EMT Chapter 27 Test
A bullet fired from a gun at close range passes through the patient's liver. However, on autopsy, the coroner discovers that the man's pancreas, stomach, and gallbladder were also injured, even though not in direct contact with the bullet. As a knowledgeable EMT, you would recognize that which of the following is responsible for injury to these additional organs? A. Cavitation B. Drag force C. Profile impact D. Blunt injury
A
A patient has been critically hurt in a nighttime motor vehicle collision. She was wearing a seat belt and hit a tree at 70 mph. The car she was driving weighed 2 tons and was equipped with air bags that did deploy. Which of the following had the greatest impact on her being injured? A. Speed of the vehicle at impact B. Deployment of air bags C. Weight of the vehicle D. Nighttime conditions
A
A patient involved in a motor vehicle collision is complaining of neck pain. Which of the following pieces of information would cause the EMT to have a high index of suspicion that the patient may have suffered more significant injuries beyond isolated neck pain? A. Death of the car's driver B. Lack of air bags in the car C. Difficulty turning is head to the right D. History of heart problems
A
A young female wears her lap belt low, over her upper thighs, because the belt is uncomfortable when worn properly. If involved in a head-on "up and over" type collision, to what injury is she most prone, given the position of her lap belt? A. Dislocated hips B. Bilateral arm fractures C. Internal abdominal injury D. Tibia-fibula fractures
A
After assessing these patients, which would the EMT identify as suffering from multisystem trauma? A. 61-year-old male; became dizzy and fell down five stairs; laceration to the head; open fracture to the left lower leg B. 31-year-old female; large laceration to her leg from a hunting knife; bleeding controlled C. 89-year-old female fell in a nursing home; hematoma to the back of her head D. 24-year-old male; slipped on ice; tenderness to the right shoulder
A
Two cars have collided head on. One car was traveling 55 mph and the other 35 mph. The total speed of impact would be: A. 90 mph. B. 35 mph. C. 20 mph. D. 55 mph.
A
What are the MOST common patterns of impact seen in motorcycle accidents? A. Head-on, angular, and ejection B. Pavement, vegetation, and vehicular C. Angulated, lateral, and direct D. Grill, hood, and windshield
A
What is the first act of patient care that should be performed on the multisystem trauma patient? A. Establish spinal stabilization. B. Provide oxygenation. C. Establish a patent airway. D. Control external hemorrhage.
A
When caring for patients at a motor vehicle crash involving a frontal impact, remember that: A. the driver will continue to move forward at the same speed at which the vehicle was traveling. B. a "spider web" crack should lead you to be suspicious about abdominal injuries. C. "up and over" injuries involve the knees, femurs, hips, acetabulum, and spine. D. "down and under" movement by the driver may cause the driver to be ejected though the windshield.
A
Approximately what percentage of trauma victims are multisystem trauma patients? A. 10% B. 90% C. 75% D. 50%
A Rationale Approximately 90 percent of trauma patients have a simple or single injury that involves only one body system, such as a fractured tibia or a soft tissue laceration with no major bleeding. A multisystem trauma patient (the remaining 10 percent of trauma patients) has multiple injuries or involvement of more than one body system. The body systems may include the central nervous, pulmonary, cardiovascular, gastrointestinal, urinary, reproductive, musculoskeletal, and integumentary systems. Multiple organ injuries are considered to be multisystem trauma, even though they may be part of the same body system.
On what factor does the pattern of tertiary phase injuries depend? A. Distance and point of impact B. Direction C. Velocity D. Mass
A Rationale Tertiary phase injuries occur when the patient is thrown away from the source of the blast. The injuries are much the same as would be expected from ejection from a vehicle. The pattern depends on the distance the person is thrown and the point of impact.
A 49dash-yeardash-old male has been stabbed in the lower right chest. Police tell you that the patient got into an argument with an unidentified man, who then stabbed him before fleeing the scene. After assessing the patient, you are suspicious that the knife punctured the lung and is causing internal bleeding. In this situation, the mechanism of injury would be: A. internal hemorrhage. B. stab wound to the right chest. C. assailant with a knife. D. penetrating trauma to the lungs.
B
A patient has been stabbed with a knife at the fifth intercostal space on the right side of the chest. Assessment reveals him to be short of breath and coughing. Which question is it MOST important for the EMT to ask about the weapon? A. "Did the person twist the knife?" B. "How long was the knife?" C. "Did the knife penetrate your chest easily?" D. "Was the knife clean or dirty?"
B
A patient with severe head and neck pain states that he was properly wearing his seat belt when another car struck him from behind. As a knowledgeable EMT, you would realize that the complaint of: A. head and neck pain indicates that he was not wearing his seat belt. B. head and neck pain could occur when the seat belt is properly worn. C. head pain suggests that he was not wearing the seat belt properly. D. head and neck pain indicates that the lap belt was worn without the shoulder harness.
B
During an in-service focusing on care of the trauma patient, the medical director asks whether anyone can correctly describe the "platinum 10 minutes." Which response is BEST? A. "If the transport to a trauma center is going to exceed 10 minutes, EMS should strongly consider the use of an aeromedical helicopter." B. "EMS should initiate transport of the critically injured trauma patient to the hospital within 10 minutes of arriving on scene." C. "EMS should spend a total of 10 minutes assessing the patient for life-threatening injuries prior to initiating transport to a trauma center." D. "EMS systems should be designed so that it takes an ambulance no longer than 10 minutes to respond to a trauma call."
B
What piece of information would you provide to a group of young teenage drivers to decrease their chance of suffering a "whiplash" type injury if involved in a motor vehicle collision? A. Position the car's seats in a full upright position. B. Ensure that the head rest is properly positioned. C. Make sure the car has side door air bags. D. Properly wear seat belts with a headrest in the down position.
B
When population density does not permit a commitment to level I trauma center requirements, what level of trauma center may act as a regional trauma center? A. Rural trauma center B. Level II C. Level IV D. Level III
B
Which statement MOST accurately describes the "platinum 10 minutes" as it applies to care of the trauma patient? A. The goal for total amount of time from the actual injury to arrival of EMS at the scene B. The target scene time for EMS as it applies to the seriously injured trauma patient C. The amount of time EMS should spend on scene with any patient suffering traumatic injury D. The time it should take the transporting ambulance to get the trauma patient to the closest medical facility
B
You are first on the scene of a multiple-casualty incident. After establishing the safety of the scene and calling for additional resources, you and your partner begin to triage. While your partner calls for the injured to go to him, you begin moving among the injured and first come to a female patient in her mid-30s who is not breathing and has multiple significant open wounds and fractures. After you reposition her airway, she still does not resume respirations. What is your NEXT action? A. Check for bleeding that requires intervention. B. Tag her and move on. C. Initiate ventilations and check for a pulse. D. Initiate a large-bore IV.
B
In evaluating the kinetic energy that was involved in an accident, which factor has the greatest effect on energy? A. Angulation B. Velocity C. Density D. Mass
B Rationale Kinetic energy in a moving body is calculated this way: the mass (weight in pounds) times the velocity (speed in feet per second) squared, divided by 2. As the mass of a moving object is doubled, its kinetic energy is also doubled. You would be injured twice as badly if you were hit by a 2-pound rock than if you were hit by a 1-pound rock that was thrown at the same speed. However, velocity is a much more significant factor than mass. Suppose you were hit by a rock that was thrown at a velocity of 1 foot per second, then hit by the same rock that was thrown again at a velocity of 2 feet per second. When thrown at 2 feet per second, the rock would be not twice as harmful as when thrown at 1 foot per second; it would be four times as harmful, because the factor of velocity is squared.
A 27dash-yeardash-old male was involved in an altercation and was struck in the ribs with a baseball bat. Assessment reveals intact skin with noted bruising to the right lateral chest. When palpating this area, pain, instability, and crepitus are all observed. The patient also complains of difficult and painful breathing. The EMT would recognize: A. pulmonary injury caused by penetrating trauma. B. chest wall injury caused by acceleration forces. C. chest injury caused by blunt trauma. D. thoracic injury secondary to penetrating trauma.
C
A shoulder harness worn without a lap belt can result in: A. airbag injury. B. steering wheel deformation. C. severe neck injury. D. loss of control.
C
An 8-year-old boy fell forward off of a swing onto outstretched arms. He did not hit his head or lose consciousness and is complaining of left forearm pain. There is deformity to the left wrist, but no other injuries or life threats. His vital signs are pulse 132, respirations 20, blood pressure 108/62, and SpO2 100%. The proper care of this patient would be: A. apply high-concentration oxygen and anatomically splint the forearm when the patient is immobilized to a long backboard. B. immediately load and transport, splinting the injury en route. C. splint the forearm and apply a cold pack before transporting non-emergently. D. call ALS so that the patient can be given intravenous pain medications before splinting the forearm.
C
Assessment of a patient involved in a motor vehicle accident reveals him to have crepitus to the left humerus, instability to the left lateral chest wall and flank, and pain on palpation to left hip region. He also complains of pain to the right side of the neck. Based on this injury pattern, the EMT would recognize the patient was: A. an unrestrained driver involved in a headdash-on collision. B. an unrestrained occupant in a car struck from the side. C. the driver of a car hit on the driver's side. D. the passenger in a car hit from behind.
C
Emergency Medical Responders have removed an intoxicated and confused patient from a car that struck another vehicle at a high rate of speed. The patient was unrestrained and his car did not have air bags. Assessment reveals deformity bilaterally to the hips and femurs and bruising to the knees. Based on this injury pattern, the EMT would recognize what type of injury mechanism? A. Up and over B. Lateral impact C. Down and under D. High velocity
C
In a motor vehicle collision, the impact of the victim within the passenger compartment is called: A. a deceleration impact. B. an additional impact. C. the body collision. D. a tertiary collision.
C
The "blown outward" appearance of a bullet exit wound is the result of: A. damage by the bullet forcing debris and bodily contents out of the wound. B. the bullet and displaced bone fragments. C. damage by the bullet and the cavitational wave. D. the bullet and hot gases.
C
Which action has the highest priority in treating the multisystem trauma patient? A. Airway B. Primary assessment C. Life threats that were identified during the general impression D. Circulation
C Rationale Assessment of the trauma patient is conducted in a sequence that promotes a systematic approach to the patient. However, there are times when you must deviate from the sequence to provide emergency care for a life threat. As an example, airway is always assessed before circulation in the sequence. However, if you identify a major bleed (arterial or venous) during the general impression, you must first control the bleeding before moving on in the assessment. Adhering rigidly to a sequence when presented with obvious life threats may contribute to the deterioration of the patient.
A lap belt that is worn too low can result in what injury from a frontal crash? A. Fractured pelvis B. Knee fractures C. Dislocated hips D. Abdominal injuries
C Rationale If the lap belt is worn too low, it can dislocate the hips. Worn too high, it can cause abdominal compression and spinal fracture. A shoulder strap worn without a lap belt can result in severe neck injury.
The first point of impact in head-first falls is typically: A. the shoulders. B. the crown of the head. C. the arms. D. the face.
C Rationale In head-first falls, the pattern of injury begins with the arms and extends up to the shoulders. The head may be forcibly hyperextended, hyperflexed, or compressed, all of which can cause extensive damage to the cervical spine. As the body continues its downward motion, the torso and legs are thrown either forward or backward. Chest, lower spine, and pelvic injuries are also common.
According to the "golden principles" of prehospital trauma care, how quickly should EMS attempt to transport a patient to the hospital after arriving on scene? A. Within 20 minutes B. Within 15 minutes C. Within 5 minutes D. Within 10 minutes
D
A "whiplash" type neck injury is most often observed with what type of collision? A. Frontal impacts B. Rollover C. Ejection D. Rear-end impact
D
Regardless of the cause, every blast has three phases. Which phase is NOT one of these phases? A. The tertiary phase, in which injuries are the result of being thrown back from the blast B. The primary phase, in which injuries are due to the pressure wave of the blast affecting the body C. The secondary phase, in which injuries are due to flying debris propelled by the force of the blast D. The immediate phase, in which injuries occur at the instant the blasts occurs
D
Types of injuries you should suspect in frontal impact collisions include: A. the "paper bag" syndrome, which results from compression of the abdomen against the steering column. B. air trapped in the lungs from a closure of the epiglottis, causing traumatic asphyxiation. C. a torn aorta as a result of compression force to the heart. D. a separation of the cartilage connecting the ribs and the sternum, which can result in a torn intercostal artery.
D
What is the MOST critical consideration in treating the critical trauma patient? A. Treating fractures B. Full immobilization before transport C. Performing reassessments on time D. Limiting on-scene time to 10 minutes
D
What is the term for maintaining suspicion about the types of injuries a patient may have even though the patient presents as very stable? A. Mild feeling of certainty B. Sense of injury potential C. Interpretation of bodily forces D. High index of suspicion
D
Which injury is MOST serious, warranting immediate and rapid transport to the hospital? A. Open fracture to the left lower leg B. Large, deep laceration to the arm with bone visible C. Deformity to the right ankle with pain rated as a 10/10 D. Instability and crepitus to the left lateral chest wall
D
Which statement BEST describes the goal of EMS in a trauma system? A. Providing all trauma patients with a complete battery of diagnostic tests and access to specialists B. Providing the highest level of care possible within a 10-minute transport time for all patients C. Transporting as many patients as possible by air medical transportation D. Getting the right patient to the right facility in the right amount of time
D
Which statement is TRUE about child car seats when they are properly installed? A. Car seats should restrain a child at two points: the midpelvis and the chest. B. To prevent spinal cord injury, the car seat should face backward in the upright position. C. Injuries to children from airbag deployment are eliminated if the car seat is in the front passenger seat, facing backward. D. Having the car seat facing backward and in the reclining position will reduce spinal cord injury during a collision.
D
In a rear-end collision, a headrest that is in the fully down position: A. can decrease the severity of a whiplash injury. B. does not affect the severity of a whiplash injury. C. protects the driver from a secondary collision. D. can increase the severity of a whiplash injury.
D Rationale If there is a headrest that has been properly positioned and seat belts are worn, injury is minimized. However, if the vehicle does not have headrests or if the headrests are improperly positioned, the neck is hyperextended, and the anterior spinal ligaments are often stretched or torn. This is often referred to as a whiplash injury. An improperly positioned headrest that is pushed all the way down to restrain just the neck and not the head can actually contribute to the severity of the injury by creating a fulcrum against which the neck can be bent backward.
Full-thickness abrasions seen in a motorcycle accident are most likely the result of: A. rear impact. B. frontal impact. C. angular collision. D. laying the bike down.
D Rationale Laying the bike down is an evasive action on the part of the rider that is designed to prevent ejection and separation of the driver from the bike in an impending collision. The bike is turned sideways and "laid down" with the driver's inside leg dragging on the pavement or ground. The driver tends to lose speed faster than the bike, so this maneuver causes the bike to move out from under the driver. Abrasions can range from superficial abrasions, involving only the epidermis, to full-thickness abrasions, which extend through the subcutaneous tissue and, in severe cases, to the covering over the bone.
