Module 3

Methods to control bleeding are...

-direct local pressure -elevation -pressure dressing -tourniquet -splinting device

Signs of serious internal bleeding include the following:

-vomiting blood (hematemesis) -black tarry stools (melena) -coughing up blood (hemoptysis) -distended abdomen -broken ribs

An infant with a total blood volume of 800 mL would start showing signs of shock when as little as ______ of blood is lost.

100 mL

Significant vital sign changes will occur if the typical adult acutely loses more than ______ of his or her total blood volume.

20%

What is the approximate blood volume of a 75-kg adult?

5.25 L

Which of the following scenarios is an example of a direct injury?

A passenger fractures her patella after it strikes the dashboard.

Which of the following statements regarding the clotting of blood is correct?

A person taking aspirin will experience slower blood clotting.

Which of the following statements regarding compartment syndrome is correct?

Compartment syndrome typically develops within 6 to 12 hours after an injury.

Which of the following statements regarding striated muscle is correct?

It forms the major muscle mass of the body and usually crosses at least one joint.

Which of the following statements regarding hemophilia is correct?

Patients with hemophilia may bleed spontaneously.

A subluxation occurs when

a joint is incompletely dislocated.

bleeding from the nose, ears and/or mouth may result from...

a skull fracture. Other causes include, high blood pressure and sinus infection. Evaluate the MOI and consider the more serious problem of skull fracture

If direct pressure with a sterile dressing fails to immediately stop severe bleeding from an extremity, you should apply:

a tourniquet proximal to the injury.

three arms of the perfusion triad must be functioning to meet this demand

a working pump (heart) set of intact pipes (blood vessels) and fluid volume (enough oxygen-carrying blood)

Which of the following splinting devices would be MOST appropriate to use for a patient who has an open fracture of the forearm with external bleeding?

air splint

bleeding around the face always presents a risk for...

airway obstruction or aspiration. Maintain a clear airway by positioning the patient appropriately and using suction when indicated

During your assessment of a 29-year-old female with significant deformity to her left elbow, you are unable to palpate a radial pulse. Your transport time to the hospital is approximately 40 minutes. You should:

apply gentle manual traction in line with the limb and reassess for a pulse.

Following direct trauma to the left upper back, a 44-year-old male presents with diaphoresis and restlessness. His blood pressure is 100/50 mm Hg, his pulse rate is 120 beats/min and weak, and his respirations are 24 breaths/min and labored. Your assessment reveals abrasions and contusions over the left scapula. You should:

apply high-flow oxygen, consider spinal precautions, and transport without delay.

Most cases of external bleeding from an extremity can be controlled by:

applying local direct pressure.

A 76-year-old male experienced sudden pain to his left thigh when he was standing in line at the grocery store. Your assessment reveals ecchymosis and deformity to the distal aspect of his left femur, just above the knee. Distal circulation and sensory and motor functions are intact. The MOST appropriate method of splinting this injury involves:

applying padded board splints to both sides of the leg.

With regard to musculoskeletal injuries, the zone of injury is defined as the:

area of soft-tissue damage surrounding the injury.

The smaller vessels that carry blood away from the heart and connect the arteries to the capillaries are called the:

arterioles.

In moving joints, the ends of the bones are covered with:

articular cartilage.

You receive a call to a local gymnasium for a basketball player with a dislocated shoulder. Upon arrival, you find the patient, a 17-year-old male, sitting on the ground. He is holding his left arm in a fixed position away from his body. There is an obvious anterior bulge to the area of injury. You should

assess distal pulse, motor, and sensory functions.

A young male was shot in the abdomen by an unknown type of gun. He is semiconscious, has shallow breathing, and is bleeding externally from the wound. As you control the external bleeding, your partner should:

assist the patient's ventilations.

A 21-year-old male was thrown over the handlebars of his motorcycle when he rear- ended a car that was stopped at a red light. He was wearing a helmet, which he removed prior to your arrival. He is conscious, but restless, and has closed deformities to both of his femurs. His skin is pale, his heart rate is rapid and weak, and his respirations are rapid and shallow. In addition to applying high-flow oxygen and protecting his spine, you should:

bind his legs together on the backboard, keep him warm, and transport without delay.

Which of the following structures is regulated by smooth muscle?

blood vessels

An organ or tissue may be better able to resist damage from hypoperfusion if the:

body's temperature is considerably less than 98.6°F (37.0°C).

The musculoskeletal system refers to the:

bones and voluntary muscles of the body.

A fracture is MOST accurately defined as a

break in the continuity of the bone.

When caring for a patient with a possible fracture of the scapula, the EMT should:

carefully assess the patient for breathing problems.

perfusion

circulation of blood in adequate amounts to meet each cell's current needs for oxygen, nutrients, and waste removal

Perfusion is MOST accurately defined as the:

circulation of blood within an organ in adequate amounts to meet the body's metabolic needs.

The MOST commonly fractured bone(s) in the body is the:

clavicle.

When assessing a patient with a possible fracture of the leg, the EMT should:

compare it to the uninjured leg.

A 54-year-old male accidentally shot himself in the leg while cleaning his gun. Your assessment reveals a small entrance wound to the medial aspect of his right leg. The exit wound is on the opposite side of the leg and is actively bleeding. The patient complains of numbness and tingling in his right foot. You should:

control the bleeding and cover the wound with a sterile dressing.

A 39-year-old male accidentally cut his wrist while sharpening his hunting knife. He is conscious and alert with adequate breathing, but is bleeding significantly from the wound. You should:

control the bleeding with direct pressure.

Common signs and symptoms of a sprain include all of the following, EXCEPT:

deformity.

The MOST significant hazard associated with splinting is:

delaying transport of a critically injured patient

The disruption of a joint in which the bone ends are no longer in contact is called a:

dislocation.

Which of the following musculoskeletal injuries would MOST likely result in deformity?

displaced fracture

A supracondylar or intercondylar fracture is also known as a fracture of the:

distal humerus.

A Colles fracture involves a fracture of the:

distal radius

In nontrauma patients, an early indicator of internal bleeding is:

dizziness upon standing.

A(n) __________ fracture occurs in the growth section of a child's bone and may lead to bone growth abnormalities.

epiphyseal

Assessing a person's neurovascular status following a musculoskeletal injury includes all of the following, EXCEPT:

evaluating proximal pulses.

In which of the following situations would external bleeding be the MOST difficult to control?

femoral artery laceration and a blood pressure of 140/90 mm Hg

Traction splints are used primarily to immobilize and secure fractures of the:

femur.

As red blood cells begin to clump together to form a clot, __________ reinforces the clumped red blood cells.

fibrinogen

A 39-year-old male sustained a large laceration to his leg during an accident with a chainsaw and is experiencing signs and symptoms of shock. You should:

follow appropriate standard precautions.

A 67-year-old male presents with weakness, dizziness, and melena that began approximately 2 days ago. He denies a history of trauma. His blood pressure is 90/50 mm Hg and his pulse is 120 beats/min and thready. You should be MOST suspicious that this patient is experiencing:

gastrointestinal bleeding.

In which of the following situations should the EMT splint an injured limb in the position of deformity?

if resistance is encountered or the patient experiences severe pain

A 17-year-old football player collided with another player and has pain to his left clavicular area. He is holding his arm against his chest and refuses to move it. Your assessment reveals obvious deformity to the midshaft clavicle. After assessing distal pulse, sensory, and motor functions, you should

immobilize the injury with a sling and swathe.

During your rapid secondary assessment of a 19-year-old female with multiple trauma, you note bilateral humeral deformities and a deformity to the left midshaft femur. Her skin is diaphoretic and her pulse is rapid and weak. Your partner has appropriately managed her airway and is maintaining manual stabilization of her head. The MOST appropriate treatment for this patient includes:

immobilizing her to a backboard and rapidly transporting.

When splinting an injury of the wrist, the hand should be placed:

in a functional position.

Bleeding from the nose following head trauma:

is a sign of a skull fracture and should not be stopped.

When splinting a possible fracture of the foot, it is MOST important for the EMT to:

leave the toes exposed.

Bones are connected to other bones by bands of tough fibrous tissues called:

ligaments.

A person who experiences a calcaneus fracture after jumping and landing on his or her feet would MOST likely experience an accompanying fracture of the

lumbar spine.

Atrophy is a condition that occurs when:

muscle decreases in size and function because of disease or trauma

The MOST common and significant complication associated with fractures or dislocations of the knee is:

neurovascular compromise.

hypoperfusion or shock occurs when...

one or more of these three arms is not working properly and the cardiovascular system fails to provide adequate profusion

Which of the following musculoskeletal injuries would pose the greatest threat to a patient's life?

pelvic fracture with hypotension

if bleeding from the nose is present and a skull fracture is not suspected...

pinch both nostrils together for 15 minutes. If the patient is awake and has a patent airway, place a gauze pad inside the upper lip against the gum

A 43-year-old man is experiencing a severe nosebleed. His blood pressure is 190/110 mm Hg and his heart rate is 90 beats/min and bounding. Appropriate treatment for this patient includes:

pinching the patient's nostrils and having him lean forward.

if bleeding is present at the nose and a skull fracture is suspected...

place a gauze pad loosely under the nose

After applying a pressure dressing to a laceration on a patient's arm, you notice that blood is slowly beginning to saturate it. You should:

place additional dressings over the wound.

A 77-year-old woman slipped and fell on a throw rug and landed on her left hip. She denies striking her head or losing consciousness. Assessment of her left leg reveals that it is shortened and externally rotated. Distal pulses, sensory, and motor functions are intact. You should:

place her onto a scoop stretcher, pad around her left hip with pillows, and secure her to the scoop with straps.

The MOST reliable indicator of an underlying fracture is:

point tenderness.

Crepitus and false motion are

positive indicators of a fracture.

A 45-year-old female was the unrestrained passenger of a small car that rear-ended another vehicle at a moderate rate of speed. She is conscious and alert, but complains of pain to both of her knees. There is visible damage to the dashboard on the passenger's side of the vehicle. In addition to fractures or dislocations of the knees, you should be MOST suspicious for:

posterior hip dislocation.

A 22-year-old male was kicked in the abdomen multiple times during an attack by a gang. He is conscious but restless and his pulse is rapid. Your assessment reveals a large area of bruising to the right upper quadrant of his abdomen. The MOST appropriate treatment for this patient includes:

preparing for immediate transport.

The primary purpose for splinting a musculoskeletal injury is to:

prevent further injury.

A "hip" fracture is actually a fracture of the:

proximal femur.

The PASG is absolutely contraindicated in patients who have:

pulmonary edema.

Applying ice to and elevating an injured extremity are performed in order to:

reduce pain and swelling.

During transport of a 40-year-old female with acute abdominal pain, you note that she has stopped talking to you and has become extremely diaphoretic. You should:

repeat the primary assessment.

The pectoral girdle consists of the:

scapulae and clavicles.

Which of the following types of muscle is under direct voluntary control of the brain?

skeletal

Which of the following organs can tolerate inadequate perfusion for up to 2 hours?

skeletal muscle

Which of the following joints allows no motion?

skull sutures

arterioles

smallest branches of arteries leading to the vast network of capillaries

What type of muscle contracts and relaxes to control the movement of the contents within its structures?

smooth

Following blunt trauma to the abdomen, a 21-year-old female complains of left upper quadrant abdominal pain with referred pain to the left shoulder. Your assessment reveals that her abdomen is distended and tender to palpation. On the basis of these findings, you should be MOST suspicious of injury to the:

spleen.

A ____________ is a musculoskeletal injury in which there is partial or temporary separation of the bone ends as well as partial stretching or tearing of the supporting ligaments

sprain

A 22-year-old female was ejected from her car after striking a tree head-on. As you approach her, you note obvious closed deformities to both of her femurs. She is not moving and does not appear to be conscious. You should:

stabilize her head and perform a primary assessment.

During your rapid secondary assessment of a 30-year-old male who fell 25′, you note crepitus when palpating his pelvis. Your partner advises you that the patient's blood pressure is 80/50 mm Hg and his heart rate is 120 beats/min and weak. After completing your assessment, you should:

stabilize the pelvis with a pelvic binder and protect the spine.

When using a stick and square knot as a tourniquet to control severe bleeding from an amputated arm, the EMT should:

stop twisting the stick when the bleeding stops.

Skeletal muscle is also referred to as __________ muscle.

striated

Deformity caused by a fracture would MOST likely be masked by:

swelling.

The severity of bleeding should be based on all of the following findings, EXCEPT:

systolic blood pressure.

Skeletal muscle is attached to the bone by tough, ropelike fibrous structures called:

tendons

Which of the following body systems or components is the LEAST critical for supplying and maintaining adequate blood flow to the body?

the filtering of blood cells in the spleen

aorta

the main artery that receives blood from the left ventricle and delivers it to all the other arteries that carry blood to the tissues of the body

An open fracture is MOST accurately defined as a fracture in which:

the overlying skin is no longer intact.

If a dislocated shoulder has spontaneously reduced before your arrival, the only way to confirm the injury is by noting:

the patient history.

In general, musculoskeletal injuries should be splinted before moving the patient unless:

the patient is clinically unstable.

The act of pulling on a body structure in the direction of its normal alignment is called:

traction.

External bleeding from a vein is relatively easy to control because:

veins are under a lower pressure.

In older patients, the first indicator of nontraumatic internal bleeding may be:

weakness or dizziness.