EMT Chapter 28 - Questions

When assessing a patient with a suspected head or spine injury, which of the following should you do? 1.Administer high-flow oxygen 2.Assess the patient in the position found 3.Hyperventilate the patient 4.Remove the cervical collar during secondary assessment to facilitate reassessment of vital signs.

1 and 2

Which of the following are signs of Cushing triad? 1.Irregular respirations 2.Bradycardia 3.Hypertension 4.Loss of sensation

1, 2, and 3

Following a head injury, a 20-year-old female opens her eyes spontaneously, is confused, and obeys your commands to move her extremities. You should assign her a GCS score of:

14

The cervical spine is composed of ___ vertebrae

7

What is a correct statement regarding the cranium?

80% of the cranium is occupied by brain tissue

Coordination of balance and body movement is controlled by the:

Cerebellum

What acts as a shock absorber for the CNS?

Cerebrospinal Fluid

While performing a secondary assessment of a patient who was hit with a tire iron on the side of the head, you find a depressed area above the patient's left ear. This indicates that the patient could have what?

Epidural Hematoma (nearly always the result of a blow to the head that produces a linear fracture).

The MOST important immediate treatment for patients with a head injury, regardless of severity, is to:

Establish an adequate airway

(T/F) The structure of the skull and the presence of the meninges in effect reduce the likelihood of problems in the closed head injuries.

False (the closed bony structure of the skull (which is similar to a vault) and the meninges may lead to serious problems in closed head injuries. Severe injury may cause bleeding within the skull. Such bleeding causes increased pressure inside the skull and compresses softer brain tissue. In many cases, only prompt surgery can prevent permanent brain damage.)

(T/F) Central nervous system structures are very strong even though they are not well protected.

False (very fragile despite good protection)

You are assessing a man who has a head injury and note that cerebrospinal fluid is leaking from his ear. You should recognize that the patient is at risk for:

Bacterial Meningitis

In a(n) ___, CSF flows freely from the patient's ear; this type of injury can be difficult to diagnose with a radiograph.

Basilar Skull Fracture

Battle sign is an indication of what?

Skull Fractures

What is a correct statement regarding cervical collars?

A cervical collar is used in addition to, not instead of, manual immobilization

Name the service that these steps belong to: 1. Apply in-line stabilization. 2. Measure the proper collar size. 3. Place the chin support first. 4. Wrap the collar around the neck and secure the collar. 5. Ensure proper fit and maintain neutral, in-line stabilization until the patient is secured to a backboard.

Applying a cervical collar

The body's functions that occur without conscious effort are regulated by the ___ nervous system

Autonomic

When controlling bleeding from a scalp laceration with a suspected underlying skull fracture, you should:

Avoid excessive pressure when applying the bandage

You are treating a patient who went face-first through a windshield. She has extensive head injuries and is displaying hypertension, bradycardia, and Cheyne-Stokes respirations. What should you suspect?

Cushing Triad

When assessing a conscious patient with an MOI that suggests spinal injury, you should:

Determine is the strength in all extremities is equal

When placing a patient onto a long backboard, the EMT at the patient's ___ is in charge of all patient movement.

Head

When securing a patient to a backboard, what area of the body should you secure last?

Head

You are reassessing a patient and you find that her left pupil is dilated and fixed. What does this indicate?

Increased Intracranial Pressure

During your primary assessment of a semiconscious 30-year-old female with closed head trauma, you note that she has slow, irregular breathing and a slow, bounding pulse. As your partner maintains manual in-line stabilization of her head, you should:

Instruct him to assist her ventilations while you perform a rapid assessment

Cushing triad in a patient is a sign of what?

Intracranial Pressure

When opening the airway of a patient with a suspected spinal injury, you should use the:

Jaw-Thrust Maneuver

A high school football player was injured during a tackle and complains of neck and upper back pain. He is conscious and alert and is breathing without difficulty. The EMT should:

Leave his helmet and shoulder pads in place

When caring for a patient with a possible head injury, it is MOST important to monitor the patient's:

Level of Consciousness

Name a skull fracture that would be the LEAST likely to present with palpable deformity or other outward signs.

Linear

Accounting for approximately 80% of all skull fractures, what often presents with no physical signs?

Linear Skull Fractures

The time between the initial period of unconsciousness and a subsequent loss of consciousness is referred to as what?

Lucid Interval

Lacerations to the scalp:

May be an indicator for deeper, more serious injuries

Name the service that these steps belong to: 1. Take standard precautions. Kneel behind the patient and firmly place your hands around the base of the skull on either side. 2. Support the lower jaw with your index and long fingers, and the head with your palms. Gently lift the head into a neutral, eyes forward position, aligned with the torso. Do not move the head or neck excessively, forcefully, or rapidly. 3. Continue to manually support the head while your partner places a rigid cervical collar around the neck. Maintain manual support until you have completely secured the patient to a backboard.

Performing manual inline stabilization

The ___ nervous system consists of 31 pairs of spinal nerves and 12 pairs of cranial nerves.

Peripheral

You are treating a patient who might have a skull fracture. What should you do if a dressing you have applied to a head wound becomes soaked?

Place a clean dressing over the bloody one

When immobilizing a child on a long backboard, you should:

Place padding under the child's shoulders as needed

Name the service that these steps belong to: 1. Kneel at the patient's head with your partner at one side. Open the face shield to assess airway and breathing. Remove eyeglasses if present. 2. Prevent head movement by placing your hands on either side of the helmet and fingers on the lower jaw. Have your partner loosen the strap. 3. Have your partner place one hand at the angle of the lower jaw and the other at the occiput. 4. Gently slip the helmet about halfway off, then stop. 5. Have your partner slide the hand from the occiput to the back of the head to prevent the head from snapping back. 6. Remove the helmet and stabilize the cervical spine. Apply a cervical collar and secure the patient to a long backboard. Pad as needed to prevent neck flexion or extension

Removing a helmet

A patient who cannot remember the events that preceded (came before) his or her head injury is experiencing:

Retrograde Amnesia

Name the service that these steps belong to: 1. Take standard precautions. Stabilize the head and neck in a neutral, in-line position. Assess pulse, motor, and sensory function in each extremity. Apply a cervical collar. 2. Insert an immobilization device between the patient's upper back and the seat. 3. Open the side flaps and position them around the patient's torso, snug around the armpits. 4. Secure the upper-torso flaps, then the mid-torso flaps. 5. Secure the groin (leg) straps. Check and adjust the torso straps. 6. Pad between the head and the device as needed. Secure the forehead strap and fasten the lower head strap around the cervical collar. 7. Place a long backboard next to the patient's buttocks, perpendicular to the trunk. 8. Turn and lower the patient onto the long backboard. Lift the patient, and slip the long backboard under the immobilization device. 9. Secure the immobilization device and long backboard to each other. Loosen or release the groin straps. Reassess pulse, motor, and sensory function in each extremity.

Securing a patient found in a sitting position

Name the service that these steps belong to: 1. Apply and maintain manual cervical stabilization. Assess distal functions in all extremities. 2. Apply a cervical collar. 3. Rescuers kneel on one side of the patient and place their hands on the far side of the patient. 4. On command, rescuers roll the patient toward themselves, quickly examine the back, slide the backboard under the patient, and roll the patient onto the backboard. 5. Center the patient on the backboard. 6. Secure the upper torso first. 7. Secure the pelvis and upper legs. 8. Begin to secure the patient's head using a commercial immobilization device or rolled towels. 9. Place the tape across the patient's forehead to secure the immobilization device. 10. Check all straps and readjust as needed. Reassess distal functions in all extremities.

Securing a patient to a long backboard

(T/F) The most prominent and most easily palpable spinous process is at the seventh cervical vertebrae at the base of the neck.

True

Name the service that these steps belong to: 1. Place the mattress on a flat surface near the patient, with the head end of the mattress at the patient's head. 2. Allow air to enter the mattress. Keep the valve stem open until the mattress is soft and pliable. 3. Smooth the mattress. Remove any sharp or bulky items that may damage the mattress. 4. Connect the pump to the mattress. 5. Determine which method you will use to move the patient onto the mattress. If you will use the log roll method, evacuate the mattress until it is partially rigid (this step is not needed if using the scoop stretcher method). The surface should be smooth and the beads should be spread out as evenly as possible. If using the scoop stretcher, you do not need to partially evaluate the mattress at this stage. 6. Move the patient onto the vacuum mattress using the method you determined during the previous step. Maintain spinal alignment. 7. If the vacuum mattress is partially rigid, open the valve to allow air to enter. Keep the valve open until the mattress is pliable. 8. Conform the mattress to each side of the patient's head, close to the shoulders but not the top of the head. Continue to hold these "head blocks" that you have formed, and have a second person hold up the sides of the mattress to the patient's hips until the mattress is evacuated of air completely. 9. Secure the patient's chest, hips, and legs. 10. Secure the patient's head. Pad any voids at the top of the shoulders. 11. Ensure the patient is as comfortable as possible, then evacuate the remaining air to achieve immobilization. 12. Disconnect the vacuum pump and ensure that the valve is closed or secured. 13. Reassess and adjust the straps around the chest, hips, and legs. 14. Check the patient's neurovascular status and recheck all straps prior to lifting or moving the patient

Using a vacuum mattress