Chapter 33

Because significant force is required to fracture the mandible: Select one: A. most mandibular fractures are associated with a spinal fracture. B. it is often fractured in more than one place and is unstable to palpation. C. patients with a possible mandibular fracture should be intubated routinely. D. a mandibular fracture can be ruled out in cases of minor blunt facial trauma.

it is often fractured in more than one place and is unstable to palpation.

You are transporting a conscious middle-aged woman with anterior neck trauma. She is on high-flow oxygen, has spinal precautions in place, and has a large-bore IV line of normal saline in place. When you reassess her vital signs, you note that her blood pressure is 90/64 mm Hg, her pulse rate is 120 beats/min, and her respirations are 22 breaths/min with adequate depth. You should: Select one: A. begin assisting her ventilations with a bag-mask device, rapidly infuse 2 L of IV fluid, and reassess. B. keep the patient warm and infuse enough isotonic crystalloid solution to maintain adequate perfusion. C. elevate her legs, apply a blanket, and administer IV fluid boluses until her heart rate is within a normal range. D. start a second IV line and administer crystalloid IV fluids until her systolic blood pressure is at least 100 mm Hg.

keep the patient warm and infuse enough isotonic crystalloid solution to maintain adequate perfusion.

A young man was assaulted and has extensive maxillofacial injuries. Your primary assessment reveals that he is semiconscious, has shallow breathing, and has blood draining from the corner of his mouth. Initial management for this patient involves: Select one: A. inserting an oropharyngeal airway, preoxygenating him with a bag-mask device for 2 minutes, and then intubating his trachea. B. applying a cervical collar, performing a blind finger sweep to clear his airway, and providing ventilatory assistance with a bag-mask device. C. fully immobilizing his spine, inserting a nasopharyngeal airway, and hyperventilating him with a bag-mask device at a rate of 20 breaths/min. D. manually stabilizing his head in a neutral position, suctioning his oropharynx, and assisting ventilations with a bag-mask device and 100% oxygen.

manually stabilizing his head in a neutral position, suctioning his oropharynx, and assisting ventilations with a bag-mask device and 100% oxygen.

Vascular injury following trauma to the anterior neck would MOST likely present with: Select one: A. hemoptysis. B. parasthesia. C. pulse deficits. D. dysphagia.

pulse deficits.

Alkali or strong acid burns to the eye should be irrigated continuously for at least ___ minutes. Select one: A. 10 B. 15 C. 20 D. 30

20

A fracture of all midfacial bones, separating the entire midface from the cranium: Select one: A. is commonly associated with facial elongation and dental malocclusion. B. should be stabilized by placing bulky dressings across the fractured area. C. is almost always accompanied by multiple severe fractures of the mandible. D. is referred to as a Le Fort I fracture and most commonly results from a fall.

is commonly associated with facial elongation and dental malocclusion.

When treating a patient with an ocular injury, what should you do to avoid an increase in intraocular pressure? Select one: A. Apply light pressure to both eyes. B. Discourage the patient from coughing. C. Administer prophylactic atropine sulfate. D. Ensure that the patient remains supine.

Discourage the patient from coughing.

What part of the eye is MOST commonly injured following a thermal burn? Select one: A. Globe B. Retina C. Cornea D. Eyelid

Eyelid

Which of the following cranial nerves innervates the muscles that cause motion of the eyeballs and upper eyelids? Select one: A. Optic B. Ophthalmic C. Oculomotor D. Trigeminal

Oculomotor

Which of the following is the MOST significant complication associated with a fractured nasal bone? Select one: A. Facial swelling B. Lateral displacement C. Damage to the septum D. Posterior epistaxis

Posterior epistaxis

You are caring for a man with a chemical burn to both eyes. The patient, who has contact lenses in place, is in severe pain and tells you that he can't see. Proper care for this patient includes: Select one: A. carefully removing his contact lenses, flushing both eyes for at least 20 minutes, and transporting with continuous eye irrigation. B. leaving his contact lenses in place to avoid further injury and transporting at once with irrigation of both eyes performed en route. C. removing his contact lenses, covering both eyes with moist, sterile dressings, administering a narcotic analgesic, and transporting. D. asking the patient to remove his contact lenses, irrigating both eyes for no more than 10 minutes, covering both eyes with sterile dressings, and transporting.

carefully removing his contact lenses, flushing both eyes for at least 20 minutes, and transporting with continuous eye irrigation.

A ruptured tympanic membrane: Select one: A. commonly results in permanent hearing loss. B. is characterized by CSF leakage from the ears. C. commonly leads to an infection of the middle ear. D. is extremely painful but typically heals spontaneously.

is extremely painful but typically heals spontaneously.

If you are unable to orotracheally intubate a patient due to massive maxillofacial trauma and severe oropharyngeal and nasopharyngeal bleeding, you would MOST likely have to perform: Select one: A. nasotracheal intubation. B. a needle or surgical cricothyrotomy. C. pharmacologically assisted intubation. D. digital (tactile) intubation.

a needle or surgical cricothyrotomy.

Appropriate management for a patient with severe epistaxis, tachycardia, and diaphoresis following an injury to the face includes: Select one: A. positioning the patient supine and elevating his or her legs 12 to 18 inches. B. administering enough IV crystalloid fluids to maintain adequate perfusion. C. pinching the patient's nares together and instructing him or her to lean back. D. applying direct pressure to the bridge of the nose and keeping the patient calm.

administering enough IV crystalloid fluids to maintain adequate perfusion.

Significant blunt injuries to the larynx or trachea pose an IMMEDIATE risk of: Select one: A. airway compromise. B. hypovolemic shock. C. mediastinal inflammation. D. aspiration of gastric contents.

airway compromise.

The primary risk associated with oral and dental injuries is: Select one: A. malocclusion. B. intraoral infection. C. permanent tooth loss. D. airway compromise.

airway compromise.

Following blunt trauma to the face, a 30-year-old man presents with epistaxis, double vision, and an inability to look upward. You should suspect: Select one: A. traumatic conjunctivitis. B. an orbital blowout fracture. C. traumatic retinal detachment. D. fracture of the cribriform plate.

an orbital blowout fracture.

When managing the airway of an unresponsive patient with serious anterior neck trauma and shallow breathing, you should: Select one: A. apply a cervical collar and perform intubation immediately. B. ventilate the patient with an oxygen-powered ventilation device. C. give oxygen via nonrebreathing mask and apply a pulse oximeter. D. assist ventilations with a bag-mask device and prepare to intubate.

assist ventilations with a bag-mask device and prepare to intubate.

In addition to massive bleeding, injury to a carotid or vertebral artery would MOST likely cause: Select one: A. hemiparalysis. B. an air embolism. C. severe bradycardia. D. cerebral hypoxia.

cerebral hypoxia.

The ONLY indication for removing contact lenses in the prehospital setting is: Select one: A. chemical eye burns. B. acute conjunctivitis. C. cardiopulmonary arrest. D. a foreign body in the eye.

chemical eye burns.

General care for an eye injury involves: Select one: A. applying direct pressure to the globe. B. irrigating the eye with sterile saline solution. C. covering both eyes to minimize further injury. D. applying a cold compress to the eyeball.

covering both eyes to minimize further injury.

You are dispatched to a high school where a 16-year-old female was stabbed in the eye with a pencil. The patient is conscious and in severe pain. A classmate removed the pencil prior to your arrival. The MOST appropriate care for this patient's injury includes: Select one: A. irrigating the injured eye with sterile saline, covering both eyes with a protective eye shield, and transporting immediately. B. applying an icepack to the affected eye, administering 1 µg/kg of fentanyl IM, elevating the patient's legs, and transporting. C. covering the affected eye with a sterile dressing and protective eye shield, covering the unaffected eye, and transporting promptly. D. covering the affected eye with a moist, sterile dressing, applying gently pressure to reduce intraocular pressure, and transporting at once.

covering the affected eye with a sterile dressing and protective eye shield, covering the unaffected eye, and transporting promptly.

During an explosion, a 42-year-old construction worker sustained a large laceration to the lateral aspect of his neck when he was struck by a piece of flying debris. The patient is conscious, but complains of difficulty hearing. In addition to protecting his spine, you should be MOST concerned with: Select one: A. administering high-flow oxygen via nonrebreathing mask as soon as possible. B. covering the laceration with an occlusive dressing and controlling the bleeding. C. carefully examining his ear to determine if his tympanic membrane is ruptured. D. applying a bulky dressing to the laceration and securing it firmly with a bandage.

covering the laceration with an occlusive dressing and controlling the bleeding.

A 51-year-old woman sustained a large laceration to her cheek when she was cut by a knife during a robbery attempt. The patient is conscious and alert and has severe oral bleeding. She denies any other trauma. Your FIRST action should be to: Select one: A. suction her oropharynx for up to 15 seconds. B. manually stabilize her head in a neutral position. C. control the intraoral bleeding with sterile gauze. D. ensure that she is sitting up and leaning forward.

ensure that she is sitting up and leaning forward.

Signs and symptoms of retinal detachment include: Select one: A. flashing lights, specks, or floaters in the field of vision. B. double vision and partial or complete loss of peripheral vision. C. immediate pain and total loss of vision following blunt eye trauma. D. paralysis of upward gaze and greater than 50% loss of central vision.

flashing lights, specks, or floaters in the field of vision.

A conscious but combative patient with severe facial trauma is fully immobilized on a backboard. During your assessment, the patient begins coughing up large amounts of blood. You suction her oropharynx, but her mouth quickly refills with blood. You should: Select one: A. preoxygenate the patient with a bag-mask device for 2 minutes and then perform nasotracheal intubation. B. roll the backboard on its side, suction her oropharynx, and prepare to perform pharmacologically assisted intubation. C. alternate suctioning of her oropharynx for 15 seconds and assisting ventilations for 2 minutes until her airway is clear of blood. D. continually suction her oropharynx until it is clear of blood, apply oxygen via nonrebreathing mask, and administer a sedative drug.

roll the backboard on its side, suction her oropharynx, and prepare to perform pharmacologically assisted intubation.

Proper treatment for an open wound to the neck includes: Select one: A. administering 2 L of IV crystalloid solution. B. sealing the wound with an occlusive dressing. C. prompt transportation to a hyperbaric chamber. D. applying a circumferential pressure dressing.

sealing the wound with an occlusive dressing.

Open soft-tissue facial trauma following a significant mechanism of injury: Select one: A. often requires removal of foreign bodies that are impaled in the face. B. is of most concern due to the possibility of permanent disfigurement. C. suggests that the patient may have a closed head injury or spinal injury. D. dictates the need for immediate intubation to protect the patient's airway.

suggests that the patient may have a closed head injury or spinal injury.

Movement of both of the eyes in unison is called: Select one: A. dysconjugate gaze. B. sympathetic eye movement. C. extraocular movement. D. physiologic anisocoria.

sympathetic eye movement.

A flattened appearance to the face and loss of sensation over the cheek following blunt facial trauma is MOST indicative of a(n): Select one: A. zygomatic fracture. B. orbital skull fracture. C. Le Fort I fracture. D. temporomandibular joint dislocation.

zygomatic fracture.