EMT- Chapter 28 (head & spine trauma)

You have been called to a residence of a diabetic patient who is confused. 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 the following physical exam findings, which one is most concerning? a. Bruise to the left temple b. Blood glucose level of 77 mg/dl c. SpO2 at 96% d. Heart rate of 62 beats per minute

a. Bruise to the left temple

Your patient is a young adult male in police custody after he crashed his car into a utility pole. There is minor front-end damage to vehicle, and the airbags deployed. The patient was not wearing a seatbelt and has an abrasion on his forehead. He is awake and oriented to person, time, and place. His speech is slurred and he has an odor of alcohol on his breath. The arresting officer states that he just wants you to check the patient out before he transports him to jail. Which one of the following is most appropriate? a. Contact medical command. b. Have the patient sign a refusal-of-care form. c. Release the patient to the police. d. Have the officer sign a refusal-of-care form.

a. Contact medical command.

In which of the following situations would the EMT be the LEAST likely to immobilize a patient's spine? a. No distracting injuries or evidence of intoxication b. No spinal pain, but tingling in the extremities c. Unresponsive, but moving all extremities equally d. Pain to the c-spine, but no numbness or tingling.

a. No distracting injuries or evidence of intoxication

Which of the following statements regarding motor nerves is correct? a. They carry information from the CNS to the muscles. b. They are part of the CNS and control reflexes. c. They transmit information from the body to the brain via the spinal cord. d. They perform special functions such as sight, smell, and hearing.

a. They carry information from the CNS to the muscles.

The MOST reliable sign of a head injury is: a. a decreased level of consciousness. b. decreased sensation in the extremities. c. an abnormally low blood pressure. d. a pulse that is rapid and thready.

a. a decreased level of consciousness.

An epidural hematoma is MOST accurately defined as: a. bleeding between the skull and dura mater. b. an injury caused by a damaged cerebral artery. c. bleeding between the dura mater and brain. d. venous lacerations that occur within the brain.

a. bleeding between the skull and dura mater.

The _______________ contain(s) about 75% of the brain's total volume. a. cerebrum b. brain stem c. cerebellum d. meninges

a. cerebrum

The tough, fibrous outer meningeal layer is called the: a. dura mater. b. gray mater. c. arachnoid mater. d. pia mater.

a. dura mater.

When immobilizing a patient on a long backboard, you should: a. ensure that you secure the torso before securing the head. b. follow the commands of the person at the patient's torso. c. have the patient exhale before fastening the torso straps. d. secure the torso and then center the patient on the board.

a. ensure that you secure the torso before securing the head.

You have been called for a patient with extreme back pain. When you are obtaining a medical history, from the patient, he tells you that he has a history of damaged disks in his vertebrae. As a knowledgeable EMT, you should recognize that: a. fluid-filled structures between the vertebrae have been injured. b. ligaments on the side of the spinal column were overstretched. c. nerves making up the spinal cord have been damaged. d. vertebrae making up the spinal column were fractured.

a. fluid-filled structures between the vertebrae have been injured.

A patient is being extricated from a car using a vest-type short immobilization device. After the patient has been extricated, the EMT should: a. immobilize the patient with the vest-type short immobilization device to a long backboard. b. remove the vest-type short immobilization device and secure the patient to a long backboard. c. place the patient in a semi-Fowler's position on the stretcher for transport to the hospital. d. secure the patient and vest-type short immobilization device in a supine position on the stretcher with the feet elevated.

a. immobilize the patient with the vest-type short immobilization device to a long backboard.

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 breathing shallow and irregular. A radial pulse that is moderate in strength is palpated. Her pulse is 64 beats per minute, respirations are 8, and blood pressure is 210/110 mmHg. She has noted deformity to her forehead and a left pupil that is fixed and dilated. Manual in-line stabilization is being held by Emergency Medial Responders (EMR). The EMT's priority action at this point would be to: a. provide positive pressure ventilation at 20 breaths per minute. b. perform the secondary assessment to identify additional injuries. c. use the Glasgow Coma Scale to determine the exact severity of her brain injury. d. apply oxygen via a nonrebreather face mask at 15 lpm.

a. provide positive pressure ventilation at 20 breaths per minute.

Which one of the following patients has an isolated head injury that should be considered the most serious? a. 31-year-old male who is nonverbal and extends his arms and legs when you pinch the muscles on his shoulder b. 21-year-old male wearing a deformed motorcycle helmet who does not respond to verbal or painful stimuli c. 62-year-old female who fell and hit her head and is becoming very confused and combative d. 53-year-old female who fell and has a large laceration that is bleeding heavily to the back of her head

b. 21-year-old male wearing a deformed motorcycle helmet who does not respond to verbal or painful stimuli

Which of the following interventions may be used to help reduce intracranial pressure? a. Maintaining SpO2 at 90% b. 30-degree elevation of the head c. Supine with the legs elevated d. Increasing the patient's body temperature

b. 30-degree elevation of the head

Which one of the following assessment findings is most indicative of increasing pressure within the skull from a closed-head injury? a. Respirations of 24 per minute b. Blood pressure of 192/106 mmHg c. Heart rate of 132 beats per minute d. Right pupillary constriction

b. Blood pressure of 192/106 mmHg

A window washer has fallen 20 feet from scaffolding while washing the windows on an office building. He is alert and oriented, but states that he cannot move or feel his legs. Additionally, because his blood pressure is 82/48 mmHg, you suspect spinal shock. What other assessment finding reinforces your suspicion of spinal shock? a. Heart rate of 144 b. Cool and clammy skin c. SpO2 at 92% d. Flushed and dry skin

b. Cool and clammy skin

Which one of the following best describes the purpose of determining a Glasgow Coma Scale score (GCS) in a patient with a head injury? a. The score is important in guiding the EMT's treatment of the patient. b. It helps determine whether a patient's mental status is improving or deteriorating. c. It allows the EMT to predict the patient's likelihood of recovery. d. The score gives information about the type of injury to the brain.

b. It helps determine whether a patient's mental status is improving or deteriorating.

An Emergency Medical Responder reports that a patient has bruising to the lumbar area of the back. Based on this statement, the EMT should expect to find bruising in which area? a. Neck b. Lower back c. Upper back d. Buttocks

b. Lower back

You are assessing a patient who tells you that he called 911 because of severe back pain. He informs you that his back pain is coming from a recent fracture of his coccyx. Based on this information, where should the EMT expect the patient to be complaining of pain? a. Upper back b. Pelvic area c. Lower back d. Neck

b. Pelvic area

Which of the following nerves carry information from the body to the brain via the spinal cord? a. Motor b. Sensory c. Central d. Somatic

b. Sensory

A 61-year-old male has fallen off a roof. Your primary assessment findings include unresponsiveness, shallow breathing, and a weak and slow radial pulse. His skin is cool and dry. Emergency Medical Responders are maintaining manual in-line spinal stabilization. Which one of the following should you do immediately? a. Apply a cervical collar. b. Start positive pressure ventilation. c. Place the patient in the shock position. d. Transfer to the stretcher for rapid transport.

b. Start positive pressure ventilation.

A trauma surgeon informs you that the patient you transported to the emergency department earlier was diagnosed with an epidural hematoma. The patient was taken into surgery and the hematoma was removed. Right now the patient is in guarded condition. Based on this information, the EMT should recognize that an epidural hematoma is: a. blood from a ruptured artery forming a hematoma within a section of brain tissue. b. a pocket of arterial blood collected between the skull and dura mater. c. cerebral spinal fluid accumulated in a pocket on top of the brain tissue. d. blood from a ruptured vein collected between the dura mater and brain tissue.

b. a pocket of arterial blood collected between the skull and dura mater.

The _______________ is the best-protected part of the CNS and controls the functions of the cardiac and respiratory systems. a. cerebral cortex b. brain stem c. spinal cord d. cerebellum

b. brain stem

The MOST common and serious complication of a significant head injury is: a. a skull fracture. b. cerebral edema. c. acute hypotension. d. a hypoxic seizure.

b. cerebral edema.

If you do not have the appropriate-size cervical collar, you should: a. ask the patient to keep his or her head in a neutral position. b. use rolled towels to immobilize the patient's head. c. place sandbags on either side of the patient's head. d. defer cervical immobilization and apply lateral head blocks.

b. use rolled towels to immobilize the patient's head.

A female patient with a suspected head injury has slow, shallow breathing. The MOST appropriate treatment for her includes: a. hyperventilating her at 30 breaths/min. b. ventilation assistance to maintain an ETCO2 of 30 to 35 mm Hg. c. ventilation assistance to maintain an oxygen saturation of 90%. d. administering oxygen via a nonrebreathing mask.

b. ventilation assistance to maintain an ETCO2 of 30 to 35 mm Hg.

An EMT is rapidly extricating a critically injured patient from a severely damaged vehicle. Which one of the following would the EMT recognize as acceptable given this patient's condition? a. The long backboard can be omitted and the patient can be placed directly onto the stretcher as long as a cervical collar has been applied. b. Manual in-line spinal stabilization can be omitted in the vehicle, but should be taken once the patient has been extricated and is on the long backboard. c. A vest-type or other short spine immobilization device can be omitted, but a cervical collar and manual in-line spinal stabilization are still required. d. A vest-type or other short spine immobilization device still needs to be used to extricate the patient from the vehicle.

c. A vest-type or other short spine immobilization device can be omitted, but a cervical collar and manual in-line spinal stabilization are still required.

Which of the following sets of vital signs depicts Cushing triad? a. Blood pressure, 200/100 mm Hg; pulse, 140 beats/min; respirations, 28 breaths/min b. Blood pressure, 90/50 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min c. Blood pressure, 190/110 mm Hg; pulse, 55 beats/min; respirations, 30 breaths/min d. Blood pressure, 80/40 mm Hg; pulse, 30 beats/min; respirations, 32 breaths/min

c. Blood pressure, 190/110 mm Hg; pulse, 55 beats/min; respirations, 30 breaths/min

A patient was killed immediately following a self-inflicted gunshot wound to the head. Which portion of the central nervous system was most likely damaged in order to cause the rapid death of the patient? a. Cerebrum b. Cerebellum c. Brainstem d. Meninges

c. Brainstem

A patient involved in an altercation has been struck at 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 one of the following signs and symptoms best indicates the patient has suffered a brain injury? a. Ecchymosis to the side of the face b. Weakness to both arms c. Confusion and combativeness d. Complaint of a headache

c. Confusion and combativeness

A male driver was ejected from his vehicle after it rolled several times at a high rate of speed. As you approach the patient you note that he is unresponsive and struggling to breathe. He also has a laceration to the left side of his face and multiple contusions to his legs. After assigning another EMT to take manual in-line spinal stabilization, what should you do? a. Apply a properly sized cervical collar. b. Start positive pressure ventilation. c. Open the airway using the jaw-thrust maneuver. d. Insert an oropharyngeal airway.

c. Open the airway using the jaw-thrust maneuver.

Which one of the following signs or symptoms best indicates the patient has suffered an injury to the thoracic spine? a. Paralysis of the arms b. Altered mental status c. Tingling in the legs d. Cool and diaphoretic skin

c. Tingling in the legs

A 45-year-old male was working on his roof when he fell approximately 12 feet, landing on his feet. He is conscious and alert and complains of an ache in his lower back. He is breathing adequately and has stable vital signs. You should: a. allow him to refuse transport if his vital signs remain stable. b. perform a rapid head-to-toe exam and immobilize his spine. c. immobilize his spine and perform a focused secondary exam. d. obtain a Glasgow Coma Score value and give him oxygen.

c. immobilize his spine and perform a focused secondary exam.

You and your partner are preparing to extricate a patient from a car using a vest-type short spine immobilization device. After ensuring that in-line manual spinal stabilization is being maintained, your next instruction should be: a. "Let's get the cervical collar applied before we place the vest." b. "Let's turn the patient toward the door of the car before applying the vest." c. "Let's place the vest on the backboard and carefully move him from the car onto it." d. "Let's check his motor, sensory, and pulses in the arms and legs."

d. "Let's check his motor, sensory, and pulses in the arms and legs."

The EMT is caring for a patient who has a problem with the autonomic component of his nervous system. Which one of the following signs or symptoms might be evident? a. Inability to move facial muscles b. Difficulty walking c. Trouble remembering his name d. Elevated heart rate

d. Elevated heart rate

Which of the following statements regarding a basilar skull fracture is correct? a. In most cases, mastoid bruising occurs. b. They are typically the result of local, low-energy trauma to the head. c. Bloody CSF commonly leaks from the nose. d. The absence of raccoon eyes or Battle sign does not rule it out.

d. The absence of raccoon eyes or Battle sign does not rule it out.

After your partner assumes manual in-line stabilization of the patient's head, you should: a. use four people to log roll the patient onto a backboard. b. thoroughly palpate the patient's head for deformities. c. apply an appropriately sized rigid cervical collar. d. assess distal neurovascular status in the extremities.

d. assess distal neurovascular status in the extremities.

A temporary loss or alteration of part or all of the brain's abilities to function without physical damage to the brain MOST accurately describes a(n): a. intracerebral hematoma. b. intracranial hemorrhage. c. cerebral contusion. d. cerebral concussion.

d. cerebral concussion.

The hormone responsible for the actions of the sympathetic nervous system is: a. thyroxine. b. insulin. c. aldosterone. d. epinephrine.

d. epinephrine.

When the parasympathetic nervous system is activated: a. heart rate and blood pressure increase. b. blood is shunted away from the digestive organs. c. hormones are released that prepare the body for stress. d. the heart rate decreases and the blood vessels dilate.

d. the heart rate decreases and the blood vessels dilate.