answers EMS 113

Where are the likley pediatric injuries to be found if a child is struck by a vehicle?

anterior

A post MVC patient presents with a possible TBI and GCS of 13. Which is appropriate?

10 minutes and dip

An unresponsive patient is pulled from a burning vehicle involved in a MVC. EMTs note the patient has a blood pressure of 98/60 and extensive burns to the back, chest and arms, but no other signs of external injury. Which should be suspected as a cause of hypotension?

Burn shock

A patient presents with suspected head injury after a fall down the stairs. What should the initial first responder in the EMS crew do upon patient contact?

C-spine motion restriction

An adult trauma patient presents as follows: VS BP 100/74, P 128, R 30, skin is very pale moist and cool. What percentage of blood loss has occured?

30 to 40%

A shift from aerobic to anaerobic metabolism during hemorrhagic shock will result in which of the following?

A loss of body temperature

During assessment of a fall patient which of the following would be an indication for initiation of spine motion restriction?

A tingling sensation and weakness of the extremities

How is airway alignment maintained when it is necessary to place an infant on a long board?

Place padding under the shoulders

What is the total BSA burned if an adult has burns to the bilateral circumferential arms and the chest with no abdominal burns noted?

27%

A burn patient presents with thick blisters, some of which have ruptured. The skin is red and the patient can feel pressure, but not pain. This patient has which classification of burn?

Deep partial thickness

A patient has severe scalp hemorrhage and a depressed skull fx is suspected. How should the bleeding be addressed?

Direct pressure

What should be assessed before and after splinting an extremity injury?

Distal pulse, movement and sensation

Which mechanism would likely cause a compression injury to the spinal column?

Diving into a shallow pool

Which chemical burn is treated by first brushing off residue or powder?

Dry

A youth football player was hit and fell to the ground landing on the left elbow. The patient cannot move the lower arm and complains of pain in the elbow. What should be suspected?

Elbow dislocation

Which of the following groups suffer fractures of C1 and C2 more easily?

Elderly

Which type of burn produces entry and exit wounds?

Electrical

A pt. presents unconscious on a construction site with electrical wires on them. What is indicated first?

Ensure the electrical source is no longer energized

A pt. was hit by a line drive ball during a baseball game. The ball struck the side of the pts. head and no external bleeding is noted. The pt. was unconscious immediately after being struck, but regained consciousness and was speaking to EMS. During assessment the pt. has a sudden unexpected deterioration of mental status. Which is the likely cause?

Epidural hematoma

A conscious and alert adult is walking around the scene of a rear end MVC. The patient was in the lead vehicle which sustained major damage. The patient states they do not want EMS treatment. How should an EMT proceed at this point?

Explain to the patient a spine injury may exist due to the mechanism of injury

Supraorbital pressure is applied to a patient who has not responded to voice. Which would indicate the lowest (worst) response level to this painful stimuli?

Extension posturing

Which statement is true regarding penetrating or puncture injuries?

Extent of the injury is difficult to determine by looking at the wound

A patient is found on the ground next to a 24 foot extension ladder. Which sign or symptom would cause responders to suspect cervical column / spinal cord injury?

Extremity movement on only one side of the body

Why are infants or young children with a burn injury at greater risk of hypoperfusion than an adult with a burn injury?

Fluid (plasma) loss is greater due to body surface in relation to mass

Which statement is true when comparing an identical burn pattern in an adult vs. a child?

Fluid and heat loss in children are greater

An adult presents as follows following a lateral impact MVC into their door: VS: BP 100/78, P 122, R 24, SpO2 95% on room air, skin is pale cool and moist, BGL 102, pupils PERL. Which of the following injuries could cause this presentation?

Fractured femur

Which type of vehicle crash produces up and over or down and under injuries?

Front end

A patient has an uncontrolled nosebleed and trauma has been ruled out as a cause. How should the patient be positioned for transport?

Full Fowlers leaning forward

Which EMS assessment tool is used to trend the improvement or deterioration a TBI?

GCS

A patient involved in a motor vehicle crash is reliable and ambulatory but complains of some numbness and tingling. After applying a cervical collar what should EMTs do next?

Have the patient maintain self restriction as they sit down onto the stretcher

Which of the following accounts for a greater BSA when adjusting the rule of nines for an infant or a child?

Head

Direct pressure is not stopping a bleed and a tourinquet is not able to be placed. Which represents the best alternative?

Hemostatic agents

Which would cause suspicion of internal bleeding rather than a TBI when assessing a multi trauma pt.?

Hypertension

A pt. presents with lateral chest trauma. Which would raise suspicion of a tension pneumothorax?

Hypotension

Which are secondary TBI complications that increase pt. mortality?

Hypotension and hypoxia

Which of the following must be kept in mind when evaluating the response from application of a painful stimulus during the assessment of a possible spinal cord injury??

If a patient cannot feel pain they also will not be able to feel light touch

Which of the following best describes the general rules used to splint a long bone fracture?

Immobilize the joints above and below the fracture site

Which of the following statements regarding the spinal cord motor tracts is correct?

Impulses are sent from the spinal cord to the muscles

Which presentation of a closed TBI would indicate evolving brain herniation?

Increased systolic BP, bradycardia and respiratory changes

A pt. presents with pain in the anterior shoulder after a fall onto an outstretched arm. There is a midlclavicular deformity with point tenderness upon palpation. What type of force caused this injury?

Indirect

A tourniquet has been applied to an arterial bleed in an extremity. After placement the extremity is still bleeding. What should be done next?

Place a second tourniquet proximal to the first tourniquet

Which of the following is the preferred material to be used as an occlusive dressing for an abdominal, chest, or large neck injury?

Plastic wrap

Which represents the best emergency care practice for a TBI?

Prevent or limit secondary brain injury

Which would indicate that a pt .with suspected internal bleeding is progressing into severe shock?

Radial pulse cannot be palpated

A confused high school football player is lying motionless on the field and presents with a suspected concussion and spinal injury. The certified athletic director is with EMS personnel and states the pt. received a "vicious blow to the side of the head from another players helmet". How should EMS proceed based on this information?

Remove only the face guard

A patient was involved in a MVC. Bystanders state the patient appeared to be briefly unconscious prior to EMS arrival. Which would cause an EMT to suspect a concussion?

Repeated questioning about what had happened

A restaurant worker was splashed by hot oil used to cook french fries. Which classification of burn is this?

Scald

A trauma pt. presents with diffuse upper quadrant abdominal pain and an open fracture of the tibia and fibula. VS: BP 102/88, P 128, R 26, SpO2 96% on room air, skin is pale cool and moist. Which is suspected?

Shock due to internal bleeding

Which burn presentation requires priority transport?

Singed nasal hairs and hoarseness

A patient presents with a possible posterior dislocation of the shoulder. What method is used to stabilize the injury?

Sling and swath

A GSW victim has an entry wound in the lateral right lower abdominal quadrant. A corresponding posterior exit wound is noted at the same approximate position as the anterior wound. Which organ injury should be suspected?

Small or large intestine

A mid size SUV struck a large pick-up truck in a lateral MVC at a high rate of speed. Which of the following would lead to suspicion of serious injuries?

Speed of the vehicle

A MVC patient presents as follows, VS: BP 98/70, P 70, R 20. The patient is unable to move their legs and has no response to light touch or pain in the lower extrmities. Skin is pale cool and moist from the nipple line to the head,and dry, flushed and warm below the nipple line. What is suspected?

Spinal shock

A patient slipped on ice and twisted their ankle. The patient was able to stand and walk after the incident, but called EMS due to persistent tenderness. Which injury most likely occurred?

Sprain

Which acute or occult TBI is caused by bleeding from bridging veins?

Subdural hematoma

A 6 year old patient experienced blunt abdominal trauma. Which would indicate the child may abruptly deteriorate?

Tachycardia

If a helmet has not been removed prior to EMS arrival, under what circumstances would EMS remove a football or motorcycle helmet?

The head moves freely inside the helmet

Which is the first priority for treatment of a trauma victim?

c spine first

Which physically connects the brain with the spinal cord?

Brainstem

Which TBI is the result of acceleration and deceleration forces?

Diffuse axonal injury

Having a patient adduct and abduct the fingers assesses which of the spinal cord tracts?

Motor

Why are GSW exit wounds of larger diameter than entrance wounds?

Cavitation

Which soft tissue injury is generally a combination of a penetration-puncture and a crush injury?

Bite

Why should hypothermia be avoided during treatment of a trauma patient?

Low body temperature may slow clotting

A patient with a large burn injury presents with hypotension hours after the incident. Which is the likely cause?

Decreased hydrostatic pressure

A football player has an apparent cervical injury. The patient's helmet has been removed by the athletic trainer and an EMT due to a loose fit. How should EMTs secure the patient to the backboard without causing or aggravating the injury, until shoulder pads can be removed?

Add padding behind the head to maintain a neutral in-line position

Which should an EMT assess first when treating a patient with a major burn?

Airway involvement

Broken skin is noted over the site of a fractured tibia. Which is suspected?

An open fracture

Which treatment is correct for a thermal burn to a patients eye?

Apply dry sterile dressings to both eyes

Which injury presents with a loose flap of skin and possible severe bleeding?

Avulsion

An unresponsive patient is found to have sustained blunt force trauma to the head. It is unknown when the injury occurred. EMTs note a dried bloody, watery discharge from the ears and nose and find no palpated deformity. Ecchymosis is noted behind the ear. Which is suspected?

Basilar skull fracture

While conducting a neurological assessment on a patient involved in a MVC EMTs note the following: A loss of motor function and light touch sensation on the left side of the body, but retention of pain sensation on the left side. The right side of the body has normal motor function and light touch sensation, but has no sensation to pain. Which is suspected?

Brown-Sequard syndrome

A high school football player is down on the field. The patient has loss of function and pain sensation in the arms, but has normal motor and sensory function in the legs. Which injury is suspected?

Central cord syndrome

A child involved in a frontal MVC was in a car seat in the rear of the vehicle and forward facing. What injury should be anticipated when encountering a pediatric patient seated in this fashion?

Cervical spinal cord injury

A patient is complaining of a burning sensation and extreme pain after fracturing an extremity. The site appears very swollen and upon palpation feels hard. Which is suspected?

Compartment syndrome

Which patient needs spine motion restriction based on presentation?

Conscious with a distracting injury

A patient presents with an evisceration. Which treatment is appropriate?

Cover the organ with moistened sterile dressing and apply an occlusive bandage

Which is correct when dressing a burn injury?

Cover with dry sterile dressing

A reliable patient is seated in a vehicle which was involved in a rear end collision. The patient has no apparent injury that would prevent them from self extricating from the vehicle. What is the first step in this process?

Instruct the patient to hold their neck and head in a neutral position and not move

A vehicle has 14" intrusion into the drivers side door. EMTs should have an index of suspicion of what potentially fatal injury?

Internal bleeding from the pelvis or femur

A trauma patient complains of abdominal pain and presents as follows, VS- BP 120/80, P 100, R 22 with bilaterally clear lungs with equal expansion, skin is warm pink and dry. Reassessment 10 minutes later reveals the following second set of VS: BP 108/90, P 130, R 32 bilaterally clear lungs with equal expansion, skin pale cool and moist. The patient has no external signs of injury but is now anxious and fidgety. What is suspected?

Internal hypovolemic injury

A patient presents with a GSW to the upper back. The entrance wound is 1 inch lateral to C-7 with little external bleeding. What should be done first?

Look for an exit wound

After being struck by a vehicle, an unconscious child is suspected of having a closed TBI. Which is appropriate?

Maintain an open airway and SpO2 greater than or equal to 95%

Extensive bleeding and difficulty managing the airway are common with GSW's to which part of the body?

Neck

A geriatric female patient is found lying on the floor in the doorway of her home. The patient states she was walking when she felt a sharp pain in the upper thigh which caused the fall. The patient has a PMH of cancer and osteoporosis. Which is the suspected?

Nontraumatic fracture of the femur

A patient has fallen from a ladder and is unresponsive but breathing. There is a large pool of blood surrounding the back of the patient's head, but not noted coming from the ears or nose. The patient has a BP of 106/88 and pulse of 128. What is suspected?

Open scalp injury

Which of the following is a sign, or symptom of shock?

Pain

A pt. presents with a fractured humerus.Which of the following would indicate associated blood vessel injury?

Pale, cool skin distal to the fracture

Which injury can be stabilized using the KED turned upside down?

Pelvic

When should an impaled object be removed in the field?

The object is in the cheek and obstructing airflow to the trachea

A patient has been burned from a chemical that splashed onto their arms and chest. No initial care has been undertaken by coworkers and there is a language barrier. What should be on-site to help guide the EMTs treatment?

The safety data sheet

A vest type device or short board SMR device is indicated for a pt. seated in a vehicle. Which of the following is correct?

The top of the device should be even with the top of the patient's head

A patient involved in a single vehicle, low speed, property damage only MVC admits to consumption of ETOH while watching a NFL game 3 hours prior to the crash. The patient is denying any injury, pain, or loss of consciousness. Which of the following is most appropriate?

Transport due to suspicion of impaired decisional capacity

Which patient should be removed from a MVC using the rapid extrication technique?

Unresponsive

A patient complains of abdominal pain that has not subsided for three days and a "swollen abdomen". Assessment reveals diffuse lower quadrant pain upon palpation. The patient also states their stools have been dark and tarry. What should be suspected?

Upper G.I. internal bleeding

Which is the most common mechanism of traumatic injury?

falls

Which injury should be anticipated if a motorcycle rider "lays the bike down"?

full thickness abrasions

A motorcycle struck the rear of a stationary vehicle at high speed. When developing suspicion of injury patterns, which must be first taken into consideration?

has helmet

A patient presents with severe bleeding which EMTs have now stopped. Which of the following should be initiated in an effort to maintain aerobic metabolism despite the blood loss?

high flow O2 to an SpO2 of 95% or greater

What type of connective tissue connects muscles to bones?

tendons