Chapter 32 Orthopaedic Injuries + Chapter 33 Environmental Emergencies
You are dispatched to a residence for a young female who is sick. The patient complains of a rash to her lower extremities and truncal area. Your assessment reveals a small, painful blister on her inner thigh. As your partner is taking the patients vital signs, she states that she and her family returned from a camping trip two days ago. On the basis of this patient's presentation, you should suspect: A) exposure to poison ivy B) an allergic reaction C) Rocking Mountain spotted fever D) Lyme disease
D
Skeletal muscle is also referred to as: - smooth muscle. - striated muscle. - autonomic muscle. - involuntary muscle.
striated muscle.
A patient with a core body temperature of 95°F (35°C) will MOST likely experience: A) rapid breathing B) muscle stiffness C) loss of consciousness D) a slow pulse
A
An air embolism associated with diving occurs when: A) the diver holds his or her breath during a rapid ascent B) high water pressure forces air into the mediastinum C) the diver hyperventilates prior to entering the water D) the alveoli completely collapse due to high pressure
A
Burns associated with lightning strikes are typically: A) superficial B) partial-thickness C) third-degree D) full-thickness
A
Heat loss from the body through respiration occurs when: A) warm air is exhaled into the atmosphere B) the core body temperature is greater than 98 degrees C) air temperature is greater than body temperature D) cool air is inhaled and displaces warm air
A
The diving reflex might allow a person to survive extended periods of submersion in cold water secondary to: A) bradycardia and a slowing of the metabolic rate B) increases in the metabolic rate and oxygen demand C) tachycardia and a lowering of the blood pressure D) laryngospas that protects the lungs from water
A
To obtain the most accurate reading of a patient's core body temperature, you should place a special hypothermia thermometer: A) into the patient's rectum B) under the patient's tongue C) under the patient's armpit D) behind the patient's knee
A
You are dispatched to a local high school track and field event for a 16 year old male who fainted. The outside temperature is approximately 95 degrees with high humidity. Upon your arrival, the patient is conscious, alert, and complains of nausea and a headache. His skin is cool, clammy, and pale. You should: A) move him into the cooled ambulance B) give him a liquid salt solution to drink C) apply chemical ice packs to his axillae D) administer 100% supplemental oxygen
A
Neurovascular function should be reassessed every minutes. A. 5 to 10 B. 10 to 15 C. 15 to 20 D. 20 to 30
A. 5 to 10
An open fracture is MOST accurately defined as a fracture in which: Select one: A. a large laceration overlies the fracture. B. the overlying skin is no longer intact. C. bone ends protrude through the skin. D. a bullet shatters the underlying bone.
A. the overlying skin is no longer intact.
What is the primary goal of in-line traction? - Minimize pain - Avoid further neurovascular compromise - Reduce swelling - Prevent permanent disability
Avoid further neurovascular compromise
What is the primary goal of in-line traction? Minimize pain. Avoid further neurovascular compromise. Reduce swelling. Prevent permanent disability.
Avoid further neurovascular compromise.
Compared to adults, infants and children are at higher risk for hypothermia for all of the following reasons, EXCEPT: A) a decreased ability to shiver B) a relatively small surface area C) a smaller overall muscle mass D) a smaller amount of body fat
B
Covering a patient's _________ will significantly minimize radiation heat loss. A) extremities B) head C) chest D) abdomen
B
For sweating to be an effective cooling mechanism: A) several layers of clothing must be worn B) it must evaporate from the body C) the body must produce at least 1L per hour D) the relative humidity must be above 90%
B
Geriatric patients, newborns, and infants are especially prone to hyperthermia because they: A) have smaller body surface areas B) exhibit poor thermoregulation C) have relatively smaller heads D) have less body fat
B
Heatstroke occurs when: A. a person's core body temperature rises above 103°F (39°C). B. the body's heat-eliminating mechanisms are overwhelmed. C. a person becomes dehydrated secondary to excess water loss. D. the ambient temperature exceeds 90°F (32°C) and the humidity is high.
B
High air temperature reduces the body's ability to lose heat by: A) evaporation B) radiation C) convection D) conduction
B
High humidity reduces the body's ability to lose heat through: A) radiation B) evaporation C) conduction D) convection
B
In contrast to Lyme disease, Rocky Mountain spotted fever: A) causes painful joint swelling after a few days or weeks B) can cause paralysis and cardiorespiratory collapse C) might be confused with rheumatoid arthritis D) presents with flu like symptoms and a bullseye rash
B
In contrast to the brown recluse spider, the black widow spider: A) has a bite that is typically painless until a blister develops B) is large and has a red-orange hourglass mark on its abdomen C) has a bite that usually produces local pain but no systemic signs or symptoms D) is very small and has a violin-shaped marking on its back
B
Rough handling of a hypothermic patient with a pulse may cause: A) pulseless electrical activity B) ventricular fibrillation C) ventricular tachycardia D) profound bradycardia
B
The venom of a brown recluse spider is cytotoxic, meaning that it: A) destroys the body's red blood cells B) causes severe local tissue damage C) weakens the structure of the bones D) suppresses the respiratory drive
B
To assess a patient's general body temperature, pull back on your glove and place the back of your hand on his or her skin at the: A) forehead B) abdomen C) neck D) chest
B
When the body loses sweat, it also loses: A) nutrients B) electrolytes C) plasma D) erythrocytes
B
You respond to a local lake where a diver complains of difficulty breathing that occurred immediately after rapidly ascending from a depth of approximately 30 feet. On assessment, you note that he has cyanosis around his lips and has pink froth coming from his nose and mouth. You should: A) position him supine with his head elevated 30 degrees, suction his mouth and nose, hyperventilate him with a bag valve mask, and contact medical control for further guidance B) suction his mouth and nose, apply high flow oxygen, monitor the patient's breath sounds for a pneumothorax, and contact medical control regarding transport to a recompression facility C) place him in a semi sitting position, suction his mouth and nose, apply a continuous positive airway pressure (CPAP) device, and transport to the closest emergency department D) suction his mouth and nose, keep him supine and elevate his legs to prevent air bubbles from en
B
a 30-year-old male was rescued after being lost in the woods for approximately 18 hours. The outside temperature is 30 degrees. He is immediately placed in the warmed ambulance, where you perform a primary assessment. He is unresponsive, pale, and apnea. You should: A) apply an automated external defibrillator and assess his cardiac rhythm B) assess for a carotid pulse for up to 60 seconds C) apply chemical heat packs to his groin and axillae D) open his airway and give two rescue breaths
B
a 31 year old male was bitten on the leg by an unidentified snake. The patient is conscious and alert and in no apparent distress. Your assessment of his leg reveals two small puncture marks with minimal pain and swelling. In addition to administering oxygen and providing reassurance, further care for this patient should include: A) transporting only with close, continuous monitoring B) supine positioning, splinting the leg, and transporting C) elevating the lower extremities and giving antivenin D) applying ice to the wound and transporting quickly
B
a dysbarism injury refers to the signs and symptoms related to changes in: A) rapid descent B) barometric pressure C) rapid ascent D) decompression
B
a frostbitten foot can be identified by the presence of: A) blanching of the skin B) mottling and blisters C) gross deformity D) soft, smooth skin
B
which of the following conditions would be the least likely to increase a person's risk of hypothermia? A) severe infection B) hyperglycemia C) spinal cord injury D) head injury
B
In which of the following situations should the EMT splint an injured limb in the position of deformity? Select one: A. When distal circulation and neurological functions are absent B. If resistance is encountered or the patient experiences severe pain C. If a traction splint will be used to immobilize the injured extremity D. If transport time to the hospital is greater than 20 to 30 minutes
B. If resistance is encountered or the patient experiences severe pain
You found instability in the pelvis during your assessment. How will you move this patient to your stretcher? A. Log roll the patient onto a backboard. B. Use a scoop stretcher. C. Ask the patient to slide onto the stretcher. D. Perform a direct ground lift.
B. Use a scoop stretcher.
The primary goal of placing the patient's legs in in-line traction is to: A. minimize pain. B. avoid further neurovascular compromise. C. reduce swelling. D. prevent permanent disability.
B. avoid further neurovascular compromise.
A fracture is MOST accurately defined as a(n): Select one: A. break in the continuity of the bone. B. disruption in the midshaft of a bone. C. total loss of function in a bone. D. abnormality in the structure of a bone.
B. break in the continuity of the bone
When you assess distal circulation in the patient's lower extremities, you should palpate the __________ pulse. A. femoral B. dorsalis pedis C. popliteal D. iliac
B. dorsalis pedis
During your assessment of the lower extremities, the patient reports pain when you palpate his thigh. This is called: A. guarding. B. point tenderness. C. swelling. D. bruising.
B. point tenderness.
Which of the following statements regarding drowning is correct? A) patients with submersion injury might deteriorate rapidly because of pulmonary injury and cerebral hypoxia B) hypoxia in the drowning victim initially occurs due to water in the lungs C) large amounts of water enter the lungs in a small number of drowning victims D) artificial ventilations can easily be performed in patients with a laryngospasm
B??????
All of the following terms refer to a body part that is cold but not frozen, EXCEPT: A) immersion foot B) frostnip C) frostbite D) trench foot
C
Breath-holding syncope is caused by a decreased stimulus to breathe and occurs when: A) a diver holds his or her breath during a staged ascent B) a swimmer breathes shallowly before entering the water C) a swimmer hyperventilates prior to entering the water D) a diver holds his or her breath for a long period of time
C
Hypothermia can worsen internal bleeding secondary to: A) severe muscle rigidity B) a decreased heart rate C) blood clotting abnormalities D) cardiac arrhythmias
C
Signs of late heatstroke include: A. hot, moist skin. B. nausea and vomiting. C. a weak, rapid pulse. D. a change in behavior.
C
The two MOST efficient ways for the body to eliminate excess heat are: A) perspiration and tachycardia B) hyperventilation and tachycardia C) sweating and vasodilation D) respiration and bradycardia
C
Which of the following most accurately describes hyperthermia? A) heat evaporates a significant amount of body water B) the body eliminates more heat than it can generate C) the body is exposed to more heat than it can lose D) the core body temperature exceeds 99.5 degrees
C
Which of the following statements regarding lightning strikes is correct? A) cervical spine fractures are the most common cause of lightning-related deaths B) victims who are struck by lightning often experience severe full-thickness burns C) lightning strikes might cause cardiac dysrhythmias that spontaneously resolve D) the tissue damage pathway caused by lightning usually occurs through the skin
C
a 20 year old male was pulled from cold water by his friends. The length of his submersion is not known and was not witnessed. You perform a primary assessment and determine that the patient is apneic and has a slow, weak pulse. You should: A) ventilate with a bag valve mask, apply a rigid cervical collar, remove his wet clothing, and transport rapidly. B) suction his airway for 30 seconds, provide rescue breathing, keep him warm, and transport at once. C) provide rescue breathing, remove his wet clothing, immobilize his entire spine, keep him warm, and transport carefully. D) apply high flow oxygen via a nonrebreathing mask, immobilize his spine, keep him warm, and transport rapidly
C
the EMT must assume that any unwitnessed water-related incident is accompanied by: A) cold-water immersion B) alcohol intoxication C) possible spinal injury D) an air embolism
C
the venom of a black widow spider is toxic to the: A) renal system B) cardiovascular system C) nervous system D) respiratory system
C
You perform a secondary assessment of the entire body and find instability in the pelvis and deformity to the midshaft area of the femur in both legs. The patient's injuries were the result of a(n): A. high-energy impact. B. indirect force. C. direct blow. D. twisting force.
C. direct blow.
Further assessment of a patient reveals no other injuries or life threats. His vital signs include the following: pulse rate, 104 beats/min; blood pressure, 118/72 mm Hg; and respirations, 20 breaths/min. Using the musculoskeletal grading system, you would classify this patient's injuries as: A. minor. B. moderate. C. severe. D. critical.
C. severe.
After being stung on the leg by a jellyfish, a man complains of severe pain to his leg, dizziness, and difficulty breathing. He has a red rash covering his trunk, and his blood pressure is 90/50mm Hg. The EMT should: A) begin transport and immerse his leg in hot water to help reduce pain B) apply warmth to the sting area and cover it with a dry sterile dressing C) remove the stingers from his leg by scraping them with a stiff object D) administer oxygen and epinephrine and prepare for rapid transport
D
Common signs and symptoms of heat exhaustion include all of the following, EXCEPT: A) tachycardia B) nausea C) dry tongue and thirst D) hot, dry skin
D
Drowning is MOST accurately defined as: A) water in the lungs following submersion in water B) temporary survival after submersion in water C) death beyond 24 hours after submersion in water D) death from suffocation after submersion in water
D
Hypothermia occurs when the core body temperature falls below: A) 88 degrees B) 90 degrees C) 98 degrees D) 95 degrees
D
The MOST prominent symptom of decompression sickness is: A) dizziness and nausea B) difficulty with vision C) tightness in the chest D) abdominal or joint pain
D
The body's natural cooling mechanism, in which sweat is converted to a gas, is called: A) convection B) conduction C) radiation D) evaporation
D
The transfer of heat to circulating air, such as when cool air moves across the body's surface, is called: A) conduction B) radiation C) evaporation D) convection
D
When a warm hand is immersed in water that is 70°F (21°C), heat is transferred from the hand to the water through a process called: A) convection B) evaporation C) radiation D) conduction
D
Which of the following is a sign of pit viper envenomation? A) signs and symptoms of hypoperfusion B) syncope and bleeding at distal sites C) general weakness and diaphoresis D) local swelling and ecchymosis
D
Which of the following medications increases a person's risk of a heat-related emergency? A) Aspirin B) Motrin C) Tylenol D) Diuretics
D
You are assessing a 33 year old male who complains of severe abdominal pain, weakness, and nausea. He tells you that he was gathering wood to build a fire when he felt a sudden, sharp pain on the back of his hand. Your assessment reveals that the patient's abdomen is rigid and painful to palpation. You should suspect: A) Rocky Mountain spotted fever B) a brown recluse spider bite C) envenomation from a pit viper D) a black widow spider bite
D
You receive a call to a residence for a sick patient. Upon your arrival, you find the patient, a 53 year old diabetic male, lying down on his front porch. His wife tells you that he was mowing the lawn in the heat for the past three hours. The patient is confused and has hot, moist skin. His pulse is weak and thready, and his blood pressure is 90/50mm Hg. You should: A) place him in a sitting position and have him drink 1 L of water B) perform a head to toe assessment and look for signs of trauma C) administer one tube of oral glucose and reassess his mental status D) load him into the ambulance and begin rapid cooling interventions
D
During your secondary assessment of a 30-year-old male who fell 25 feet, 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: Select one: A. perform a focused physical exam with emphasis on the pelvis. B. defer spinal immobilization and transport to a trauma center. C. stabilize the pelvis with a pelvic binder and protect the spine. D. log roll the patient onto a long backboard and transport at once.
D. stabilize the pelvis with a pelvic binder and protect the spine.
A disruption of a joint in which the bone ends are no longer in contact is known as what? - Dislocation - Fracture - Sprain - Strain
Dislocation
A disruption of a joint in which the bone ends are no longer in contact is known as what? Dislocation Fracture Sprain Strain
Dislocation
Which sign/symptom would give you a high index of suspicion that a patient may have compartment syndrome? - Referred pain - Limb deformity - Disproportionate pain - Hypersensation
Disproportionate pain
Which sign/symptom would give you a high index of suspicion that a patient may have compartment syndrome? Referred pain Limb deformity Disproportionate pain Hypersensation
Disproportionate pain
Which MOI causes a fracture or dislocation at a distant point? Direct blow Indirect force Twisting force High-energy injury
Indirect force
Which of the following musculoskeletal injuries has the GREATEST risk for shock due to blood loss? Pelvic fracture Posterior hip dislocation Unilateral femur fracture Proximal humerus fracture
Pelvic fracture
Which of the following musculoskeletal injuries would pose the greatest threat to a patient's life? Select one: A. Bilateral femur fractures B. Nondisplaced long bone fractures C. An amputated extremity D. Pelvic fracture with hypotension
Pelvic fracture with hypotension
What is the most reliable indicator of an underlying fracture? - Deformity - Guarding - Point tenderness - Crepitus
Point tenderness
What is the most reliable indicator of an underlying fracture? Deformity Guarding Point tenderness Crepitus
Point tenderness
When assessing distal circulation in a patient's lower extremities, which pulse should you palpate? - Femoral - Dorsalis pedis - Popliteal - Iliac
Popliteal
When assessing distal circulation in a patient's lower extremities, which pulse should you palpate? Femoral Dorsalis pedis Popliteal Iliac
Popliteal
In the musculoskeletal injury grading system, under which category would you place a laceration of a major nerve or blood vessel? Moderate Serious Severe Critical
Serious
Which of the following would you use to stabilize an AC separation? - Zippered air splint - Rigid splint - Sling and swathe - Traction splint
Sling and swathe
Which of the following would you use to stabilize an AC separation? Zippered air splint Rigid splint Sling and swathe Traction splint
Sling and swathe
You are attending to a patient with a nondisplaced elbow fracture. She has a strong pulse and good capillary refill. How should you address this type of injury? - Splint from the shoulder joint to the wrist joint to stabilize the entire arm. - Apply a Sager traction splint to stabilize the joint. - Apply a sling and swathe to reduce pain. - Apply ice to reduce swelling.
Splint from the shoulder joint to the wrist joint to stabilize the entire arm.
You are attending to a patient with an nondisplaced elbow fracture. She has a strong pulse and good capillary refill. How should you address this type of injury? Splint from the shoulder joint to the wrist joint to stabilize the entire bone. Apply a Sager traction splint to stabilize the joint. Apply a sling and swathe to reduce pain. Apply ice to reduce swelling.
Splint from the shoulder joint to the wrist joint to stabilize the entire bone.
Which of the following is a drawback of an air splint? - Temperature changes affect air pressure in the splint. - It does not provide uniform contact, so bone movement is possible. - It restricts distal blood flow. - It is complicated to use and requires multiple EMTs.
Temperature changes affect air pressure in the splint.
Which of the following is a drawback of an air splint? Temperature changes affect air pressure in the splint. It does not provide uniform contact, so bone movement is possible. It restricts distal blood flow. It is complicated to use and requires multiple EMTs.
Temperature changes affect air pressure in the splint.
With regard to musculoskeletal injuries, the zone of injury is defined as the: Select one: A. area of soft-tissue damage surrounding the injury. B. area of obvious deformity over the site of impact. C. part of the body that sustained secondary injury. D. exact part of the bone or joint that was disrupted.
area of soft-tissue damage surrounding the injury.
When caring for a patient with a possible fracture of the scapula, the EMT should: Select one: A. recognize that scapular fractures are life threatening. B. assume that minimal force was applied to the back. C. carefully assess the patient for breathing problems. D. apply rigid board splints across the chest and back.
carefully assess the patient for breathing problems.
The MOST significant hazard associated with splinting is: Select one: A. delaying transport of a critically injured patient. B. aggravation of the injury or worsened pain. C. reduction in circulation distal to the injury site. D. compression of nerves, tissues, and vasculature.
delaying transport of a critically injured patient.
When treating an open extremity fracture, you should: apply a splint and then dress the wound. dress the wound before applying a splint. irrigate the wound before applying a dressing. allow the material that secures the splint to serve as the dressing.
dress the wound before applying a splint.
Which MOI causes a fracture or dislocation at a distant point? - Direct blow - Indirect force - Twisting force - High-impact injury
indirect force
A patient tripped, fell, and landed on her elbow. She is in severe pain and has obvious deformity to her elbow. You should: assess distal pulses. manually stabilize her injury. assess her elbow for crepitus. apply rigid board splints to her arm.
manually stabilize her injury.
The purpose of splinting a fracture is to: reduce the fracture if possible. prevent motion of bony fragments. reduce swelling in adjacent soft tissues. force the bony fragments back into anatomic alignment.
prevent motion of bony fragments.
A "hip" fracture is actually a fracture of the: Select one: A. femoral shaft. B. pelvic girdle. C. proximal femur. D. pubic symphysis.
proximal femur.
A motorcyclist crashed his bike and has closed deformities to both of his midshaft femurs. He is conscious, but restless; his skin is cool and clammy; and his radial pulses are rapid and weak. The MOST appropriate splinting technique for this patient involves: applying rigid board splints. applying two traction splints. securing him to a long backboard. immobilizing his femurs with air splints.
securing him to a long backboard.
A young male has a musculoskeletal injury and is unresponsive. You will NOT be able to assess: false motion. distal pulses. capillary refill. sensory and motor functions.
sensory and motor functions.
In the musculoskeletal injury grading system, under which category would you place a laceration of a major nerve or blood vessel? - Moderate - Serious - Severe - Critical
serious
To effectively immobilize a fractured clavicle, you should apply a(n): sling and swathe. air splint over the entire arm. rigid splint to the upper arm, then a sling. traction splint to the arm of the injured side.
sling and swathe.
A patient injured her knee while riding a bicycle. She is lying on the ground, has her left leg flexed, is in severe pain, and cannot move her leg. Your assessment reveals obvious deformity to her left knee. Distal pulses are present and strong. The MOST appropriate treatment for her injury involves: wrapping her entire knee area with a pillow. splinting the leg in the position in which it was found. straightening her leg and applying two rigid board splints. straightening her leg and applying and inflating an air splint.
splinting the leg in the position in which it was found.
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: Select one: A. apply manual stabilization to both of her femurs. B. assess for a carotid pulse and assist her ventilations. C. stabilize her head and perform a primary assessment. D. administer oxygen and perform a rapid assessment.
stabilize her head and perform a primary assessment.
You respond to a soccer game for a 16-year-old male with severe ankle pain. When you deliver him to the hospital, the physician tells you that he suspects a sprain. This means that: there is a disruption of the joint and the bone ends are no longer in contact. the patient has an incomplete fracture that passes only partway through the bone. stretching or tearing of the ligaments with partial or temporary dislocation of the bone ends has occurred. the muscles of the ankle have been severely stretched, resulting in displacement of the bones from the joint.
stretching or tearing of the ligaments with partial or temporary dislocation of the bone ends has occurred.
You respond to a soccer game for a 16-year-old male with severe ankle pain. When you deliver him to the hospital, the physician tells you that he suspects a sprain. This means that: - there is a disruption of the joint and the bone ends are no longer in contact. - the patient has an incomplete fracture that passes only partway through the bone. - stretching or tearing of the ligaments with partial or temporary dislocation of the bone ends has occurred. - the muscles of the ankle have been severely stretched, resulting in displacement of the bones from the joint.
stretching or tearing of the ligaments with partial or temporary dislocation of the bone ends has occurred.
Skeletal muscle is also referred to as: smooth muscle. striated muscle. autonomic muscle. involuntary muscle.
striated muscle.
A fracture of the femoral shaft is best stabilized with a _______.
traction splint, such as a Sager splint.
