Chapter 29 - Trauma to the Head, Neck and Spine WB

After performing the primary assessment and rapid trauma exam on a spine injured patient, your next step is to: a. determine the patient's priority b. administer high-concentration oxygen c. immobilize the patient on a long spine board d. determine the mechanism of injury

A

If a responsive patient has the mechanism of injury of a spinal injury, the EMT should do all of the following except: a. assess for spinal pain by asking the patient to move b. keep the patient still while asking him or her questions c. assess for equality of strength in the extremities d. assess for tingling in the extremities

A

When assessing a suspected spine injured patient, you note a reversal of the normal breathing pattern. This is likely a result of damage to the nerves that control the: a. rib cage b. diaphragm c. abdomen d. lungs

A

When immobilizing a 6 year old or younger child on a long backboard: a. provide padding beneath the shoulder blades b. it is unnecessary to apply a cervical collar c. place a chin cup or chin strap on the patient d. secure the head first and then secure the torso

A

Which of the following is a late sign of skull or traumatic brain injury? a. temperature increase b. raccoon eyes c. irregular breathing patterns d. battle's sign

A

You are treating a 19 year old male who was in a fight. His face has multiple fractures, his nose is broken, and his jaw may be fractured. The primary concern for emergency care of a facial fracture or jaw injury is the: a. external bleeding b. patient's airway c. loss of teeth d. basilar skull fracture

B

Prior to and after immobilization, the EMT should assess: a. pulses in all extremities b. motor function in all extremities c. sensation in all extremities d. all of these

D

Which of the following would not create a high index of suspicion of a spine injury? a. motor vehicle or motorcycle collisions b. falls that cause open fractures to the ankles c. trauma patients who are found unconscious d. a fall from two times the patient's height

D

You are treating a 35 year old female who has an injury to one of her spinal vertebrae. Based on the frequency of injury, it is most likely one of the: a. lumbar and sacral b. thoracic and cervical c. coccygeal and thoracic d. cervical and lumbar

D

At a point in the development of the 35 year old male patient who was involved in a car crash and sustained an injury to the third, fourth, or fifth cervical vertebrae, the patient begins to exhibit hypotension. Why does this develop?

Loss of smooth muscle control allows the dilation of the blood vessels, especially in the periphery, which causes distal pooling of the blood and ultimately hypotension

You are treating a 52 year old man who was involved in a serious high-speed collision. If the patient is up and walking around at the scene, you should: a. assess for a potential spinal injury b. check with medical direction for orders c. check with bystanders about the patient's mental status d. assume that the patient is uninjured

A

You suspect that your patient may have a traumatic brain injury. His signs and symptoms may include: a. blood or fluid flowing from the ears and/or nose b. yellow discoloration in the eyes c. bruising around the base of the nose d. pain at the base of the neck

A

Skull or traumatic brain injury may result in: a. airway swelling and dizziness b. altered mental status and unequal pupils c. difficulty moving below the waist d. headache and hypoperfusion

B

The function of the spinal column is to: a. produce cerebrospinal fluid b. protect the spinal cord c. allow for back movement in all directions d. manufacture platelets

B

The patient does not complain of any spinal pain. It is important to remember that a lack of spinal pain does not rule out the possibility of spinal cord injury because: a. spinal injuries seldom cause pain b. other painful injuries may mask it c. spinal injuries are not painful until shock sets in d. a patient may feel the pain but cannot verbalize it

B

What is the significance of an increase in carbon dioxide in the injured brain? a. it decreases the blood pressure b. it causes brain tissue swelling c. it raises the heart rate d. it causes brain tissue shrinkage

B

Which is the correct order of steps for applying a short spine immobilization device? 1. secure the device to the patient's torso 2. secure the patient's head to the device 3. position the device behind the patient 4. evaluate torso fixation and pad behind the neck as necessary a. 3,2,1,4 b. 3,1,4,2 c. 4,3,1,2 d. 3,4,1,2

B

You are assessing a 22 year old male who was involved in a bar fight earlier this evening. It is now 4am and the family called the ambulance because he has been vomiting. You notice he has a bruise behind the ear. Further assessment reveals that he also has discoloration of the soft tissues under both eyes. This finding is called: a. Cushing's disease b. Raccoon eyes c. Battle's sign d. Posturing syndrome

B

You are assessing a 27 year old male who you suspect has a spine injury. If he complains of pain when you attempt to place his head in a neutral in-line position, you should: a. pad the neck before immobilizing b. steady the head in the position found c. continue with the stabilization procedure d. contact medical direction immediately

B

You are assessing a 27 year old male who you suspect has a spine injury. One EMT on your crew should: a. strap the patient's head, then the torso, to the long spine board b. maintain constant manual in-line immobilization until the patient is secured to a backboard c. assess for range of cervical spine motion d. pad the neck before stabilizing

B

You are treating a 45 year old male who was involved in a high speed car crash. You have decided to use the rapid extrication technique, which is typically used in all of the following situations except when: a. moving a patient rapidly from a unsafe scene b. a stable, low priority patient must be immobilized c. more seriously injured patients must be accessed d. moving a high priority patient

B

Your patient is a 19 year old male who was involved in a motorcycle crash. You should consider keeping the helmet on the patient: a. if it interferes with breathing management b. if it has a snug fit that allows no head movement c. by using a two-rescuer procedure d. if it hinders immobilization

B

You are treating a patient who is a 35 year old male patient who was involved in a car crash and sustained an injury to the third, fourth, or fifth cervical vertebrae. Why doesn't this patients pulse increase like that of most other patients in shock?

Because the messages from the brain to the adrenal gland, which secretes epinephrine to increase the heart beat, travel through the spinal cord. in this instance, the spinal cord may be damaged or severed.

If a patient is found on her back with arms extended above the head, this may indicate a ___ spine injury. a. thoracic b. lumbar c. sacral d. cervical

D

If a stable 22 year old male patient is found in a sitting position on the ground and is complaining about back pain, the EMT should: a. apply a cervical collar and rapidly transport the patient b. ask the patient to lie down, then immobilize c. immobilize with a short splint board or extrication vest d. perform a rapid take-down procedure with a long spine board

C

On your size-up of an automobile collision, you notice that both sides of the windshield have a spider-web crack. It is wise to call for a backup ambulance because: a. every collision should have a two ambulance response b. patients hitting their heads on the windshield will be critical c. both the driver and the passenger require spinal injury treatment d. it takes four EMS personnel to properly immobilize one patient.

C

The spine is made up of ____ vertebrae. a. 35 b. 23 c. 33 d. 38

C

When a patient has a scalp injury: a. expect minimal bleeding b. determine the wound depth c. expect profuse bleeding d. palpate the site with the fingertips

C

When the spine is excessively pulled, which commonly occurs during a hanging, this is called a(n) ___ injury. a. excessive rotation b. lateral bending c. distraction d. compression

C

Which of the following is generally not a sign of traumatic brain injury, except in infants? a. bleeding from the nose and ears b. unequal pupils c. hypoperfusion d. seizures

C

Which of the following statements about the rigid cervical collar is false? a. a collar of an incorrect size can hyperextend the neck b. maintain manual stabilization when applying a rigid cervical collar c. the collar completely eliminates neck movement d. the collar should never obstruct the airway

C

You are assessing a 22 year old male who was involved in a bar fight earlier this evening. It is now 4am and the family called the ambulance because he has been vomiting. You notice he has a bruise behind the ear. This is called: a. Cushing's disease b. Raccoon eyes c. Battle's sign d. Posturing syndrome

C

You are treating a 22 year old male who was assaulted with a knife. The attacker slashed the patient's throat. Initially there was considerable blood, but you were able to control it and bandage the wound. The patient went into sudden cardiac arrest. What is the most likely cause? a. a stroke b. a heart attack c. an air embolism d. infection from the wound

C

Your patient fell down the stairs and may have injured his spine. Examples of findings that may lead you to consider a spine injury include all of the following except: a. the presence of priapism b. the loss of bladder control c. an increased pulse rate d. nerve impairment to the extremities

C

All of the following are examples of cervical-spine injuries that can result from a diving accident except: a. excessive extension b. compression c. excessive flexion d. lateral bending

D

You are treating a patient who fell backward and struck his head. You suspect that he is developing increased ICP. The time it takes to develop the symptoms from an increased ICP depend on: a. the rate of bleeding into the head b. the location of the bleed c. the age of the patient d. all of these are important factors

D

You are treating a patient who has a steel rod penetrating the skull. You should: a. shorten lengthy objects, using any available tools b. elevate the patient's legs immediately c. remove the object and quickly control the bleeding d. stabilize the object with bulky dressings

D

Your 35 year old male patient was involved in a car crash and sustained an injury to the third, fourth, or fifth cervical vertebrae. He may have an injury to what nerve? What would be the expected effect on the patient.

The patient may have an injury to the phrenic nerve, which controls the movement of the diaphragm (main muscle fro breathing)

You are treating a 35 year old female who failed to wear a helmet and struck her head when she fell off her bike. In most EMS systems, she would be taken to a trauma center if her Glasgow Coma Scale (GCS) score was less than: a. 8 b. 10 c. 12 d. 15

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