of the neck may strike the steering wheel, resulting in a fractured larynx. D) injuries to the parietal aspect of the skull are common as the head strikes the side window.

A) protective gear worn by the rider.

42. Structural protection afforded to a motorcycle rider during a crash comes from: A) protective gear worn by the rider. B) the main frame of the motorcycle. C) side foot pedals and the handlebars. D) the handlebars and large engine block.

A) not protect the cervical spine

43. A properly worn motorcycle helmet will: A) not protect the cervical spine. B) eliminate the risk of head trauma. C) decrease the risk of a spinal injury. D) minimize the trauma caused by secondary impacts.

D) femurs and tibias

44. Following a head-on collision of a motorcycle and a truck, the motorcyclist would MOST likely experience initial injury to the: A) cervical spine. B) chest and abdomen. C) wrists and forearms. D) femurs and tibias.

B) systolic blood pressure is less than 90 mm Hg

7. According to the American College of Surgeons, an injured patient should be transported to a Level I trauma center if his or her: A) heart rate is greater than 100 beats/min. B) systolic blood pressure is less than 90 mm Hg. C) respiratory rate is less than 14 breaths/min. D) Glasgow Coma Scale score is less than 15.

A) Rear-end collision with restrained driver

8. Which of the following mechanisms of injury poses the LEAST threat for significant injury? A) Rear-end collision with restrained driver B) Death of an occupant in the same vehicle C) Motorcycle crash at greater than 20 mph D) Vehicular intrusion of greater than 12 inches

B) maximum time spent at a scene for a trauma patient

16. The "platinum 10 minutes" refers to the: A) maximum amount of time to extricate a patient. B) maximum time spent at a scene for a trauma patient. C) amount of time before decompensated shock occurs. D) amount of time taken to perform a rapid assessment.

C) aorta.

25. The MOST common site of deceleration injury in the chest is the: A) heart. B) esophagus. C) aorta. D) vena cava.

C) allow enough forward flexion and subsequent compression to rupture the uterus.

41. Lap belts that are worn alone and too high by a pregnant woman: A) usually do not injure the fetus because the uterus is a highly muscular organ. B) will provide adequate protection for the uterus if the air bag properly deploys. C) allow enough forward flexion and subsequent compression to rupture the uterus. D) will provide equal distribution of forces and prevent forward flexion of the mother.

A) be run over by the vehicle as they are propelled to the ground.

48. Unlike adults, children who are struck by a motor vehicle are MORE likely to: A) be run over by the vehicle as they are propelled to the ground. B) experience injuries to the lower extremities from the initial impact. C) be propelled onto the hood of the vehicle during the second impact. D) turn away from the oncoming vehicle, resulting in posterior trauma.

C) involves a disruption of the skin and underlying tissues in a small, focused area.

52. Unlike blunt trauma, penetrating trauma: A) is especially common during the primary blast injury following an explosion. B) often causes damage to a large body surface area, even from a single projectile. C) involves a disruption of the skin and underlying tissues in a small, focused area. D) is usually more fatal because of the severe external bleeding that accompanies it.

A) The size of the attacker

53. Which of the following factors is the LEAST influential in the severity of a stab wound? A) The size of the attacker B) The anatomic area involved C) The length of the knife blade D) The angle of penetration

D) upward

54. Compared to stab wounds to the posterior part of the body, stab wounds to the anterior part of the body are generally: A) downward. B) single. C) multiple. D) upward.

B) contaminants that were driven into the wound can cause a severe infection.

55. If a person survives the initial trauma from a shotgun wound at close range: A) nervous system damage is likely due to the internal dispersal of the pellets. B) contaminants that were driven into the wound can cause a severe infection. C) he or she typically dies within 24 hours secondary to liver or renal failure. D) it is likely that only soft tissue was injured and major organs were spared.

C) fires at a higher velocity.

56. Compared to a handgun, a rifle: A) is less accurate. B) fires a single projectile. C) fires at a higher velocity. D) has less powerful ammunition.

A) Two or more proximal long bone fractures B

9. Which of the following injuries would MOST likely require transport to a Level I trauma center? A) Two or more proximal long bone fractures B) Superficial burns to an entire lower extremity C) Lateral neck pain following a motor vehicle crash D) Penetrating injury that is distal to the elbow or knee

C) has 24-hour in-house coverage by general surgeons.

11. A specific attribute of a Level I trauma center is that it: A) is involved in an injury prevention program. B) can initiate definitive care for all injured patients. C) has 24-hour in-house coverage by general surgeons. D) has rapid access to an off-site anesthesiologist.

B) be able to initiate definitive care for all injured patients.

12. At a minimum, a Level II trauma center should: A) have an in-house neurosurgeon 24 hours a day. B) be able to initiate definitive care for all injured patients. C) have access to an emergency physician within 20 minutes. D) provide total care for every aspect of a patient's injuries.

B) trauma.

1. The acute physiologic and structural change that occurs in a patient's body when an external source of energy dissipates faster than the body's ability to sustain and dissipate it is called: A) injury. B) trauma. C) deceleration. D) kinematics.

D) has a known bleeding disorder

10. If the mechanism of injury does not appear to be significant, you should consider transporting an injured patient to a Level I trauma center if he or she: A) is older than 45 years of age. B) takes any kind of medication. C) is emotionally upset or angry. D) has a known bleeding disorder.

A) the patient takes a deep breath just before impact and the lungs rapidly decompress at the time of impact.

32. During a frontal collision, MOST pneumothoraces occur when: A) the patient takes a deep breath just before impact and the lungs rapidly decompress at the time of impact. B) the diaphragm rapidly ascends into the chest cavity during impact, causing an increase in intrathoracic pressure. C) the chest strikes the steering wheel, which fractures one or more ribs and causes a perforation injury to one of the lungs. D) the patient is ejected through the windshield, and his or her chest collides with a secondary object outside the vehicle.

D) trauma to the upper extremities depends on the spatial orientation of the arms upon impact.

33. During a lateral impact collision: A) the far-side occupant, even if properly restrained, experiences double the amount of force as the driver. B) the patient's head moves away from the object causing the impact, resulting in stretching injuries. C) properly worn seat belts protect the passenger from pelvic trauma at the time of impact. D) trauma to the upper extremities depends on the spatial orientation of the arms upon impact.

B) the position of the headrest.

34. The severity of hyperextension injuries to the neck following a rear-end collision depends MOSTLY on: A) the proper use of seat belts. B) the position of the headrest. C) proper deployment of the air bags. D) whether the driver tenses up.

B) greatest deceleration

35. Following a rotational impact, the MOST severely injured patient(s. will likely be found at the point of: A) least deceleration. B) greatest deceleration. C) secondary impact. D) greatest acceleration.

C) Unrestrained passengers are struck with each change in direction the car makes.

36. Which of the following statements regarding rollover motor vehicle crashes is correct? A) Injuries to the passengers are usually not serious if seat belts are worn properly. B) Ejection of the patient from the vehicle increases the chance of death by 5 times. C) Unrestrained passengers are struck with each change in direction the car makes. D) The restrained occupant's head and neck usually remain stationary during a rollover.

A) Minimal risk of whiplash injuries after a rear-end collision

37. Which of the following is NOT a benefit of a properly worn seat belt? A) Minimal risk of whiplash injuries after a rear-end collision B) Prevention of partial or complete ejection from the vehicle C) Prevention of occupants from violently contacting each other D) Distribution of deceleration energy over a greater surface area

D) Abdominal and lumbar spine

38. What type of injuries will MOST likely occur if a passenger is wearing his or her lap belt above the pelvic bone during a frontal impact? A) Pelvic and lumbar spine B) Femur and thoracic spine C) Kidney and thoracic spine D) Abdominal and lumbar spine

B) Air bags will provide protection from both initial and secondary impacts

39. All of the following statements regarding front air bags are correct, EXCEPT: A) Small children riding in the front seat can be killed when the air bag deploys. B) Air bags will provide protection from both initial and secondary impacts. C) Without the use of a seat belt, front air bags are insufficient in preventing ejection. D) Front air bags will not activate in side impacts or impacts to the front quarter panel.

B) amount of energy in the object and the mechanism by which the object is delivered to the body.

4. The primary determinants of the extent of trauma a patient sustains are the: A) type of object that strikes a patient and the part of the body that sustains the most impact. B) amount of energy in the object and the mechanism by which the object is delivered to the body. C) size of the object that strikes the body and any secondary injuries that occur if the patient falls. D) physical size of the patient and the part of the body that sustains direct impact from an object.

B) minor skin burns

40. Common air bag-related injuries include: A) spinal fractures. B) minor skin burns. C) hyperflexion injuries. D) abdominal abrasions.

B) cause an unpredictable combination of blunt injuries

45. After a motorcyclist is ejected from his or her motorcycle, secondary collisions: A) most commonly involve a stationary object. B) cause an unpredictable combination of blunt injuries. C) typically cause bilateral fractures of the femurs and tibias. D) result in less severe injuries if the rider is wearing leather.

B) adults tend to turn to the side or away from the impact.

46. When an adult pedestrian is struck by a motor vehicle, lateral and posterior injuries are most common because: A) the patient is thrust onto the hood of the vehicle. B) adults tend to turn to the side or away from the impact. C) the patient is thrown and lands on his or her side or back. D) the initial impact by the bumper spins the patient to the side.

C) pelvis and chest

47. The second impact that occurs when an adult pedestrian is struck by a motor vehicle would MOST likely result in injuries to the: A) head and neck. B) hips and knees. C) pelvis and chest. D) lower extremities.

D) chest and abdomen strike the grille or low on the hood of the car.

49. According to the Waddell triad, the second impact from a motor vehicle occurs when the: A) head strikes the ground, resulting in skull and facial fractures. B) car's bumper strikes the pelvis and femurs instead of the knees. C) child is run over by the car as he or she is propelled to the ground. D) chest and abdomen strike the grille or low on the hood of the car.

C) Blunt trauma is difficult to diagnose by paramedics in the field and is often more lethal than penetrating trauma.

5. Which of the following general statements regarding trauma is correct? A) Bullet impact is less if the energy in the bullet is applied to a small area. B) The position of the patient at the time of the event is considered to be an internal factor. C) Blunt trauma is difficult to diagnose by paramedics in the field and is often more lethal than penetrating trauma. D) Rapidly applied amounts of energy are better tolerated than a similar amount of energy applied over a longer period.

A) compression or burst fractures to the lumbar spine.

50. When a person falls from a significant height and lands on his or her feet, axial loading results in: A) compression or burst fractures to the lumbar spine. B) shearing injuries to the liver, spleen, and aorta. C) crushing injuries to the heels and hip dislocations. D) disc injuries to the lower cervical and upper thoracic spine.

B) 15 feet

51. The MOST significant fall occurs from a height greater than: A) 10 feet. B) 15 feet. C) 1.5 times the patient's height. D) 2 times the patient's height.

A) The most important factor for the seriousness of a gunshot wound is the type of tissue through which the projectile passes

57. Which of the following general statements regarding gunshot wounds is correct? A) The most important factor for the seriousness of a gunshot wound is the type of tissue through which the projectile passes. B) Injuries from a shotgun blast are most devastating when the distance between the gun and the target is less than 100 yards. C) Wounds to lower extremities that are not associated with a fracture or neurovascular compromise are always explored surgically. D) Tissue of high elasticity, such as muscle, is less able to tolerate temporary cavitation than tissue of low elasticity, such as the liver.

D) Tattoo marks from powder burns

58. Which of the following characteristics of an entry wound indicates that the weapon was fired at close range? A) Abrasions around the wound B) Indentation of cutaneous tissues C) Severe bleeding from the wound D) Tattoo marks from powder burns

A) Exit wounds occur when the projectile's energy is not entirely dissipated along its trajectory through the body.

59. Which of the following statements regarding exit wounds is correct? A) Exit wounds occur when the projectile's energy is not entirely dissipated along its trajectory through the body. B) Compared to entrance wounds, exit wounds are generally much smaller and typically have regular edges. C) Despite fragmentation of the projectile, there is usually only one exit wound for each round that is fired. D) With low-velocity gunshot wounds, the exit wound is always a mirror image of the entrance wound.

D) Mechanism of injury

6. Which of the following will be of MOST benefit in helping the paramedic predict the type of injuries that a patient experienced? A) Index of suspicion B) Past medical history C) Age of the patient D) Mechanism of injury

D) the patient is struck by flying debris, such as shrapnel.

60. During an explosion, secondary blast injuries occur when: A) hollow organs rupture due to the pressure wave. B) the patient is thrown against a stationary object. C) the patient sustains severe burns from the intense heat. D) the patient is struck by flying debris, such as shrapnel.

B) Primary blast injuries are the most easily overlooked.

61. Which of the following statements regarding primary blast injuries is correct? A) Primary blast injuries are typically the most obvious injuries. B) Primary blast injuries are the most easily overlooked. C) Primary blast injuries are the result of flying glass or shrapnel. D) Primary blast injuries are due entirely to intense heat.

C) lessens as the person is farther away from the center of the explosion.

62. The peak magnitude of the pressure wave experienced by a person: A) causes secondary and tertiary injuries as a result of the explosion. B) will cause less severe trauma if the person is standing beside a solid object. C) lessens as the person is farther away from the center of the explosion. D) causes more severe trauma if the person is in an open area during the explosion.

C) farther from the explosion.

63. The shock wave velocity from an explosion is slower and its duration is longer if a person is: A) closer to the explosion. B) standing behind a solid object. C) farther from the explosion. D) standing beside a solid object.

A) Liver

64. Which of the following organs is LEAST susceptible to pressure changes caused by an explosion? A) Liver B) Lungs C) Tympanic membrane D) Gastrointestinal tract

D) bradycardia and hypotension

65. A vagus nerve-mediated form of cardiogenic shock without compensatory vasoconstriction that may be seen following a blast injury would MOST likely present with: A) syncope and hypertension. B) hypertension and bradycardia. C) hypotension and tachycardia. D) bradycardia and hypotension.