Prehospital Emergency Care, Chapter 35

21) While a 43-year-old man was cleaning a window, the glass broke and a sharp piece sliced his groin. Assessment shows him to have a large laceration to his left scrotum, with a testicle exposed and protruding through the sac. Blood is pouring from the laceration, and the patient rates the pain as an 8/10. What should the EMT do first? A) Apply direct pressure to the injury to stop the hemorrhage B) Provide oxygen at 15 lpm C) Call for advanced life support assistance D) Cover the exposed testicle with moist dressing, and dress it loosely to collect the blood that is escaping

A) Apply direct pressure to the injury to stop the hemorrhage

9) A patient has been assaulted and sustained blunt trauma to the abdomen. As you start the primary assessment, you note that he is vomiting blood and you begin to suction him immediately. After the airway has been suctioned, you should: A) Check the adequacy of the patient's breathing B) Examine the abdomen for specific injuries C) Obtain a full set of vital signs D) Administer oxygen with a nonrebreather face mask

A) Check the adequacy of the patient's breathing

3) Which abdominal organ or structure, if seriously injured, would cause the most rapid death? A) Descending aorta B) Spleen C) Stomach D) Large intestine

A) Descending aorta

15) A patient has referred pain to her left shoulder. What should the EMT suspect? A) Hemorrhage from the spleen B) Rupture of the small intestine C) Damage to the gallbladder D) Trauma to the right kidney

A) Hemorrhage from the spleen

10) A 45-year-old female was at a family reunion and fell off a trampoline. She hit a picnic table with the left side of her lower rib cage. Now, she is very anxious and confused. Her airway is open and her breathing adequate. Her radial pulse is rapid and weak, and her skin is cool and diaphoretic. Vital signs are pulse, 132 beats/min; respirations, 20 breaths/min; blood pressure, 102/78 mmHg; and SpO2, 97% on ambient air. The patient has ecchymosis to the left lower rib area as well as tenderness and instability to the rib cage. She also has a superficial abrasion to her forehead. Given these findings, you would suspect and treat her for which condition? A) Hypovolemic shock B) Hypoxia C) Spinal shock D) Closed head injury

A) Hypovolemic shock

1) A patient has been stabbed in the right upper quadrant of the abdomen. Which solid organ should the EMT be most concerned with being injured? A) Liver B) Stomach C) Small intestine D) Kidney

A) Liver

26) A middle-aged male sustained blunt force trauma to the abdomen, resulting in an isolated tear and perforation of the large intestine. When following up on the patient, what would the EMT suspect occurred, given the organ that was injured? A) The patient developed an infection B) The patient rapidly decompensated into shock C) The patient has profound hypoxia D) The patient developed severe internal bleeding

A) The patient developed an infection

28) The EMT has fundamental understanding of abdominal trauma when he states: A) "Evisceration injuries can be recognized by dark-colored bruising over the top of the injury site." B) "Blunt trauma is especially lethal because of the large number of organs that can be affected." C) "Injuries to solid organs like the bladder tend to be more lethal than injuries to hollow organs." D) "Injuries to hollow organs tend to be worse than injuries to solid organs because of the increased potential for blood loss."

B) "Blunt trauma is especially lethal because of the large number of organs that can be affected."

2) The EMT recognizes that the division between the thoracic and abdominal cavities lies approximately: A) At the level of the umbilicus B) At the fifth intercostal space C) Below the twelfth rib D) Above the twelfth thoracic vertebra

B) At the fifth intercostal space

34) You are transporting a male patient with a deep stab wound to the groin, with damage also noted to the genitalia following an assault by his girlfriend. The patient is alert and oriented, albeit restless. Vital signs on scene were pulse, 128 beats/min; respirations, 20 breaths/min; blood pressure, 108/64 mmHg; and SpO2, 92%. Oxygen is being administered via nasal cannula. Upon reassessment, which sign would be most concerning to the EMT? A) Patient's urge to void B) Blood pressure is now 106/88 mmHg C) SpO2 stabilizing at 96% despite O2 therapy D) Heart rate of 132 beats/min

B) Blood pressure is now 106/88 mmHg

23) You have been called for a deeply disturbed psychiatric patient who has cut off the tip of his penis with a steak knife. Assessment reveals the 31-year-old male to be crying, with blood noted to his hands and pants. The primary assessment reveals no acute life threats. At this time, your priority is to: A) Place the amputated penis in sterile water B) Control any active bleeding that may be occurring C) Prevent the patient from urinating D) Determine why the patient cut himself

B) Control any active bleeding that may be occurring

7) You have arrived on the scene of a stabbing. As you approach the patient, you note that his shirt is off and a single stab wound to the right lower quadrant of the abdomen is evident. The patient appears unresponsive as you approach. At the patient's side, your first action should be to: A) Cover the wound with a nonporous dressing B) Examine the patient's airway C) Quickly look for additional stab wounds D) Provide oxygen via nonrebreather face mask

B) Examine the patient's airway

32) You are transporting an alert and oriented male who sustained severe abdominal trauma in an assault. The primary survey indicates a patent airway with respirations of 24 breaths per minute. Breath sounds are present bilaterally. The patient has a rapid and weak radial pulse of 144 beats per minute, and his skin is pale and cool. The blood pressure is 92/64 mmHg and SpO2 is 92%. Best management of the respiratory and oxygenation parameters would include: A) Positive pressure ventilation with supplemental oxygen B) High-concentration oxygen through a nonrebreather mask C) Application of a nasal cannula at 4 lpm O2 D) Encouraging the patient to slow his respirations

B) High-concentration oxygen through a nonrebreather mask

16) A 74-year-old female complains of abdominal pain after falling down five stairs off her front porch and striking her abdomen and left hand on a mailbox at the bottom. The patient also reports pain in her left wrist and right ankle, both of which show obvious deformity. She is alert and oriented, and her abdomen is free of bruising but tender in the left upper and lower quadrants. Her vital signs are pulse, 132 beats/min; respirations, 22 breaths/min; blood pressure, 106/86 mmHg; and initial SpO2, 93% on room air. Oxygen has been applied, and the patient has full spine motion restriction precautions in place. Advanced life support has been requested and is 12 minutes away from your current location. What is your next action? A) Apply ice to the wrist and ankle while awaiting arrival of the ALS unit B) Initiate immediate transport and intercept with the ALS unit C) Monitor the patient and wait for ALS assistance D) Secure the wrist and ankle to board splints, initiate transport, and cancel the ALS unit

B) Initiate immediate transport and intercept with the ALS unit

20) The EMT's care for an open chest wound and for an abdominal evisceration are similar in that: A) Air must be periodically released from both wounds B) Occlusive dressings should be placed over both wounds C) Moist dressings are placed over both wounds D) Both wounds can cause the trapping of air in the body

B) Occlusive dressings should be placed over both wounds

13) Which one of these injuries is most likely to cause peritonitis? A) Contusion to the pancreas B) Stab wound to the small intestine C) Blunt trauma to the spleen D) Bullet injury to the liver

B) Stab wound to the small intestine

27) You are assessing a young male patient who was assaulted with a baseball bat and struck once on the left upper quadrant of the abdomen. You would recognize that this patient has Kehr's sign when he makes which statement? A) "I am having a hard time breathing!" B) "My belly hurts really bad." C) "My left shoulder is killing me!" D) "It really hurts for me to breathe."

C) "My left shoulder is killing me!"

5) You have been called for a male patient who was shot with a rifle. Assessment reveals an entrance wound to the left lower quadrant of the abdomen. A hemorrhaging exit wound to the left lower back is also located. What should you do immediately? A) Cover the abdominal wounds with dry sterile gauze dressings B) Auscultate the patient's breath sounds C) Cover the entrance wound with a gloved hand D) Place a cervical collar on the patient

C) Cover the entrance wound with a gloved hand

17) You have been called for a 42-year-old male who complains of back pain. At the scene, the man tells you that he was lying on the floor when his 5-year-old son unexpectedly jumped feet first onto his back. He gives a medical history of high blood pressure and asthma, for which he takes medications. As you assess the patient, which finding provides the greatest indication that the patient has sustained an abdominal injury? A) Bruise to his back B) Mild nausea C) Discoloration around the umbilicus D) Shortness of breath

C) Discoloration around the umbilicus

30) While returning from a call, you are flagged down by a frantic family member of a 12-year-old male patient. She is standing in the yard, and reports that the child was shot in the abdomen and is now inside the house. She states that she has already called the police, who have not arrived yet, and that the shooter is another family member who has since left the scene. What is your best course of action? A) Go to the porch and have the patient brought to you B) Carefully look for scene hazards and enter once you feel safe C) Move the ambulance and wait for law enforcement to arrive D) Cautiously enter the house and be ready to vacate if any hazards are found

C) Move the ambulance and wait for law enforcement to arrive

8) You have just arrived on the scene of a very serious motor vehicle collision. Emergency Medical Responders (EMRs) have rapidly extricated an unresponsive female from the driver's seat. The EMRs report that she was unrestrained and struck the steering wheel with her chest and abdomen. As you start the primary assessment, you note that the patient has snoring respirations and demonstrates shallow breathing at a rate of 24 breaths per minute. What should you do next? A) Obtain vital signs B) Secure the patient to backboard with a cervical collar placed C) Perform a jaw-thrust maneuver D) Start positive pressure ventilation

C) Perform a jaw-thrust maneuver

24) A female patient suffered a straddle injury (genitalia trauma) while trying to balance on top of a chain-link fence, after she fell with a leg on each side of the fence. At this time, you would: A) Apply an ice pack wrapped in a towel to the genital area B) Gently put sterile gauze dressings into the opening of the vaginal canal to stop the bleeding C) Place a moist compress, such as a moist sanitary pad, over the injury to control the bleeding D) Clean the area with sterile saline and apply direct pressure with a gloved hand while monitoring for ongoing bleeding

C) Place a moist compress, such as a moist sanitary pad, over the injury to control the bleeding

18) During a motor vehicle collision, a confused unrestrained male struck the steering wheel with his abdomen. Currently, he is confused and complains of generalized abdominal pain, which he rates as 6/10. Assessment indicates red marks across his lower abdomen caused by the steering wheel. His pulse is 140 beats/min, respirations are 24 breaths/min, blood pressure is 108/88 mmHg, and SpO2 is 86%. The patient looks pale and has moist skin. What is most appropriate when providing oxygen to this patient? A) Provide 2 lpm through a nasal cannula B) Provide 8 lpm through a simple face mask C) Provide 15 lpm through a nonrebreather mask D) Oxygen can be withheld due to the SpO2 reading

C) Provide 15 lpm through a nonrebreather mask

11) You have arrived on the scene of an assault involving a knife. Assessment of the unresponsive 21-year-old male patient reveals him to have sustained multiple lacerations to the arms and abdomen, and a section of his intestine is now protruding through a large laceration in the area around the umbilicus. He has lost a significant amount of blood. His airway is open and he is breathing poorly at a rate of 28 breaths per minute. His radial pulse is weak, and his skin is cool and pale. What should the EMT do first? A) Cover the intestine with saline-soaked gauze B) Secure the patient to a long spine board C) Start positive pressure ventilation D) Check the blood pressure

C) Start positive pressure ventilation

29) At the scene of a motor vehicle accident, a car has extensive front-end damage and a deformed steering wheel. The restrained driver, who was self-extricated, is in the care of EMRs, who have applied a cervical collar and continue to maintain spine motion restriction precautions. The patient's airway is patent and respirations adequate. His radial pulse is rapid and weak, and his skin is cool and diaphoretic. The EMRs report the following vital signs: pulse, 136 beats/min; respirations, 20 breaths/min; blood pressure, 100/68 mmHg; and SpO2, 95% with supplemental O2 being administered. The right forearm is deformed, and the head, chest, and upper back are uninjured according to your assessment. Your next action would be to: A) Start positive pressure ventilation B) Repeat the vital signs C) Change the nonrebreather mask to a nasal cannula D) Check the abdomen for injury

D) Check the abdomen for injury

33) On scene, you encounter a restless patient who has been stabbed in the right upper quadrant of the abdomen and now complains of abdominal pain and a dry mouth. Assessment reveals no immediate life threats to the airway or breathing. The radial pulse is rapid and weak, and the skin cool and diaphoretic. Vital signs are pulse, 124 beats/min; respirations, 20 breaths/min; blood pressure, 122/88 mmHg; and SpO2, 90% on room air. The injury is isolated, with no involvement of the head, neck, or back. In managing the scene and the patient, which observation would cause you to immediately intervene? A) An EMR placing his gloved hand over the injury to control the bleeding B) Application of supplemental oxygen C) An EMR placing the patient in a lateral recumbent position with the knees flexed D) Family giving the patient water to drink since he is thirsty

D) Family giving the patient water to drink since he is thirsty

25) You are transporting a female patient who was sexually assaulted by having a foreign body inserted deep into her vagina. You are attempting to control hemorrhage by the appropriate means. As you reassess the patient, which finding is of most concern? A) Pain increases from 7/10 to 10/10 B) Large blood clots form at the vaginal entrance C) The patient informs you she has a sexually transmitted disease D) Heart rate increases from 116 to 140 beats/min

D) Heart rate increases from 116 to 140 beats/min

4) A patient who experienced blunt trauma to the abdomen has a lacerated liver. Given this information, what would represent the most immediate threat to life? A) Liver infection B) Significant pain C) Development of acute peritonitis D) Internal hemorrhage

D) Internal hemorrhage

31) If a patient has severe retroperitoneal bleeding from an organ located within this cavity, she has most likely injured her: A) Stomach B) Liver C) Large intestine D) Kidney

D) Kidney

14) A patient has been shot in the abdomen. Assessment reveals that the bullet entered the body in the right upper quadrant and exited the lower right back. Given this finding, the EMT should assume which solid organs may have been injured? A) Liver and gallbladder B) Liver, gallbladder, and right kidney C) Liver, gallbladder, right kidney, and small intestine D) Liver, right kidney, and pancreas

D) Liver, right kidney, and pancreas

19) An industrial worker has sustained a laceration to his abdomen. On closer inspection, you note what appears to be fat tissue and a portion of intestine protruding through the wound. Which intervention is most appropriate for treating this injury? A) One attempt at replacement of the eviscerated material in the abdomen using sterile gloves B) Dry sterile dressing applied over the wound C) Direct pressure using gloved palms to the injury D) Occlusive dressing applied over saline-soaked gauze

D) Occlusive dressing applied over saline-soaked gauze

6) You have arrived on the scene for a patient assaulted with a baseball bat. As you approach, which position would seemingly indicate that he has suffered an injury to the abdomen? A) Supine with legs extended and toes pointed B) Prone with hands on the back C) Standing with restless movement and pacing D) On his side with knees drawn to the chest

D) On his side with knees drawn to the chest

22) A 16-year-old male has been struck in the genitalia by a baseball. Assessment indicates a tremendous amount of edema as well as hematoma formation and bruising to his scrotum. The primary assessment reveals no life-threatening conditions; however, the patient is crying and rates the pain as 10/10. Which action is most appropriate for this patient? A) Rapid transport using lights and sirens B) Application of warm packs to the scrotum C) Apply direct pressure to the site of injury D) Place cool compresses to the testicles

D) Place cool compresses to the testicles

12) A patient has sustained a large abdominal evisceration, such that a large portion of intestines are now exposed. After properly managing this injury, you are preparing the patient for transport. You ascertain that there is no evidence of spinal injury. How should you place the patient on the stretcher for transport? A) Prone position, to maintain pressure on the abdomen B) Semi-Fowler's position, to promote adequate breathing C) Lateral recumbent position with legs extended D) Supine position, with knees and hips flexed

D) Supine position, with knees and hips flexed