Chapter 43 Trauma Systems and Mechanism of Injury

The most critical factor in the survival of any severely injured patient is the: A) c. Time from incident to definitive care B) d. Type of protective factors employed C) b. Skills of trauma surgeons at the receiving hospital D) a. Presence of ALS providers at the scene

A

There are currently four types of restraint systems used in motor vehicles in the United States. These systems include: A) b. Lap belt, shoulder restraints, air bags, and child safety seats B) c. Lap belt, shoulder restraints, head restraints, and air bags C) d. Lap belt, air bags, head restraints, and child safety seats D) a. Lap belt, shoulder restraints, head restraints, and child safety seats

A

Which of the following should the paramedic consider regarding a projectile that fragments? A) a. Each piece of the fragmented projectile crushes its own path into the body. B) d. The fragments cause a temporary cavity that is considerably smaller. C) c. Low-velocity projectiles tend to fragment easier than high-velocity fragments. D) b. Exit wounds are very common with projectiles that break into fragments.

A

An example of a high-order explosive includes: A) a. Gun powder B) c. Nitroglycerin C) b. Molotov cocktail D) d. Pipe bomb

B

Cavitation is: A) b. The breaking apart of a projectile as it passes through the body B) a. An opening produced by a force that pushes body tissue laterally away from the path of a projectile C) c. The end-over-end motion of a projectile D) d. Wind resistance experienced by a projectile

B

During a lateral impact, if the damaged vehicle moves away from the impact: A) c. The victim sustains an up-and-over injury pathway B) d. The victim sustains torsion to the head, neck, and torso C) b. The victim sustains a down-and-under injury pathway D) a. The victim absorbs most of the impact from the collision

B

During the initial assessment of the patient described in question 79, you notice a penetrating chest wound. This wound was most likely the result of the _____ blast injury. A) a. Miscellaneous B) c. Secondary C) b. Primary D) d. Tertiary

B

In a frontal motorcycle collision, injuries to the driver are caused by: A) d. Rearward movement of the motorcycle after impact B) b. The driver being propelled over the handlebars C) a. Hyperflexion of the torso D) c. Rapid acceleration and twisting of the torso

B

In a trauma system, prehospital care is divided into three aspects that include: A) d. Triage, treatment, and injury prevention B) b. Treatment, transportation, and triage guidelines C) a. Staging, triage guidelines, and treatment D) c. Triage, staging, and rapid transportation

B

Low-velocity falls in the elderly: A) a. Are likely to cause only minor injuries B) b. Can cause severe head and spinal injury C) d. May pose a threat of disability to the older patient D) c. Are inconsequential and usually result in no injury

B

Medium-energy weapons would include: A) A. Civilian hunting rifles, military-style rifles, and assault rifles B) B. Guns with short barrels that have less power, such as handguns and some rifles C) C. Knives, needles, ice picks, tree branches falling onto rebar at a construction site, and fence posts in a motor vehicle collision that cause tissue damage as a result of their sharp, cutting edges D) D. Rocket launchers, grenades, and landmines

B

The major difference between the adult and child when involved in a pedestrian versus motor vehicle collision is that: A) A. The adult tends to face the threat, whereas the child will turn away. B) B. The child tends to face the threat, whereas the adult will turn away. C) C. Both will face the threat. D) D. Both will turn away from the threat.

B

The paramedic should consider transporting the trauma patient by air ambulance when: A) a. Critical care needs are met by ground ambulance crews B) b. Road conditions may delay reaching the trauma center C) d. Time delays are inconsequential to patient care D) c. The weather plays no factor in transportation

B

The phase of trauma care in which the paramedic delivers direct patient care is known as: A) d. Preplanning B) b. Postevent C) a. Incident D) c. Preevent

B

Trauma care is divided into three phases: preevent, event, and postevent. Which of the following best describes the postevent phase? A) c. Reducing injuries through injury-prevention programs B) b. Lowering morbidity and mortality through optimum care C) d. Wearing appropriate personal protective equipment D) a. Conducting safety awareness training after the incident

B

Which is the correct statement regarding laying a motorcycle down to avoid impact with an object? A) b. Abrasions and fractures will be on the opposite side of the body. B) a. Abrasions and fractures will be on the affected side of the body. C) d. The rider slides on the back and may sustain head injuries. D) c. The injuries can be more severe than striking the object.

B

Which of the following best describes kinetic energy? A) c. Kinetic energy = Mass × Acceleration B) b. Kinetic energy = 1/2 mass × Velocity2 C) a. Kinetic energy = 1/2 mass × Acceleration D) d. Kinetic energy = Mass × Deceleration

B

Injuries to the lung that are the result of trauma similar to a crash scenario include lung rupture known as the: A) d. Pressure effect B) a. Balloon effect C) c. Paper bag effect D) b. Blow-out effect

C

Medium-energy weapons include: A) a. AK 47s B) c. Knives and picks C) b. Handguns D) d. M-16s

C

Shoulder restraints act to: A) b. Allow up-and-over movement in a frontal crash B) a. Allow hyperflexion of the torso in the event of a collision C) c. Prevent folding of the body at the waist during a crash D) d. Prevent lateral twisting of the head, neck, and chest

C

The patient from question 79 also has 20% third-degree burns to the anterior thorax. This injury can be classified as the _____ blast injury. A) a. Primary B) d. Tertiary C) b. Quaternary (miscellaneous) D) c. Secondary

C

The typical third impact in an auto-pedestrian collision is the: A) d. Vehicle hitting the body B) c. Vehicle hitting a stationary object C) a. Pedestrian striking the ground D) b. Pedestrian striking the hood of the vehicle

C

In blast injuries, what phase results when a victim is propelled through space by the explosion and then strikes a stationary object. A) A. Primary blast injury B) B. Propellius missilus C) C. Secondary blast injury D) D. Tertiary blast injury

D

National standards concerning the use of ground ambulance transportation define the 'reasonable amount of time' that it takes severe trauma patients to reach definitive care after their injuries as being within: A) d. 120 minutes B) c. 90 minutes C) a. 10 minutes D) b. 60 minutes

D

You are called to the scene to assist a 2-year-old male who has fallen approximately 3 feet onto a concrete surface. On your arrival, the child is breathing but unconscious. You suspect trauma to which area of the body? A) b. The feet B) a. The buttocks C) d. The upper extremities D) c. The head

D

A young woman and her 2-year-old daughter sustained minor to moderate injuries in a motor vehicle crash. Both mother and daughter are visibly upset. Which statement describes what the paramedic should do when transporting the woman and her daughter? A) b. Be sure to secure each patient separately using a stretcher or child seat as needed. B) d. The paramedic should hold the child to reassure both the mother and daughter. C) a. Allow the woman to hold her daughter because it will calm the distressed child. D) c. It is permissible to transport the mother and daughter on the same stretcher.

A

Which of the following is the correct statement regarding a rollover crash? A) d. The injuries are predictable because of the mechanism. B) b. The greater the speed, the less severe the injuries. C) a. Shear forces do not apply to rollover collisions. D) c. The greater the speed, the more severe the injuries.

D

Which of the following statements is correct when comparing penetrating and blunt trauma? A) c. Penetrating trauma causes more severe tissue damage than blunt trauma. B) a. Blunt trauma does not have the same force as penetrating trauma. C) d. Because blunt trauma does not penetrate the skin, it does not cause cavitation. D) b. Both blunt trauma and penetrating trauma can cause cavitation.

D

Which of the following statements pertaining to data collection and analysis of trauma patients is correct? A) d. It is conducted by the public health department or EMS agency. B) c. It is a less important administrative aspect of a trauma system. C) b. It has little value in assessing trauma treatment of overall care. D) a. It analyzes injury patterns, treatment, and overall care.

D

A patient was cut by several large shards of glass that blew out from a window during an explosion. This is an example of a: A) d. Tertiary blast injury B) c. Secondary blast injury C) b. Quaternary blast injury D) a. Primary blast injury

B

The expectation that certain injuries or patterns of injuries have resulted to a body part, organ, or system based on the mechanism of injury and the force of impact to the patient is known as: A) c. Index of suspicion B) d. Mechanism of action C) a. Energy-related injury D) b. Index of energy transfer

A

Exit wounds differ from entrance wounds in that the exit wound is: A) b. Ragged and torn tissue with a stellate appearance B) d. Usually smaller than the entrance wound C) a. Burned around the edges of the skin D) c. Round with a smooth edge

A

In frontal collisions, the lap belt: A) c. Keeps the torso from moving forward B) d. Prevents the body from moving backward C) b. Allows the body to move with the vehicle D) a. Allows room for the torso to reach the dashboard

A

Kinematics may be defined as: A) b. The process of predicting injury patterns B) a. The process of investigating the causes of motor vehicle crashes C) d. The study of forces and motion D) c. The study of fatal injury patterns

A

When a vehicle collides with another vehicle or strikes an object on the side of the vehicle, this is called: A) A. Lateral impact B) B. Rear-end impact C) C. Rollover impact D) D. Rotational impact

A

When an adult pedestrian is struck by a car, the injuries on initial impact are usually: A) a. Fractures to the legs B) d. Abdominal injuries C) b. Head and neck injuries D) c. Arm and shoulder injuries

A

When energy is applied to an object, there is a corresponding movement of particles within that object. This describes the concept of: A) b. Energy exchange B) d. Kinetic energy C) c. Inertia D) a. Conservation of energy

A

Which of the following best describes a level 2 trauma center? A) d. Usually a nonteaching or community hospital B) a. Created with rural and remote areas in mind C) c. Most are found in large university-based hospitals D) b. May not be a hospital but rather a clinic-type facility

A

A body in motion will stay in motion until acted on by some external force. This statement best defines: A) d. Principles of kinetic energy B) b. Newton's first law of motion C) a. Conservation of energy D) c. Newton's laws on force

B

A car strikes a tree at 50 miles per hour. Newton's first law of motion states that the: A) b. Energy of the body inside the vehicle cannot be destroyed, but the form can be changed B) c. Force on the body equals the mass times acceleration C) a. Body inside the car will travel at 50 miles an hour until acted on by an outside force D) d. Kinetic energy of the body will be determined primarily by the velocity

C

A shotgun is a low-velocity, short-range weapon. Which of the following statements is correct pertaining to wounds caused by shotguns? A) b. If fired at a distance, the pellets are spread out and may cause severe injury. B) a. If fired at a close range, the pellets are compact and cause little damage. C) d. The wad, if it enters the skin, increases the potential for infection from the injury. D) c. The pellets enter the body at the same time and tend to fragment quickly.

C

Which of the following best describes the effect of body armor on medium- and high-energy projectiles? A) b. High-energy projectiles cannot pierce body armor. B) d. Most high-energy projectiles can penetrate body armor. C) c. Injuries to the heart and lungs can occur because of blunt force. D) a. Few medium-energy projectiles can penetrate body armor.

C

According to the trauma center categories, a level III trauma center is: A) A. A regional resource center that offers a full spectrum of services from prevention programs to patient rehabilitation, serves as the leader in trauma care for a geographic area, and can be mostly found in large, university-based hospitals because of the requirements for the patient care, education and teaching programs, and research. B) B. Able to provide evaluation, resuscitation, and operative intervention for stabilization. (usually a community hospital). C) C. Created with rural and remote areas in mind, provides initial stabilization, and may be a clinic-type facility rather than a hospital. D) D. Provides comprehensive trauma care, does not include research as an essential component, and is usually a nonteaching or community hospital.

D

Damage can occur when one organ or structure moves either faster or slower relative to other objects in the portion of the body or body system. This best describes the concept known as: A) c. Kinetic energy B) d. Shear C) b. Inertia D) a. Compressive force

D

Deaths caused by penetrating trauma: A) b. Are increasing yearly B) c. Have been steadily declining since 1990 C) d. Have no predictable patterns, making prevention difficult D) a. Are generally not preventable

D

During a frontal crash, the center of gravity of a motorcycle typically causes the rider to be: A) d. Trapped under the bike when it falls to the side B) b. Thrown backward from the bike C) a. Rolled forward with the bike D) c. Thrown over the handlebars

D

During a vertical fall, a child typically falls: A) b. Face down and could have abdominal trauma B) a. Arms first and may have broken arms C) c. Feet first and could sustain ankle fractures D) d. Head first and may have severe head injuries

D

Ejection from vehicles: A) d. Never occurs when occupants are restrained B) c. Is becoming more common as fewer people are wearing seat belts C) b. Decreases the risk for spinal trauma but increases the risk for head trauma D) a. Creates a sixfold increase in the risk for death

D

In a motor vehicle crash, a frontal or head-on impact can result in a down-and-under injury pathway. This means: A) c. The victim moves laterally and strikes the window and door B) d. The victim moves upward and ultimately strikes the windshield C) a. The impact is at an angle with less trauma to the victim D) b. The victim continues forward toward the steering wheel and moves downward in the seat

D

In a motor vehicle crash, a frontal or head-on impact can result in an up-and-over injury pathway. This means: A) c. The victim moves laterally and strikes the window and door B) a. The impact is at an angle with less trauma to the victim C) b. The victim moves downward in the seat and strikes the dashboard D) d. The victim moves upward and ultimately strikes the windshield or roof

D

The leading cause of death in children under 9 years of age is injuries sustained from: A) c. Pedestrian injuries B) d. Bicycle crashes C) a. Falls D) b. Motor vehicle crashes

D

The patient is a 28-year-old male involved in a knife fight. He sustained a stab wound to the flank just above the area parallel to the navel. The paramedic should consider that: A) d. Damage may be minimal, as there are few structures in the area B) b. Damage can include the liver or stomach C) c. Damage can include the spleen and lung tissue D) a. Damage can include the kidney and hollow organs of the abdomen

D

The type of tissue involved in the impact of a projectile determines the severity of the damage. Which of the following sustains the most severe damage as a result of a penetrating projectile? A) c. Liver B) d. Lungs C) a. Bone D) b. Intestines

D

There are four types of child car seats, including: A) c. Highback booster seat, safety belt seat, rear facing, and side facing B) a. Backless safety seat, rear facing, front facing, and side facing C) b. Front facing, rear facing, side facing, and highback booster seat D) d. Rear facing, front facing, highback booster seat, and safety belt seat

D

There are three mechanisms of injury when a pedestrian is struck by a motor vehicle. These three mechanisms include: A) a. Striking the bumper, striking the ground, and secondary strike by vehicle B) d. Striking the bumper, striking the windshield, and striking another pedestrian C) b. Striking the bumper, striking the hood, and run over by another vehicle D) c. Striking the bumper, striking the hood, and striking the ground

D