Chp 15,29,30,34,35,36

What size ET tube would be MOST appropriate to use for a 4 year old child

5.0

A convenience store clerk was stabbed during a robbery attempt. He is semiconscious with shallow breathing and weak radial pulses. During the rapid assessment, you find a single stab wound to his left anterior chest. His jugular veins are diminished but equal. The MOST appropriate treatment for this patient involves

Covering the stab wound with an occlusive dressing, assisting ventilations, transporting at once, and establishing large-bore IV lines en route

Signs of neurogenic shock include all of the following EXCEPT A) bradycardia B) flushed skin C) diaphoresis D) hypothermia

Diaphoresis

ANy noramotensive patient with a sternal fracture should recieve

ECG monitoring

A patient with hemorrhagic shock would be expected to have B) warm, flushed skin Flattened jugular veins C) widened pulse pressure D) an increased hematocrit

Flattened jugular veins

When looking inside a patient's mouth, you cannot see the posterior pharynx and only the base of the uvula is exposed. This is indicative of a Mallampati Class

III

After inserting the Combitube to the proper depth, you should next

Inflate the pharyngeal cuff with 100 mL of air

Which of the following conditions would MOST likely cause laryngeal spasm and edema A) croup B) inhalation injury C) Viral pharyngitis D) Mild asthma attack

Inhalation injury

After inserting the needle into through the cricothyroid membrane, you should next:

Insert the needle about 1 cm farther and then aspirate with the syringe

A 19-year old woman ingested a large quantity of Darvon. She is responsive to pain only and has slow, shallow respirations. The Most appropriate airway managment for this patient involves

Inserting a nasal airway and assisting ventilations with a bag-mask device

A 19 year old woman fell from a second story window and landed on her head. She is unconscious with a blood pressure of 168/104 mm Hg, Heart rate of 56 bpm, and irregular respirations of 8 bpm. Further assessment reveals blood draining from her nose and bilaterally dilated pupils that are slow to react. In addition to employing full spinal precautions, the MOST appropriate treatment for this patient involves

Intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessment

Which of the following statement regarding multilumen airways is correct A) Multilumen airways can be used safely in pediatric patients if ET intubation is unsuccessful B) To ensure proper placement, multilumen airways should be inserted under direct laryngoscopy C) Multilumen airways are equipped with an oropharyngeal cuff, which eliminates the need for a mask seal D) Compared with esophageal airways, multilumen airway devices have not been shown to provide better ventilation

Multilumen airways are equipped with an oropharyngeal cuff, which eliminates the need for a mask seal

Following blunt trauma to the anterior chest, a 44 year old woman presents with restlessness, respiratory distress, perioral cyanosis, and tachycardia. Further assessment reveals a midline trachea, engorged jugular veins, and absent breath sounds on the right side of her chest. you should

Perform an immediate needle thoracentesis to the right side of the chest

common clinical findings associated with a subdural hematoma include all of the following except A) rapidly increasing intracranial pressure B) an underlying skull fracture C) a fluctuating level of consciousness D) unilateral hemiparesis or slurred speech

Rapidly increasing intracranial pressure

Which of the following mechanisms of injury poses the LEAST threat for significant injury A) rear-end collision with restrained driver B) Death of an occupant in the same vehicle C) motorcycle crash at greater than 20 mph D) Vehicular intrusion of greater than 12 inches

Rear-end collision with restrained driver

Which of the following assessment findings is MOST suggestive of intra-abdominal hemorrhage A) signs of shock B) palpable pain C) diffuse tenderness D) Nausea and vomiting

Signs of shock

Cerebrospinal fluid drainage from the ears is MOST indicative of

a skull fracture

An intubated 33-year-old man is becoming agitated and begins moving his head around. Your estimated time of arrival at the hospital is 15 minutes. You should

administer a sedative medication

A 50 year old man was working on his car when the jacks collapsed and the car landed on his chest. Your assessment reveals profound cyanosis and swelling to his chest and face, agonal respirations, and a weak carotid pulse. This patient will benefit MOST from

aggressive airway management and rapid transport

Negative-pressure ventilation occurs when

air is drawn into the lungs when intrathoracic pressure decreases

pneumothorax is MOST accurately defined as

air or gas within the pleural cavity

A pulmonary contusion following blunt chest trauma results in

alveolar and capillary damage with intraparenchymal lung hemorrhage

A 17 year old high school football player was struck in the abdomen by another player during a tackle. Your assessment reveals signs of shock and pain to the patient's left shoulder, which is unremarkable for trauma. Examination of the patients abdomen is also unremarkable for obvious injury. Based on your assessment findings and the patient's clinical presentation, you should be MOST suspicious of

an injury to the spleen

the exchange of oxygen and carbon dioxide between the alveoli and the blood the pulmonary capillaries is called

external respirations

compared to a handgun a rifle

fires at a higher velocity

Grey Turner Sign is defined as ecchymosis to the ___________ and is indicative of ______________

flank, retroperitoneal bleeding

a 40 year old man fell 20 feet from a tree while trimming branches. your assessment reveals that he is unresponsive. You cannot open his airway effectively with the jaw-thrust maneuver. You should

carefully open his airway with the head tilt-chin lift maneuver

Inserting a nasopharyngeal airway in a patient with CSF drainage from the nose following head trauma may

cause the device to enter the brain through a hold caused by a fracture

Following a traumatic brain injury, initial swelling of the brain occurs due to

cerebral vasodilation

Which of the following signs of a basilar skull fracture would MOST likely observed in the prehospital setting

cerebrospinal fluid drainage from the ear

The hypoxic drive stimulates breathing in patients with

chronically decreased PaO2 levels

Orotracheal intubation should be performed with the patient's head

in the sniffing position

You are intubating a 60 year-old-man in cardiac arrest and have visualized the ET tube passing between the vocal cords. After removing the laryngoscope blade from the patient's mouth, manually stabilizing the tube, and removing the stylet, you should

inflate the distal cuff with 5 to 10 mL of air

After properly positioning the patient's head for intubation, you should open his or her mouth and insert the laryngoscope blade

into the right side of the mouth and sweep the tongue to the left

Crackles or rales in the lungs following a myocardial contusion would MOST likely result from

left ventricular dysfunction

When assessing the severity of a traumatic brain injury, the MOST important assessment parameters is the patient's

level of consciousness

Which of the following types of skull fracture would be LEAST likely to present with gross physical signs A) open fracture B) depressed fracture C) basilar fracture D) line fracture

linear fracture

Fractures of the lower rib cage should make you MOST suspicious for injuries to the

liver or spleen

Hypotension that is associated with neurogenic shock is the result of

loss of alpha receptor stimulation

In contrast to a curved laryngoscope blade, a straight laryngoscope blade is designated to

extend beneath the epiglottis and lift it up

Penetrating abdominal trauma MOST commonly results from

low-velocity gunshot or stab wounds

A 21 year old woman was thrown from a horse and landed on her head. Upon arrival at the scene, you find the patient lying supine. She is conscious and has her head turned to the side. As you attempt to move her head to a neutral in-line position, she screms in pain. You should

maintain her head in the position found and continue with your assessment

a 45 year old unrestrained man was ejected from his small truck when it struck a tree. The patient is found approximately 20 feet from the wreckage. Your primary assessment reveals that he is unresponsive and has sonorous respirtation and a rapid pulse. Your initial actions should include

manually stabilizing his head and opening his airway with the jaw-thrust maneuver

You should insert the ET tube between the vocal cords until the

proximal end of the cuff is 1 to 2 cm past the vocal cords

EMS providers can have the MOST positive impact on mortality and mobidity from abdominal trauma by

recognizing the need for rapid transport

periumbilical eccymosis

referred to as Cullen sign and may take several hours to develop following abdominal trauma

The preferred site for performed a needle thoracenteis is

superior to the third rib into the intercostal space at the midclavicular line

If the pleural space becomes filled with air or blood

surface tension is lost and the lung collapses

A motorcycle or football helmet should be removed if

the patient is breathing shallowly and access to the airway is difficult

During a frontal collision, MOST penumothoraces occur when

the patient takes a deep breath just before impact and the lungs rapidly decompress at the time of impact

The ______ is an anatomic space located between the base of the tongue and epiglottis

vallecula

A trauma patient with suspected internal hemorrhage and inadequate breathing requires

ventilation assistance and rapid transport

According to the most current guidelines for emergency cardiac care, the most reliable method for monitoring correct endotracheal tube placement is

waveform capnography

The King airway should NOT be used in patients

with known esophageal disease

Which of the following factors would MOST likely produce a falsely normal pulse oximetry reading

carboxyhemoglobin

An epidural hematoma typically causes rapid deterioration in the patient's condition because

it is associated with brisk arterial bleeding

Which of the following clinical signs may not be present in a patient with a tension pneumothorax and associated internal bleeding A) tachycardia B) jugular vein distention C) mediastinal shift D) contralateral tracheal deviation

jugular vein distention

The major complication associated with hollow organ injury is

peritonitis caused by rupture and spillage of toxins

You have successfully controlled a large arterial hemorrhage from a 42 year old mans leg with direct pressure and a pressure dressing. He is conscious, but restless. His nblood pressur is 84/58 mm Hg, pulse is 120 beats/min, and RR 24 bpm. You should

Administer high-flow oxygen, keep him warm, transport, and establish two large-bore IV lines en route

A construction worker fell approximately 15 feet and landed on his head. He is semiconscious. His respiratory rate is 14 breaths/min with adequate depth. Further assessment reveals blood draining from his nose. You should

Administer oxygen via nonrebreathing mask and continue your assessment

All of the following statements regarding front air bags are correct EXCEPT A) small children riding in the front seat can be killed when the air bag deploys B) Air bags will provide protection from both initial and secondary impacts C) Without the use of a seat belt, front air bags are insufficient in preventing ejection D) front air bags will not activate in side impacts or impacts to the front quarter panel

Air bags will provide protection from both initial and secondary impacts

Which of the following patients may benefit from CPAP A) Alert patient with respiratory distress following submersion in water B) Comatose patient with shallow breathing after overdosing on heroin C) Trauma patient with labored breathing and extensive chest wall bruising D) patient with pulmonary edema who is unable to follow verbal commands

Alert patient with respiratory distress following submersion in water

Which of the following signs would you MOST likely observe in a patient with compensated shock A) anxiety or agitation B) dilation of the pupils C) absent peripheral pulses D) response to painful stimuli

Anxiety or agitation

You are treating a 20 year old woman with a large laceration involving the brachial artery. The patient is confused, is pale, and has weak peripheral pulses. your initial attempts to control the bleeding have failed. You should

Apply a proximal tourniquet, administer high-flow oxygen, transport, and establish vascular access en route.

secondary brain injuries include all of the following EXCEPT A) axonal injury B) cerebral edema C) cerebral ischemia D) intracranial hemorrhage

Axonal injury

What spinal cord injury Is characterized by motor loss on the same side as the injury, but below the lesion

Brown-Sequard syndrome

Which of the following general statements regarding gunshot wounds is correct A) the most important factor for the seriousness of a gunshot wound is the type of tissue through which the projectile passes B) injuries from a shotgun blast are more devastating when the distance between the gun and the target is less than 100 yards Wounds to lower extremities that are not associated with a fracture or neurovascular compromise are always explored surgically C) Wounds to lower extremities that are not associated with a fracture or neurovascular compromise are always explored surgically D) Tissue of high elasticity, such as muscle, is less able to tolerate temporary cavitation than tissue of low elasticity, such as the liver

The most important factor for the seriousness of a gunshot wound is the type of tissue through which the projectile passes

The MOST disastrous consequence of a severe traumatic brain injury

a decrease in cerebral perfusion pressure

a free-floating segment of fractured ribs

a flail chest

A 39 year old man sustained an abdominal evisceration after he was cut in the abdomen with a machete. The patient is semiconscious and is breathing shallowly. You should

assist ventilations with a bag-mask device; cover the exposed bowel with moist, sterile dressings and protect them from injury; transport at one; and initiate IV therapy enroute

If the mechanism of injury indicates that your patient may have sustained a spinal cord injury

assume that a spine injury exists, regardless of the neurologic findings

In contrast to secondary spinal cord injury primary spinal cord injury occurs:

at the moment of impact

A 16 year old boy collapsed after being struck in the center of the chest by a line drive during a high school baseball game. Your assessment reveals that he is pulseless and apneic. As your partner initiates one-rescuer CPR, your MOST important action should be to

attach the ECG leads and be prepared to defibrillate

When ventilating a patient with facial injuries it is MOST important to

be alert for changes in ventilation compliance

A disadvantage of ET intubation is that it

bypasses the upper airway's physiologic functions of warming, filtering, and humidifying

A 59 year old construction worker collapsed on the job and fell into a pile of steel rods. Your assessment reveals that he is pulseless and apneic, and has a 12 inch steel rod impaled in his epigastrium. As your partner and an emergency medical responder begin CPR, you should

control any external bleeding, stabilize the rod in place with bulky dressings, apply the cardiac monitor, and start at least one large-bore IV line en route to the hospital

Neuromuscular blocking agents

convert a breathing patient with a marginal airway into an apneic patient with no airway

Immediate treatment for an open pneumothorax involves

converting the pneumothorax to a closed injury

Dysrthymias following a myocardial contusion are usually secondary to

damage to myocardial tissue at the cellular level

The third phase of a motor vehicle accident involves

deceleration of internal organs

extension of the arms and extension of the legs

decerebrate posturing

What type of skull fracture is MOST common following high-energy direct trauma to a small surface area of the head with a blunt object

depressed fracture

involves stretching shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the cell body

diffuse axonal injury

Sudden deceleration of a motor vehicle that is traveling at 60 mph

dissipates tremendous forces and causes major injuries

Early signs and symptoms of increased intracranial pressure include

headache and vomiting

Common clinical findings associated with a traumatic asphyxia include all of the following EXCEPT A) hyphema B) exopthalmos C) facial cyanosis D) tongue swelling

hyphema

the "platinum 10 minutes" refers to the

maximum time spent at a scene for a trauma patient

In contrast to negative-pressure ventilation, positive-pressure ventilation

may impair blood return to the heart

During tracheobronchial suctioning, it is MOST important to

monitor the patient's cardiac rhythm and oxygen saturation

All of the following factors would increase a person's respiratory rate EXCEPT A) narcotic analgesic use B) increased metabolism C) the use of amphetamines D) a rise in body temperature

narcotic analgesic use

The cricothyroid membrane is the ideal site for making a surgical opening into the trachea because

no important structures lie between the skin covering the cricothyroid membrane and the airway

Before securing the ET tube in place with a commercial device, you should

note the centimeter marking on the ET tube at the patient's teeth

changes in the rate and depth of breathing are regulated primarily by the

pH of the CSF fluid

Under normal conditions, the central chemoreceptors in the brain increase the rate and depth of breathing when the

pH of the CSF increases

endotracheal intubation is MOST accurately defined as

passing an ET tube through the glottic opening and seal off the trachea

The circulation of blood through an organ or tissue in amounts adequate to meet the body's demands

pefusion

Which of the following types of shock is caused by poor blood vessel function A) septic B) cardiogenic C) hypovolemic D) hemorrhagic

septic

truamatic injuries to the aorta are MOST commonly the result of

shearing forces

During abrupt deceleration

shearing or rupturing of internal organs can occur

Which of the following factors does NOT contribute to the extent of injury from a gunshot wound to the abdomen A) size of the patient B) profile of the bullet C) trajectory of the bullet D) distance of the bullet traveled

size of the patient