Chapter 24

What three collisions occur in every crash?

1. Vehicle vs object 2. Passenger vs interior surface of vehicle 3. Passenger's internal organs against solid structures of the body

coup-contrecoup brain injury

A brain injury that occurs when force is applied to the head and energy transmission through brain tissue causes injury on the opposite side of original impact.

cavitation

A phenomenon in which speed causes a bullet to generate pressure waves, which cause damage distant from the bullet's path.

Trauma Score

A score calculated from 1 to 16, with 16 being the best possible score. It relates to the likelihood of patient survival with the exception of a severe head injury. It takes into account the Glasgow Coma Scale (GCS) score, respiratory rate, respiratory expansion, systolic blood pressure, and capillary refill.

Revised Trauma Score (RTS)

A scoring system used for patients with head trauma

Arterial air embolism

Air bubbles in the arterial blood vessels.

blunt trauma

An impact on the body by objects that cause injury without penetrating soft tissues or internal organs and cavities.

projectile

Any object that moves through the air or through space under the influence of gravity, such as a bullet by a weapon

index of suspicion

Awareness that unseen life-threatening injuries may exist when determining the mechanism of injury.

Traumatic injuries can be described as _______ trauma or ________ trauma.

Blunt; penetrating

Trauma emergencies

Emergencies that are the result of physical forces applied to a patient's body.

medical emergencies

Emergencies that require EMS attention because of illnesses or conditions not caused by an outside force.

(T/F) Energy can be both created and destroyed

False

(T/F) Headrests are the major cause of whiplash-type injuries in rear-impact collisions

False

(T/F) Helmets are reliable at protecting against cervical spine injuries

False

(T/F) Rapid transport of an unstable trauma patient takes priority over assessing and managing the ABCs

False

(T/F) Tertiary blast injuries result from flying debris, such as glass or shrapnel, striking the patient.

False

(T/F) The energy of a moving object is called potential energy

False

penetrating trauma

Injury caused by objects, such as knives and bullets, that pierce the surface of the body and damage internal tissues and organs.

tympanic membrane

The eardrum; a thin, semitransparent membrane in the middle ear that transmits sound vibrations to the internal ear by means of auditory ossicles.

Mechanism of injury (MOI)

The forces, or energy transmission, applied to the body that cause injury

potential energy

The product of mass, gravity, and height, which is converted into kinetic energy and results in injury, such as from a fall.

(T/F) All patients with chest trauma, regardless of the injury, should be reassessed every 5 minutes

True

(T/F) In car-versus-pedestrian collisions, the speed of the vehicle should be the first step in determining the mechanism of injury

True

(T/F) In the United States, traumatic injuries are the leading cause of death for people younger than 44 years

True

(T/F) Injuries to the aorta are relatively common in lateral impacts from a motor vehicle collision

True

(T/F) Penetration or perforation to the chest wall is called an open chest wound

True

(T/F) Rear-ended collisions often cause whiplash injuries

True

(T/F) The injury potential of a fall is related to the height from which the patient fell

True

(T/F) Work is defined as force acting over distance.

True

(T/F) You should perform frequent neurologic assessments in patients with a presumed head injury

True

Your patient has a Glasgow Coma Scale (GCS) score of 13, a systolic blood pressure of 80 mm Hg, and a respiratory rate of 8 breaths/min. His Revised Trauma Score (RTS) is: a) 9. b) 8. c) 11. d) 10.

a) 9.

Which of the following injuries would MOST likely occur as a direct result of the third collision in a motor vehicle crash? a) Aortic rupture b) Forehead lacerations c) Extremity fractures d) Flail chest

a) Aortic rupture

"A comprehensive regional resource capable of providing every aspect of trauma care from prevention through rehabilitation" is the definition of a _____________ trauma center. a) Level I b) Level II c) Level III d) Level IV

a) Level I

Which of the following statements regarding gunshot wounds is correct? a) The speed of a bullet has the greatest impact on the injury produced. b) Low-velocity bullets will cause the greatest amount of trauma. c) The size of a bullet has the greatest impact on the injury produced. d) High-velocity bullets will cause less severe internal injuries.

a) The speed of a bullet has the greatest impact on the injury produced.

A young male sustained a gunshot wound to the abdomen during an altercation. As your partner is assessing and managing his airway, you should control the obvious bleeding and then: a) assess for an exit wound. b) obtain baseline vital signs. c) apply a cervical collar. d) auscultate bowel sounds.

a) assess for an exit wound.

In a motor vehicle collision, as the passenger's head hits the windshield, the brain continues to move forward until it strikes the inside of the skull, resulting in a _______ injury. a) compression b) lacertion c) lateral d) motion

a) compression

Significant clues to the possibility of severe injuries in motor vehicle collisions include: a) death of a passenger b) a blown out tire c) broken glass d) a deployed airbag

a) death of a passenger

Damage to the body that resulted from a pressure wave generated by an explosion is found in what type of blast injury? a) primary b) secondary c) tertiary d) miscellaneous

a) primary

When the speed of a motor vehicle doubles, the amount of kinetic energy: a) quadruples. b) triples. c) doubles. d) is not affected.

a) quadruples

A young boy was riding his bicycle down the street when he hit a parked car. What will raise your index of suspicion for this collision? a) The MOI b) The type of the bike c) how loudly he's crying d) A quick visual assessment

a) the MOI

A young boy was riding his bicycle down the street when he hit a parked car. What was the first collision? a) the bike hitting the car b) the bike rider hitting his bike or the car c) the bike rider's internal organs against the solid structures of the body d) the bike rider striking the pavement

a) the bike hitting the car

Force acting over a distance is the definition of: a) work. b) kinetic energy. c) potential energy. d) latent energy.

a) work.

Glasow Coma Scale

an evaluation tool used to determine level of consciousness, which evaluates and assigns point values (scores) for eye opening , verbal response, and motor response, which are then totaled; effective in elping predict patient outcomes

Optimally, on-scene time for critically injured patients should be less than ______ minutes. a) 5 b) 10 c) 15 d) 20

b) 10

A fall from more than ______ times the patient's height is considered to be significant. a) 1-2 b) 2-3 c) 3-4 d) 4-5

b) 2-3

Which of the following destinations is most appropriate for a 41-year-old male patient who was involved in a rollover motor vehicle collision and is unconscious and unresponsive, assuming that travel times to each is equal? a) A Level IV or Level III trauma center b) A Level I or Level II trauma center c) Only a Level I trauma center d) Any designated trauma center is acceptable.

b) A Level I or Level II trauma center

Which of the following findings would be LEAST suggestive of the presence of high-energy trauma? a) Intrusion into the vehicle b) Deployment of the air bag c) Steering wheel deformity d) Dismounted seats

b) Deployment of the air bag

Which of the following is NOT considered a type of impact associated with a motorcycle crash? a) Head-on b) Rotational c) Controlled d) Ejection

b) Rotational

Which types of motor vehicle collisions present the greatest potential for multiple impacts? a) Frontal and rotational b) Rotational and rollover c) Lateral and rollover d) Rear-end and rotational

b) Rotational and rollover

A contusion to a patient's forehead along with a spider-webbed windshield suggests possible injury to the: a) nose b) brain c) face d) heart

b) brain

According to the American College of Surgeons Committee on Trauma (ACS-COT), an adult trauma patient should be transported to the highest level of trauma center if he or she: a) has a systolic blood pressure of less than 110 mm Hg or a heart rate greater than 110 beats/min. b) has a GCS score of less than or equal to 13 with a mechanism attributed to trauma. c) was involved in a motor vehicle crash in which another patient in the same vehicle was killed. d) has a bleeding disorder or takes anticoagulant medications and has any blunt or penetrating injury.

b) has a GCS score of less than or equal to 13 with a mechanism attributed to trauma.

Airbags decrease injury to all of the following EXCEPT: a) chest b) heart c) face d) head

b) heart

Your awareness and concern for potentially serious underlying and unseen injuries or illness is called the a) mechanism of injury b) index of suspicion c) scene size-up d) general impression

b) index of suspicion

__________ impacts are commonly referred to as T-bone crashes. a) frontal b) lateral c) rear-end d) rollover

b) lateral

Which of the following is considered a type of impact from a motor vehicle collision? a) Ejection b) Rollover c) crush d) penetration

b) rollover

The amount of kinetic energy that is converted to do work on the body dictates the __________ of the injury. a) location b) severity c) cause d) speed

b) severity

A young boy was riding his bicycle down the street when he hit a parked car. What was the second collision? a) the bike hitting the car b) the bike rider hitting his bike or the car c) the bike rider's internal organs against the solid structures of the body d) the bike rider striking the pavement

b) the bike rider hitting his bike or the car

The index of suspicion is MOST accurately defined as: a) the way in which traumatic injuries occur. b) your awareness and concern for potentially serious underlying injuries. c) the detection of less obvious life-threatening injuries. d) a predictable pattern that leads to serious injuries.

b) your awareness and concern for potentially serious underlying

"For every action, there is an equal and opposite reaction" is: a) Newton's first law b) Newton's second law c) Newton's third law d) a false statement

c) Newton's third law

Which of the following interventions is the MOST critical to the outcome of a patient with multisystem trauma? a) Intravenous fluid administration b) Elevation of the lower extremities c) Rapid transport to a trauma center d) Early administration of oxygen

c) Rapid transport to a trauma center

The three collisions in a frontal impact include all of the following EXCEPT: a) car striking object. b) passenger striking vehicle. c) air bag striking passenger. d) internal organs striking solid structures of the body.

c) air bag striking passenger

Energy can be: a) created b) destroyed c) converted d) lost

c) converted

The most common life-threatening event in a rollover is _________ or partial ejection of the passenger from the vehicle. a) vehicle intrusion b) centrifugal force c) ejection d) spinal cord injury

c) ejection

Medium-velocity penetrating injuries may be caused by a: a) knife b) military assault rifle c) handgun d) slingshot

c) handgun

Following a blunt injury to the head, a 22-year-old female is confused and complains of a severe headache and nausea. On the basis of these signs and symptoms, you should be MOST concerned with the possibility of: a) airway compromise. b) spinal cord injury. c) intracranial bleeding. d) a fracture of the skull.

c) intracranial bleeding

The energy of a moving object is called: a) potential energy b) thermal energy c) kinetic energy d) work

c) kinetic energy

Approximately 25% of severe injuries to the aorta occur during: a) rear-end collisions. b) frontal collisions. c) lateral collisions. d) rollover collisions.

c) lateral collisions.

Your quick primary assessment of the patient and evaluation of the _____ can help to direct lifesaving care and provide critical information to the hospital staff. a) environment b) index of suspicion c) mechanism of injury d) abdominal area

c) mechanism of injury

When assessing an elderly patient who fell, it is important to remember that: a) bilateral hip fractures usually occur when an elderly person falls. b) elderly patients who fall usually have a secondary head injury. c) osteoporosis can cause a fracture as a result of a fall from a standing position. d) any fall in the elderly is considered to be high-energy trauma.

c) osteoporosis can cause a fracture as a result of a fall from a standing position.

When assessing a patient who experienced a blast injury, it is important to remember that: a) solid organs usually rupture from the pressure wave. b) primary blast injuries are typically the most obvious. c) primary blast injuries are the most easily overlooked. d) secondary blast injuries are usually the least obvious.

c) primary blast injuries are the most easily overlooked.

Patients suffering from an open wound to the neck may experience all of the following EXCEPT: a) significant bleeding b) air embolism c) tension pneumothorax d) subcutaneous crepitation

c) tension pneumothorax

A young boy was riding his bicycle down the street when he hit a parked car. How many collisions took place? a) one b) two c) three d) four

c) three

According to the Association of Air Medical Services, you should consider air medical transport of a trauma patient if: a) the patient requires advanced life support care and stabilization, and the nearest ALS-ground ambulance is more than 5 to 10 minutes away. b) he or she was involved in a motor vehicle crash in which another occupant in the same vehicle was killed, even if your patient's injuries are minor. c) traffic conditions hamper the ability to get the patient to a trauma center by ground within the ideal time frame for the best clinical outcome. d) ground transport will take your ambulance out of service for an extended period of time, regardless of the severity of the patient's injuries.

c) traffic conditions hamper the ability to get the patient to a trauma center by ground within the ideal time frame for the best clinical outcome.

A 12-year-old male jumped approximately 12 feet from a tree and landed on his feet. He complains of pain to his lower back. What injury mechanism is MOST likely responsible for his back pain? a) Direct trauma to the spinal column b) Secondary fall after the initial impact c) Lateral impact to the spine d) Energy transmission to the spine

d) Energy transmission to the spine

Which of the following is the most common cause of death from a blast injury? a) amputation b) burns c) chest trauma d) head trauma

d) head trauma

Burns from hot gases and respiratory injuries from inhaling toxic gas are associated with which type of blast injury? a) Primary b) Secondary c) Tertiary d) Miscellaneous

d) miscellaneous

While en route to a major motor vehicle crash, an on-scene police officer advises you that a 6-year-old male who was riding in the front seat is involved. He further states that the child was only wearing a lap belt and that the air bag deployed. On the basis of this information, you should be MOST suspicious that the child has experienced: a) lower extremity fractures. b) blunt trauma to the head. c) open abdominal trauma. d) neck and facial injuries.

d) neck and facial injuries.

A patient complaining of chest tightness, coughing up blood, and subcutaneous emphysema following an explosion may be suffering from a: a) myocardial blast injury b) ruptured tympanic membrane c) ruptured peritoneal cavity d) pulmonary blast injury

d) pulmonary blast injury

All of the following are considered types of motorcycle impacts EXCEPT: a) head-on collision b) angular collision c) controlled collision d) rear collision

d) rear collision

A 15-year-old female was struck by a small car while riding her bicycle. She was wearing a helmet and was thrown to the ground, striking her head. In addition to managing problems associated with airway, breathing, and circulation, it is MOST important for you to: a) inspect the helmet for cracks. b) leave her bicycle helmet on. c) obtain baseline vital signs. d) stabilize her entire spine.

d) stabilize her entire spine.

Which of the following is NOT considered appropriate use of air medical services? a) The distance to a trauma center is greater than 25 miles b) traffic/road conditions make it unlikely to get the patient to the hospital in a timely manner c) there is a mass-casualty incident d) the closest trauma center is 10 minutes away by ground transport

d) the closest trauma center is 10 minutes away by ground transport

How can motor vehicle crashes be classified? (5 ways)

frontal (head-on), lateral (T-bone), rear-end, rotational (spins), and rollovers

pulmonary blast injuries

pulmonary trauma resulting from short-range exposure to the detonation of explosives

drag

resistance that slows a projectile, such as air

kinetic energy

the energy of a moving object

Work

the measure of force over distance

trajectory

the path followed by a projectile flying or an object moving under the action of given forces.

deceleration

the slowing of an object

Mulitsystem Trauma

trauma that affects more than one body system