PHTLS - Thoracic Trauma (CH12), PHTLS Pretest, PHTLS pre test 8th edition, phtls 8th test

A fractured femur can result in___________________mL of hemorrhage.

1000 TO 2000

After falling from the third story at a construction site, a 27-year-old male is found in contrast with unequal pupils and a regular respirations. Which of the following is most appropriate rate of ventilations?

20 BPM

Your patient is a 32 year old female who was thrown from a horse and struck her head on the ground. She was not wearing a helmet. She does not respond verbally or open her eyes to painful stimuli, but responds to painful stimuli with decerebrate posturing. Her right pupil is dilated and does not react to light. Her respirations are 6 per minute and irregular, pulse 56, blood pressure 188/98. You should ventilate the patient at a rate of?

20 BPM.

your patient is a 20yr old male who struck his head on a teammates knee while diving to catch a football. He was not wearing a helmet. He demonstrates decerebrate posturing and has a GCS score of 4. His heart rate is 58, blood pressure 180/102 and his left pupil is dilated. What is the best ventilation rate to use when managing this patient?

20 breaths per minute

What percentage of blood volume loss in an adult patient is associated with findings of tachycardia (>120/beats/minute), tachypnea (30-40 Breaths/min), and hypotension (systolic BP <90mmHg)?

30 TO 40

The most common fractured ribs are ribs:

4 THROUGH 8.

the target blood pressure for a trauma patient with suspected intraabdominal hemorrhage is what?

80-90 mmHg

a 20 yr old female was ejected from her vehicle during a high speed roll-over motor vehicle collision. She has significant bleeding from a large laceration. Your initial assessment reveals a GCS score of 7, systolic bp of 70 and pupils that are equal but respond sluggishly to light. After establishing two large bore IV lines, you should titrate the infusion rate to achieve a target bp of at least

90 mmHg

Which of the following patients should be treated first in a blast-related multiple patients situation?

A 30-year-old female with altered level of consciousness and decreased capillary refill

Which of the following findings is not expected in assessment of a pregnant patient?

A DECREASED BLOOD PRESSURE IN THE THIRD TRIMESTER.

Which of the following is indicated for the prehospital management of a circumferential second degree burn extending from the wrist to the elbow in a 70 Kg patient?

A DRY STERILE DRESSING ANALGESIA

Which of the following mechanisms is most likely to result in cardiac tamponade?

A PATIENT IS STRUCK IN THE LEFT ANTERIOR CHEST BY A NAIL EJECTED FROM A NAIL GUN.

Your patient is an injured construction worker bleeding profusely from a large laceration to the left thigh. He is confused and has pale, moist skin. Direct pressure applied to the wound by a first responder has failed to control the bleeding. The next step in controlling bleeding is to apply:

A TOURNIQUET TO THE LACERATION.

Which of the following best describes shock?

A state of inadequate energy production/ low perfusion

An electrical burn caused by superheated air near the source of electricity is an

ARC burn.

What is the most important physical finding a patient with a suspected traumatic brain injury?

Abnormal levels of consciousness

When energy produced by cells occurs during the state of inadequate oxygenation, it is referred to as which of the following conditions?

Anaerobic metabolism

Prehospital providers respond we 16-year-old male who punched a glass window and sustained a large laceration to his arm that is bleeding heavily. He is restless, diaphoretic and was a weak, 30 pulse. What is the most appropriate action?

Apply direct pressure

Which of the following groups of findings represents Cushing's phenomenon?

BRADYCARDIA ABNORMAL RESPIRATORY PATTERN ELEVATED BLOOD PRESSURE

Which of the following organs are most sensitive to hypotension?

Brain

When the application of kinetic energy to the body from either a blunt or penetrating mechanism displaces tissue, this is known as

CAVITATION

PASG is contraindicated in patients with

CHEST TRAUMA.

A chemical solution with a pH of 4.0 is considered an ACID and causes damage to the tissues via

COAGULATION NECROSIS.

Which of the following is an example of the tertiary phase blast injury?

CRUSHING INJURY DUE TO STRUCTURAL COLLAPSE.

Assessment

Capnograph

What is the best method for confirming proper placement of an endotracheal tube in a trauma patient that has a palpable pulse?

Capnography

Inadvertent hyperventilation of a patient with suspected traumatic brain injury may lead to which complication?

Cerebral vasoconstriction

Care of the trauma patient in the field is an involving science and should be evidence-based. As lifelong learners, we must be prepared to adapt our practices based on research. This is because research may lead to which of the following?

Change in our current practices

You're call to treat a patient who was knocked unconscious when he slipped and fell on a wet floor striking his head. it is now several hours later he is awake but confused, does not recall the incident, and is vomiting with a headache. which of the following injuries is most likely?

Concussion

EMS response and adult barista who spilled a cup of hot coffee and sustained partial thickness burns to the abdomen and right leg. The patient ran cool water over the branch which of the following interventions is most appropriate next up?

Cover burn area with dry sterile dressing's

A hemothorax is differentiated from a tension pneumothorax by:

DULL PERCUSSION ON THE AFFECTED SIDE.

Prehospital the writers respond to a male patient lying on the ground after being struck by a high-speed motor vehicle. The patient is apneic and pulseless. What is the most appropriate action?

Declare the patient dead....(This was the actual answer on the test...)

Which of the following types of traumatic brain injury is most likely to be associated with hemorrhage from the middle meningeal artery?

EPIDURAL HEMATOMA

EMS response for a patient who has sustained a blunt injury to the head. She had a period of consciousness followed by a brief period of consciousness and then became unresponsive just as EMS arrived. Based solely on this information, what is the most likely injury?

Epidural hematoma

Which injury is most likely to be sustained by the driver in a lateral impact collision to the left side of the vehicle with no side impact airbags (assuming the driver sits on the left)?

FRACTURED LEFT CLAVICLE.

What is the most common cause of death from trauma patients over 75 years of age?

Falls

In addition to oxygen what is required to maintain the metabolic processes of life and energy production?

Glucose

The most common type of shock in trauma patients is

HYPOVOLEMIC.

The patient presents with a blunt trauma injury to the chest. On exam, he has absent breath sounds on the one side of his chest and respiratory distress which additional sign would indicate that the patient has a tension pneumothorax?

Hemodynamic compromise

A 38 male sustained a large wound to his right thigh while at work what are the following actions is the most important initial step?

Hemorrhage control

What is the most common type of shock resulting from trauma?

Hemorrhagic

In addition to direct pressure, tourniquets and immobilizing fractures, which of the following is most effective by controlling hemorrhage

Hemostatic agents

Which of the following best guides the decision to provide spinal immobilization?

History and complaint

EMS response for patient valve in a motor vehicle versus car collision. The patient is unresponsive with vital signs of BP 82/palpitation, are our 24, pulse 128. What is the most likely type of shock?

Hypovolemic

The most common threat to life among trauma patients is?

INTERNAL HEMORRHAGE

Excessive fluid resuscitation of the trauma patient can result in which of the following?

Increased blood loss

The prehospital assessment of the trauma patient begins of which of the following?

Information provided by the dispatcher

What is most likely source of hemorrhage in a patient with unexplainable signs of shock?

Intra-abdominal injury

Cardiac tamponade is suspected with the findings of muffled heart sounds___________, and___________ known as___________.

JUGULAR VEIN DISTENTION, and HYPOTENSION, known as BECK'S TRIAD.

A 55-year-old male is found unconscious after being assaulted. Assessment reveals snoring respirations, bradypnea, facial swelling, and unequal pupils. What is the most appropriate first step?

Jaw thrust maneuver

The preferred fluid for resuscitation of the patient with significant burns is:

LACTATED RINGER'S SOLUTION.

During pregnancy, signs and symptoms of shock may appear _______ due to an _________ in maternal blood volume.

LATER, INCREASE

Your patient is an 82 year old female who was an unrestrained front seat passenger in a motor vehicle collision. Which of the following is the most reliable indication of shock in this patient?

LEVEL OF CONSCIOUSNESS.

Which of the following signs of shock is not found during the primary survey?

Low blood pressure measurement

Which of the following is the most common cause of spinal injuries?

MOTOR VEHICLE COLLISIONS.

A patient who sustained extensive blunt trauma to his trunk has absent lung sounds on the right, marked respiratory distress, tachycardia and hypertension. What is the most appropriate intervention?

Needle decompression

When administering isotonic crystalloid solution, about ___________ will remain in the vascular system after 1 hour.

ONE-THIRD

Thoracic Trauma - Penetrating Injury

Objects of varying size transgress the chest wall, enter the thoracic cavity, and possibly injure the organs within the thorax. When a penetrating wound creates a communication between the chest cavity and the outside world, air tends to rush into the pleural space through the wound during inspiration when the pressure inside the chest I lower than the outside, and because the resistance to airflow through the wound is often less that that through the airways.

Management of flail chest includes:

PAIN MANAGEMENT VENTILATORY SUPPORT 100%O2

The greatest threat to life from injury to hollow abdominal organ is

PERITONITIS.

Which of the following findings indicate the need for immobilization when using a selective spinal immobilization protocol?

Pain or tenderness along the spine

Thoracic Trauma - Rib Fractures (Management)

Pain relief - Primary goal in initial management IV access IV narcotic analgesics Monitor Vitals especially Resp. Rate and Depth. Encourage patient to take deep breaths and cough to prevent the collapse of the alveoli (atelectasis) and the potential for pneumonia and other complications.

Thoracic Trauma - Hemothorax

Pathophysiology - Occurs when blood enters the pleural space. Because this space can accommodate a large volume of blood (2500-3000 ml), hemothorax can represent a source of significant blood loss and the loss of this circulating blood volume into the pleural space is a greater physiologic insult to the patient than the collapse of the lung that the hemothorax produces. Assessment: Presentation - some distress, chest pain and SOB are prominent features, generally signs of significant shock (tachycardia, tachypnea, confusion, pallor and hypotension.) Breath sounds on side of injury are diminished or absent (percussion note is DULL). Pneumothorax may be present in conjuction with hemothorax, increasing the likelihood for cardiorespiratory compromise. **Because of loss of circulating blood volume, JVD often are NOT present. Management: Constant observation to detect physiologic deterioration while providing appropriate support. High flow O2 Ventilation support via BVM or ETT if indicated. Hemodynamic status monitored. IV access an appropriate fluid therapy provided with a goal of maintaining adequate perfusion without large volumes (SBP 80-90) Rapid Transport to appropriate facility for surgical intervention.

Thoracic Trauma - Rib Fractures (Assessment)

Patients with simple rib fractures may have few symptoms. Most often they will complain of: Chest Pain and DIB Present with: Labored respirations Chest wall tenderness and crepitus Vital signs Respiratory rate and depth of breathing Pulse Ox Capnography

Which subset of patients compensates for blood loss the longest?

Pediatrics

EMS arrived on scene and finds a emergency medical responder to immobilize a pediatric patient onto a long backboard. They know that the patient's head is in a flex position. Which of the following actions is most appropriate?

Place padding under the patients torso

In addition to using appropriately sized equipment, frequently reassessing the patient, employing age-appropriate Imobilization techniques, prehospital providers should do which of the following when managing pediatric patients?

Preserve body heat

Which of the following is a golden principle of trauma care?

Provide adequate pain relief

Which best describes the goal of airway management?

Provide for adequate exchange of oxygen and CO2

EMS is treating an unrestrained driver of an automobile involved in a high-speed crash who struck his chest against the steering column. Prehospital providers no paradoxical movement of a portion of the patient's chest wall. The patient's respiratory rate is 16 and oxygen saturation is 94%. What is the most appropriate action?

Provide supplemental oxygen and observe

Prehospital providers have treated a sucking chest wound with an occlusive dressing. During transport to the hospital, the patient developed increasing respiratory distress with increased respirations and absent lung sounds are noted on repeat auscultation. What is the most appropriate next intervention?

Remove the occlusive dressing

A burn with reddened, glistening base that may have blisters is most characteristic of a

SECOND degree burn.

Which of the following is contraindicated in the management of a pregnant trauma patient in the third trimester?

SUPINE POSITION.

Hypotension due to spinal cord trauma occurs due to interruption of the _______________nervous system pathway.

SYMPATHETIC

A male patient suffered a stab wound to his left flank. He is found to be in stage III shock. During the 25 minute transport to the trauma center, intravenous fluids should be administered at a rate sufficient to maintain a:

SYSTOLIC BP OF 80 TO 90.

When approaching a trauma patient what is the first thing must be made?

Scene safety

You respond for a patient who is sustained a GSW to the right upper thorax he is barely responsive, pale, and diaphoretic which of the following is most appropriate for transport?

Scoop stretcher

Endotracheal intubation is a technique that requires which of the following?

Substantial training to maintain proficiency

Which of the following is a preventable cause of secondary brain injury?

Systemic hypoxia

After falling from The high bar, a gymnast has loss of senstation from the nipples down what area of the spine is most likely damage?

T4

Hypotension in hemothorax is associated with:

THE ABILITY OF EACH SIDE OF THE THORAX TO HOLD UP TO 3 LITERS OF BLOOD.

During the assessment of the trauma patient, auscultation of the lung sounds is first performed during:

THE PRIMARY SURVEY.

Minute volume of ventilation is best represented as

TIDAL VOLUME x ventilatory rate

Which of the following indicates that a trauma patient is having trouble breathing?

The patient breathing is noticeable

What is the most common cause of airway obstruction in the unconscious trauma patient?

Tongue

The most appropriate for airway maneuver for trauma patients as which of the following?

Trauma jaw thrust

Thoracic Trauma - Physiology

Two components of chest physiology that are most likely to be impacted by injury - BREATHING and CIRCULATION Ventilation - mechanical act of drawin in air through the mouth and nose to the trachea and bronchi then to lungs to alveoli. Respiration - delivery of oxygen to the cells.

While caring for a patient who was involved in an altercation, he vomits and his airways totally obstructed with vomitus and blood. What is the maximum amount of time that you can suction his airway?

Until his airways clear

Thoracic Trauma - Rib Fractures (pathophysiology)

Upper ribs are broad, thick and particularly well protected by the shoulder girdle and muscles. Requires great energy to fracture the upper ribs and patient is at risk for significant injuries such as traumatic disruption of the aorta. Rib fractures occur most often to Ribs 4-8 laterally, where they are thin and have less over lying musculature. Broken ends of ribs may tear muscle, lung and blood vessels with possibility of an associated pulmonary contusion. Simple rib fractures are rarely life threatening in adults, may be deadly in the elderly patient. Compression of the lung may rupture the alveoli and lead to pneumothorax. Fracture of the lower ribs may be associated with injuries of the Spleen and Liver and may indicate the potential for intra-abdominal injuries. These injuries may also present with signs of blood loss or shock.

Spinal cord injuries can lead to hypotension due to which of the following physiologic changes?

Vasodilation below the level of injury

IV fluids administered to patients in shock should be _______ in order to ______________ ______________.

WARM, PREVENT HYPOTHERMIA.

Units responding to a motor vehicle accident on the highway should consider which of the following as part of their pre-arrival assessment?

Weather conditions

In trauma care, a Principle is defined as which of the following?

What needs to be done

When should the secondary survey be accomplished?

When the time and situation allow

an adult male sustained a deep laceration to his distal thigh. Bright red blood is spurting from the wound. Direct pressure is not controlling the bleeding. What is the most appropriate next step?

apply a tourniquet and tighten it until bleeding stops

your patient has a deep laceration to his antecubital fossa with significant bleeding. What is the most appropriate initial action?

apply direct pressure

your patient is a middle aged male who crashed his motorcycle. He is unresponsive. After opening the airway using a modified jaw thrust, you note the patient has respirations at a rate of 6. Auscultation reveals breath sounds are absent on the left side. What is the most appropriate next intervention?

begin ventilation with BVM

medication used by trauma patients for pre-existing conditions may cause what?

beta-blockers may prevent tachycardia with blood loss

what best explains the mechanism by which gas exchange is impaired in pulmonary contusion?

blood in the alveoli

hypotension of unknown etiology in a trauma patient should be assumed to result from what?

blood loss

during the primary survey of a trauma patient, you note that the patient is agitated and confused, and has multiple injuries from an altercation. what is the most appropriate first treatment priority?

correction of possible hypoxia

what is the preferred prehospital wound management for a patient which a 36% body surface area flame burn?

dry sterile dressings

the potential for death or serious injury is greatest in which of the following motor vehicle collisions? -down and under -ejection from vehicle -lateral compression -up and over

ejection from vehicle

what is the preferred adjunct device for verifying placement of an ET tub in a patient with a perfusing rhythm?

end-tidal CO2 monitoring

what is a key finding that differentiates cardiac tamponade from tension pneumothorax?

equal breath sounds

what best describes shock?

generalized inadequate tissue perfusion

bilateral femur fractures are most often associated with which type of motorcycle crash?

head-on impact

the most immediate life threatening condition resulting from injury to solid abdominal organs is what?

hemorrhage

what is the preferred fluid for resuscitation of hemorrhagic shock in the prehospital setting?

lactated ringers

Pulmonary Volumes

lly stiff.

an 18 yr old female was struck by a car and has sustained an apparent left femur fracture. communication with her is hampered because she only speaks a foreign language. which finding, by itself, does not mandate immobilization of the cervical spine?

mechanism of injury

essential airway skills include manual clearing of the airway, manual maneuvers, suctioning and what?

oropharyngeal airway

what is the most important reason to maintain an open airway in the trauma patient?

prevents hypoxemia and hypercarbia

Which of the following is the earliest signs of deterioration in a patient with a flail chest?

respiratory rate increase

which assessment is most beneficial in differentiating hemorrhagic shock from neurogenic shock in the prehospital setting?

skin

You arrive at the scene of a motor vehicle collision in which a vehicle struck a tree. Which is the best indicator of potential injury? -circumference of vehicle -diameter of the tree -mass of the vehicle -speed of the vehicle

speed of the vehicle

the body initially compensates for blood loss through activation of what?

sympathetic nervous system

D

tongue