Chapter 25 Trauma Overview:

Which of the following would be considered a significant mechanism of injury?

-Motor vehicle collision greater than 40 mph or motorcycle crashes greater than 20 mph -A car-versus-pedestrian accident greater than 15 mph -Death of an occupant in the vehicle

Which of the following would be considered multisystem trauma?

-chest and multiple extremity trauma -head and spinal trauma -chest and abdominal trauma

Which of these reasons would be an appropriate use of emergency air medical services for trauma patients?

-there is a mass casualty incident -Distance to the trauma center is greater than 20 to 25 miles -Traffic conditions or hospital availability make it unlikely that the patient will get to trauma center via ground within ideal time frame.

You are assessing a patient who was in a front-end car crash. His CGS score is 12, his systolic blood pressure is 81 mm Hg, and his respiratory rate is 22 breaths/min. What is this patient's Revised Trauma Score? 7 10 12 15

10

You are assessing a patient who opens her eyes when you speak to her, who can respond to you but seems confused as to time and place, and who localizes pain. What is her Glasgow Coma Scale score? 7 10 12 15

12

significant intrusion

12-18in 0n side-24in and over for front and back

How many categories of trauma are there?

2

collision we expect to harm the body

2nd collision

How many collisions are there in a typical vehicle impact? 1 2 3 4

3

how the body is harmed internally

3rd collision

For people younger than age _______, traumatic injuries are the leading cause of death in the United States.

44

The body has increasing difficulty in compensating for shock and traumatic injuries after how long?

60 minutes

Which of the following would cause blunt trauma?

A motor vehicle collision

decrease the severity of deceleration injuries and decrease injury to the chest, face, and head.

Airbags

Which of the following would MOST likely result from the third collision in the "three-collision" effect that occurs during a high-speed, frontal impact motor vehicle crash? Extensive damage to the automobile Flail chest and lower extremity fractures Massive external trauma with severe bleeding Aortic rupture or compression injury to the brain

Aortic rupture or compression injury to the brain

What is index of suspicion? A. Life-threatening injuries are present with a significant mechanism of injury. B. The patient has an illness that is not caused by an outside force. C. Awareness that due to the mechanism of injury, unseen injuries may be present. D. Awareness that the mechanism of injury will rule out any life-threatening injuries.

C. Awareness that due to the mechanism of injury, unseen injuries may be present.

When caring for victims of traumatic injuries, what should an EMT do to avoid delays in treatment and transport?

Call for ALS and helicopter assistance early

Which of the following mnemonics works BEST when assessing a trauma patient?

DCAP-BTLS

Which of the following is important to do when treating a patient with penetrating trauma?

Determine the length of the penetrating object

When treating a patient who experienced a pulmonary blast injury, you should:

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:

Severe abrasion injuries can occur when motorcycle riders are slowed after a collision by road drag. Road drag is most often associated with which type of motorcycle impact? Head-on collision Angular collision Ejection Controlled crash

Ejection

You would mostly commonly use the Revised Trauma Score scoring system for a patient with the potential for what type of trauma? Abdominal Head Chest Extremity

Head

Which of the following statements regarding the first collision that occurs during a motor vehicle crash is correct?

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

Which level of trauma center would fit the definition that includes "able to provide prompt assessment, resuscitation, and stabilization of injured patients and emergency operations"?

Level 3

What level of trauma center provides prompt assessment, resuscitation, and stabilization of injured patients and emergency operations? Level I Level II Level III Level IV

Level III

3 Organs that contain air are most susceptible to pressure changes.

Middle ear Lung Gastrointestinal tract

A 20-year-old man has major open facial injuries after his vehicle struck a tree head-on. Which of the following findings within the car would MOST likely explain his injury pattern? Deployed airbag Bent steering wheel Nonintact windshield Crushed instrument panel

Nonintact windshield

Which of the following is NOT true regarding digital photos of a crash scene?

Photos can be shared over social media

Damage to the body by pressure wave

Primary blast injuries

result from short-range exposure to the detonation of explosives.

Pulmonary blast injuries

Which category of blast injuries includes mental health emergencies?

Quaternary

Burns from hot gases or fires started by the blast

Quaternary (miscellaneous) blast injuries

In which type of vehicle crash are you most likely to find a patient with whiplash injuries? Frontal Rear-end Rollover Rotational

Rear-end

effective in preventing a second collision inside the motor vehicle.

Seat belts and airbags

What type of blast injury occurs when objects are propelled by the force of the blast wave and strike the victim, causing injury? Primary Secondary Tertiary Quaternary

Secondary

Which of the following factors has the greatest impact on the risk of injury? Mass Speed Distance Gravity

Speed

At what step in the ACS-COT/CDC updated field triage decision scheme would you assess the mechanism of injury and evidence of high-energy impact? Step 1 Step 2 Step 3 Step 4

Step 3

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?

Stomach rupture

Why should on-scene time be limited to 10 minutes or less for trauma patients?

Surgical intervention is usually required

Victim is hurled by the force of the explosion.

Tertiary blast injuries

Which of the following statements regarding low-energy penetrating injuries is correct?

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

What are the three collisions involved in a frontal motor vehicle crash?

The collision of the car against some type of object. The collision of the passenger against the interior of the car. The collision of the passenger's internal organs against the solid structures of the body.

Which of the following injuries can be used to assist in triaging patients because they indicate risk of pressure injuries to the lungs?

Tympanic membrane injuries

If a patient has a penetrating injury to the neck that results in an open wound, what should the EMT do?

Use occlusive dressing

What is a coup-contrecoup injury?

a brain injury that occurs when force is applied to the head and energy transmission through the brain tissue causes injury on the opposite side of the original impact.

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. 8. c. 9. d. 10.

a. 7.

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. Compression of the head against the roof b. Lateral bending of the neck during the crash c. Impact of the head against the steering wheel d. Whiplash injury to the neck during the rollover

a. Compression of the head against the roof

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. door b. dashboard c. windshield d. steering wheel

a. door

Two of the MOST common mechanisms of injury for blunt trauma are: a. falls and motor vehicle collisions. b. low-caliber gunshot wounds and falls. c. gunshot wounds and vehicle ejections. d. motor vehicle collisions and stabbings

a. falls and motor vehicle collisions.

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 surface struck. c. the height of the fall. d. the primary impact point.

a. the speed of the fall.

The driver of 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. transport to a trauma center. b. a focused exam of her forearm. c. transport to a community hospital. d. a secondary assessment at the scene.

a. transport to a trauma center.

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

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

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

b. have general surgeons who are in-house 24 hours a day.

The energy of a moving object is called: a. latent energy. b. kinetic energy. c. potential energy. d. converted energy.

b. kinetic energy.

When assessing the interior of a crashed motor vehicle for damage, you are gathering information regarding the: a. index of suspicion. b. mechanism of injury. c. kinetic energy. d. potential energy

b. mechanism of injury.

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. injury to the cervical spine. b. potential airway compromise. c. damage to internal structures. d. alterations in his mental status.

b. potential airway compromise.

While assessing a young male who was struck in the chest with a steel pipe, you note that his pulse is rapid and irregular. You should be MOST suspicious for:

bruising of the heart muscle

Which of the following statements regarding the first collision that occurs during a motor vehicle crash is correct? a. It provides the least amount of information about the mechanism of injury. b. It has a direct effect on patient care because of the obvious vehicular damage. c. It is the most dramatic part of the collision and may make extrication difficult. d. 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.

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. Severe burns b. Fractured bones c. Stomach rupture d. Impaled objects

c. Stomach rupture

Which of the following patients has experienced the MOST significant fall? a. a 4′8″ patient who fell 12 feet b. a 5′0″ patient who fell 13 feet c. a 4′6″ patient who fell 13 feet d. a 5′9″ patient who fell 14 feet

c. a 4′6″ patient who fell 13 feet

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

c. avoid giving oxygen under positive pressure.

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

c. bruising of the heart muscle.

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

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

Passengers who are seated in the rear of a vehicle and are wearing only lap belts have a higher incidence of injuries to the _____________ spine during a rear-end crash. a. thoracic and sacral b. lumbar and coccygeal c. thoracic and lumbar d. lumbar and sacral

c. thoracic and lumbar

The phenomenon in which the rapid changes in tissue and fluid pressure that occur with the passage of a projectile result in serious injury to internal organs distant to the actual path of the bullet is known as: cavitation. drag. fragmentation. tumble.

cavitation

In the case of a motor vehicle crash, the energy of the speeding vehicle is converted into the work of stopping the vehicle, which is accomplished by:

crushing the vehicle's exterior

Which of the following statements regarding low-energy penetrating injuries is correct? a. Internal injuries caused by low-velocity bullets are usually easy to predict. b. Exit wounds are typically easy to locate with low-energy penetrating injuries. 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.

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

d. identify contact points and predict potential injuries.

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.

door

what body part is most sensitive to blast injuries.

ear

Death from a rollover motor vehicle crash is MOST often secondary to: crushing injuries. airbag-related trauma. multiple collisions to the interior of the car. ejection of the patient from the motor vehicle.

ejection of the patient from the motor vehicle.

All of the following are concepts of energy, EXCEPT:

expressed energy

Two of the MOST common mechanisms of injury for blunt trauma are:

falls and motor vehicle collisions

Evaluation of the interior of a crashed motor vehicle during extrication will allow the EMT to:

identify contact points and predict potential injuries

All of the following are criteria that can help identify a critically injured patient, EXCEPT:

injuries to the head

Which of the following is an example of a nonsignificant injury?

injury to an isolated body part

The energy of a moving object is called:

kinetic energy

, which type of crash causes approximately 30% of all fatalities that occur in motor vehicle crashes?

lateral

When assessing the interior of a crashed motor vehicle for damage, you are gathering information regarding the:

mechanism of injury

the way traumatic injuries occur, describes the forces acting on the body that cause injury

mechanism of injury

When assessing a stab wound, it is important for the EMT to remember that: stabbings to an extremity are rarely associated with an exit wound. the majority of the internal trauma will be near the path of the knife. most stabbings are unintentional and cause less severe internal injury. more internal damage may be present than the external wound suggests.

more internal damage may be present than the external wound suggests.

Injury to more than one body system

multisystem trauma

A penetration or perforation of the integrity of the chest is called an

open chest wound.

Second-leading cause of trauma death after blunt trauma

penetrating trauma

A patient is suffering from decreasing blood pressure, asymmetrical chest wall movement, and a narrow pulse pressure. You should have a high index of suspicion for which of the following conditions?

pneumothorax or hemothorax

For the symptoms of noisy or labored breathing; decreasing or low Glasgow Coma Scale (GCS) score; and a rapid, weak pulse, which of the following injuries would you expect?

significant bleeding or foreign bodies in the upper or lower airway

Which of the following might be the only sign of blunt trauma?

skin discoloration

A young male experienced severe blunt chest trauma when his passenger car struck another vehicle head-on. During your inspection of the interior of his vehicle, you would MOST likely find: deployed airbags. steering wheel deformity. starring of the windshield. a crushed instrument panel.

steering wheel deformity.

Which of the following injuries would NOT be a primary blast injury?

suffocation

A 40-year-old man was standing near a building when it exploded. He has multiple injuries, including a depressed skull fracture, severe burns, and an impaled object in his abdomen. His head injury was MOST likely caused by ___________ blast injuries. primary secondary tertiary quaternary

tertiary

Traumatic injury occurs when:

the body's tissues are exposed to energy levels beyond their tolerance.

Internal injuries caused by gunshot wounds are difficult to predict because:

the bullet may tumble or ricochet within the body.

potential energy

the product of mass, force of gravity, and height. Mostly associated with the energy of falling objects

An unrestrained driver collided with a bridge pillar. Upon inspection of the interior of his vehicle, you note that the lower dashboard is crushed. During your assessment of the patient, you will MOST likely encounter: trauma to the pelvis. blunt abdominal trauma. a severe closed head injury. penetrating thoracic trauma.

trauma to the pelvis.

Relationship between distance and severity of injury varies depending on the

type of weapon involved.

It is important to consider _______ as well as obvious injuries with any type of trauma.

unseen

Kinetic energy is a calculation of: weight and size. weight and speed. mass and weight. speed and force.

weight and speed.