NREMT STUDY ME TRUAMA
Hypovolemia
low blood volume
Osteo
refers to the bones
An 18 year old male was hit by a car while walking. When you ask him his name, he opens his eyes and responds with inappropriate words. During your physical examination, you noted he had a lower left arm fracture after he withdrew and had facial grimace when you assessed the arm. What should you record as his Glasgow Coma Scale score?
10 is the answer. He opens his eyes when you speak to him so record a 3 for eye-opening. He uses inappropriate words so that's a 3, and he withdraws from pain which is a 4.
Hypovolemic shock
A condition in which low blood volume, due to massive internal or external bleeding or extensive loss of body water, results in inadequate perfusion. Dehydration causes hypovolemic shock.
Distributive Shock
A condition that occurs when there is widespread dilation of the small arterioles, small venules, or both.
When a patient has a tension pneumothorax, the major complication is
A lack of perfusion pressure to the tissues. Tension pneumothorax causes hypoperfusion to tissues and possible death. There is ineffective lung movement, but the pressure on the great vessels causes obstruction of circulation, the major complication leading to hypoperfusion.
Which of the following patients will most likely have complications as a result of blood loss?
An 82 year old male shot in the leg and BP 94/82. Geriatric patients do not tolerate shock well.
You are approaching a young male at a scene of a shooting. As you approach him, he is mumbling and you see a large amount of blood oozing from a leg wound. He has a weak rapid brachial pulse. You should first
Apply a tourniquet to the leg. This is an emergent transport situation, but a tourniquet should be applied first.
An 11 year old male fell while riding rounding a curve on his bicycle and struck his head against a curb. He is unresponsive and has a long scalp laceration with underlying skull exposed and active bleeding. You should first
Apply direct Pressure. You should first control the hemorrhage with direct pressure.
Following injury, as blood loss continues the body's feedback systems are alerted by
Baroreceptors. Baroreceptors wrap around large arteries and sense the size of the artery and its stretch with each heartbeat.
If present, which of the following findings represents the most serious finding in a patient with an eye injury?
Blood in the anterior chamber of the eye. Blood in the anterior chamber of the eye is called hyphema, a true medical emergency.
Reversible shock
Blood loss of 35% can cause this
A 19 year old male was shot in his right upper arm. You see active bleeding and bone fragments in the wound. His vital signs are P 108, R 16, and BP 86/68. You should suspect a laceration of the
Brachial Artery.
A 42 year old male was the unrestrained driver involved in a single-car crash in a rural area at 3:00 AM. When you arrive at 3:45 he is unresponsive and slumped over the steering wheel. You observe a large bruise over his chest. After initial stabilization, you determine his vital signs are P 86 and irregular, R 18, and BP 116/82. You should suspect
Cardiac Contusion. This stem indicates classic signs of cardiac contusion.
A 78 year old male was struck by a car while crossing the street. When you arrive, he is lying in the roadway, has a scalp laceration, and angulation of the right radius and femur. His pelvis is unstable. As you begin to package him, he becomes unresponsive and apneic. You should first
Check for a pulse. It's likely this elderly male is rapidly deteriorating from his injuries, and you need to see if he has a pulse. If you can't find a pulse, he'll need chest compressions, and then an AED applied.
You are called by law enforcement to a domestic disturbance where a 29 year old male has multiple human bite marks that have capillary bleeding. He has no other injuries and refuses transport. You should
Clean the wounds, explain the likelihood of infection, and have him sign a refusal form. As long as an adult has the capacity to understand the consequences of his actions, he can refuse medical transport.
Internal bleeding and muscle damage around the site of a fibula fracture can lead to
Compartment syndrome. Compartment syndrome occurs when there is bleeding within a muscle sheath without an avenue for that bleeding to exit the sheath.
A 51 year old male was splashed in the eyes with an alkali solution. He immediately flushed his eyes and continued for 20 minutes prior to your arrival. You should transport and
Continue to flush his eyes. An alkali solution in the eye can cause serious damage, so it is best to continuously flush the patient's eyes rather than relying on the removal of the solution based upon a time limit.
A 46 year old male was shot in the head with a 22 caliber pistol. He does not respond to painful stimuli. His vital signs are P 106, R 12, and BP 110/74. You should
Cover the wound and rapidly transport. Small caliber bullets bounce around inside the brain.
A 25 year old male has a gunshot wound in his right chest. Your partner reports a weak, thready pulse. You see irregular, slow breathing. You should FIRST
Cover the wound with a gloved hand. You must cover an open chest wound as soon as it is discovered.
A 26 year old female who is two months postpartum is found at home hanged with a rope around her neck. What type of injury should you suspect?
Distraction injuries occur in hanging incidents. . In these cases, the body is distracted from the head. It is not a compression or flexion of the cervical spine that causes the death.
Most chemical burns are initially managed by flushing with large amounts of water for extended periods of time, except chemicals that are
Dry Powders. Dry powders should be brushed away.
The most reliable sign of hemorrhage from kidney trauma is
Ecchymosis in the flanks of the abdomen. The kidneys are retroperitoneal organs outside the abdominal cavity.
Which of the following responses should receive a Glasgow Coma Scale score of 8?
Eyes only open to pain; speaks incomprehensible sounds; withdraws from painful stimuli. This is another method to ask a GCS question, but this type is easier because you should know a GCS of 15 is normal, and a GCS of 3 is critical. So this is 8; in the middle. The answer is eyes open only with pain (E - 2), speaks incomprehensible sounds (V - 2) and withdraws from pain (M - 4).
The most frequent cause of trauma and hospital admissions in the elderly is
Falls. The consequences of falls bring many elderly to the hospital.
Which of the following would suffer the loss of heat most rapidly? A patient who
Fell into icy water. The body is 70% water and falling into ice water can create rapid hypothermia.
On examination of the abdomen immediately following blunt trauma, the abdomen will be soft even if there is bleeding because
Fresh blood is not an abdominal wall irritant. It will take a while for bleeding to irritate the peritoneal membrane and cause the patient to have a rigid abdominal wall.
A 22 year old male was stabbed in the abdomen. He is leaning against a wall and you observe a puncture wound to the right upper abdominal quadrant. He becomes faint when he stands up to get on the stretcher. You should suspect the reason he became faint was due to
He suffered an orthostatic hypotensive event.
A 21 year old male fell from his motorcycle. He responds to your questions by moaning. He has multiple rib fractures and a stable chest wall. His vital signs are P 108, R 18, BP 96/74, and SpO2 is 92% on room air. You should suspect
Hemopneumothorax. Most likely with the hypotension he is bleeding into the chest due to rib fractures.
An unresponsive 26 year old male is found in an alley outside a bar. His skin is pale and clammy. His vital signs are P 118, R 16, BP 104/82, and SpO2 is 95% on room air. You should suspect
Hypovolemic shock. He has cold, clammy skin and a narrow pulse pressure, hence the best (and correct) answer.
You are bicycle riding with a 63 year old male on a hot day. After riding 70 miles he tells you he feels odd, stops riding and vomits. You advise him to
Immediately seek a cold environment. Seeking a cold environment such as an air-conditioned building will help him recover but he's done riding for that day.
A 19 year old male was shot in the right side of his chest. He is sitting on your stretcher. If there is an accumulation of blood in the pleural space, when auscultating his chest, you should expect to hear
Increased breath sounds over lower right posterior chest when compared to the lower left chest. Breath sounds transmit more loudly across areas of the lungs that are filled with fluid. When blood collects in the pleural space it will become dependent based upon the patient's position.
A 56 year old female has generalized weakness and has been outside all night in 40 degrees F weather. She is shivering and her hands are cold to the touch. To determine if she has hypothermia, you should
Insert your hand below her clothing and feel her abdomen. Detecting hypothermia can be complicated, but if the patient has a cold abdominal wall below his/her clothing, you are dealing with hypothermia.
You achieve ROSC on a 20 year old male who was electrocuted while working with electrical wires. He vital signs are P 88, R 12, BP 108/68, and SpO2 is 95% on room air. You should next
Inspect his body for entrance and exit wounds.
What should be your primary concern for an unresponsive 49 year old male who has multiple contusion to the left side of his body, flail chest, and fracture of his left femur after a fall?
Internal bleeding.
An unresponsive 42 year old male was struck by a car while crossing the street. He has a scalp laceration and an angulated lower left leg. His breath sounds are clear. His vital signs are P 124, R 16, and BP 92/68. You should suspect
Intra-abdominal bleeding. He shows signs of hypovolemic shock.
Thirty minutes after blunt trauma that has resulted in a liver laceration, inspection of the abdominal wall shoulds show which of the following findings?
Little or no change in appearance. On inspection immediately after an injury, the finding of contusion is rare.
A patient who has cardiac tamponade will have hypoperfusion of the brain due to a/an
Loss of Cardiac Afterload. Cardiac afterload means blood flow after ventricular contractions.
Which of the following is most likely to be injured by the primary blast of an explosion?
Lungs. The lungs are hollow organs, and hollow organs are most often injured by the primary wave of blasts. The primary wave affects hollow (gas-filled) organs via highly pressurized gasses.
A 21 year old male jumped from a window on the third floor to escape a fire. His left upper leg is shortened, angulated, and deformed. He is in severe pain. You should suspect
Mid-shaft femur fracture. A mid-shaft femur fracture will demonstrate signs provided in the question stem
The amount of external pressure that must be applied to a wound to stop arterial bleeding is
One mmHg greater than the systolic pressure of the artery causing the hemorrhage. Control of bleeding with direct pressure only requires one mmHg greater than the highest (systolic) pressure in the vessel.
Which assessment findings should cause you to suspect a gunshot victim is in irreversible shock?
Oozing wounds, thready pulse, irregular respirations.
A 21 year old male soccer player is unable to ambulate following an injury to his right lower leg. He has a 2 cm laceration on his tibial crest. His leg is not angulated. You should suspect a/an
Open Fracture. You should suspect that the bone protruded through the skin and then went back in under the skin.
A bone condition that mostly affects females who are post-menopausal is
Osteoporosis. Menopause changes hormonal levels, and one complication is the loss of estrogen that affects bone density
When a patient has been shot in the abdomen, the organ that is least likely to be injured is the
Pancreas. The pancreas is a small and thin gland, residing behind the stomach.
A 12 year old male fell from his bike striking his clavicle against a curb. On examination, you find a fracture of the clavicle and the first and second ribs. You should suspect an underlying
Pneumothorax and major vessel injury. Injuries that are high up in the chest fracturing ribs one and two present with serious underlying complications because vessels and nerves are near the surface of the chest wall in this location.
A 19 year old male was shot in the abdomen with a small caliber weapon. When you arrive he is conscious and upset about being shot. He complains of no other injuries. His vital signs are P 104, R 14, BP 108/82. You should first
Prepare for transport. A narrow pulse pressure and tachycardia in an upset patient indicate he is in compensated shock and likely bleeding into his abdomen.
A 16 year old male was stabbed in his left lower abdominal quadrant. He is comfortable but upset about the incident. His vitals are P 94, R 14, BP 128/82, and SpO2 is 96% on room air. You should
Provide support and transport. Provide supportive care. This patient needs monitoring but currently is not sick.
A 38 year old male was lost in the forest while hiking. His feet are waxy, white, and hard to touch. It will take an hour to carry him to your ambulance. You should
Provide supportive care. You should not rewarm frostbite (a frozen extremity) unless you are prepared to assure it will not refreeze and you have the ability to relieve a lot of pain that will accompany rewarming; so supportive care is recommended.
A stab wound which perforates the stomach will cause
Rapid chemical Peritonitis. The stomach contains acid. When released it will cause rapid, chemical peritonitis (inflammation of the lining of the abdomen).
You should remove an impaled object if it is impaled in
Remove any impaled object that obstructs airflow.
A 22 year old male received blunt trauma to his abdomen. During your assessment, you hear bowel sounds in his right chest. You should suspect
Ruptured Diaphragm. The bowel sounds in the chest indicate the most likely cause of his condition is a ruptured diaphragm. This sign is difficult to detect.
Which of the following is a commonly associated complication of a severe head injury?
Seizures. They are common post-head injury.
Cardiogenic Shock
Shock caused by inadequate function of the heart, or pump failure.
Obstructive shock
Shock that occurs when there is a block to blood flow in the heart or great vessels, causing an insufficient blood supply to the body's tissues.
Which of the following conditions can cause distributive shock?
Spinal Cord Injury. Spinal cord injury can cause dilation of the blood vessels and result in distributive shock.
A 56 year old male is in respiratory arrest following a head-on car crash while not wearing a seat belt. He has significant facial and torso trauma. You palpate an irregularity to his cervical spine at C-4. You should suspect his arrest is due to
Spinal cord compression above the C-4 level.
A 26 year old male has an anterior dislocation of his left hip. How should you manage this injury?
Splint his legs together and immobilize him.
School officials called 9-1-1 for a 7 year old male has a pencil stuck in his eye socket immediately lateral to his nose. He has vision out of that eye. You should
Stabilize the Pencil. Never remove an impaled object unless it is blocking the airway. You should use a method to stabilize the pencil.
A conscious 21 year old male was struck in the head with an arrow. The arrow entered his forehead, is impaled, and exits above his occiput area. Blood is draining down his face into his mouth. You should
Stabilize the arrow and transport. Likely the arrow is stabilized, and in this case, the patient needs rapid transport.
A 12 year old male fell from his bicycle and complains of upper leg pain. Before you begin your assessment, he screams, "Don't touch my leg!" In order to assess if he has a fracture, you should
Strike his heel with the palm of your hand.
Which of the following is the most important factor that affects the amount of injury a patient suffers as a result of a car crash?
The speed the vehicles were moving. Speed kills.
A 22 year old female was the restrained driver in a single car crash where her car glanced alongside a utility pole. She is crying but does not complain of pain. She tells you she is 14 weeks pregnant. You should
Transport her routinely without lights and siren. She needs transport to assess fetal health.
A 26 year old was struck by lightning while playing golf. When you arrive, he has amnesia and an irregular pulse. You observe his skin is pale, cool, and diaphoretic. As you prepare to transport him you should
Utilize spinal motion restriction precautions. Spinal fractures are a possible complication of lightning strikes.
Irreversible Shock
When the body has lost the battle to maintain perfusion to vital organs. Even if adequate vital signs return, the patient may die days later due to organ failure.
During a fight a 19 year old male had a lower tooth knocked out. Your partner finds the tooth while you control bleeding. You should
Wrap the tooth in saline-soaked gauze. Wrapping the tooth in saline-soaked gauze is the best choice.
A 28 year old female was shot in the chest. You have managed the wound. What other care should you complete on the scene?
You should begin transport of this patient. Oxygen can be started en route.
Osteoporosis
a condition in which the bones become fragile and break easily
Osteosclerosis
abnormal hardening of bone
cardiac tamponade
acute compression of the heart caused by fluid accumulation in the pericardial cavity. expands the pericardial sac and thus reduces the space available for ventricular contractions.
A 68 year old male was the restrained driver of a car that was struck on the driver's side door with 20 inches of intrusion. You observe irregular chest wall movement on the left side. You should suspect fractures of
adjacent ribs in more than one place. A flail segment is a fracture of two or more ribs in two or more places. The only choice here that fits that description is adjacent ribs in more than one place.
Osteomyelitis
inflammation of the bone and bone marrow (caused by bacterial infection)
Osteopenia
is a precursor of osteoporosis and is found early in x-rays.
Orthostatic Hypotension
low blood pressure that occurs upon standing up.
Hemiplegia
paralysis of one side of the body
barbituates and benzodiazepines
sedatives; potentiate each other and alcohol. Physiological dependence and psychological dependence can develop. Cross-tolerance and cross-dependence. Overdose s/s include stupor, unconsciousness, death from respiratory depression. Withdrawal s/s anxiety, insomnia, nausea, seizures.
Sepsis
toxic inflammatory condition arising from the spread of microbes, especially bacteria or their toxins, from a focus of infection
