Chapter 24 EMT Trauma Overview

According to the American College of Surgeons, an adult trauma patient meets Level I criteria if he or she: A. has a systolic blood pressure of less than 110 mm Hg or a heart rate greater than 110 beats/min. B. was involved in a motor-vehicle crash in which another patient in the same vehicle was killed. C. has a GCS score of less than or equal to 8 with a mechanism attributed to trauma. D. has a bleeding disorder or takes anticoagulant medications and has any blunt or penetrating injury.

...

identify critically ill patient

1) dangerous MOI 2) decreased level of C 3) threats to airway, breathing, circulation

classification of motor vehicle accidents

1) frontal (head on) 2) rear-end 3) lateral (t-bone) 4) rotational spines

kinetic energy

1/2 m x v^2

children: falls of greater than ___ feet or ______________ vehicle crash

10 feet, greater than 25 mph

a fall more than ______ feet is considered significant

20 feet

trauma score

A score calculated from 1 to 16, with 16 being the best possible score. It relates to the likelihood of patient survival with the exception of a severe head injury. It takes into account the Glasgow Coma Scale (GCS) score, respiratory rate, respiratory expansion, systolic blood pressure, and capillary refill.

revised trauma score

A scoring system used for patients with head trauma.

During your assessment of a patient with a head injury, you note that he opens his eyes when you pinch his trapezius muscle, is mumbling, and has his arms curled in toward his chest. You should assign him a GCS score of: A. 7. B. 9. C. 8. D. 10.

A. 7

Which of the following injuries would MOST likely occur as a direct result of the third collision in a motor vehicle crash? A. Aortic rupture B. Forehead lacerations C. Flail chest D. Extremity fractures

A. Aortic rupture

What types of motor vehicle collisions present the greatest potential for multiple impacts? A. Rotational and rollover B. Rear-end and rotational C. Frontal and rotational D. Lateral and rollover

A. Rotational and rollover

Which of the following statements regarding gunshot wounds is correct? A. The speed of a bullet has a greater impact on causing injury than the mass. B. The size of a bullet has the greatest impact on producing injury. C. High-velocity bullets will cause less severe internal injuries. D. Low-velocity bullets will cause the greatest amount of internal injury.

A. The speed of a bullet has a greater impact on causing injury than the mass

When evaluating the mechanism of injury of a car-versus-pedestrian collision, you should first: A. approximate the speed of the vehicle that struck the pedestrian. B. determine if the patient was propelled away from the vehicle. C. evaluate the vehicle that struck the patient for structural damage. D. determine if the patient was struck and pulled under the vehicle.

A. approximate the speed of the vehicle that struck the pedestrian

When treating a patient who experienced a pulmonary blast injury, you should: A. avoid giving oxygen under positive pressure. B. administer large amounts of intravenous fluid. C. use a demand valve to ventilate the patient. D. suspect an accompanying cardiac tamponade.

A. avoid giving oxygen under positive pressure

Signs of a pulmonary blast injury include: A. coughing up blood. B. an irregular pulse. C. multiple rib fractures. D. vomiting blood.

A. coughing up blood

The cervical spine is MOST protected from whiplash-type injuries when the: A. headrest is appropriately positioned. B. air bag correctly deploys upon impact. C. rear end of the vehicle is initially struck. D. patient tenses up at the time of impact.

A. headrest is appropriately positioned

When assessing a patient who experienced a blast injury, it is important to remember that: A. primary blast injuries are the most easily overlooked. B. solid organs usually rupture from the pressure wave. C. primary blast injuries are typically the most obvious. D. secondary blast injuries are usually the least obvious.

A. primary blast injuries are the most easily overlooked

Factors that should be considered when assessing a patient who has fallen include all of the following, EXCEPT: A. the speed of the fall. B. the primary impact point. C. the surface struck.

A. the speed of the fall

Passengers who are seated in the rear of a vehicle and are wearing only lap belts have a higher incidence of injuries to the: A. thoracic and lumbar spine. B. lumbar and coccygeal spine. C. thoracic and sacral spine. D. lumbar and sacral spine.

A. thoracic and lumbar spine

arterial air embolism

Air bubbles in the arterial blood vessels.

projectile

Any object propelled by force, such as a bullet by a weapon.

index of suspicion

Awareness that unseen life-threatening injuries may exist when determining the mechanism of injury.

While assessing a young male who was struck in the chest with a steel pipe, you note that his pulse is irregular. You should be MOST suspicious for: A. underlying cardiac disease. B. bruising of the heart muscle. C. a lacerated coronary artery. D. traumatic rupture of the aorta.

B. bruising of the heart muscle

During your assessment of a patient who experienced a blast injury, you note that he has a depressed area to the front of his skull. This injury MOST likely occurred: A. as a direct result of the pressure wave. B. during the tertiary phase.

B. during the tertiary phase

Two of the MOST common mechanisms of injury for blunt trauma are: A. low-caliber gunshot wounds and falls. B. falls and motor vehicle collisions. C. gunshot wounds and vehicle ejections. D. motor vehicle collisions and stabbings.

B. falls and motor vehicle collisions

Evaluation of the interior of a crashed motor vehicle during extrication will allow the AEMT to: A. determine the vehicle's speed at the time of impact. B. identify contact points and predict potential injuries. C. assess the severity of the third collision of the crash. D. recognize if the driver hit the brakes before impact.

B. identify contact points and predict potential injuries

When assessing the interior of a crashed motor vehicle for damage, you are gathering information regarding the: A. kinetic energy. B. mechanism of injury. C. index of suspicion. D. potential energy.

B. mechanism of injury

When assessing an elderly patient who fell, it is important to remember that: A. elderly patients who fall usually have a secondary head injury. B. osteoporosis can cause a fracture that may have resulted in the fall. C. any fall in the elderly is considered to be high-energy trauma. D. bilateral hip fractures usually occur when an elderly person falls.

B. osteoporosis can cause a fracture that may have resulted in the fall

A 30-year-old male sustained a stab wound to the neck when he was attacked outside a nightclub. During your assessment, you should be MOST alert for: A. alterations in his mental status. B. potential airway compromise. C. injury to the cervical spine. D. damage to internal structures.

B. potential airway compromise

When the speed of a motor vehicle doubles, the amount of kinetic energy: A. doubles. B. quadruples.

B. quadruples

When a motor vehicle strikes a tree while traveling at 40 mph, the unrestrained occupant: A. is thrust under the steering column onto the floorboard. B. remains in motion until acted upon by an external force. C. will decelerate at the same rate as the motor vehicle. D. will most likely be thrown over the steering column.

B. remains in motion until acted upon by an external force

The index of suspicion is MOST accurately defined as: A. a predictable pattern that leads to serious injuries. B. your concern for potentially serious underlying injuries.

B. your concern for potentially serious underlying injuries

A small compact car was involved in a rollover crash. As you are approaching the vehicle, you note that the roof is significantly collapsed. The patient, a 29-year-old male, is complaining of severe pain in his neck and to the top of his head as well as numbness and tingling in his extremities. Witnesses who removed the patient from the vehicle state that he was wearing his seatbelt. What injury mechanism is MOST likely responsible for this patient's condition? A. Lateral bending of the neck during the crash B. Impact of the head against the steering wheel C. Compression of the head against the roof D. Whiplash injury to the neck during the rollover

C. Compression of the head against the roof

Which of the following would MOST likely occur as the direct result of the second collision in a motor vehicle crash? A. Collapsed dashboard B. Intrathoracic hemorrhage C. Deformed steering wheel D. Caved-in passenger door

C. Deformed steering wheel

A 12-year-old male jumped approximately 12' from a tree and landed on his feet. He complains of pain to his lower back. What injury mechanism is MOST likely responsible for his back pain? A. Lateral impact to the spine B. Direct trauma to the spinal column C. Energy transmission to the spine D. Secondary fall after the initial impact

C. Energy transmission to the spine

With regard to the three collisions that occur during a motor vehicle crash, which of the following statements regarding the first collision is correct? A. It has a direct effect on patient care because of the obvious vehicular damage. B. It occurs when the unrestrained occupant collides with the interior of the vehicle. C. It is the most dramatic part of the collision and may make extrication difficult. D. It provides the least amount of information about the mechanism of injury.

C. It is the most dramatic part of the collision and may make extrication difficult

A young male sustained a gunshot wound to the abdomen during an altercation with a rival gang member. As your partner is assessing and managing his airway, you should control any obvious bleeding and then: A. auscultate bowel sounds. B. apply a cervical collar. C. assess for an exit wound. D. obtain baseline vital signs.

C. assess for an exit wound

The phenomenon of pressure waves emanating from the bullet, causing damage remote from its path, is known as: A. capitation. B. conversion. C. cavitation. D. congruent.

C. cavitation

When a driver is in a car equipped with an air bag, but is not wearing a seatbelt, he or she will MOST likely strike the __________ when the air bag deploys upon impact. A. dashboard B. steering wheel C. door D. windshield

C. door

In contrast to a Level III trauma center, a Level I trauma center must: A. be able to stabilize patients before transferring to a higher level facility. B. be involved in trauma prevention programs. C. have general surgeons that are in-house 24 hours a day. D. have access to an emergency physician within 30 minutes.

C. have general surgeons that are in-house 24 hours a day

According to the Association of Air Medical Services (AAMS), you should consider air medical transport of a trauma patient if: A. the patient requires advanced life support care and stabilization, and the nearest paramedic ground ambulance is more than 5 to 10 minutes away. B. ground transport will take your ambulance out of service for an extended period of time, regardless of the severity of the patient's injuries. C. he or she was involved in a motor-vehicle crash in which another occupant in the same vehicle was killed, even if your patient's injuries are minor. D. traffic conditions hamper the ability to get the patient to a trauma center by ground within the ideal time frame for the best clinical outcome.

C. he or she was involved in a motor-vehicle crash in which another occupant in the same vehicle was killed, even if your patient's injuries are minor

While en route to a major motor vehicle crash, an on-scene police officer advises you that a 6-year-old male who was riding in the front seat is involved. He further states that the child was only wearing a lap belt and that the air bag deployed. On the basis of this information, you should be MOST suspicious that the child has experienced: A. lower-extremity fractures. B. blunt trauma to the head. C. neck and facial injuries. D. open abdominal trauma.

C. neck and facial injuries

When caring for an occupant inside a motor vehicle equipped with an air bag that did not deploy upon impact, it is MOST important to: A. recognize that the force of impact was most likely not severe. B. realize that the air bag malfunctioned at the time of impact. C. remember that it could still deploy and seriously injure you. D. suspect that the patient may have experienced serious injuries.

C. remember that it could still deploy and seriously injure you

If one or more occupants in the same vehicle are killed in a crash, the AEMT should: A. rapidly assess only the survivors who have experienced obvious trauma. B. allow the survivors to refuse transport if they have no obvious injuries. C. suspect that all living occupants experienced the same serious trauma. D. transport the survivors only if they have injuries or complain of pain.

C. suspect that all living occupants experienced the same serious trauma

A sport utility vehicle lost control and struck a utility pole head-on. The driver was killed instantly. The passenger, a young female, is conscious and alert and has several small abrasions and lacerations to her left forearm. Treatment for the passenger should include: A. a focused exam of her forearm. B. transport to a community hospital. C. transport to a trauma center. D. a secondary assessment at the scene.

C. transport to a trauma center

Which of the following patients has experienced the MOST significant fall? A. A 5'-0" patient who fell 13' B. A 5'-9" patient who fell 14' C. A 4'-8" patient who fell 13' D. A 4'-6" patient who fell 13'

D. A 4'-6" patient who fell 13'

Which of the following findings would be LEAST suggestive of the presence of high-energy trauma? A. Intrusion into the vehicle B. Dismounted seats C. Steering wheel deformity D. Deployment of the air bag

D. Deployment of the air bag

By what mechanism is a person injured when he or she falls from a significant height? A. As the person falls, the amount of kinetic energy is converted into work; work is then converted to kinetic energy upon impact. B. Kinetic energy is converted to potential energy; the potential energy is then converted into the work of bringing the body to a stop. C. Potential energy is created as the person is falling; the potential energy is then converted into kinetic energy upon impact. D. Potential energy is converted to kinetic energy; the kinetic energy is then converted into the work of bringing the body to a stop.

D. Potential energy is converted to kinetic energy; the kinetic energy is then converted into the work of bringing the body to a stop

Which of the following interventions is the MOST critical to the outcome of a patient with multisystem trauma? A. Elevation of the lower extremities B. Early administration of oxygen C. Intravenous fluid administration D. Rapid transport to a trauma center

D. Rapid transport to a trauma center

If a person is standing near a building that explodes, which of the following injuries would he or she MOST likely experience as a result of the pressure wave? A. Fractured bones B. Severe burns C. Impaled objects D. Stomach rupture

D. Stomach rupture

Which of the following statements regarding low-energy penetrating injuries is correct? A. Exit wounds are typically easy to locate with low-energy penetrating injuries. B. Internal injuries caused by low-velocity bullets are usually easy to predict. C. It is usually easy to differentiate between an entrance wound and an exit wound. D. The area of injury is usually close to the path the object took through the body.

D. The area of injury is usually close to the path the object took through the body.

A 40-year-old female, unrestrained, impacted the steering wheel of her vehicle with her chest when her vehicle hit a tree while traveling at 45 mph. She is conscious and alert, but is experiencing significant chest pain and shortness of breath. Given the mechanism of injury and her present condition, it is LEAST likely that she experienced: A. a cardiac contusion. B. a pulmonary contusion. C. multiple rib fractures. D. a head injury.

D. a head injury

Air bags are designed to: A. be used with or without a shoulder harness. B. prevent a second collision inside the car. C. prevent the driver from sustaining head trauma. D. decrease the severity of deceleration injuries.

D. decrease the severity of deceleration injuries

A driver involved in a rollover motor vehicle crash will MOST likely experience serious injuries or death if he or she: A. experiences multiple impacts. B. remains within the vehicle. C. is wearing only a lap belt. D. is ejected or partially ejected.

D. is ejected or partially ejected

The energy contained in a moving object is called: A. potential energy. B. latent energy. C. converted energy. D. kinetic energy.

D. kinetic energy

Approximately 25% of severe injuries to the aorta occur during: A. rollover collisions. B. rear-end collisions. C. frontal collisions. D. lateral collisions.

D. lateral collisions

A 15-year-old female was struck by a small car while riding her bicycle. She was wearing a helmet and was thrown to the ground, striking her head. In addition to managing problems associated with airway, breathing, and circulation, it is MOST important for you to: A. obtain baseline vital signs. B. leave her bicycle helmet on. C. inspect the helmet for cracks. D. stabilize her entire spine.

D. stabilize her entire spine

Internal injuries caused by gunshot wounds are difficult to predict because: A. exit wounds caused by the bullet are usually small. B. the caliber of the bullet is frequently unknown. C. the area of damage is usually smaller than the bullet. D. the bullet may tumble or ricochet within the body.

D. the bullet may tumble or ricochet within the body.

Force acting over a distance defines the concept of: A. kinetic energy. B. potential energy. C. latent energy. D. work.

D. work

trauma emergencies

Emergencies that are the result of physical forces applied to a patient's body.

pulmonary blast injuries

Pulmonary trauma resulting from short-range exposure to the detonation of explosives.

potential energy

The product of mass, gravity, and height, which is converted into kinetic energy and results in injury, such as from a fall.

mechanism of injury

The way in which traumatic injuries occur; the forces that act on the body to cause damage. Includes potential energy, kinetic energy and the energy of work.

index of suspicion

Your awareness and concern for potentially serious underlying and unseen injuries

GCS

an evaulation tool use to determine LOC - points assigned to eye opening, verbal response, motor response - points are then totaled

Quaternary blast

burns from hot gases started by blast, respiratory injury from inhaling toxic gases, suffocation, poisoning, crush injuries - all resulting from the blast

temporary cavitation

caused by the acceleration of the bullet and causes a stretching of the tissues

permanent cavitation

caused by the bullet path and remains once the bullet has passed through the tissue

Energy can never be

created or destroyed, but can only be converted or transformed

secondary blast

damage to the body results from being struck by flying debris, such as a shrapnel from the device or glass or splinters

significant MOIs car accidents for transport to trauma center

death, deformity of vehicle (severe front, moderate from lateral, severe damage to rear, rotation is involved), ejection from vehicle

Work

defined as a force acting over a distance

primary blast

due entirely to the blast itself, damage to the body caused by the pressure wave generated by explosion

multisystem trauma

emergencies that require EMS attention b/c of illnesses or conditions not caused by an outside force

kinetic object

energy of a moving object, reflects the relationship b/w the mass (weight) of the object and the velocity of speed at which it is traveling.

multisystem trauma

falls from heights, motor vehicle and motorcycle crashes, car vs. pedestrian (or motorcycle/bicycle), gunshot wounds and stabbings

four types of motorcycle impacts

head on, angular, ejection, controlled crash

Medical emergencies

include illnesses or conditions not caused by an outside force.

tertiary blast

injuries occure when the patient is hurled by the force of the explosion against a stationary object

blunt trauma

is the result of force (or energy transmission) to the body that causes injury w/o anything penetrating soft tissues or internal organs and cavities (bruises)

during transport of trauma patient

obtain SAMPLE history and complete a secondary asst.

Trauma emergencies

occur as a result of physical forces applied to the body

Coup-Contracoup Injuries

occurs when brain continues forward motion and strikes the inside of the skull, resulting in a compression injury to the anterior portion of the brain

drag

resistance that slows a projectile such as air

blunt trauma

results from object making contact with body

penetrating trauma

results in injury by objects that pierce and penetrate the surface of the body and injure the underlying soft tissues, internal organs, and body cavities. caused by objects, such as knives and bullets

deceleration

slowing of an object

cavitation

speed causes a bullet to generate pressure waves which cause damage distant from the bullet's path

tympanic membrane

the eardrum, a thin, semi-transparent membrane in the middle ear that transmits sound vibrations to the internal ear by means of auditory ossicles

work

the measure of force over a distance

trajectory

the path a projectile takes once it is propelled