Chapter 29- Chest and Abdominal Trauma

Q27- Two cars have collided head on. One car was traveling 55 mph and the other 35 mph. The total speed of impact would be:

90 mph.

Newton's FIRST LAW

A body at rest will remain at rest and a body in motion will remain in motion unless acted upon by some outside force.

For which of the following wounds should the EMT apply an absorbent dressing moistened with sterile saline and then cover it with an occlusive dressing? A gunshot wound to the abdomen from which a loop of intestine is protruding A stab wound to the chest A laceration to the neck The stump of an amputated extremity

A gunshot wound to the abdomen from which a loop of intestine is protruding

...

A patient who collapses in cardiac arrest after a force to the center of the chest should receive CPR.

Which of the following is an accurate definition of a flail chest? A lung that has been punctured by a fractured rib, resulting in a buildup of air A section of the chest wall that is unstable, leading to breathing problems The fracture of one rib in two or more consecutive places The fracture of at least four ribs in two or more places

A section of the chest wall that is unstable, leading to breathing problems

What is the correct terminology for a wound in which a vacuum has been created within the chest, drawing air into the thorax with each breath? A sucking chest wound A closed tension pneumothorax An open chest wound A gurgling chest wound

A sucking chest wound

You are evaluating a 28-year-old female patient who was the belted driver in a car-versus-tree motor vehicle crash. She is also 30 weeks' pregnant. She is complaining of severe abdominal pain with cramping, and you can see blood soaking into her shorts and onto the driver's seat. As you prepare for a rapid extrication, you are worried that she may have experienced: A) a. Abruptio placentae B) c. Liver laceration C) b. Femoral artery laceration D) d. Premature labor

A) a. Abruptio placentae

Sprains are categorized according to the: A) a. Extent of ligament damage B) d. Type of tissue involved C) b. Number of cartilages damaged D) c. Type of tendons damaged

A) a. Extent of ligament damage

If you determine the musculoskeletal injury is isolated, then you can perform a(n): A) a. Focused assessment B) b. Ongoing assessment C) c. Rapid trauma assessment D) d. Head-to-toe assessment

A) a. Focused assessment

Mortality secondary to solid abdominal organ injury is primarily caused by: A) a. Hemorrhagic shock B) d. Organ death C) c. Infection D) b. Ileus

A) a. Hemorrhagic shock

Which penetrating object is least likely to have a straight trajectory through the body? A) b. Bullet B) c. Glass shard C) d. Knife D) a. Arrow

A) b. Bullet

A mnemonic for remembering signs and symptoms of musculoskeletal injury is: A) b. DCAP-BTLS B) a. AVPU C) d. SAMPLE D) c. OPQRST

A) b. DCAP-BTLS

You are treating a 44-year-old female patient who was struck by a car while crossing the street and was thrown 25 feet. She is responding to verbal stimuli, does not move appropriately, and has a pulse rate of 132 beats/min, a respiratory rate of 32 breaths/min, a blood pressure of 88/68 mm Hg, and pale and clammy skin. When you remove her clothing, her upper abdominal quadrants are bruised, rigid, and tender. Appropriate care for this patient includes: A) b. Establishing a large-bore IV B) d. Providing oxygen via nasal cannula C) c. Positioning her in the left lateral recumbent position to protect her airway D) a. Administering fentanyl for pain

A) b. Establishing a large-bore IV

As a paramedic, you realize that your ability to quickly recognize and treat a musculoskeletal injury helps to limit: A) b. Loss of use B) a. Disease C) c. Morbidity D) d. Mortality

A) b. Loss of use

Common signs and symptoms following an injury to a hollow abdominal organ include: increasing intrathoracic pressures. irritation and peritonitis. massive hemorrhage. absence of unilateral pulses.

irritation and peritonitis.

Hematoma

Large amount of pooling blood that collects under the skin

Dermis

Layer of the skin contains hair follicles, nerve endings and sweat glands.

You can use ----- for abdominal injuries if protocol allows

PASG

TRAUMATIC ASPHYXIA

distended neck veins-head, neck, and shoulders appearing dark blue or purple-bloodshot and bulging eyes-swollen blue tongue and lips-chest deformity

CARDIAC TAMPONADE

distended neck veins-very weak pulse-low blood pressure-steadily decreasing pulse pressure

flail chest

fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment

paradoxical motion

movement of ribs in a flail segment that is opposite to the direction of movement of the rest of the chest cavity

compression

occurs when severe blunt trauma causes the chest to rapidly compress

occlusive dressing

one-way dressing on a chest wound

Blunt trauma, compression, and penetrating trauma are mechanisms that can injure the chest. Chest injuries are classified as either

open or closed

PNEUMOTHORAX

respiratory difficulty-uneven chest wall movement-reduction of breath sounds on the affected side of the chest (listen with stethoscope)

HEMOTHORAX

signs of pneumothorax plus coughed-up frothy red blood

Some drawbacks to using sterile aluminum foil as an occlusive dressing include: sterility cannot be ensured unless the materials were autoclaved. a flutter valve is difficult to create. foil cannot create an airtight seal. skin lacerations may occur from the sharp edges.

skin lacerations may occur from the sharp edges.

TREATMENT: abdominal injuries

-carefully monitor airway in presence of vomiting -place patient on back with knees flexed to reduce tension on abdominal muscles -administer oxygen -treat for shock -if allowed, utilizer pneumatic anti-shock garments (PASG) -nothing to patient by mouth -continuously monitor vital signs

In a sprain, which of the following is injured? A) d. Tendon B) b. Ligament C) c. Muscle D) a. Bone

B) b. Ligament

A PASG can be used in place of which other type of splint? A) b. Ridged B) a. Flexible C) d. Air splint D) c. Sling and swath

C) d. Air splint

Prehospital management of internal genitalia or bladder injury includes: A) c. Foley catheter placement B) b. Flushing saline into the genitalia with a plastic catheter C) d. Attention to the ABCs and treating hemorrhagic shock if present D) a. Applying a compression bandage to the genitalia

C) d. Attention to the ABCs and treating hemorrhagic shock if present

The most serious concern of a bladder rupture is: A) a. Loss of the body's ability to eliminate urine B) b. Massive hemorrhage C) d. Shock and/or peritonitis D) c. Urine and blood leakage

C) d. Shock and/or peritonitis

Which of the following solid organs can be injured with trauma to the upper left abdominal quadrant? A) c. Pancreas B) a. Appendix C) d. Spleen D) b. Kidney

C) d. Spleen

How does prehospital management of solid organ injury differ from management of hollow organ injury? A) b. Solid organ injuries require less fluid resuscitation. B) c. Solid organ injuries require treatment at a trauma center, unlike hollow organ injuries. C) d. There is no difference in prehospital management. D) a. Hollow organ injuries require less fluid resuscitation.

C) d. There is no difference in prehospital management.

An athlete with an injury to the chest resulting in cardiac arrest with ventricular fibrillation should be treated with...

CPR and defibrillation

Abdominal Injuries

Can be open or closed Internal bleeding can be severe if organs or blood vessels are lacerated or ruptured Serious, painful reactions if hollow organs rupture Evisceration may occur

Blunt trauma

Can fracture ribs, sternum, and costal (rib) cartilages Lungs, airway and great vessels of the heart

Beck's triad (Decreased blood pressure, jugular vein distention and distant muffled heart sounds) are signs of

Cardiac tamponade

JVD, signs of shock and narrowed pulse pressure are signs and symptoms of

Cardiac tamponade

JVD, very weak pulse, low BP, steadily decreasing pulse pressure, are signs of

Cardiac tamponade

When an injury to the heart causes blood to flow into the surrounding pericardial sac, the condition produced is..

Cardiac tamponade

An open chest wound is a true emergency that requires rapid initial care and immediate transport.

Care for an open chest wound involves sealing the wound to prevent air from entering the chest cavity. Care also may include application of a dressing that will allow air to escape the chest cavity while preventing air from entering. An open chest wound is a true emergency that requires rapid initial care and immediate transport.

Treatment:Abdominal Injuries

Carefully monitor airway in presence of vomiting Place patient on back with knees flexed to reduce tension on abdominal muscles Administer oxygen Treat for shock

Q27- A bullet fired from a gun at close range passes through the patient's liver. However, on autopsy, the coroner discovers that the man's pancreas, stomach, and gall bladder were also injured, even though not in direct contact with the bullet. As a knowledgeable EMT, you would recognize that which of the following is responsible for injury to these additional organs?

Cavitation.

Vitreous Humor

Clear jelly in the posterior of the eye, between the lens and retina -can not be replaced

...

Closed chest and abdominal wounds bear a high risk for underlying organ system damage and internal bleeding. Use mechanism of injury and patient assessment to recognize the signs and symptoms of shock.

Type of injury when the skin is not broken but injury did happen to the chest is classified as....

Closed chest injury

When air enters the chest cavity through an open chest wound, pressure balance within the chest cavity is destroyed. This causes the lung on the injured side to

Collapse

You are on an EMS standby for a boxing tournament. During one of the matches, one of the female boxers delivers a forcible uppercut to the chest of her opponent, who falls to the ground. The match is declared over on the basis of a TKO. However, the opponent fails to arise following a 1-2 minute interval. EMS is summoned to the ring. You find the patient pulseless and breathing agonal gasps. You suspect which of the following traumatic conditions? Cardiac tamponade Aortic dissection Tension pneumothorax Commotio cordis

Commotio cordis

When someone gets hit in the center of the chest, just when the heart is vulnerable. Could cause an injury called

Commotion cordis

In addition to lacerations, blunt trauma resulting in a closed chest injury creates the potential for which of the following internal injuries? Abrasion Contusion Evisceration Avulsion

Contusion

Which of the following is NOT an open tissue injury? Contusion Evisceration Avulsion Abrasion

Contusion

Based on your knowledge of anatomy, you would suspect a patient with a stab wound in the upper right quadrant to be at risk for: A) c. A perforated bladder, causing infection B) d. A perforated stomach, causing infection C) b. A lacerated spleen, causing internal hemorrhage D) a. A lacerated liver, causing internal hemorrhage

D) a. A lacerated liver, causing internal hemorrhage

A major risk for both an expectant mother and her fetus following a serious traumatic event is: A) d. Preecclampsia B) c. Placenta previa C) b. HELLP syndrome D) a. Abruptio placentae

D) a. Abruptio placentae

Appropriate care for abdominal organs protruding through the abdominal wall includes: A) b. Covering the organs with a dry dressing B) c. Inserting the organs back into the body C) d. Having the patient lie supine and providing aggressive pain management D) a. Covering the organs with moist dressing

D) a. Covering the organs with moist dressing

A Colles fracture refers to what area of the body? A) b. Mandible B) d. Ribs C) c. Proximal tibia D) a. Distal radius

D) a. Distal radius

When the diaphragm ruptures: A) d. The chest wall cannot expand normally B) c. Partially digested food does not flow from the stomach into the duodenum C) b. Chest cavity organs can fall into the abdominal cavity D) a. Herniation of the abdominal contents upward into the chest cavity occurs

D) a. Herniation of the abdominal contents upward into the chest cavity occurs

Your patient is complaining of muscle spasms in the lower leg. Your choice of treatment would be to: A) d. Administer compression B) a. Administer medication C) c. Apply ice D) b. Apply heat

D) b. Apply heat

You are managing a 25-year-old male patient who was involved in a gang-related fight; police have secured the scene. During your assessment, you find several stab wounds along the patient's right flank and lower back. The patient is awake and anxious, in obvious pain. While your partner obtains vital signs, appropriate management for the stab wounds includes: A) a. Applying wet sterile dressings over each wound and then an occlusive dressing B) c. Only covering them with an occlusive dressing C) d. Packing each wound with gauze to control internal bleeding D) b. Covering the wounds with gauze or trauma dressings

D) b. Covering the wounds with gauze or trauma dressings

Which of the following organs is in the retroperitoneal space? A) a. Bladder B) d. Spleen C) c. Liver D) b. Kidney

D) b. Kidney

Before performing a reduction of a dislocated joint, which class of medication should be administered to help with muscle relaxation? A) d. Narcotics B) b. Anesthetics C) a. Analgesics D) c. Benzodiazepines

D) c. Benzodiazepines

To reduce pain and swelling in the first 24 hours after a sprain, apply: A) a. Heat and ice, alternating every 3 to 4 hours B) d. Warm soaks C) b. Heat first, and then ice, once the muscles are warmed D) c. Immobilization and ice

D) c. Immobilization and ice

You are evaluating a 16-year-old male patient who was playing hockey with his friends at an outdoor skating rink when he slammed against his hockey stick, driving the handle deep into his epigastric region. He believes he fell on top of the stick and it caught under his ribs. He is also in obvious respiratory distress, and his abdomen appears slightly sunken; he seems unable to take a full breath. Which of the following interventions is contraindicated in this patient? A) d. Performing rapid sequence intubation B) a. Performing bag-mask ventilations without an ETT in place C) b. Having the patient lie supine D) c. Inflating a pneumatic antishock garment

D) c. Inflating a pneumatic antishock garment

Which of the following injuries can be caused by a shearing mechanism following abdominal trauma? A) d. Liver injury B) a. Bladder perforation C) b. Intestinal tearing along the aorta D) c. Kidney tearing at the ligamentum teres Points Earned: 0.0/1.0

D) c. Kidney tearing at the ligamentum teres

You're an off-duty EMT who encounters a patient sitting behind the wheel of a vehicle that ran off the road along an isolated county road. It appears the patient was unrestrained, or not wearing a seat belt, and struck the steering wheel with his chest. On assessment, you notice a paradoxical motion to the patient's chest on inspiration and expiration. When you radio for dispatch of an ambulance, which of the following pieces of information would you be sure to include? The patient may have an abdominal evisceration. The patient is showing signs of abdominal bleeding. The patient is showing signs of an open chest injury. The patient may have a flail chest.

The patient may have a flail chest.

Your patient is a 55-year-old male who was found in the parking lot behind a tavern. He states that he was assaulted and robbed by three individuals. He is complaining of being "hit in the face and kicked and punched in his ribs and stomach." Your examination reveals contusions and swelling around both eyes, bleeding from the nose, a laceration of his upper lip, and multiple contusions of the chest, abdomen, and flanks. Which of the following should cause the greatest concern regarding the prehospital care of this patient? The presence of any defensive wounds the patient may have sustained Getting a description of the assailants The possibility of a pneumothorax Reducing the swelling around his eyes by applying a cold pack

The possibility of a pneumothorax

Which of the following is a true statement regarding the skin's status in the case of a closed chest injury? Internal contusions and lacerations cannot occur. The skin may be penetrated and occluded. The skin is penetrated. The skin is not penetrated.

The skin is not penetrated.

Which of the following is required in the management of all open soft-tissue injuries? Provision of high-concentration oxygen to the patient The use of Standard Precautions by the EMT Cervical spine precautions Application of a disinfectant solution during clean-up

The use of Standard Precautions by the EMT

Q27- An unrestrained female driving a small car is involved in a rollover-type collision. Why is her risk for serious injury and death significantly increased?

There are more impacts in a roll over.

Mesentery

Tissue connecting intestines to the walls of the body

Which of the following types of bandages should NOT be used by the EMT providing wound care? Self-adherent roller gauze Tourniquet A triangular bandage Adhesive tape

Tourniquet

Which of the following is an unreliable sign for determining the presence of a tension pneumothorax? Answer Distended neck veins Signs and symptoms of shock Shortness of breath Trachea that shifts to the side opposite the injury

Trachea that shifts to the side opposite the injury

A very late sign of tension pneumothorax, difficult to detect

Tracheal deviation

You are stabilizing a patient who has just been stabbed in the chest to the right of the mediastinum. After placing the patient on supplemental oxygen, his shortness of breath resolves. You also cover the wound with an occlusive dressing. The patient is asymptomatic at the time you're making the decision to transport. Which of the following BEST encapsulates the correct strategy for transport? The patient does not necessarily need transport, so allow him to refuse if he wants. Transport the patient emergently because of the high index of suspicion for a serious injury. Begin transport non-emergently and upgrade if the patient's condition deteriorates. Transport the patient non-emergently because he's complaint free.

Transport the patient emergently because of the high index of suspicion for a serious injury.

JVD, extensive bruising of the face and neck bulgy eyes are signs of...

Traumatic asphyxia

JVD, head, neck, and shoulders appearing dark blue or purple, bloodshot and bulging eyes, swollen and blue tongue and lips, chest deformity, are signs of

Traumatic asphyxia

Sudden compression of the chest, causing severe pressure on heart and lungs is associated with...

Traumatic asphyxia

Your patient was working on a car when it fell off the jack and trapped him between the tire and ground. His face is very blue and his eyes are bloodshot. Which of the following has the patient most likely suffered? Hemothorax Traumatic asphyxia Pneumothorax Flail chest

Traumatic asphyxia

Moist Sterile Dressing

Treatment of laceration to the eyeball

Commotio Cordis

Uncommon condition Trauma to chest when heart is vulnerable Ventricular fibrillation (VF) Treat like VF patient: CPR, defibrillation An example of such a condition a young athlete who tries to catch a baseball, but misses. The ball strikes the patient in the center of the chest and the patient collapses in cardiac arrest. What is commotio cordis? How is it different from other traumatic injuries to the chest?

Aqueous Humor

Watery fluid in the anterior of the eye, can be replaced

...

You are caring for a patient who was shot in the chest with a nail gun. You applied an occlusive dressing around the wound. The patient is suddenly deteriorating. He is having extreme difficulty breathing and his color has worsened.

Q27- During an in-service focusing on care of the trauma patient, the medical director asks if anyone can correctly dscribe the "platinum 10 minutes.". Which of the following indicates the best response?

"EMS should initiate transport of the critically injured trauma patient to the hospital within 10 minutes of arriving on scene."

Q27- A patient has been stabbed with a knife at the fifth intercostal space on the right side of the chest. Assessment reveals him to be short of breath and coughing. Which one of the following questions is it most important for the EMT to ask regarding the weapon?

"How long was the knife?"

Assessment:Open Chest Wound

"Sucking chest wound" Direct entrance wound to chest May or may not be a sucking sound May be gasping for air

ASSESSMENT: open chest wound

-"sucking chest wound" -direct entrance wound to chest -may/may not be a sucking sound - may be gasping for air

aortic injury

-aorta is the largest blood vessel in the body -penetrating trauma can cause direct damage -blunt trauma can sever or tear the aorta -damage can cause high-pressure bleeding; often fatal -patient complains of pain in chest, abdomen, or back -signs of shock -differences in blood pressure between right and left arms

open chest injuries

-difficult to tell what is injured from entrance wound -assume all wounds are life-threatening -open wounds allow air into chest (sets imbalance in pressure, causes lung to collapse)

cardiac tamponade

-direct injury to heart causing blood to flow into the pericardial sac around the heart -pericardium is a tough sac that rarely leaks -increased pressure on heart so chambers cannot refill -blood backs up into veins -distended neck veins -shock and narrowed pulse pressure

TREATMENT: impaled object

-do not remove -stabilize with bulky dressings bandaged in place -leave patients legs in position found to avoid muscular movement that may move impaled object

TREATMENT: evisceration

-do not touch or replace eviscerated organs -apply sterile dressing moistened with sterile saline over wound site -for large evisceration,maintain warmth by placing layers of bulky dressing over occlusive dressing

TREATMENT: open chest wound

-maintain open airway -seal wound -occlusive dressing -administer oxygen -treat for shock -immediate transport -consider ALS

ASSESSMENT: flail chest

-mechanism of injury -difficulty breathing/ hypoxia -chest wall muscle contraction

ASSESSMENT: abdominal injuries

-pain, initially mild but rapidly becoming intolerable as bleeding worsens -nausea -weakness -thirst -indications of blunt trauma to chest, abdomen, or pelvis -coughing up or vomiting blood -rigid and/or distended abdomen

injuries within the chest cavity

-pneumothorax (air in the chest) -hemothorax (blood in the chest) -hemopneumothorax (air and blood)

TREATMENT: flail chest

-primary assessment for life threats - administer oxygen, use bulky dressing to stabilize flail segment -monitor patient for respiratory rate and depth (assist ventilations if too shallow)

traumatic asphyxia

-sudden compression of chest forcing blood out of the organs and rupturing blood vessels -neck and face darker in color -may cause bulging eyes, distended neck veins, broken blood vessels in face

commotio cordis

-uncommon condition -trauma to chest when heart is vulnerable -ventricular fibrillation (VF) -treat like VF patient: CPR, defibrillation

Define evisceration. Discuss the steps for appropriate treatment.

...

Some EMS systems may recommend that you apply an occlusive dressing as well. It may be necessary to remoisten the dressings with additional saline in order to ensure that the eviscerated organ or organs do not dry out.

...

The chest cavity can hold up to ________ liter(s) in an adult, leading to the possibility of massive internal hemorrhage without any external blood loss. 3 5 0.5 1

3

It is possible to bleed to death within the chest cavity, the chest can hold............liters of blood

3 liters

Your crew is called to an assisted-care facility for a 73-year-old female who fell while getting out of the shower. On arrival you observe that the patient is in a considerable amount of pain and complains of left proximal leg pain. The knee of the affected leg is flexed and the leg is shortened and internally rotated. This presentation is typical of what type of injury? A) c. Distal femur fracture B) d. Proximal femur fracture C) a. Dislocation of the hip D) b. Dislocation of the knee

A) c. Distal femur fracture

'Buddy splinting' refers to a technique in which a broken: A) c. Finger or toe is taped to an adjacent but uninjured finger or toe B) b. Arm is secured to a rigid splint C) d. Leg is secured by holding the injury in place against a long backboard D) a. Arm is secured to a long backboard

A) c. Finger or toe is taped to an adjacent but uninjured finger or toe

Your crew is called to a local skating rink to treat a 42-year-old female who fell. She is complaining of severe elbow pain and is supporting the affected limb against her body. To manage this situation effectively, you should: A) c. Splint the arm in the position found, using a pillow or blanket B) a. Rotate the arm to 90 degrees and secure it with a rigid splint C) b. Rotate the arm to 90 degrees and secure it with a sling and swathe D) d. Splint the arm in the position found, using a traction splint

A) c. Splint the arm in the position found, using a pillow or blanket

Which organ can have an 'organ fracture,' causing massive internal hemorrhage? A) d. Liver B) a. Appendix C) c. Intestine D) b. Bladder

A) d. Liver

You are evaluating a 33-year-old female patient who was ejected from a motorcycle when her husband lost control on a corner. After exposing her body, you observe abrasions across her right flank and abdomen and note that bruising is developing along the posterior aspect of her right flank. Based on this information, you suspect that your patient: A) d. May have internal abdominal injuries B) a. Has fatal injuries C) b. Is in decompensated hemorrhagic shock D) c. Likely has superficial abdominal injuries only

A) d. May have internal abdominal injuries

When assessing musculoskeletal injuries, paramedics should: A) d. Not be concerned with differentiating among sprains, strains, and fractures B) a. Make every attempt to diagnose the injury correctly C) c. Manage patients as though they have a strain D) b. Manage patients as though they have a sprain

A) d. Not be concerned with differentiating among sprains, strains, and fractures

What would you expect to find during your assessment of a patient you believe may have internal abdominal traumatic injuries? A) d. Tenderness B) a. A soft abdomen C) c. Obvious external blood loss D) b. Early development of a rigid and distended abdomen

A) d. Tenderness

You are treating a 40-year-old female patient who was stabbed in the right upper quadrant with a steak knife. Oxygen has been administered, and the entry wound has been covered with a sterile dressing. Appropriate care for this patient includes: A) d. Transport to the closest trauma center B) c. Transport to the closest emergency department for a blood transfusion C) a. Administration of IV epinephrine to help the patient compensate D) b. IV fluids infusing at a KVO rate

A) d. Transport to the closest trauma center

If the diaphragm is injured it may allow -------------- to enter the thoracic cavity

Abdominal contents

Pain, often starting mild then becoming intolerable, cramps, nausea, weakness, thirst obvious injuries, wounds near the diaphragm, bruises, signs of shock, coughing up or vomiting blood, rigid, and or tender abdomen, guarded abdomen, distended abdomen, patient lies very still, with legs drawn up are signs and symptoms of

Abdominal injury

Evisceration

Abdominal organs protruding from an open woundnon the abdomen.

Pneumothorax

Accumulation of air in the pleural space

Hemothorax

Accumulation of blood in the pleural space

Which of the following injuries requires the use of an occlusive dressing? An open wound to the chest An open wound to the neck An open wound to the abdomen from which a loop of intestine is protruding All of the above

All of the above

Which of the following is of concern with a puncture wound? The object that remains impaled in the body The strong possibility of contamination Hidden internal bleeding with minimal external bleeding All of the above

All of the above

Which of the following is true concerning lacerations? They may be caused by blunt trauma. They may be caused by penetrating trauma. They may indicate deeper underlying tissue damage. All of the above

All of the above

Which of the following is NOT appropriate in caring for a patient with closed soft-tissue injuries and a significant mechanism of injury? Treat for shock if you think there are internal injuries even if the patient's vital signs are normal. Anticipate vomiting. Splint any swollen, deformed extremities. All of the answer choices are appropriate.

All of the answer choices are appropriate.

Which of the following injuries does NOT produce distended neck veins? Traumatic asphyxia Tension pneumothorax Cardiac tamponade All of the answer choices may cause distended neck veins.

All of the answer choices may cause distended neck veins.

20 minutes

Amount of time chemical burns to the eyes should be flushed

...

An open chest or abdominal wound is considered to be one that penetrates not only the skin but the chest and abdominal wall to expose internal organs.

Which of the following BEST describes an evisceration? An open wound of the abdomen from which organs protrude A flap of skin that is partially or completely torn away from the underlying tissue An accumulation of blood beneath the skin, resulting in swelling The epidermis that is scraped away by a rough surface

An open wound of the abdomen from which organs protrude

Balloon like protrusion on an artery are known as

Aneurysm

Aortic Injury

Aorta is the largest blood vessel in the body Penetrating trauma can cause direct damage Blunt trauma can sever or tear the aorta Damage can cause high-pressure bleeding; often fatal Patient complains of pain in chest, abdomen, or back Signs of shock Differences in blood pressure between right and left arms

A condition in which an inner layer of the wall of the aorta begins to tear

Aortic dissection

Which of the following traumatic chest injuries may result in massive, often fatal internal hemorrhage? Hemopneumothorax Hemothorax Aortic dissection Cardiac tamponade

Aortic dissection

Blunt trauma, such as deceleration from a severe motor vehicle collision can cause this type of injury...

Aortic injury and dissection

Tearing chest pain radiating to the back, differences in pulse or blood pressure between the right and left extremities or between the arms and legs, cardiac arrest, are signs of

Aortic injury or dissection

Bleeding from open abdominal injuries should initially be controlled with which one of the following techniques? Packing the wound with rolled gauze Applying an occlusive dressing Applying direct pressure to the wound Applying an ice pack or chemical cold pack

Applying direct pressure to the wound

If the patient with flail chest is breathing inadequately you should...

Assist ventilations with oxygen attached

An occlusive dressing should be at least.....inches wider than the wound. Should be sealed on .....sides to provide a ...... .......

At least 2 inches, sealed in 3 sides, flatter valve

Your crew is called to the scene of a sports injury at a local park. A 43-year-old female injured her ankle while sliding into home base. There is gross deformity at the joint that appears consistent with a severe dislocation. She is in a tremendous amount of pain and has extreme difficulty when trying to wiggle her toes. Her distal pulse is absent. Proper intervention would include analgesics and: A) b. Attempted reduction by pulling on the toes B) a. Attempted reduction by pulling on the talus C) d. Splinting the injury in the position found, using a pillow or blanket D) c. Attempted reduction by taking the ankle through its full range of motion

B) a. Attempted reduction by pulling on the talus

A break that involves several breaks in the bone, causing bone fragment damage, is called a(n): A) d. Spiral fracture B) a. Comminuted fracture C) c. Open fracture D) b. Greenstick fracture

B) a. Comminuted fracture

As a rule, fractures and dislocated joints should be: A) b. Immobilized with a soft splint B) a. Immobilized in anatomic position and in a position of comfort C) c. Reduced in the field D) d. Repositioned in the field

B) a. Immobilized in anatomic position and in a position of comfort

Which hollow organ is most commonly injured as a result of blunt force trauma? A) d. Uterus B) a. Small intestine C) b. Spleen D) c. Stomach

B) a. Small intestine

An elderly man complains of severe pain in his upper thigh and hip after a fall. The leg on the affected side is shortened and internally rotated. Which action would be appropriate? A) d. Pad behind the knee for comfort. B) b. Apply PASG and inflate leg segments. C) c. Attempt to reduce the dislocation. D) a. Apply a traction splint.

B) b. Apply PASG and inflate leg segments.

You respond to a patient complaining of shoulder pain after falling from a bicycle and landing on his outstretched hand. As a paramedic, you know this type of MOI is classified as: A) d. Twisting B) b. Indirect C) c. Penetrating D) a. Direct

B) b. Indirect

Which of the following is correct regarding the use of traction splints? A) d. Traction splints are used to reduce open, midshaft long-bone fractures. B) b. Traction splints are used for isolated midshaft femur fractures. C) c. Traction splints are used for proximal femur fractures or hip dislocations. D) a. Traction splints are used for dislocations of the knee with associated femur fracture.

B) b. Traction splints are used for isolated midshaft femur fractures.

Immobilization of an injured femur requires: A) d. Only one rescuer B) c. At least two rescuers C) b. At least three rescuers D) a. A four-person crew

B) c. At least two rescuers

A bone break common in children, in which the bone is bent but only broken on the outside of the bend, is called a: A) d. Stress fracture B) c. Greenstick fracture C) b. Comminuted fracture D) a. Closed fracture

B) c. Greenstick fracture

A critical assessment finding during your evaluation of a patient who experienced abdominal trauma is: A) d. Pain B) c. Hypovolemic shock C) b. Bruising D) a. Anxiety

B) c. Hypovolemic shock

A grade 2 sprain usually results in: A) a. A dislocated joint B) c. Immediate pain and swelling C) b. An unstable joint D) d. Vascular compromise

B) c. Immediate pain and swelling

One of the most common causes of vascular abdominal injuries is: A) b. Blast injuries B) c. Improper use of seat belts C) d. Knife wounds D) a. Bone fracture fragments

B) c. Improper use of seat belts

Following a traumatic pancreatic injury, the major concern becomes: A) b. Hyposecretion of insulin B) c. Leakage of digestive enzymes into the peritoneal space C) a. Hypersecretion of insulin D) d. Massive hemorrhage

B) c. Leakage of digestive enzymes into the peritoneal space

You and your partner have splinted a possible midshaft radial-ulna fracture. After applying the splint, PMS is reevaluated, noting that the pulse is absent. Your next action would be to: A) b. Contact medical control B) c. Loosen the splint C) a. Apply ice D) d. Realign the injury

B) c. Loosen the splint

You are evaluating an extremity fracture of the lower arm. You find a distal pulse; however, your patient states there is numbness below the sight of the injury. Using the 6 P's of assessment, you state this is: A) b. Paralysis B) c. Paresthesia C) a. Pallor D) d. Pressure

B) c. Paresthesia

As a paramedic, you recognize the greatest potential of blood loss is from a fracture of the: A) c. Rib B) d. Pelvis C) b. Humerus D) a. Femur

B) d. Pelvis

You are managing an unresponsive 50-year-old female patient who was in a car-versus-tree motor vehicle crash. She is in the driver's seat wearing a chest strap but no waist belt. Her pulse rate is 134 beats/min, her respiratory rate is 36 breaths/min, and her blood pressure is 76/52 mm Hg. The imprint of her seat belt is clearly defined across her chest and abdomen, and her abdomen is rigid and bruising. You suspect that your patient may have: A) c. A tension pneumothorax B) d. Ruptured a blood vessel C) b. A ruptured spleen D) a. A cardiac tamponade

B) d. Ruptured a blood vessel

Your crew is called to a local park for a 34-year-old male who injured his shoulder while playing softball. There is swelling at the left shoulder where the clavicle meets the proximal humerus. If this is the patient's only injury, what device should you use for immobilization? A) c. Short backboard B) d. Sling and swathe C) b. Rigid splint D) a. Long backboard

B) d. Sling and swathe

Other than hemorrhage, the major cause of mortality following a traumatic duodenal rupture is: A) b. Ileus B) d. Spillage of intraluminal contents into the peritoneum C) a. Bowel infarction from ischemia D) c. Inability to digest food/malnutrition

B) d. Spillage of intraluminal contents into the peritoneum

An easy way to remember the various components of musculoskeletal injury assessment is to recall: A) a. The four M's of musculoskeletal assessment B) d. The six P's of musculoskeletal assessment C) c. The mnemonic TIC D) b. The mnemonic ARM-LEGS

B) d. The six P's of musculoskeletal assessment

You are evaluating a 28-year-old female patient who was the belted driver in a car-versus-tree motor vehicle crash. She is also 30 weeks' pregnant. She is complaining of severe abdominal pain with cramping, and you can see blood soaking into her shorts and onto the driver's seat. As you prepare to extricate the patient, you advise everyone on scene that you are going to immobilize the patient: A) a. In a traditional manner B) d. With padding underneath her right hip and pelvis only to elevate the right side of her pelvis C) b. On her left side on the backboard with padding in the spaces D) c. With padding under her feet and legs supine on the backboard

B) d. With padding underneath her right hip and pelvis only to elevate the right side of her pelvis

...

Because of the vulnerability of large vascular organs, internal bleeding should be assumed in most abdominal trauma. EMTs must watch carefully for shock and must initiate rapid transport to an appropriate facility.

Hematuria

Blood in the Urine

Ecchymosis

Bluish black color of a bruise

Treatment: Evisceration

Do not touch or replace eviscerated organs Apply sterile dressing moistened with sterile saline over wound site For large evisceration, maintain warmth by placing layers of bulky dressing over occlusive dressing

...

Blunt or penetrating trauma can damage the abdomen. The level of damage typically depends upon the organ system injured beneath the skin. An abdominal injury can be either open or closed. In a closed injury, the abdominal wall remains intact. Structures such as the liver, spleen, and diaphragm are particularly vulnerable to blunt abdominal trauma.

Type of trauma that can fracture the ribs, the sternum, and the costal (rib) cartilages

Blunt trauma

...

Blunt trauma, penetrating trauma, and compression are mechanisms that can injure the chest and abdomen. Open or closed pertains to the integrity of the chest or abdominal wall after injury. Seal open chest wounds to prevent air from entering the chest cavity.

...

Breath sounds have become almost totally absent on the side with the impaled nail. What complication might you suspect is causing his worsening condition? How could this be corrected?

Stabilize impaled objects using -------------- dressing

Bulky

Type of dressing used to stabilize a flail segment

Bulky dressing

Penetrating objects

Bullets, knives, pieces of metal or glass, steel rods, pipes, other objects. Can damage internal organs and impair respiration

Electrical Burns

Burn with the most potential for serious internal injury.

You are evaluating a 14-year-old female patient who fell off a top bunk and onto a binder. You expose her abdomen and can see a line of demarcation from the edge of the binder across both lower quadrants. When you palpate the abdomen, it is soft and nontender in all quadrants, and she rates her pain at 3 out of 10. Her heart rate is 86 beats/min, her respiratory rate is 20 breaths/min, her blood pressure is 114/60 mm Hg, and her skin is normal. You suspect that your patient: A) c. May have perforated her stomach B) b. Likely has massive internal bleeding C) a. Appears to only have superficial injuries but should still be evaluated by a physician D) d. Will likely have liver swelling

C) a. Appears to only have superficial injuries but should still be evaluated by a physician

Following recognition of a pelvic fracture, your next intervention should be to: A) d. Provide pharmacologic pain management B) b. Apply a traction splint C) a. Apply a pelvic binder D) c. Inflate the abdominal compartment only of a pneumatic antishock garment

C) a. Apply a pelvic binder

The best indicator of bladder or internal genitalia injury in the male patient is: A) d. Scrotal swelling and bruising B) c. Prehospital Foley catheter placement to look for blood in the urine C) a. Blood at the urethral meatus D) b. Swelling of the penis

C) a. Blood at the urethral meatus

A fracture or dislocation should be realigned when: A) b. The lower leg is involved B) d. The site is bleeding C) a. Circulation is impaired D) c. The patient reports extreme pain

C) a. Circulation is impaired

Traction splints are designed specifically to be used for what type of injuries? A) d. Tibia fractures B) c. Pelvic fractures C) a. Femur fractures D) b. Knee dislocations

C) a. Femur fractures

A patient injured his hand while punching someone with a closed fist. You anticipate his injury to be to the: A) c. Second phalange B) d. Thumb C) a. Fifth metacarpal D) b. First carpal

C) a. Fifth metacarpal

Following blunt abdominal trauma, the primary problem that develops for the patient is: A) c. Pain B) b. Ileus C) a. Hemorrhage D) d. Swellin

C) a. Hemorrhage

A condition where the abdominal wall is damaged and underlying abdominal structures are protruding through the abdominal wall is known as: A) a. Abdominal contusion B) c. Abdominal inversion C) b. Abdominal evisceration D) d. Abdominal protrusion

C) b. Abdominal evisceration

When an expectant mother experiences significant abdominal trauma, the placenta can separate from the uterine wall. This condition is known as: A) a. Abruptio placental previa B) c. Placenta previa C) b. Abruptio placentae D) d. Uterine rupture

C) b. Abruptio placentae

Before manipulating any injured extremity, you must: A) a. Administer intravenous analgesic per medical direction B) c. Place the patient on high-flow oxygen C) b. Assess distal pulses, sensation, and motor function D) d. Position the patient on a long backboard

C) b. Assess distal pulses, sensation, and motor function

After consulting with medical direction, a decision has been made to attempt realignment of a badly angulated tibia-fibula fracture. While attempting to realign the bone fragments, you observe obvious anatomic resistance to your effort. You should: A) a. Administer a muscle relaxant, and reattempt realignment B) d. Pull harder C) b. Cease your efforts to realign, and transport D) c. Gently rotate the limb, reapply traction, and then splint

C) b. Cease your efforts to realign, and transport

Your crew is called to a local nightclub for a 23-year-old male with a hand injury. The patient tells you that he hit a brick wall when he missed his intended target. The patient's knuckles and the entire back of his hand are edematous and painful. His hand has limited movement of the distal phalanges. His hand is open and his fingers are bent. To immobilize this injury, you should: A) d. Straighten the fingers and then immobilize the hand B) b. Close the hand into a fist and then immobilize the hand C) c. Immobilize the hand in a position of function D) a. 'Buddy splint' the fingers together

C) c. Immobilize the hand in a position of function

Paramedics play a vital role in early abdominal trauma management by: A) d. Triaging with patients who may or may not have suffered internal injuries following abdominal trauma B) a. Controlling internal bleeding C) c. Providing rapid response and rapid transport to a trauma center D) b. Identifying for the surgeons which organ is bleeding

C) c. Providing rapid response and rapid transport to a trauma center

_____________muscles are involved in movement. A) a. Cardiac B) b. Involuntary C) c. Skeletal D) d. Smooth

C) c. Skeletal

Once the decision has been made to realign a fracture site, you should: A) d. Wait to perform the procedure and realign only if the patient loses distal circulation B) b. Continue realignment attempts until the gross deformity has been reduced C) a. Continue realignment attempts until distal pulses are present D) c. Make only one attempt at realignment

D) c. Make only one attempt at realignment

You are called to the ski patrol headquarters of a ski resort because there has been a skiing accident. When you arrive, you find a 23-year-old male patient immobilized and in obvious pain. He reportedly lost control on the mogul run and tumbled down the side, eventually striking a tree. During your assessment, his abdomen is slightly rigid with rebound tenderness. There is no abdominal bruising; it just appears slightly red. His pulse rate is 82 beats/min, his respiratory rate is 18 breaths/min, his blood pressure is 136/72 mm Hg, his skin is normal, and he rates his pain as a 10 out of 10. Based on these findings, you suspect: A) d. Spleen rupture B) b. Pelvis fracture C) a. Massive internal hemorrhage D) c. Potential intestinal rupture

D) c. Potential intestinal rupture

After controlling the airway and any severe external bleeding in a patient with traumatic abdominal injuries, the most important treatment is to: A) d. Stabilize any musculoskeletal injuries B) a. Establish two large-bore IVs C) b. Provide aggressive pain management D) c. Provide early rapid transport to a trauma center

D) c. Provide early rapid transport to a trauma center

The greatest factor in the amount of energy causing trauma to a patient is: A) b. The angle at which an object strikes the body B) a. Patient weight C) d. The insulting object's weight D) c. The insulting object's velocity

D) c. The insulting object's velocity

A fracture of a child's bone at the epiphyseal plate commonly leads to: A) b. Infection B) d. Torn ligaments and tendons C) a. Frequent breakage of bones in the future D) c. Unusual deformity of the joint or an unnatural bending

D) c. Unusual deformity of the joint or an unnatural bending

A fracture of the femur can result in blood loss of up to: A) c. 1000 mL B) a. 250 mL C) b. 500 mL D) d. 2000 mL

D) d. 2000 mL

Your ambulance crew is called to a scene where a 42-year-old female fell from a second-story balcony and landed on her outstretched right arm. There is gross deformity at the shoulder. The patient is unconscious. You should address immobilization of the deformed right shoulder by: A) c. Applying a traction splint B) b. Applying a sling and swathe C) a. Applying a sling D) d. Immobilizing the patient to a long backboard

D) d. Immobilizing the patient to a long backboard

If an expectant mother improperly wears a seat belt too high and is involved in a motor vehicle crash, she could experience what condition? A) b. Placenta previa B) a. Fetal decapitation C) c. Preterm labor D) d. Placental abruption

D) d. Placental abruption

Which of the following is a solid abdominal organ? A) c. Stomach B) b. Intestines C) a. Gallbladder D) d. Spleen

D) d. Spleen

Hollow organ rupture is most frequently caused by which of the following mechanisms? A) c. Skiing accidents B) a. Contact sport collisions C) b. Restrained drivers in motor vehicle crashes D) d. Unrestrained drivers in motor vehicle crashes

D) d. Unrestrained drivers in motor vehicle crashes

The most common bones to receive stress fractures are: A) a. Bones of the arm B) c. Ribs C) b. Long bones D) d. Weight-bearing bones

D) d. Weight-bearing bones

Q27- A patient involved in a motor vehicle collision is complaining of neck pain. Which of the following pieces of information should cause the EMT to have a high index of suspicion that the patient may have suffered more significant injuries beyond the complaint of neck pain?

Death of the car's driver.

Open Chest Injuries

Difficult to tell what is injured from entrance wound Assume all wounds are life-threatening Open wounds allow air into chest Sets imbalance in pressure Causes lung to collapse

Dyspnea

Difficulty Breathing

Patients with pneumothorax will have........lung sounds on the affected side

Diminished or absent

Cardiac Tamponade

Direct injury to heart causing blood to flow into the pericardial sac around the heart Pericardium is a tough sac that rarely leaks Increased pressure on heart so chambers cannot fill Blood backs up into veins Usually a result of penetrating trauma Distended neck veins Shock and narrowed pulse pressure

Treatment:Impaled Object

Do not remove Stabilize with bulky dressings bandaged in place Leave patient's legs in position found to avoid muscular movement that may move impaled object

Q27- Emergency Medical Responders have removed an intoxicated and confused patient from a car that struck another car at a high rate of speed. The patient was unrestrained and his car did not have airbags. Assessment reveals deformity bilaterally to the hips and femurs and bruising to the knees. Based on this injury pattern, the EMT would recognize what type of injury mechanism?

Down and under.

...

EMTs should learn signs and symptoms, and treatment procedures for specific chest and abdominal injuries.

Newton's Second LAW

Energy cannot be created or destroyed but can be changed in form.

An intestine or other internal organ protruding through a wound in the abdomen

Evisceration

You are dispatched to a 42-year-old male who was shot in the abdomen and thrown from a vehicle. The patient is critical and a high-category trauma; however, due to the mechanism of illness, it is necessary to backboard the patient prior to transport. What is an important assessment before securing the patient? Verifying trauma center ER bed availability Examining the patient for entrance and exit wounds Searching for presence of diaphoresis, tachycardia, and hypotension Performing a distal neurological assessment

Examining the patient for entrance and exit wounds

Compensated

FIRST stage of SHOCK

Q27- As part of your service to the community, you are certified as a car seat specialist and provide monthly classes on the safe transport of infants and children. Several cars pulled into your station and asked you to look at their car seats. Which of the following car seat positions would indicate that the parent is safely transporting his or her infant (less than one year old)?

Facing backward in the back seat in a reclined position.

Fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment

Flail chest

You are caring for a 27-year-old male who has a puncture wound to the right upper chest. The patient was stabbed with a serrated steak knife by his ex-girlfriend. You have placed an occlusive dressing to the site and began emergent transport to the closest trauma center. However, while en route the patient begins to complain of increasing shortness of breath. You notice a decrease in ventilatory volume and an increase in thoracic diameter. Which of the following options would be the best step to perform next? Free a corner or edge of the dressing to release pressure buildup. Begin providing BVM-assisted ventilations to the patient. Call dispatch for an ALS intercept en route to the hospital. Begin providing CPR to the patient.

Free a corner or edge of the dressing to release pressure buildup.

Q27- Which of the following best describes the goal of a trauma system?

Getting the right patient to the right facility in the right amount of time.

Q27- Which one of the following is a high-velocity wound that carries the greatest risk for death when considering the concept of cavitation?

Gunshot wound to the spleen.

Condition when the chest cavity fills with blood and air

Hemopneumothorax

Condition when the chest cavity fills with blood

Hemothorax

Uneven chest wall movement, reduction of breath sounds on affected side plus coughing up frothy red blood are sings of

Hemothorax

What is the underlying cause of bluish or reddish facial discoloration following a traumatic asphyxiation? High pressure on the chest leads to blood being forced from the right atrium into the face and neck. The patient has become hypoxic due to a chest injury and the finding suggests central cyanosis. The physiological strain of the body results in a flushed appearance and increased risk of a hypertensive event. Bluish or reddish facial discoloration is not associated with traumatic asphyxiation; a pale discoloration is usually present

High pressure on the chest leads to blood being forced from the right atrium into the face and neck.

...

If a patient develops signs of tension pneumothorax, arrange immediately for ALS intercept.

Treatment: Abdominal Injuries

If allowed, utilize pneumatic anti-shock garments (PASG) Nothing to patient by mouth Continuously monitor vital signs

Assessment:Abdominal Injuries

Indications of blunt trauma to chest, abdomen, or pelvis Coughing up or vomiting blood Rigid and/or distended abdomen Feel an abdomen. Have students work in pairs and palpate their partner's abdomen. Feeling a normal abdomen will help them differentiate abnormal changes.

If possible position the patient with a chest injury on his/her....

Injured side

Q27- You are responding to a call for a 4 year-old child hit by a car. When assessing the child, which of the following injury patterns would you recognize as typical based on the child's age and mechanism of injury?

Injuries to the head, femurs, chest and abdoment.

...

Is the patient displaying signs of a tension pneumothorax? Is there an open wound in the abdomen that needs to be dressed and covered?

...

Is the patient's breathing adequate, inadequate, or absent? Is the patient displaying signs of shock? Is there an open wound in the chest that needs to be sealed?

Which of the following BEST describes the benefit of a three-sided occlusive dressing over a four-sided occlusive dressing for an open chest wound? It eliminates the need to continue monitoring the patient's respiratory status. It prevents the development of a hemothorax by allowing blood to escape. It allows easy access for re-examination of the wound en route to the hospital. It reduces the chances of developing a tension pneumothorax.

It reduces the chances of developing a tension pneumothorax.

Q27- A car has been hit head-on by another vehicle at a moderate rate of speed. Seatbelts were in place and the airbags deployed. The patient is complaining of chest pain. Quick observation reveals a bruise to his sternum. The EMT would immediately:

Lift the airbag and check the steering wheel.

Viseral Peritoneum

Lining the abdominal organ

Parital Peritoneum

Lining the abdominal wall

The ------ is the most commonly injured organ in the abdomen because of its size and position

Liver

Which of the following is a vascular organ in the abdomen that can produce blood loss quickly enough to result in life-threatening hemorrhage following high mechanism of injury blunt trauma? Intestines Liver Pancreas Kidneys

Liver

Treatment:Open Chest Wounds

Maintain open airway Seal wound Occlusive dressing Administer oxygen Treat for shock Immediate transport Consider ALS

Which of the following is a strategy to maintain an occlusive dressing to bloody or diaphoretic skin? Do not use occlusive dressings in this case. Manually maintain pressure. Do not use adhesive tape. Wrap the dressing circumferentially with gauze.

Manually maintain pressure.

Assessment: Flail Chest

Mechanism of injury Difficulty breathing/hypoxia Chest wall muscle contraction Mechanism of injury causing blunt trauma to the chest wall is capable of creating a flail segment in the chest. The patient will have difficulty breathing, which over time will cause hypoxia. The chest wall muscles will initially tighten to splint the area but will eventually cause fatigue and make the flail segment more visible. A visible segment is a late sign.

On assessment of the midsection of a 32-year-old male who was struck by a car, you find an abdominal evisceration with several loops of his large intestine exposed. The abdomen appears to have a clean-cut laceration and the bleeding is controlled. Which of the following is the BEST approach toward managing the exposed intestines? Moisten a sterile dressing with saline solution and cover the abdominal contents. Gently replace the intestines after moistening with sterile saline solution. Leave the abdominal contents in the place in which they were found and transport immediately. Cover the abdomen with an occlusive dressing of aluminum foil.

Moisten a sterile dressing with saline solution and cover the abdominal contents.

Can you use aluminum foil as an occlusive dressing in the abdomen???

NO, it may cut the organs

A 36-year-old male was accidentally shot with a nail gun into the chest. You see the nail, which protrudes about 2 to 3 centimeters from the thorax, when you visualize the injury site. Under which of the following circumstances should you remove the nail from the injury site? Answer Bleeding from the patient's wound is minimal. The patient develops a tension pneumothorax. The patient begins to complain of shortness of breath. None of the above

None of the above

Some protocols recommend to apply an ----------------dressing on top of the moistened dressing

Occlusive

How to position a patient with abdominal injuries

On his back, legs flexed at the knees

...

Open chest and abdominal wounds are life threatening.

Q27- An unrestrained driver of a car that has struck a tree at 45 mph has suffered a contusion (bruise) to his heart. The EMT would recognize that this injury occurred during which impact of the collision?

Organ collision.

ASSESSMENT: injuries within the chest cavity

PNEUMOTHORAX-respiratory difficulty-uneven chest wall movement-reduction of breath sounds on the affected side of the chest (listen with stethoscope) TENSION PNEUMOTHORAX-increased respiratory difficulty-indications of developing shock-distended neck viens-tracheal deviation-reduced or absent breath sounds HEMOTHORAX-signs of pneumothorax plus coughed-up frothy red blood TRAUMATIC ASPHYXIA-distended neck veins-head, neck, and shoulders appearing dark blue or purple-bloodshot and bulging eyes-swollen blue tongue and lips-chest deformity CARDIAC TAMPONADE-distended neck veins-very weak pulse-low blood pressure-steadily decreasing pulse pressure AORTIC INJURY OR DISSECTION-tearing chest pain radiating to the back-differences in pulse or blood pressure between the right and left extremities or between the arms and legs-palpable pulsating mass (if the abdominal aorta is involved)-cardiac arrest

Assessment: Abdominal Injuries

Pain, initially mild but rapidly becoming intolerable as bleeding worsens Nausea Weakness Thirst

Movement of ribs in a flail segment that is opposite to the direction of movement of the rest of the chest cavity

Paradoxical motion

Lens

Part of the eye located behind the pupil and focuses light onto the retina.

When hollow organs are injured, they often spill their contents into the abdominal cavity, this can lead to...

Peritonitis

Your patient is a 21-year-old male who has a gunshot wound to the chest. Which of the following is the highest priority in managing this patient? Placing the patient in the shock position Performing a rapid trauma assessment Placing a pressure dressing over the wound to control bleeding Placing an occlusive dressing over the wound

Placing an occlusive dressing over the wound

Air in the chest cavity

Pneumothorax

Jugular veins in the neck may become distended (unless the blood volume is low) as a sign of progression of...

Pneumothorax

Uneven chest wall movement, reduction of breath sounds on affected side are signs of possible

Pneumothorax

If a commercial occlusive dressing is not available, you may improvise with

Preferably Sterile plastic

Treatment: Flail Chest

Primary assessment for life threats Administer oxygen Use bulky dressing to stabilize flail segment Monitor patient for respiratory rate and depth Assist ventilations if too shallow

Differences in pulse or blood pressure between the right and left arm or legs, is caused by

Proximal or abdominal aortic injury

Q27- A "whiplash" type neck injury is most often observed with what type of collision?

Rear end impact.

You should not ------------ eviscerated organs

Replace

The pancreas, the kidneys are not often injure because of their location on the --------------------- area

Retroperitoneal

Decompensated

SECOND stage of SHOCK

Abrasions

Scrapes that cause an open wound.

A patient presents with an open chest wound, you should

Seal the wound as soon as possible

Diaphram

Separates the thoracic and the abdominal cavity

Another vascular organ located in the left upper quadrant is the --------------- it can produce life threatening bleeding

Spleen

Q27- A patient has been critically hurt in a nighttime motor vehicle collision. She was wearing a seatbelt and hit a tree at 70 mph. The car she was driving weighted two tones and was equipped with airbags that did deploy. Which of the following had the greatest impact on her being injured?

Spped of the vehicle at impact.

Q27- As you pull to a motor vehicle collision, you quickly scan the scene for clues as to the type and severity of injuries. Which of the following scene clues would best indicate that a patient may have a head injury?

Starring of a windshield.

Which of the following is a desirable characteristic of dressings used in the prehospital management of most open wounds? Nonabsorbent Sterile Occlusive Adherent

Sterile

What type of dressing should you apply to an open abdominal injury with evisceration

Sterile dressing moistened with saline

An open chest wound in which air is "sucked" into the chest cavity

Sucking chest wound

Q27- You are assessing a male patient who was stabbed three times in the chest and abdomen. As you begin the primary assessment, you note him to have a decreased level of consciousness and gurgling respirations. Your next action would be to:

Suction the airway.

Traumatic Asphyxia

Sudden compression of chest forcing blood out of organs and rupturing blood vessels Neck and face are a darker color than rest of the body May cause bulging eyes, distended neck veins, broken blood vessels in face

Irreversible

THIRD stage of SHOCK- Can NOT FIX

Which of the following describes the proper application of an occlusive dressing for an open chest wound? Trim the dressing so that it is the exact size of the wound. Use a porous material such as a 4" by 4" gauze pad. Tape the dressing securely on three sides. None of the above

Tape the dressing securely on three sides.

A patient with jugular vein distention is most likely suffering from which of the following injuries? Pneumothorax Hemothorax Hemopneumothorax Tension pneumothorax

Tension pneumothorax

A type of pneumothorax in which air that enters the chest cavity is prevented from escaping

Tension pneumothorax

Increasing respiratory difficulty, signs of developing shock, distended neck veins, tracheal deviation (late sign) reduced or absent breath sounds on the affected side of the chest are signs of...

Tension pneumothorax

Which of the following patients is at greatest risk of respiratory failure and should be carefully monitored for ventilatory status throughout treatment and transport? Tension pneumothorax Flail chest Abdominal evisceration Hemopneumothorax

Tension pneumothorax

Why is paradoxical motion a late sign of flail chest

The chest wall muscles will tighten and splint the area until tired

Subcutaneous Layer

The deepest layer of skin

Q27- Which of the statements below best characterizes the capabilities of a Level III Trauma Center?

The hospital has some surgical capabilities to help trauma patients, but will generally stabilize and transfer them.

tension pneumothorax

a type of pneumothorax in which air that enters the chest cavity is prevented from escaping

pneumothorax

air in the chest cavity

evisceration

an intestine or other internal organ protruding through a wound in the abdomen

sucking chest wound

an open chest wound in which air is "sucked" into the chest cavity.

While palpating the radial pulses of a patient who was involved in a motor vehicle crash, you notice a difference in the strength of the pulses bilaterally. This is a finding that you suspect may be associated with: aortic dissection. tension pneumothorax. commotio cordis. flail chest.

aortic dissection.

blunt trauma

can fracture ribs, sternum, and costal (rib) cartilages

The pathophysiology of _________ is one in which the pericardial sac fills with blood to the point where the chambers of the heart no longer fill adequately, usually secondary to trauma. pericardial effusion hemopneumothorax cardiac tamponade commotio cordis

cardiac tamponade

A tension pneumothorax is most often found with a -----injury

closed chest injury

The mechanism of injury in which a patient's chest has struck an immovable object, such as a steering wheel, may most accurately be described as a: blunt trauma injury. compression injury. penetrating injury. coup contrecoup injury.

compression injury.

TENSION PNEUMOTHORAX

increased respiratory difficulty-indications of developing shock-distended neck veins-tracheal deviation-reduced or absent breath sounds

Flail chest

is a fracture of two or more consecutive ribs in two or more places. This injury can create an unstable chest wall and can lead to inadequate breathing. Injuries commonly cause damage to heart, lungs, and great vessels that are not readily detectable. A flail chest occurs from blunt trauma with a resulting fracture to two or more consecutive ribs. Paradoxical motion occurs when a flail segment moves in the opposite direction of the chest during respiration.

Q27- A 49 -year-old male has been stabbed in the lower right chest. Police on scene report that the patient got into an argument with an unidentified man, who then stabbed him before fleeing the scene. After assessing the pat, you are suspicious that the knife punctured the lung and is causing internal bleeding. In this situation, the mechanism of injury would be:

stab wound to the right chest.

flutter-valve dressing

taping the dressing down in place and leaving a side or corner of the dressing unsealed

AORTIC INJURY OR DISSECTION

tearing chest pain radiating to the back-differences in pulse or blood pressure between the right and left extremities or between the arms and legs-palpable pulsating mass (if the abdominal aorta is involved)-cardiac arrest

open chest injury

the chest wall has been penetrated

closed chest injury

the chest wall remains intact. , the skin is not broken

Q27- Assessment of a patient involved in a motor vehicle accident reveals him to have crepitus to the left humerus, instability to the left lateral chest wall and flank, and pain on palpation to the left hip region. He also complains of pain to the right side of the neck. Based on this injury pattern, the EMT would recognize the patient was:

the driver of a car hit on the driver's side.