Chapter 31 - Head Trauma QUIZ

Place a piece of sterile gauze over the ear

A 14-year-old male fell 10 feet from a retaining wall and hit his head on a metal post. He is responsive to verbal stimuli with incomprehensible speech. The secondary assessment indicates blood and fluid coming from inside the patient's left ear. You should do which one of the following?

Flexing his arms across his chest when you pinch his shoulder

A 21-year-old male has suffered a gunshot wound to the head. When you are assessing him, which one of the following findings indicates a nonpurposeful response to pain?

Take manual in-line spinal stabilization

A 41-year-old male patient has been struck in the head with a metal pipe. As you approach the patient, you note that he appears combative and has blood to the left side of his face and head and on his shirt. His breathing appears to be labored, and he is incontinent of urine. Which one of the following should you perform immediately?

Perform the jaw-thrust maneuver

A 52-year-old male is unresponsive and has bruises and lacerations to the head, chest, and abdomen. Bystanders state that the patient was intoxicated and got into a fight with several patrons of a bar. They state that he was beaten with their fists, and not other objects or weapons. The patient has snoring respirations, shallow breathing, and a strong radial pulse. His skin is warm and dry. After taking manual in-line spinal stabilization, which one of the following should be your next action?

History of alcoholism

A 57-year-old man fell on the sidewalk, hitting his head on the concrete. According to witnesses, the patient was unresponsive for several minutes following the fall. Which one of the following would be most critical to relay to the physician in the emergency department?

Start positive pressure ventilation.

A 61-year-old male has fallen off a roof. Your primary assessment findings include unresponsiveness, shallow breathing, and a weak and slow radial pulse. His skin is cool and dry. Emergency Medical Responders are maintaining manual in-line spinal stabilization. Which one of the following should you do immediately?

Bruising behind her left ear

A 68-year-old female patient is complaining of a headache and generalized weakness. Her husband informs you that she was with a friend yesterday and was involved in a motor-vehicle collision. She did strike her face on the dashboard, but refused treatment on scene. Her past medical history includes a stroke with right arm weakness and high blood pressure for which she takes medications. When assessing this patient, which one of the following findings should concern the EMT most?

The ridges of the basilar skull can injure the brain as it moves back and forth.

A car strikes a tree causing the passenger to strike his forehead against the dashboard. After the impact, the brain bounces back and forth within the skull. Based on the anatomy and physiology of the skull, which one of the following is true?

Cerebral spinal fluid coming from the puncture wound

A construction worker was accidentally shot with a nail gun. The nail penetrated the skull approximately one inch through the temporal region. Before your arrival, coworkers pulled the nail free. Based on the mechanism of injury, which one of the following signs or symptoms would provide the best evidence that the meningeal layers have been broken?

Concussion

A male soccer player was struck in the head with a soccer ball. Players state that he was dazed for several seconds following the impact and then asked the same questions over and over. Presently, he is conscious and oriented to person, but confused to place and time. He also has a reddened area to the side of his head and face. As you proceed with your assessment, his memory continues to improve. Based on these findings, the EMT should suspect which one of the following injuries?

"I take the blood thinner Coumadin."

A patient fell and has a headache. Which one of the following patient statements should be of most concern to the EMT?

Confusion and combativeness

A patient involved in an altercation has been struck at the side of the head with a baseball bat, in addition to suffering several blows to the arms and legs. When assessing this patient, which one of the following signs and symptoms best indicates the patient has suffered a brain injury?

Brainstem

A patient was killed immediately following a self-inflicted gunshot wound to the head. Which portion of the central nervous system was most likely damaged in order to cause the rapid death of the patient?

Obvious deformity to the right side of the skull with a laceration to the overlying scalp

A patient who fell out of a tree has sustained an open skull injury. Which one of the following best describes this injury?

a pocket of arterial blood collected between the skull and dura mater.

A trauma surgeon informs you that the patient you transported to the emergency department earlier was diagnosed with an epidural hematoma. The patient was taken into surgery and the hematoma was removed. Right now the patient is in guarded condition. Based on this information, the EMT should recognize that an epidural hematoma is:

Severe head injury with increasing pressure within the skull

A woman has fallen from a second-story window onto the concrete sidewalk below. She is unresponsive and has deformity noted to the back and top of her skull. Additional assessment findings include abdominal bruising and an angulated left ankle. Your partner reports that the patient's vital signs are: pulse 68, respirations 14 and irregular, blood pressure 198/110 mmHg, and SpO2 at 91%. Based on these assessment findings, which one of the following should the EMT recognize?

provide positive pressure ventilation at 20 breaths per minute.

A young female patient involved in a motor-vehicle collision responds to painful stimuli by extending her arms and legs. Her airway is open and breathing shallow and irregular. A radial pulse that is moderate in strength is palpated. Her pulse is 64 beats per minute, respirations are 8, and blood pressure is 210/110 mmHg. She has noted deformity to her forehead and a left pupil that is fixed and dilated. Manual in-line stabilization is being held by Emergency Medial Responders (EMR). The EMT's priority action at this point would be to:

Note the injury and continue assessing the patient

A young female pedestrian was hit by a car and thrown 15 feet, striking her head against a metal guardrail. You start your secondary assessment and note a deep depression to the right parietal area of her head with intact skin overlying the area. You should:

Improving memory

A young male patient was running through a park and struck his head on a low lying branch of a tree. Emergency Medical Responders have already immobilized the patient to a long board and are providing high-flow oxygen through a nonrebreather face mask. During transport, which one of the following assessment findings obtained during your reassessment would best indicate that the patient has suffered a concussion?

dressing over the top of the laceration.

An 18-year-old male patient was struck in the head by a palette of concrete blocks being moved by a crane at a construction site. He has a large laceration to the left side of his head and noted instability to the skull beneath the wound, with moderate bleeding occurring. His airway is open, his breathing is adequate, and his pulse is strong and regular. Proper care for this patient should include:

Provide high concentration oxygen

An intoxicated teenage male with a diabetic history fell down five stairs and is now responding to a shoulder pinch with garbled speech. Manual stabilization of the cervical spine is being maintained. The primary assessment reveals the airway is open, breathing is adequate, and the radial pulse is strong. His skin is warm and dry. Which one of the following should you do next?

Open head injury

An unhelmeted patient who was thrown from a motorcycle has a large scalp avulsion with obvious depression to the top of his head. These findings suggest which one of the following injuries?

look for evidence of bleeding in an area of the body other than the brain.

An unresponsive patient has been ejected from a car as it rolled at a high rate of speed. The primary assessment is complete and you are providing positive pressure ventilation with high-flow oxygen. The patient has a significant deformity to the right side of his head, and both pupils are equal but slow to react to light. He also has deformity to the forearms. Vital signs are: pulse 144, respirations 24 and inadequate, and blood pressure 90/50 mmHg. Based on this presentation, the EMT should:

Perform the jaw-thrust maneuver

An unrestrained middle-aged female was thrown from her car as it rolled in the median of an interstate. She is supine, appears unresponsive, has blood on her face, and has snoring respirations. Your first action on reaching her side should be to:

"Can you tell me what finger I am touching?"

Which one of the following instructions or questions to a patient who has suffered a possible concussion indicates that the EMT is properly assessing for sensory function in the hands?

The right pupil constricts when light is shown into it.

Which one of the following is considered a normal finding when assessing a patient suffering from a head injury?

Provide one ventilation every three seconds.

Which one of the following statements best describes the technique to be used when hyperventilating a head-injured patient with signs that the brain is herniating?

There is flexion of the arms when a shoulder is pinched.

When transporting an unresponsive patient with a traumatic brain injury, which one of the following assessment findings would suggest that the patient is suffering from a herniation of the brain?

Blood pressure of 192/106 mmHg

Which one of the following assessment findings is most indicative of increasing pressure within the skull from a closed-head injury?

It helps determine whether a patient's mental status is improving or deteriorating

Which one of the following best describes the purpose of determining a Glasgow Coma Scale score (GCS) in a patient with a head injury?

His pupils are noticeably unequal.

Which one of the following findings indicates that a patient who received a blow to the head is suffering from something other than a concussion?

Bruising behind the ear, which develops several hours after the injury

Which one of the following findings is most consistent with a basilar skull fracture?

Poor coordination when signing his name to the prehospital care report

You are assessing a patient who had a previous head injury in which a portion of the cerebellum was destroyed. Which one of the following signs and symptoms would the EMT expect to find in relation to this injury?

The left pupil constricts to light but the right pupil does not.

You are assessing the pupils of a patient who hit his head after falling from the top of a tractor trailer. Which one of the following findings would suggest a closed head injury?

Clear fluid coming from the right ear and left nostril

You are suspicious that an unhelmeted male patient who was ejected from a motorcycle may have a basilar skull fracture. As you conduct your secondary assessment, which one of the following findings reinforces this suspicion?

Occult subdural hematoma

You have been called by family members for their mother who is "not acting right." On scene the family informs you that they are concerned because their 68-year-old mother has been complaining of a headache and today is very confused. Assessment reveals a bruise to the right side of the head that family states occurred one week ago when she fell in church. Since all other aspects of the assessment are normal, you suspect a head injury. Which condition would make the most sense given these findings and history?

Bruise to the left temple

You have been called to a residence of a diabetic patient who is confused. A family member states she could not reach the patient by telephone, so she came over and found the patient awake but confused. The patient can remember his name and address, but cannot remember the day or year. He refuses to go to the hospital, but consents to an assessment. Of the following physical exam findings, which one is most concerning?

bruising and swelling of the brain tissue.

You have been called to the local community hospital for a 48-year-old male involved in a motor-vehicle collision one hour ago. He has been diagnosed with a cerebral contusion and must be transported to a trauma center for specialty care. As a knowledgeable EMT, you recognize that a cerebral contusion is:

Possible brain injury

Your assessment of a patient involved in a motor-vehicle collision reveals a deformity to the left side of the head underneath the hair. On further inspection you note that the skin overlying the deformity is still intact. Based on these assessment findings, which one of the following should be the EMT's greatest concern?

Begin administering oxygen through a nonrebreather mask.

Your patient is a 40-year-old male who fell 20 feet from a ledge while hiking. The park ranger who found him is maintaining cervical spine stabilization. The patient is combative and confused, but the airway is open and breathing is adequate. The patient has a radial pulse of 112 and a blood pressure of 96/76. Which one of the following should you do first?

Damage to the brain

Your patient is a young adult female who was struck by a vehicle while she was riding her bicycle. She was not wearing a helmet. She is unresponsive and has deformity and deep depression to the temporal area of the head. You note no bleeding and the scalp is intact. Which one of the following is the greatest threat associated with this injury?

Performing a jaw-thrust maneuver

Your patient is a young adult male with a gunshot wound to the left side of his head. He is unresponsive with snoring respirations. He is breathing six times per minute with a pulse rate of 52 and a blood pressure of 192/104 mmHg. His radial pulse is strong and his skin is cool, but not diaphoretic. In addition to in-line manual stabilization of the cervical spine, the first intervention for this patient should be which one of the following?

"Did she lose consciousness?"

Your patient is a young female, who was thrown from a horse and is now confused. Assessment findings include an open airway, adequate breathing, and a strong radial pulse. Her vital signs are normal. Which one of the following questions would be the most important to ask her mother, who was riding with her?