EMT chapter 29 trauma to the head, neck, and spine

Objects that are impaled into the head and interfere with transport should​ be: A. pushed through to the other side for removal. B. left in place and transported in a​ flat-bed vehicle. C. gently but firmly removed. D. stabilized and cut with minimal movement of the object.

stabilized and cut with minimal movement of the object.

The steps in immobilizing a supine patient to a long backboard​ include: A. securing the​ patient's torso to the board before securing the head. B. using the​ logroll, a move that ideally is performed by at least two​ rescuers: one at the head and one at the hips. C. not placing padding on the​ board, as it might move the spine out of alignment. D. removing the cervical collar once the patient is immobilized on the board.

securing the​ patient's torso to the board before securing the head.

How many vertebrae does the cervical spine​ comprise? A. Seven B. Three C. Five D. Nine

seven

The region where the jaw articulates with the remainder of the head is termed​ the: A. temporomandibular joint. B. angle of the mandible. C. parietomandibular joint. D. frontomandibular joint.

temporomandibular joint.

An injury to the cranium would directly​ affect: A. the bony structure making up the​ forehead, top,​ back, and upper sides of the skull. B. the two fused bones forming the upper jaw. C. the fluid that surrounds the brain and spinal cord. D. the part of the nervous system that controls involuntary functions.

the bony structure making up the​ forehead, top,​ back, and upper sides of the skull.

Paralysis of the extremities is a reliable sign of spinal cord​ injury: A. in pediatric patients. B. in patients who are conscious. C. if accompanied by paresthesia. D. if verbal response is also impaired.

in patients who are conscious.

Your patient is unable to move his lower jaw or speak. You should suspect an injury to​ the: A. temporal region. B. mandible. C. maxilla. D. orbit.

mandible

You have established manual​ in-line cervical spine stabilization of an unconscious trauma patient. You may release manual​ stabilization: A. when the patient is placed on the backboard. B. when immobilization has been completed. C. once a cervical collar has been applied. D. when the patient arrives at the hospital emergency department

when immobilization has been completed.

You are assessing a victim of a gunshot wound to the head. Her eyes are​ open, but she does not follow or track any movement. There is no eye​ blink, and her pupils are fixed and dilated. Her motor response score is a​ 1, and her verbal response is a 1 as well. What is her​ eye-opening score? A. 4 B. 2 C. 1 D. 3

1

The possible numerical range for the Glasgow Coma Scale​ is: A. 0 to 15. B. 3 to 15. C. 0 to 10. D. 3 to 10.

3 to 15.

You are assessing a patient who is unconscious but who responds to painful stimuli by attempting to push away the painful stimulus​ (for instance, a pinch on the​ leg) with his hand. How would you score his motor response according to the Glasgow Coma​ Scale? A. 5 B. 3 C. 6 D. 4

5

Your patient responds to painful stimulus with decorticate posturing​ (arms bent to his​ chest, fists​ clenched, and legs straight​ out), his eyes do not open to​ pain, and he makes incomprehensible sounds when you pinch him. What score would you give him on the Glasgow Coma​ Scale? A. 5 B. 3 C. 6 D. 4

6

Which of the following assessment findings in a​ head-injured patient MOST likely suggests a worsening​ condition? A. A deteriorating level of consciousness B. A reduction of a pulse rate from 110 to 80 C. Complaints of a headache D. Blood pressure of​ 120/84 with a pulse of 68 and respirations of 18

A deteriorating level of consciousness

Which of the following is MOST likely to have associated spinal​ injury? A. Facial trauma B. Burn injury C. Extremity trauma D. Abdominal injury

Facial trauma

Which of the following describes shock following spinal​ injury? A. Inadequate circulation indicated by a rapid pulse and​ cool, clammy skin B. Dilation of the blood vessels resulting in reduction of perfusion to tissues C. Paralysis of the respiratory muscles occurring with injury to the thoracic spine D. Paralysis to only one side of the body that does not resolve

Dilation of the blood vessels resulting in reduction of perfusion to tissues

You find out that one of your patients from an earlier car wreck suffered bleeding that caused the blood to collect and pool within the​ patient's skull. Based on this​ information, you know that the patient MOST likely suffered which type of brain​ injury? A. Concussion B. Laceration C. Contusion D. Hematoma

Hematoma

You just arrived at the scene of a motor vehicle crash involving two cars. The passenger of one car is sitting in the front seat unconscious with her chin to her chest. She is having snoring​ respirations, so you carefully position her head in a neutral position to clear her airway. In doing​ so, you notice that her nose is​ bleeding, there is a reddened area on her forehead at the​ hairline, and the windshield is​ starred, with some hair stuck in the fractured glass. What type of cervical injury should you​ suspect? A. Axial loading or hyperextension injury B. Axial loading or rotational injury C. Hyperextension or hyperflexion injury D. Hyperflexion or rotational injury

Hyperextension or hyperflexion injury

What is the rationale for some EMS systems employing​ "selective use of spine​ immobilization" by some EMS​ systems? A. Providing spinal immobilization on patients wastes valuable time on scene. B. Immobilization of some patients may not be beneficial based on mechanism of injury and assessment findings. C. The spine can be effectively​ "cleared" in the field by prehospital providers. D. Selective use of spinal immobilization increases health care costs.

Immobilization of some patients may not be beneficial based on mechanism of injury and assessment findings

You are caring for a​ 19-year-old female patient who was involved in a motor vehicle crash. She sustained blunt force trauma to her face with​ contusions, swelling, and minor bleeding throughout her facial region. Which of the following findings MOST strongly suggests a fractured​ mandible? A. Inability to close her mouth from a​ wide-open position B. Tenderness to palpation of her zygomatic bone C. Lower teeth that are out of alignment in the front D. Bleeding from the nose

Lower teeth that are out of alignment in the front

Your patient was unconscious for an extended period of time as a result of severe hypoglycemia. What is your primary concern for this​ patient? A. Malnutrition B. Nontraumatic brain injury C. Memory loss D. Dehydration

Nontraumatic brain injury

In managing an open wound to the​ neck, what actions can you take while waiting for occlusive dressings to be obtained or​ opened? A. Apply direct pressure to the open wound with two fingers. B. Place your gloved hand over the wound to close it off from air entry. C. Place a​ standard, sterile 4 times ×4 gauze pad over the wound. D. Apply oxygen via a nonrebreather mask at 15 lpm.

Place your gloved hand over the wound to close it off from air entry.

Which of the following findings during your primary assessment would be MOST suggestive of a brain​ injury? A. ​Rapid, weak pulse B. Poor responsiveness to verbal stimuli C. Difficulty in breathing D. Partial airway obstruction

Poor responsiveness to verbal stimuli

A​ 22-year-old male patient was involved in a physical altercation at a bar. He has no evidence of head trauma and reportedly did not fall or lose consciousness at any time. His only complaint is pain upon deep inspiration along the front of his left rib cage. Given the mechanism of injury and his​ presentation, should this patient be​ immobilized? A. Probably​ so, since he has pain in his chest B. Probably​ not, since he does not have the mechanism of injury or the symptoms to suggest the need C. Probably​ not, since evidence of spinal injury would be obvious D. Probably​ so, since he was at a bar and was likely drinking

Probably​ not, since he does not have the mechanism of injury or the symptoms to suggest the need

You and your EMT partner are equally trained and have similar experience as EMTs. Your partner suggests that the patient for whom you are caring does not need to have immobilization performed. You feel differently. What would be the best course of​ action? A. Do not immobilize the patient and discuss it later. B. Call your supervisor and ask him or her to make the decision. C. Refer to your local protocol. D. Call medical direction for expert consultation.

Refer to your local protocol.

You are on scene with a​ 24-year-old female car crash victim. During your​ assessment, she tells you that she​ can't feel all of her teeth. You note swelling to the jaw and misaligned teeth. Your primary concern in treating this patient is which of the​ following? A. Obtaining baseline set of vital signs B. Trending the​ patient's vital signs to identify signs of increased intracranial pressure C. Removing broken teeth from the airway D. Identifying the type of Le Fort fracture

Removing broken teeth from the airway

You are treating a​ 22-year-old male who was stabbed in the neck during a bar fight. What is an important part of the treatment of this​ injury? A. Checking for subcutaneous emphysema B. Laying the patient down C. Sealing the wound with an occlusive dressing D. Listening to the lung sounds right away

Sealing the wound with an occlusive dressing

You are treating a​ 6-year-old car crash victim and have decided to immobilize him. You should REFRAIN from doing which of the​ following? A. Use an armboard as a spine board. B. Pad the​ patient's shoulders. C. Secure the patient on an adult long spine board. D. Secure the patient in his child safety seat.

Secure the patient in his child safety seat.

Which of the following would be a nontraumatic cause of brain​ injury? A. Rapid deceleration from a​ head-on collision B. Knife wound to the scalp C. Gunshot wound to the head D. Severe prolonged hypotension

Severe prolonged hypotension

You respond to the scene of an explosion to treat a victim with a penetrating injury to the occipital area from shrapnel. For which of the following additional injuries should you have a high level of​ suspicion? A. Penetrating thoracic injury B. Transection of the trachea C. Spinal injury D. Carotid artery involvement

Spinal injury

You respond to the scene of an assault where you find a​ 26-year-old male patient with a knife impaled in the left lobe of his skull near the temporal membrane. He is alert but disoriented. How should you manage this​ patient's injury? A. Approximate the depth of insertion and carefully remove the knife. B. Stabilize the knife and carefully cut the handle off to prepare for transport. C. Stabilize the knife with bulky dressings. D. Perform a secondary assessment prior to stabilizing the knife.

Stabilize the knife with bulky dressings.

The bradycardia and hypotension that accompany spinal shock are due to the inability of what nervous system to innervate certain​ organs? A. Voluntary B. Sympathetic C. Parasympathetic D. Cholinergic

Sympathetic

Which of the following statements regarding the spinal cord is​ TRUE? A. The nerves that branch from the spinal cord at the vertebrae alternate from left to right. B. The spinal cord transmits and receives neural messages to and from the brain. C. The spinal cord lacks the membranes that surround the brain. D. If the spinal cord is​ severed, the body will experience widespread vasoconstriction.

The spinal cord lacks the membranes that surround the brain.

Which of the following is likely the MOST critical associated injury of serious blunt or penetrating trauma to the​ face? A. The threat to airway patency B. Mandibular dislocation C. Distortion of the facial landmarks D. The entrance of blood into the digestive tract

The threat to airway patency

In caring for an open neck​ wound, it is important to avoid compressing both carotid arteries at the same time.​ Why? A. To prevent the release of clots to the brain B. Because the carotid arteries are the only arteries that supply the heart C. To prevent a dangerous reduction of blood flow to the brain D. To allow the blood to freely flow from the brain

To prevent a dangerous reduction of blood flow to the brain

The catcher at a baseball game is struck in the front of his head by a thrown bat. He sustains a cerebral bruise on the front of his brain but also has a contusion on the back of his brain. The bruise on the back of his brain is​ called: A. a coup injury. B. a unilateral injury. C. an anterior cerebral contusion. D. a contrecoup injury.

a contrecoup injury.

If an individual sustains a head injury and blood has accumulated on top of the brain but beneath the dural lining of the​ skull, this type of injury is​ termed: A. a subdural hematoma. B. an epidural hematoma. C. a subarachnoid hemorrhage. D. an intracerebral laceration.

a subdural hematoma.

In treating a patient with suspected head or spine​ injury, manual stabilization of the head and neck can be​ released: A. after the cervical collar has been applied. B. when you find a good​ pulse, motor​ function, and sensation in the distal extremities. C. after the patient has been secured to a backboard. D. only after the cervical spine has been cleared by an​ X-ray.

after the patient has been secured to a backboard.

A large puncture wound or laceration to the neck must be immediately sealed with an occlusive dressing to​ prevent: A. excessive bleeding. B. airway compromise. C. cervical spine injury. D. an air embolus.

an air embolus.

You arrive on scene at a motor vehicle crash where you notice that the patient has severe bleeding from her head with gray matter showing. This type of injury​ is:

an open skull fracture.

Another term for a compression injury to the spine​ is: A. flexion injury. B. axial loading. C. extension injury. D. ankylosing spondylitis.

axial loading.

Which of the following is a common cause of nontraumatic brain​ injury? A. TIA B. Tinnitus C. Blood clot D. Syncope

blood clot

Manual cervical stabilization should be provided to all patients with a significant mechanism of injury​ until: A. completion of a sensory examination. B. completion of the spinal clearance protocol. C. establishment of spinal tenderness. D. completion of a neuromotor examination.

completion of the spinal clearance protocol.

When an individual sustains blunt force trauma to the head that results in a brief disruption of the neural network without any physical evidence or lasting residual​ effects, this would be termed​ a: A. brain contusion. B. cerebral hematoma. C. concussion. D. herniation.

concussion.

The regions on the surface of the body that individually are associated with specific pairs of sensory spinal nerves​ (a single nerve for each side of the​ body) are​ called: A. myotomes. B. nerve tracts. C. vertebral branches. D. dermatomes.

dermatome

The hole where the spinal cord exits the cranium is called​ the: A. foramen magnum. B. brainstem. C. vertebral foramen. D. tentorium cerebri.

foramen magnum

The most immediate concern for impalements into the head and brain is that there will​ be: A. a very noticeable scar afterward. B. hemorrhage and brain swelling. C. infection. D. an altered level of consciousness.

hemorrhage and brain swelling.

Abnormally high pressure within the skull is known​ as: A. increased intracranial pressure. B. intracranial hemorrhage. C. cerebral hypertension. D. concussive injury.

increased intracranial pressure.

When treating a patient with damage to the facial​ bones, you should have a high index of suspicion​ for: A. injury to the brain. B. cranial cohesion C. aphagia. D. thoracic separation.

injury to the brain.

The three sections of the Glasgow Coma Scale​ (GCS) include: A. breathing effort. B. appearance. C. motor response. D. level of consciousness

motor response

A brain injury is classified as nontraumatic if it​ is: A. not serious. B. not assessable on the Glasgow Coma Scale. C. not attributable to an external cause. D. not permanent.

not attributable to an external cause.

Emergency medical care of a patient with suspected spinal injury​ includes: A. palpating the cervical region for any deformities or tenderness. B. using manual cervical spine traction until a cervical collar can be applied. C. opening and maintaining the airway using the​ head-tilt, chin-lift method if the patient is responsive. D. using sandbags to immobilize the​ patient's head on the long backboard.

palpating the cervical region for any deformities or tenderness.

If your patient is wearing a​ helmet, you should leave it in place​ if: A. there are no impending airway or breathing problems. B. the helmet has been damaged. C. the helmet is loose enough to allow you to assess the​ patient's head and neck. D. the helmet is too snug to remove easily.

there are no impending airway or breathing problems.

During your primary​ assessment, it is important to​ remember: A. that inadequate breathing may result from spinal cord damage from a thoracic spine injury. B. to open the airway of an unresponsive patient using the​ head-tilt, chin-lift method. C. to initiate immediate manual​ in-line spinal stabilization according to patient need. D. that the​ patient's skin may be​ cool, pale, and moist below the site of spinal cord injury and warm and dry above the site of injury.

to initiate immediate manual​ in-line spinal stabilization according to patient need.