CH 29, CH30, CH31, CH32
A 23-year-old male sustained a musculoskeletal injury to his leg while playing organized football. He reports that his cleated foot was planted into the field when he was hit with a force that caused him to rotate. He heard a snap at this point. What mechanism of injury was applied?
Twisting force
The skin is the largest organ of the body. It is composed of three layers, including the:
epidermis
A type of musculoskeletal injury involving the bones that can be classified as open or closed is a:
fracture
White and dry to dark brown or black and charred skin is a sign of a:
full thickness burn
What is the primary risk for electrical injury patients?
Respiratory or cardiac arrest
What must happen for a joint to dislocate?
Soft tissue and ligaments must be stretched.
Which layer of the skin provides shock absorption and insulation?
Subcutaneous
What is an example of classifying a burn by agent and source?
Thermal burn from excessively hot coffee
Your patient has burns to the entire right arm and the anterior chest. What is the estimated surface area involved?
18%
Part of the assessment of a thermal burn is to calculate the percentage of the body surface area that has been burned. Your patient has burns to her anterior torso (chest and abdomen) and the anterior surface of her right arm. What is the estimated percentage of body surface burned?
22.5%
Which of the following physiological events generally indicates the onset of decompensated shock?
A drop in the patient's blood pressure
Which of the following is most likely to cause cardiogenic shock?
A massive MI that impairs the pump function of the heart
When assessing a patient, consider the possibility of closed soft-tissue injuries whenever there is swelling, pain, or deformity, as well as:
A mechanism of blunt trauma
Which of the following statements is true of a compression injury?
A mechanism of injury involving a compression injury could be a driver striking his chest on a steering column.
You are performing a secondary assessment on your 19-year-old trauma patient with a severely bruised trunk and signs of damage to the ribs and sternum. He is coughing up frothy red blood and having difficulty breathing. What injury do these signs point to?
A punctured lung
It is characteristic of arterial bleeding to be:
ABUNDANT
In a patient with uncontrolled hemorrhage due to a traumatic amputation, which of the following interventions is likely to be most effective?
Application of a tourniquet
You are treating a patient who was stabbed in the right side of the anterior chest wall. He has shortness of breath, weakness, and rapid breathing. Aside from administering oxygen, what is the most appropriate treatment for this patient?
Apply an occlusive dressing on the chest wall, and tape the dressing on three sides.
Which of the following statements is true?
Arteries carry blood from the heart.
You are called to the scene of a patient who was burned by an electrical shock while installing a washing machine. On your arrival, the patient is lying beside the washing machine on which he was working. What is your first consideration for this patient?
Assume the source of electricity is still active.
A patient with an abdominal injury will likely want to keep the legs in what position to reduce pain?
BENT
In bandaging a hand wound, what important consideration is necessary?
Bandage the hand in the position of function.
What type of injury is likely to produce a flail segment?
Blunt trauma
During severe bleeding, which of the following structures is most sensitive to hypoxia from blood loss?
Brain
Your patient has sustained a chemical burn to her hands from dry lime. How is this treated in the field?
Brush off the powder before using water to flush
TRUE STATEMENT
Bullet wounds are a type of penetrating trauma, and involve both internal and external injuries.
You are caring for a victim who was rescued from a burning building by the fire department. The patient is alert and oriented with superficial burns to the arms, chest, neck, and face. He complains that he cannot breathe well. What is this patient's most critical injury?
Burns to the face
How does the skin provide temperature regulation?
By altering the blood flow to the skin and by controlling perspiration
You are dispatched to the local park, where a 15-year-old male is in sudden cardiac arrest after being struck in the chest by a ball. As you arrive at the patient, you should immediately do which of the following?
Confirm pulseless arrest and begin CPR
A patient who was injured by lightning is awake on your arrival but is not able to hear what you are saying. He can talk, and is frightened because he does not know what happened. The patient was in a picnic area at a park and was thrown several feet to the ground when the lightning struck near him. Which of the following steps has the highest priority in this patient's assessment and treatment?
Care for spine injuries, head injuries, and severe fractures.
You arrive on scene to a private residence, where you find a 56-year-old female patient sitting in her living room complaining of pain, paresthesia, and pressure in her lower right leg. She states that a few days ago, she slipped on her way downstairs, and has had pain in her leg ever since, but she has not been to the doctor. During your examination, you note that her right lower leg is pale and pulseless. You see swelling and palpate hardness compared with the uninjured left lower leg. Based on these findings, the patient is most likely experiencing which of the following conditions?
Compartment syndrome
You are dispatched to the scene of a construction site where a 33-year-old male has been impaled with a piece of rebar to his right anterior chest near the clavicle. The rebar is too long to allow transport of the patient. The patient is alert and seated on the ground. How should you manage this injury?
Contact medical control and ensure someone stabilizes the object while it is gently cut to the desired length.
You are caring for a 46-year-old female who accidentally sustained burns to her left hand up to the wrist from boiling water. You arrive moments after the incident. Of the following, which should you do first?
Cool the burned area to stop the burning process.
When treating a patient with an open musculoskeletal injury to the thigh, how would you best treat the open wound?
Cover the open wound with a sterile dressing, elevate the extremity, and apply a cold pack to the area to help reduce swelling.
The layer of skin that is rich with blood vessels, nerves, and specialized structures is the:
DERMIS
You suspect that your patient has a tension pneumothorax. During patient assessment, which of the following findings would most lead to this suspicion?
Diminished or absent lung sounds on side affected by trauma; jugular venous distention; signs of shock
Which method is the least invasive and can control bleeding in most cases?
Direct pressure
Which of the following outlines the steps, in order of preference, for controlling bleeding?
Direct pressure, use of hemostatic agents, and tourniquet application
You arrive on scene to the local park, where you are presented with a 20-year-old male complaining of severe left shoulder pain. The patient states he fell on the ground and immediately felt a sharp pain in the shoulder. As you evaluate the shoulder, you note that the left shoulder sits lower than the right. He has intact distal pulse, motor, and sensory function, but his shoulder is locked in place and he cannot move it without severe pain. Based on the assessment findings, the patient is most likely suffering from which of the following?
Dislocation
Which of the following is true regarding decompensated shock?
During decompensated shock, the body can no longer compensate adequately.
You arrive on scene to a residence where you find a 16-year-old female patient who was shocked while plugging in an appliance in the garage. Her father states that he heard the shock and saw her get "thrown to the ground." The patient is awake and alert, and still lying on the ground. Based on the patient's presentation, how should you manage this patient's injury?
Evaluate the patient for spine injuries and stabilize the spine.
Which of the following statements about puncture wounds is correct?
Even insignificant-looking puncture wounds can cause devastating injuries.
Which patient most likely has an abdominal injury?
Patient tries to lie still with legs drawn up.
You are on scene with a 45-year-male who lacerated his hands while working in his garage. The bleeding is dark red and has a steady flow. What is the best way to manage this patient's hemorrhage?
Firmly bandaging a dressing in place
What is the resulting injury called when the burn penetrates all the way to the bottom layer of skin?
Full thickness
You are caring for a 15-year-old female who has sustained a laceration to her lower arm. It is spurting bright red blood uncontrollably. What personal protective equipment would be most preferred in managing this wound?
Gloves and a face shield
Your patient has a large bump on the forehead from being hit by a baseball. What type of injury is this?
Hematoma
The skin serves which of the following functions?
Protection
A 49-year-old male patient was injured with a chain saw while cutting down a tree. He sustained a deep, jagged laceration to his left thigh. On arrival, you find him to be conscious but breathing rapidly, with a rapid pulse and cold, clammy skin. What type of shock would you suspect that he is in?
Hypovolemic shock
In trauma patients, which form of shock is the most common?
Hypovolemic shock
You are called to the scene of a metal fabrication plant, where you are presented with a 30-year-old male patient complaining of bilateral severe eye pain. Upon examination, you notice both eyes are red and irritated. Patient states that one of the dyes he was working with splashed into his eyes. How would you manage this patient's injury?
Irrigate both eyes with copious amounts of water for at least 20 minutes or until you arrive at the medical facility
What is the primary concern about a splint that is applied too loosely?
It could allow the bone fragments to move, which could cause further damage.
What organ in the abdomen is most commonly injured by blunt trauma, and can bleed profusely enough to threaten the patient's life?
LIVER
You arrive on scene to an assault. Law enforcement has secured the scene. Your patient is a 23-year-old male with a blood-soaked shirt. The patient states that the assailant "slashed at him with a box opener." You expose the chest and note a jagged cut on his left anterior chest with steady, dark red hemorrhaging. Based on this assessment finding, the wound is most likely which of the following?
Laceration
Which element of the musculoskeletal system belongs to the lower extremities of the appendicular skeleton?
Legs
In a dislocation, what structures other than the joint capsule are likely to be injured?
Ligaments
You arrive on scene to a 34-year-old male gunshot victim lying in his living room disoriented, pale, cool, and diaphoretic, with shallow respirations. You note blood on his shirt at the chest and abdomen, and the puncture wound appears to be through the chest. What is your first priority in treating this patient?
Locate the gunshot wound on the chest, and place your gloved hand over the injury
Damage to which of the following organs is least likely in the case of abdominal bruising?
Lungs
In treating open wounds to the neck or abdomen, which type of dressing is preferred?
Occlusive dressing
SIX P'S
PAIN, PALLOR, PARESTHESIA,PULSES,PARALYSIS,PRESSURE
The term used for the delivery of oxygen and nutrients from the blood through the thin capillary walls into the cells and the removal of carbon dioxide and other waste products from the cells is:
PERFUSION
Which of the following is the best sign of a pelvic injury?
Pain in the pelvis, significant mechanism of injury, obvious deformity
In shock states, what general principle can be observed regarding perfusion?
Perfusion in some areas is inadequate because the circulatory system malfunctions.
To stabilize a hip fracture, how should you bind the legs together?
Place a folded blanket between the patient's legs and bind the legs together with wide straps, Velcro-equipped straps, or wide cravats.
When a patient has significant blood loss, which of the following clinical findings would you expect to find that signifies the presence of shock?
Rapid heart rate
Which of the following principles may help the most in ensuring the survival of a patient who is suffering from shock due to massive trauma?
Rapid transport to an appropriate facility
Which of the following should be applied to provide stability for an upper arm injury?
Sling and swathe
Injury to which of the following organs would be most likely to cause peritonitis?
Small intestine
A bruise on the abdomen could indicate injury to which of the following?
Spleen, liver, or kidneys
While assessing the abdomen of a 25-year-old female, you note that she has a large piece of glass sticking out of her right upper quadrant. What should you do?
Stabilize the glass
An open chest wound that pulls air into the thoracic cavity is known as what type of injury?
Sucking
Which of the following is most clearly an example of an open chest injury?
Sucking chest wound
You respond to the scene of a 24-year-old gunshot victim and find your patient to have a decreased mental status as well as hypotension. You note absent breath sounds on the left side of his chest, where you notice a puncture wound. From what is this patient most likely suffering?
Tension pneumothorax
In a contusion, what remains intact?
The epidermis
Why is it so important to seal holes in the chest from penetrating trauma as early as possible?
The lungs may collapse if air and blood displace lung tissue.
A 14-year-old girl has fallen from her bicycle. She sustained injuries when she landed with her arm extended to catch her fall. According to the principles of indirect mechanisms of injury, which of the following bones is least likely to have been injured in this fall?
Thoracic vertebra
What is the purpose of a flutter-valve occlusive dressing?
To allow air to escape but not enter
You are treating a 42-year-old male assault victim who presents with nausea, vomiting, and sharp abdominal pain. While inspecting his abdomen, you note redness to his right upper quadrant. Based on your assessment findings, the patient is most likely suffering from which of the following?
Traumatic hemorrhage of the liver
Your 35-year-old female patient has accidentally cut her forearm with a kitchen knife. You notice that the blood is dark red and has a steady flow. The patient is concerned she may have "cut an artery." Based on this finding, you should tell her that the source of the hemorrhage is:
VEIN
Which of the following is a guideline for the treatment of chemical burns?
Wash away the chemical with flowing water
Why does a patient in shock secondary to blood loss develop pale, cool, and clammy skin?
When the body senses low blood volume, it diverts blood from nonvital areas to vital organs.
If you see angulation when assessing a patient, then:
a bone or bones are out of anatomical position.
The first step in the progression of compartment syndrome is that:
a fracture or crush injury causes bleeding or swelling in an extremity.
The severity of external bleeding is influenced by several factors, including the bleeding person's:
ability to clot.
All burns are to be treated as more serious if:
accompanied by other injuries or medical problems.
A fracture in which the broken bone segments are at an angle to each other is called:
an angulated fracture.
Severe abdominal trauma and blood loss may cause signs and symptoms of shock, which include:
an increased heart rate.
A burn injury should be considered to be:
an injury with the potential for many far-reaching effects.
Some local protocols recommend that an abdominal evisceration should be covered with a sterile dressing moistened with sterile saline, followed by:
an occlusive dressing.
The humerus is an example of a(n):
appendicular bone.
Your patient suffered a severe electrical burn injury. In your emergency care, you should always:
assess for an entrance and an exit wound.
When performing a primary assessment of a patient with musculoskeletal injuries, you should:
avoid your focus being distracted by the most dramatic extremity injuries.
When a flap of tissue is traumatically removed, this condition is called a(n):
avulsion
When crushed, the liver and spleen:
bleed profusely and cause shock.
Cardiac tamponade occurs when:
blood enters the pericardial sac surrounding the heart.
Shock is typically caused by a problem with the heart, fluid volume, or:
blood vessels.
In the case of a large evisceration, you should place layers of:
bulky dressings over a dressing moistened with saline.
Microscopically small structures in the circulatory system that supply every cell in the body are:
capillaries
Jugular venous distention is most likely observed with:
cardiac tamponade
You are caring for a 62-year-old male patient who complains of chest pain, shortness of breath, and nausea. His heart rate is more than 120, and his blood pressure is 90/60. You notice some pallor and peripheral cyanosis on his cool, clammy skin. He is most likely suffering from:
cardiogenic shock.
It is true that all bleeding involving external blood loss:
carries the risk of transmitted infection.
An internal injury with no open pathway from the outside is called:
closed
A fracture that results in multiple bone pieces at the fracture site is termed a:
comminuted fracture
When palpating a fracture site on a patient's mid-thigh, you notice a grating sensation. This is known as:
crepitus. Crepitus is a grating sensation or sound made when fractured bone ends rub together.
Rapid, shallow breathing; pale, cool, clammy skin; and a low blood pressure in a patient with an abdominal injury are signs of:
developing shock.
To control bleeding, start with:
direct pressure and elevation.
The method of bleeding control that is the first and most successful method to try is:
direct pressure.
The sterile material that is placed directly on a wound is termed the:
dressing
Application of a cervical collar to a patient should happen:
during the secondary assessment.
Once a pressure dressing has been applied, the EMT should next:
ensure that bleeding is controlled.
Generally, when providing emergency care of open wounds, the first thing you would do is:
expose the wound.
A fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment is called a:
flail chest
A swelling caused by the collection of blood under the skin or in damaged tissues as a result of an injured or broken blood vessel is a(n):
hematoma
An open wound to the chest, if an occlusive dressing is not available, should be sealed:
immediately with a gloved hand.
For a high-priority, unstable patient with musculoskeletal injuries, you should:
immobilize the whole body on a long spine board and "load and go."
Guidelines for splinting long-bone injuries include:
immobilizing the hand or foot in the position of function.
Hypoperfusion is:
inadequate blood flow to the tissues.
An injury to the hollow organs in the abdomen typically leads to:
inflammation and infection.
When caring for a patient with an impaled object in the abdomen, the EMT should:
leave the impaled object in place and stabilize it with bulky dressings.
The tough connective tissues that bind bone ends together at joints are termed:
ligaments
Burns to the face are considered critical because:
of the potential for respiratory compromise or eye injury.
A fracture may be classified as:
open or closed
A movement of ribs in a flail segment that is opposite to the direction of movement of the rest of the chest cavity is called:
paradoxical motion
Bones are covered by a strong, white, fibrous material called the:
periosteum
When air is present in the chest cavity, the injury is called a:
pneumothorax
The signs and symptoms of internal bleeding include:
poor peripheral perfusion.
Swelling or deformity at the site of a bruise indicates a:
possible underlying fracture.
A primary reason for splinting a bone or joint injury is:
preventing movement to reduce the chance for further injury.
Burns involving the airway often lead to:
respiratory compromise
A 22-year-old female patient slipped running down stairs, and has injured her right tibia and fibula. You have used an air splint to splint the injury. To test the splint, you can:
see if you can cause a slight dent in the plastic with fingertip pressure.
Your patient was just involved in a motor vehicle collision. She is breathing very fast and shallowly. You auscultate her lung sounds and find diminished breath sounds on the right side. You suspect that the patient is most likely suffering from:
simple pneumothorax
Your patient has a nontraumatic fracture of the left wrist. Appropriate treatment would be to:
splint with a padded rigid splint.
Twisting force involves:
stretching or tearing of muscles and ligaments.
To see the effect of direct force, you would look at:
the area of the point of impact.
The first effects of a bone injury are swelling of soft tissue and:
the formation of a blood clot in the area of the fracture.
To realign an extremity, an EMT grasps the distal extremity while a partner places one hand above and one hand below the injury site, and then:
the partner supports the site while the first EMT creates gentle manual traction in the direction of the long axis of the extremity.
Burns pose greater risks to infants and children than to adults because:
their body surface area is greater in relation to their total body size.
In caring for an amputated part, it is important to:
wrap the part in sterile gauze and keep it cool.
In treating a puncture wound of the eye, if you bandage both eyes, it is because:
you want to avoid sympathetic eye movement
Internal bleeding may result from a variety of causes. If you suspect that your patient has internal bleeding, you should remember that:
your suspicion of internal bleeding may be based only on the mechanism of injury.
You are assessing a patient, and notice red discoloration with blisters on the legs. This type of burn would be classified as:
partial-thickness.