EMT EXAM 29-30

A 37-year-old male was pinned between a flatbed truck and a loading dock. On exam you find bruising to the chest distended neck veins bilaterally diminished breath sounds and bilateral scleral hemorrhaging. You should:

aggressively manage his airway.

An open pneumothorax occurs when:

air enters the pleural space from outside the body.

During your assessment of a patient with blunt chest trauma you note that the patient has shallow breathing and paradoxical movement of the left chest wall. You should:

assist ventilations with a bag-valve mask

Compression injury is most likely due to which of the following?

Improperly placed lab belt

The phrenic nerves control the diaphragm and exit the spinal cord at:

C3 C4 and C5.

Your presence is requested by law enforcement to assess a 33-year-old female who was sexually assaulted. The patient is conscious and obviously upset. As you are talking to her you note an impressive amount of blood on her clothes in the groin area. Her blood pressure is 98/58 mm Hg her pulse is 130 beats/min and her respirations are 24 breaths/min. You should:

Control any external bleeding administer oxygen and transport at once.

Following a stab wound to the left anterior chest a 25 year old male presents with a decreased level of consciousness and signs of shock. Which of the following additional assessment findings should increase your index of suspicion for a cardiac tamponade?

Engorged jugular veins

Which of the following is true regarding injury to the kidneys?

Injury to the kidneys usually indicates injury to other organs.

Which of the following organs would MOST likely bleed profusely when injured?

Liver

When should you visually inspect the external genitalia on your patient?

Only when there is a complaint of severe pain or other injury

A patient who presents with profound cyanosis following a chest injury

Requires prompt oxygenation and ventilation

Assuming that no obvious signs of intra-abdominal injury are present which of the following injuries would MOST likely cause an injury to the liver or spleen to be overlooked?

Shoulder fracture

Elevation of the rib cage during inhalation occurs when:

The intercostal muscles contract.

Which of the following statements regarding abdominal eviscerations is correct?

The protruding organs should be kept warm and moist.

You should suspect a kidney injury anytime the patient presents with _______.

a hematoma in the flank region

The mesentery is:

a membranous fold that attaches the intestines to the walls of the body.

A flail chest occurs when:

a segment of the chest wall is detached from the thoracic cage.

While jogging a 19 year old male experienced an acute onset of breath and pleuritic chest pain. He is conscious and alert with stable vital signs. Your assessment reveals that he has diminished breath sounds over the left side of the chest. You should:

administer oxygen and transport to the hospital

Which of the following is most likely to cause immediate death?

aortic rupture

A 54-year-old male experienced an avulsion to his penis when his foreskin got caught in the zipper of his pants. He was able to unzip his pants and remove the foreskin prior to your arrival. Your assessment reveals that he is in severe pain and that the avulsion is bleeding moderately. The MOST appropriate treatment for this patient includes:

applying direct pressure with a dry sterile dressing.

Injuries to the external male genitalia _______.

are rarely life-threatening

Your documentation on a sexual assault victim should _______.

be objective and factual

When worn properly a seatbelt should lie:

below the anterior superior iliac spines of the pelvis and against the hip joints.

Closed chest injuries are typically caused by ________?

blunt trauma

You are transporting a patient with blunt abdominal trauma. The patient is unstable and is experiencing obvious signs and symptoms of shock. Your estimated time of arrival at the hospital is less than 10 minutes. After treating the patient appropriately you should:

closely monitor him and reassess him frequently.

The thoracic cavity is separated from the abdominal cavity by the:

diaphragm

Difficulty breathing and a sunken appearance of the anterior abdominal wall is MOST indicative of a ruptured:

diaphragm.

Accumulation of blood in the abdominal cavity will MOST likely cause:

distention

Contraction or tensing of the abdominal muscles in an effort to ease pain is called:

guarding

When a patient stiffens the muscles of the abdomen it is known as _______.

guarding.

Peritonitis usually occurs when:

hollow abdominal organs are damaged and spill their contents into the peritoneal cavity.

You respond to a residence for a 40 year old female who was assaulted by her husband the scene has been secured by law enforcement. Upon your arrival you find the patient lying supine on the floor in the kitchen. She is semiconscious with severely labored breath sounds. As your partner is supporting her ventilations you should:

immediately request ALS support

Abdominal pain vomiting and fever are most likely due to _______.

infection

You are transporting a 42-year-old male who experienced blunt abdominal trauma. He is receiving oxygen at 12 L/min via a nonrebreathing mask and full spinal precautions have been applied. During your reassessment you note his level of consciousness has decreased and his respirations have become shallow. You should:

insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a BVM.

During your assessment of a patient who experienced blunt trauma to the abdomen you notice bruising around the umbilicus. This is a sign of:

intra-abdominal bleeding

A simple pneumothorax:

is commonly caused by blunt chest trauma

You arrive at the scene of a major motor vehicle crash. The patient a 50 year old female was removed from her vehicle prior to your arrival. Bystanders who removed her state that she was not wearing a seatbelt. The patient is unresponsive tachycardic and diaphoretic. Your assessment reveals bilaterally clear and equal breath sounds a midline trachea and collapsed jugular veins. You should be MOST suspicious that this patient has experienced a:

laceration of the aorta

In pediatric patients the liver and spleen are _______.

larger in proportion to the abdomen

Bruising to the right upper quadrant of the abdomen following blunt trauma is MOST suggestive of injury to the:

liver

Placing a pregnant patient in a supine position during the third trimester of pregnancy:

may decrease the amount of blood that returns to the heart.

When a person is lying supine at the end of exhalation the diaphragm:

may rise as high as the nipple line

If a patient with a chest injury is only able to inhale small amounts of air per breath he or she:

must increase his or her respiratory rate to maintain adequate minute volume.

A spinal cord injury at the level of C7 would MOST likely result in:

paralysis of the intercostal muscles

You have sealed the open chest wound of a 40 year old male who was stabbed in the anterior chest. Your assessment reveals that he is experiencing increasing respiratory distress and tachycardia and is developing cyanosis. You should:

partially remove the dressing.

When a hollow organ is punctured during a penetrating injury to the abdomen:

peritonitis may not develop for several hours.

The ________ nerves control the diaphragm.

phrenic

In order to avoid exacerbating a patient's injury it is especially important to use extreme caution when providing positive-pressure ventilation to patients with a:

pneumothorax

A 28 year old male was struck in the chest with a baseball bat during an altercation. He is conscious and alert and complains of severe chest pain. Your assessment reveals a large area of ecchymosis over the sternum and a rapid irregular pulse. In addition to providing supplemental oxygen you should:

prepare for immediate transport

Immediately life-threatening chest injuries must be found and managed during the _________?

primary assessment

Because the depth of an open abdominal wound is often difficult to determine:

prompt transport to the hospital is essential.

A man called EMS 12 hours after injuring his chest. Your assessment reveals a flail segment to the right side of the chest. The patient is experiencing respiratory distress and his oxygen saturations is 78%. His breath sounds are equal bilaterally and his jugular veins are normal. You should suspect:

pulmonary contusion

Early bruising following abdominal trauma often manifests as:

red areas of skin

The presence of tachycardia following a significant abdominal injury:

should be assumed to be a sign of shock.

All of the following are hollow abdominal organs EXCEPT the:

spleen.

Patients with chest injuries will often present with _______?

tachypnea

Children are often "belly breathers" because _________?

their intercostal muscles are not developed

Pleural fluid is contained between the:

visceral and parietal pleurae.