EMT CH 31
The normal response of the pupils while examined with a penlight is described as:
consensual
What is considered to be a normal finding when assessing a patient with a possible head injury?
The right pupil constricts when light is shined into the left pupil
A 14-year-old male fell 10 feet from a retaining wall and hit his head on a metal post. He is responsive to verbal stimuli with incomprehensible speech. The secondary assessment indicates blood and fluid coming from inside the patient's left ear. Given these assessment findings, the EMT should:
Place a piece of sterile gauze over the ear to catch the fluid
You are assessing a patient who had a previous brain injury in which a portion of the cerebellum was destroyed. In relation to this specific injury, which finding would the EMT expect?
Poor muscle coordination when signing his name to the prehospital care report
A 41-year-old male patient was struck in the head with a metal pipe during a fight with an angry neighbor. The scene is safe, and as you approach the patient, you note that he is combative and has blood on the left side of his head and face, and on his shirt. His breathing appears to be labored and he is incontinent of urine. Which care should you perform immediately?
Take manual cervical spine motion restriction
A male soccer player was struck in the head with a soccer ball. Players state that he was dazed for several seconds following the impact and then asked the same questions over and over. Presently, he is conscious and oriented to person, but confused about place and time. He also has a reddened area to the side of his head and face. As you proceed with your assessment, his memory continues to improve. Based on these findings, the EMT should suspect which type of injury?
concussion
You suspect that an unhelmeted male patient who was thrown from a motorcycle may have a basilar skull fracture. As you perform the secondary assessment, which finding would reinforce this suspicion?
Clear fluid coming from the right ear and the left nostril
A patient who was involved in an altercation was struck on the side of the head with a baseball bat, in addition to suffering several blows to the arms and legs. When assessing this patient, which sign or symptom best indicates the patient has suffered a brain injury?
Confusion and combativeness
A young female was thrown from a horse and is now confused. Assessment findings include an open airway, adequate breathing, and a strong radial pulse. Her vital signs are normal. Which question would be the most important to ask the patient's mother, who was riding with the patient, as soon as possible?
"Did she lose consciousness?"
A 21-year-old male has a gunshot wound to the head. As you assess him, which finding would you recognize as a nonpurposeful response to pain?
Flexing his arms across his chest when you pinch his shoulder
At a construction site, an 18-year-old male was struck in the head by a pallet of concrete blocks as it was being moved by a crane. He has a large laceration to the left side of his head, with noted instability to the skull beneath the wound. Moderate bleeding from the injury site is also noted. The patient's airway is open, his breathing is adequate, and his pulse is strong and regular. Proper care for this patient should include:
A loose dressing over the top of the laceration
A trauma surgeon informs you that the patient whom you transported to the emergency department earlier was diagnosed with an epidural hematoma. The patient was taken into surgery and the hematoma was removed, and now the patient is in critical condition. Based on this information, the EMT should recognize that in this patient:
A pocket of arterial blood collected between the skull and dura mater
A 40-year-old male fell 20 feet from a ledge while hiking. The park ranger is now maintaining manual spine motion restriction for the patient. The patient is combative and confused, but his airway is open and his breathing is adequate. The patient has a radial pulse of 112 beats/min, blood pressure of 96/76 mmHg, and SpO2 of 91% on room air. What should the EMT do first?
Begin administering supplemental oxygen
When assessing a patient with a head injury, which finding is most indicative of increasing pressure within the skull?
Blood pressure of 192/106 mmHg
A young adult female was struck by a vehicle while she was riding her bicycle. She was not wearing a helmet. She is now unresponsive and has a deformity with a deep depression to the temporal area of the head. You do not see any bleeding, and the patient's scalp is intact. What is the greatest threat associated with this injury?
Damage to the brain
Which finding indicates that a patient who received a blow to the head is suffering from something other than a simple concussion?
His pupils are noticeably unequal when assessed
A young male patient was running through a park shortly before dawn and struck his head on a low-hanging branch of a tree. Emergency Medical Responders have already provided spine motion restriction precautions and are providing supplemental oxygen since the patient was initially unresponsive. During transport, which finding obtained during your reassessment would best indicate that the patient has experienced a concussion?
Improving memory
You are transporting a patient with a past medical history of a meningeal tumor. You would recognize this kind of tumor as being located:
In tissue surrounding the brain
As brain herniation occurs, the body responds by:
Increasing systolic blood pressure in an attempt to maintain perfusion to the brain
A 57-year-old man tripped and fell on the sidewalk, hitting his head on the concrete. According to witnesses, the patient was unresponsive for several minutes following the fall. Which bit of information would be most critical to relay to the physician in the emergency department?
Known history of alcoholism
Which statement is true regarding linear skull fractures?
Linear skull fractures cannot typically be identified with palpation
A patient was ejected from a car when it overturned at a high rate of speed. The patient is unresponsive. The primary assessment is complete and you are providing positive pressure ventilation with supplemental oxygen. The patient has a significant deformity to the right side of his head, and both pupils are equal but slow to react to light. The patient also has deformity to the forearms. Vital signs are pulse, 144 beats/min; respirations, 24 breaths/min and inadequate; blood pressure, 90/50 mmHg; and SpO2, 97%. Based on this presentation, the EMT should:
Look for evidence of bleeding in an area of the body other than the brain
What best describes the purpose of determining a Glasgow Coma Scale (GCS) score in a patient with a head injury?
The GCS score helps determine whether a patient's mental status is improving or deteriorating
When using the Glasgow Coma Scale (GCS), the EMT understands that:
The higher score, the better the patient's neurologic status
You are assessing the pupils of a patient who hit his head after falling from the top of a tractor trailer. Which pupillary finding suggests a closed head injury?
The left pupil constricts to light but the right pupil does not
A woman strikes her forehead against the dashboard of her car as it strikes a tree. Immediately following the impact, her brain shifts back and forth within her skull. Based on the anatomy and physiology of the skull, which statement is true?
The ridges of the basilar skull can damage the brain as it moves back and forth
Which finding, when considered individually, is most consistent with a basilar skull fracture?
bruising behind the ear
The parameters of the Glasgow Coma Scale are:
eyes, motor, and verbal response
An unhelmeted rider, who was thrown from his motorcycle when he wrecked, has a large scalp avulsion with obvious skull depression to the top of his head with venous bleeding. These findings suggest which type of injury?
open head injury
The EMT is properly assessing for sensory function in the hands when he tells or asks the patient:
"Can you tell me which finger I am touching?"
Which patient has an isolated brain injury that should be considered the most serious?
A 21-year-old male wearing a deformed motorcycle helmet who does not respond to verbal or painful stimuli after crashing
You are assessing a patient who has sustained blunt trauma to the head. Which sign would be most indicative of the loss of cerebrospinal fluid?
Clear fluid coming from the nose
A patient with Cushing reflex is most likely experiencing which pathophysiology?
Brain herniation
A middle-aged male died immediately after a self-inflicted gunshot wound to the head. Which portion of the central nervous system was most likely damaged to cause such a rapid death?
Brainstem
You have been called to a residence of a patient with diabetes who exhibits an altered mental status. A family member states she could not reach the patient by telephone, so she came over and found the patient awake but confused. The patient can remember his name and address, but cannot remember the day or year. He refuses to go to the hospital, but consents to an assessment. Of these physical exam findings discerned on assessment, which one is most concerning?
Bruise to the left temple
You have been called to the local community hospital for a 48-year-old male who was involved in a motor vehicle collision 2 hours prior. He has been diagnosed with a cerebral contusion and must be transported to a trauma center for specialty care. As a knowledgeable EMT, you recognize that a cerebral contusion is:
Bruising and swelling of the brain tissue
A 68-year-old female patient complains of a headache and generalized weakness. Her husband informs you that she was with a friend yesterday and was involved in a motor vehicle collision. She did strike her face on the dashboard, but refused treatment on scene. Her past medical history includes a stroke with right arm weakness and high blood pressure, for which she takes medications. When assessing this patient, which finding should concern the EMT most?
Bruising behind her left ear
A patient exhibits retrograde amnesia when she:
Cannot remember falling and hitting her head
A construction worker was accidentally shot with a nail gun. The nail penetrated the skull approximately ½ inch through the temporal region. Before your arrival, coworkers pulled the nail free. Based on the mechanism of injury, which sign provides the strongest evidence that the meningeal layers have been breached?
Cerebrospinal fluid oozing from the puncture wound
A young adult male is in police custody after he crashed his car into a utility pole. There is minor front-end damage to the vehicle, and the air bags deployed. The patient was not wearing a seat belt and has an abrasion to his forehead. He is awake and oriented to person, time, and place. His speech is slurred and he has an odor resembling that of beer on his breath. The arresting officer states that he just wants you to check the patient before he transports him to jail. Given this scenario, which action seems most appropriate for the EMT to take?
Contact medical direction with assessment findings
The cerebellum is described as the area of the brain that:
Controls reflexes and assists in maintaining body posture
A young female pedestrian was hit by a car and thrown 15 feet, striking her head against a metal guardrail. You start your secondary assessment and note a deep depression to the right parietal area of her head, with intact skin overlying the area. You should:
Note the injury and continue assessing the patient
A patient who fell out of a tree has an open skull injury. What would be an appropriate way to describe and document this injury on the PCR?
Obvious deformity and instability to the right side of the skull with a laceration to the overlying scalp
An intoxicated teenage male with a history of diabetes fell down five stairs and is now responding to a shoulder pinch with garbled speech. Manual spine motion restriction precautions are being maintained by fire department EMRs. The primary assessment reveals an open airway, adequate breathing, and strong radial pulse. Vital signs are pulse 122 beats/min, respirations 18 breaths/min, blood pressure 108/60 mmHg, and SpO2 97% on room air. The patient's skin is warm and dry. Which action would be performed next?
Perform a secondary exam
An unrestrained middle-aged female was thrown from her car as it rolled in the median of an interstate. She is supine, appears unresponsive, has blood on her face, and has snoring respirations. Your first action upon reaching her side, after taking spine motion restriction precautions, should be to:
Perform the jaw-thrust maneuver
A 52-year-old male is unresponsive and has bruises and lacerations to the head, chest, and abdomen. Bystanders state that the patient was intoxicated and got into a fight with several patrons of a bar. They state that he was beaten with his opponents' fists, but not other objects or weapons. The patient has snoring respirations, shallow breathing, and a strong radial pulse. His skin is warm and dry. After providing manual spine motion restriction, what should be your next action?
Perform the jaw-thrust maneuver
A young adult male has a gunshot wound to the left side of his head. He is unresponsive with snoring respirations. He is breathing 6 times per minute with a pulse rate of 52 beats/min and a blood pressure of 192/104 mmHg. His radial pulse is strong and his skin is cool, but not diaphoretic. In addition to spine motion restriction precautions, the first intervention for this patient would be:
Performing a jaw-thrust maneuver
Your assessment of a patient who was involved in a motor vehicle collision reveals a deformity to the left side of the head underneath the hair. On further inspection, you note that the skin overlying the deformity is still intact. Based on these assessment findings, what should be the EMT's greatest concern?
Possible brain injury
Which statement best describes the technique to be used when hyperventilating a patient with a head injury who shows signs of brain herniation?
Provide 1 ventilation every 3 seconds
You are transporting a patient who experienced a right-sided head injury after a large refrigerator fell and pinned his head between the appliance and the floor. On scene, the patient was responsive to verbal stimuli with the following vital signs: pulse, 96 beats/min; respirations, 16 breaths/min; blood pressure, 134/66 mmHg; and SpO2, 95%. During transport, as you reassess the patient, what would be the clearest sign that the head injury is worsening?
Responding only to painful stimuli
A woman fell from a second-story window onto the concrete sidewalk below. She is unresponsive and has a large depression to the back and top of her skull. Additional findings include abdominal bruising and an angulated left ankle. Your partner reports that the patient's vital signs are pulse, 68 beats/min; respirations, 14 breaths/min and irregular; blood pressure, 198/112 mmHg; and SpO2, 91% on room air. Based on these assessment findings, what should the EMT suspect is occurring?
Severe head injury with increasing pressure within the skull
A 61-year-old male fell off a roof. Your primary assessment findings include unresponsiveness, agonal breathing, and a slow and weak radial pulse. The patient's skin is cool and dry. Emergency Medical Responders are maintaining manual spine motion restriction procedures. What should you do immediately?
Start positive pressure ventilation
A young female patient involved in a motor vehicle collision responds to painful stimuli by extending her arms and legs. Her airway is open, and her breathing is shallow and irregular. A radial pulse that is moderate in strength is palpated. Her pulse is 64 beats/min, respirations are 8 breaths/min and irregular, and blood pressure is 210/110 mmHg, with an SpO2 of 90% on room air. The patient has an obvious deformity to her forehead and a left pupil that is dilated and does not respond to light. Manual spine motion restriction is being maintained by Emergency Medial Responders (). At this time, the EMT's priority action is to:
Start positive pressure ventilation at 20 breaths/min
You have been called by family members for their mother, who is "not acting right." At the scene, the family informs you that they are concerned because their 68-year-old mother has been complaining of a headache for two days and is now very confused. When asking about a bruise on the right side of her forehead, the family states she fell in church a week ago and hit her head. Since all other aspects of the assessment are unremarkable, you suspect a head injury. Which type of injury would you suspect given the findings and history?
Subdural hematoma
A male patient in his thirties fell 10 feet off a loading dock, landing on his head and back. He has deformity and depression to the back of his head and is unresponsive with snoring respirations. Vital signs are pulse, 132 beats/min; respirations, agonal; blood pressure, 136/64 mmHg, and SpO2, 89%. The patient responds to painful stimuli with purposeful motion. Which instruction would you provide other caregivers at the scene?
"I need someone to start positive pressure ventilation at 12 breaths per minute."
A patient complaining of a headache states that he fell and struck the back of his head. Which statement by the patient should be of most concern to the EMT?
"I take a blood thinner for my heart."
At an industrial complex, a young male was struck in the head by a large piece of steel thrown from a grinding machine. Assessment reveals a soft, painful depression underlying a tear in his scalp, which is covered with dried blood. Clear fluid is draining from his right ear. The patient is conscious but confused and exhibits the following vital signs: pulse, 84 beats/min; respirations, 16 breaths/min and adequate; blood pressure, 142/76 mmHg; and SpO2, 90%. Emergency Medical Responders are on scene and are maintaining manual spine motion restriction precautions. Which instruction indicates the next step needed in this patient's care?
"Will someone administer supplemental oxygen to the patient?