Chapter 27
Regarding the field triage of injured patients, which of these patients is NOT a member of a special patient population that would necessitate transport to a trauma center? A. A female patient who is 12 weeks pregnant and who fell on the sidewalk, injuring her hip and wrist B. A 70-year-old male patient with a systolic blood pressure of 104 mmHg after wrecking his car into a tree C. A female patient with a suspected brain injury from a fall who also takes prescribed anticoagulants D. A male patient with a broken femur and burns to 25 percent of his body after jumping from a second-story window of a house that was on fire
A. A female patient who is 12 weeks pregnant and who fell on the sidewalk, injuring her hip and wrist
What damage is MOST common when a person falls on outstretched arms? A. Colles fracture B. Mid-shaft humerus fracture C. Elbow dislocation D. Rotator cuff injury
A. Colles fracture
A patient who was involved in a motor vehicle collision is complaining of neck pain. Which piece of information would most contribute to the EMT's high index of suspicion that the patient may have suffered more significant injuries beyond isolated neck pain? A. Death of the car's driver B. Difficulty turning is head to the right C. Lack of air bags in the car D. External damage to the car is significant
A. Death of the car's driver
A lap belt that is worn too low can result in what injury from a frontal crash? A. Dislocated hips B. Fractured pelvis C. Abdominal injuries D. Knee fractures
A. Dislocated hips
Injuries from which phase of the blast typically go unsuspected or ignored? A. Primary B. Secondary C. Tertiary D. Quaternary
A. Primary
You arrive at the scene where a young male patient fell out of a tree he was climbing. Although he fell from a lower branch, he was still reportedly 10-12 feet in the air when he fell. The patient landed on his side on the ground. Which element of the kinematics of trauma would explain the mechanism of any injuries he may have sustained? A. Rapid deceleration B. Terminal velocity C. Terminal mass D. Rapid acceleration
A. Rapid deceleration
A patient, who was constructing a bomb in his basement, has sustained a secondary-phase blast injury. Which presentation would the EMT most likely observe from this blast phase? A. Screwdriver impaled in the thorax B. Complaint of nausea after inhaling fumes C. Headache and shortness of breath D. Burns to the head, neck, and chest
A. Screwdriver impaled in the thorax
When triaging a patient, of the following, you should first assess the: A. level of consciousness. B. mechanism of the injury. C. system considerations. D. anatomy of the injury.
A. level of consciousness.
Acceleration and deceleration are measures of: A. rate. B. velocity. C. mass. D. energy.
A. rate.
The first point of impact in head-first falls is typically: A. the arms. B. the shoulders. C. the crown of the head. D. the face.
A. the arms.
In a motorcycle collision, burns are most commonly associated with: A. the leg being caught between the motorcycle and the ground. B. friction from the slide. C. continued operation of the engine. D. ignition of the fuel tank.
A. the leg being caught between the motorcycle and the ground.
In caring for a patient with a penetrating injury, it is important to remember that: A. the severity of injury caused by penetrating trauma is related to the velocity of the penetrating object. B. the damage caused by medium-velocity projectiles depends primarily on the profile and the drag of the projectile. C. bullet exit wounds are generally larger than the entrance wounds, owing to the tumbling motion of the bullet. D. a shotgun wound is an example of a low-velocity injury.
A. the severity of injury caused by penetrating trauma is related to the velocity of the penetrating object.
A patient has been stabbed with a knife at the fifth intercostal space on the right side of the chest in an attempted suicide. Assessment reveals him to be short of breath and coughing. Which question is it most important for the EMT to ask regarding the weapon? A. "How long was the knife blade?" B. "Did you push the knife in slowly or quickly?" C. "Did the knife penetrate your chest easily?" D. "Was the knife clean or dirty?"
A. "How long was the knife blade?"
Why is the exit wound of a bullet always larger than the entry wound? A. When the bullet enters the dermis, it breaks into many small pieces that travel in different directions. As these bullet pieces pass out of the body, they destroy a wide path of tissue. B. As the bullet's energy dissipates into flesh, its kinetic energy is transferred to the tissues. This causes exit wounds that are much larger than entry wounds. C. As the bullet enters the skin, it flattens out, or "mushrooms," increasing its surface area. Thus, when it exits the body, it displaces more tissue than it did when it entered. This creates the larger exit wounds. D. As the superheated metal of the bullet proceeds through the skin, it burns away all tissue that it touches. The heat destruction radiates into a tubular shape along the trajectory of the bullet, causing the bullet's exit to be larger than its entrance.
B. As the bullet's energy dissipates into flesh, its kinetic energy is transferred to the tissues. This causes exit wounds that are much larger than entry wounds.
On what factor does the pattern of tertiary phase injuries depend? A. Direction B. Distance and point of impact C. Mass D. Velocity
B. Distance and point of impact
Emergency Medical Responders have removed an intoxicated and confused patient from a car that struck another vehicle at a high rate of speed. The patient was unrestrained and his car did not have air bags. Assessment reveals deformity bilaterally to the hips and femurs and bruising to the knees. Based on this injury pattern, the EMT would recognize which type of injury mechanism? A. Up and over B. Down and under C. High velocity D. Lateral impact
B. Down and under
While conducting field triage of injured patients, which of the following special considerations indicates a need for transport to a trauma center? A. Eye injuries B. Emergency medical service (EMS) provider judgment C. Age greater than 45 years of age D. Pregnancy greater than 10 weeks
B. Emergency medical service (EMS) provider judgment
Which piece of information would you provide to a group of young teenage drivers to decrease their chance of suffering a "whiplash"-type injury if involved in a motor vehicle collision? A. Properly wear seat belts with a headrest in the down position B. Ensure that the head rest is properly positioned C. Make sure the car has side-door air bags D. Position the car's seats in a full upright position
B. Ensure that the head rest is properly positioned
As part of your service to the community, you are certified as a car seat specialist and provide monthly classes on the safe transport of infants and children. Over the course of one day, several cars have pulled into your EMS station and asked you to look at their car seats. Which car seat position would indicate that the parent is safely transporting his or her infant (younger than 1 year old)? A. Facing backward in an upright position in the front seat (45 degrees) B. Facing backward in the back seat in a reclined position (45 degrees) C. Facing forward in the back seat in a reclined position (60 degrees) D. Facing forward in the back seat in an upright position (60 degrees)
B. Facing backward in the back seat in a reclined position (45 degrees)
What is the best description of the goal of a trauma system? A. Providing all trauma patients with a complete battery of diagnostic tests and access to specialists B. Getting the right patient to the right facility in the right amount of time C. Providing the highest level of care possible within a 10-minute transport time frame for all patients D. Transporting as many patients as possible by air medical transportation
B. Getting the right patient to the right facility in the right amount of time
A patient with severe head and neck pain states that he was properly wearing his seat belt when another car struck him from behind. As a knowledgeable EMT, you would realize that the complaint of: A. Head pain suggests that he was not wearing the seat belt properly B. Head and neck pain could occur even when the seat belt is properly worn C. Head and neck pain indicates that the lap belt was worn without the shoulder harness D. Head and neck pain indicates that he was not wearing his seat belt
B. Head and neck pain could occur even when the seat belt is properly worn
Which injury is most serious, warranting immediate and rapid transport to the local trauma center? A. Open fracture to the left lower leg B. Instability and crepitus to the left lateral chest wall C. Deformity to the right ankle with pain rated as a 10/10 D. Large, deep laceration to the arm with bone visible
B. Instability and crepitus to the left lateral chest wall
What is the term for an evasive action on the part of a motorcycle rider that is designed to prevent ejection and separation of the driver from the bike in an impending collision? A. Ejection prevention B. Laying the bike down C. Positive evasion D. Side swiping
B. Laying the bike down
You arrive on the scene of a motorcycle accident and find an unresponsive male patient lying in the middle of the road with blood coming from his ears and nose. He was not wearing a helmet and has snoring respirations. Which sequence of events would be most appropriate in the care of this patient? A. Primary assessment, spine motion restriction, transfer to the ambulance after 8 minutes of scene time, all other care provided en route B. Primary assessment, airway and ventilatory management, oxygen administration, spine motion restriction precautions, transport within 10 minutes of arriving on scene C. Full spine motion restriction procedures, transfer to the ambulance, provide all assessment and care en route to the hospital, with total scene time of 7 minutes D. Primary assessment, oxygen administration, transfer to stretcher, transport within 5 minutes of arriving on scene with spine motion restriction precautions done en route
B. Primary assessment, airway and ventilatory management, oxygen administration, spine motion restriction precautions, transport within 10 minutes of arriving on scene
A patient has been critically hurt in a nighttime motor vehicle collision. She was wearing a seat belt and hit a tree at 70 mph. The car she was driving weighed 2 tons and was equipped with air bags that did deploy. Which factor had the greatest impact on the injuries she sustained? A. Deployment of air bags B. Speed of the vehicle at impact C. Weight of the vehicle D. Nighttime conditions
B. Speed of the vehicle at impact
You are assessing a male patient who was stabbed three times in the chest and abdomen. As you begin your primary assessment, you note the patient to have a decreased level of consciousness and gurgling respirations. Your next action would be to: A. Check his pulse B. Suction the airway C. Apply a cervical collar D. Obtain an SpO2 reading
B. Suction the airway
Which of the following vital signs indicates the need for transport to a trauma center? A. Glasgow Coma Scale score of 14 or less B. Systolic blood pressure less than 90 C. Respiratory rate less than 12 D. Pulse rate greater than 90
B. Systolic blood pressure less than 90
You arrive on the scene of a motor vehicle collision with multiple patients. Which of the following indicates a need for transport to a trauma center? A. Bilateral wrist fractures B. Unstable pelvis C. Open femur fracture D. Systolic blood pressure of 98
B. Unstable pelvis
In a rear-end collision, a headrest that is in the fully down position: A. can decrease the severity of a whiplash injury. B. can increase the severity of a whiplash injury. C. does not affect the severity of a whiplash injury. D. protects the driver from a secondary collision.
B. can increase the severity of a whiplash injury.
As a high-speed projectile enters the body, it can create a pressure wave that extends damage beyond the bullet pathway. This is called: A. rotational impact. B. cavitation. C. fragmentation. D. expanding pathway.
B. cavitation.
In a foot-first fall, flexing of the knees can result in: A. fractures of the spine. B. preservation of the rest of the skeletal system. C. fractures of the hips. D. fractures of the pelvis.
B. preservation of the rest of the skeletal system
During an in-service program focusing on care of the trauma patient, the medical director asks if anyone can correctly describe the "platinum 10 minutes." What statement by a participant is the best response? A. "EMS systems should be designed so that it takes an ambulance no longer than 10 minutes to respond to a trauma call." B. "EMS should initiate transport of the critically injured trauma patient to the hospital within 10 minutes of arriving on scene." C. "If the transport to a trauma center will exceed 10 minutes, EMS should strongly consider the use of an aeromedical helicopter." D. "EMS should spend 10 minutes assessing the patient for life-threatening injuries prior to initiating transport to the emergency department."
B. "EMS should initiate transport of the critically injured trauma patient to the hospital within 10 minutes of arriving on scene."
A 23-year-old roofer has fallen 20 feet from the roof of a house into shrubs below. Aside from superficial abrasions and complaint of soreness, you detect no obvious injuries. Consequently, the patient states that as long as his legs are not broken, he does not see the need to go to the hospital. As a knowledgeable EMT, your best response would be: A. "Since you did not lose consciousness, I feel better about having you refuse. Just keep an eye on your feet and watch for swelling." B. "In a fall from this height, you may have hurt some internal organs. You really need to be examined." C. "Since this is a work-related injury, you should really be evaluated in the hospital. Worker's compensation may not cover you if you do not." D. "Although you feel okay now, you will most likely be sore later on. Why don't we go to the hospital and ask about some medications for pain?"
B. "In a fall from this height, you may have hurt some internal organs. You really need to be examined."
Approximately what percentage of trauma victims are multisystem trauma patients? A. 50% B. 10% C. 75% D. 90%
B. 10%
At what height does a fall become severe enough for an adult to necessitate trauma services based solely on the mechanism of injury? A. 10 feet B. 25 feet C. 20 feet D. 30 feet
C. 20 feet
You are assessing a patient who was involved in a motorcycle accident. He states that he saw an oncoming car and "laid the bike down" to avoid an outright collision. He was wearing a helmet. Which injury pattern would make sense given the action of the motorcyclist? A. Angulation to both femurs with protrusion B. Bilateral broken forearms with upper extremity trauma C. Burn to the inside of the leg from the motorcycle exhaust pipe D. "Road rash" to the entire body surface
C. Burn to the inside of the leg from the motorcycle exhaust pipe
As blunt impact abruptly halts a portion of the body and inertia causes the remaining anatomy to continue its motion, one tissue or organ is pushed into another. What type of injury is this? A. Stretch injury B. Shearing injury C. Compression injury D. Rupture injury
C. Compression injury
A young female wears her lap belt too low, over her upper thighs, because the belt is uncomfortable when worn properly. If she is involved in a head-on "up and over" type of collision, to which injury is she most prone, given the position of her lap belt? A. Bilateral arm fractures B. Tibia-fibula fractures C. Dislocated hips D. Internal abdominal injury
C. Dislocated hips
You have arrived on the scene of an explosion in a warehouse used to store fertilizers. A paramedic, who has already triaged the nine patients involved, directs you to a young man sitting under a tree. The man states that he is having excruciating ear pain. The initial assessment and rapid trauma assessment reveal no obvious injuries. Given this presentation, the EMT would recognize the injury was likely sustained: A. From the noise of the explosion B. As a result of exposure to superheated air C. During the primary blast phase D. After the secondary blast phase
C. During the primary blast phase
What is the first act of patient care that should be performed on the multisystem trauma patient? A. Control external hemorrhage. B. Establish a patent airway. C. Establish spinal stabilization. D. Provide oxygenation.
C. Establish spinal stabilization.
In dealing with the victim of multisystem trauma, which item should receive your initial attention? A. Ensuring adequate oxygenation and ventilations B. Providing appropriate fluid resuscitation C. Establishing a patent airway D. Stopping any serious external hemorrhage
C. Establishing a patent airway
Which of these is a high-velocity wound that carries the greatest risk for death when considering the concept of cavitation? A. Gunshot wound to the stomach B. Stab wound to the liver C. Gunshot wound to the spleen D. Shotgun wound to the lung
C. Gunshot wound to the spleen
Speed being equal, which impact is most likely to damage muscles and ligaments of the neck? A. Frontal impact B. Rear impact C. Lateral impact D. They are all about the same.
C. Lateral impact
An 8-year-old boy fell forward off of a swing onto outstretched arms. He did not hit his head or lose consciousness and is complaining of left forearm pain. There is deformity to the left wrist, but no other injuries or life threats. His vital signs are pulse 132 beats/min, respirations 20 breaths/min, blood pressure 108/62 mmHg, and SpO2 100%. The proper care of this patient would be to: A. Immediately load and transport the patient, splinting the injury en route B. Call ALS so that the patient can be given intravenous pain medications before splinting the forearm C. Secure the forearm to a padded board splint and apply a cold pack to the injury site before transporting the patient nonemergently D. Apply supplemental oxygen and anatomically splint the forearm when the patient is placed on a long backboard
C. Secure the forearm to a padded board splint and apply a cold pack to the injury site before transporting the patient nonemergently
Assessment of a patient involved in a motor vehicle accident reveals him to have crepitus to the left humerus, instability to the left lateral chest wall and flank, and pain on palpation to left hip region. The patient also complains of pain to the right side of the neck. Based on this injury pattern, the EMT would recognize the patient was: A. An unrestrained rear seat occupant in a car struck from the right side B. The passenger in a car hit from behind C. The driver of a car hit on the driver's side D. An unrestrained driver involved in a head-on collision
C. The driver of a car hit on the driver's side
A car, driven by an unrestrained male, strikes a utility pole at 35 mph. Given this scenario, which would be true? A. The utility pole absorbed half of the kinetic energy, so that the body collision occurred at a speed of 17.5 mph B. The energy transferred to the body is increased by a factor of 2 C. The internal organs struck the inside of the body at a speed of 35 mph D. The patient struck the steering wheel at a combined speed of 70 mph
C. The internal organs struck the inside of the body at a speed of 35 mph
An unrestrained female driving a small car is involved in a rollover-type collision. Why is her risk for serious injury or death significantly increased? A. Rollovers are the result of high speeds B. The risk for ejection is lessened, increasing injuries suffered in the car C. There are more impacts in a rollover causing injury D. Smaller and lighter cars tend to roll multiple times
C. There are more impacts in a rollover causing injury
Injuries that are received during the secondary blast phase are caused by: A. personnel displacement. B. heat or burn injuries. C. blast projectiles. D. overpressure wave.
C. blast projectiles.
The "blown outward" appearance of a bullet exit wound is the result of: A. the bullet and hot gases. B. the bullet and displaced bone fragments. C. damage by the bullet and the cavitational wave. D. damage by the bullet forcing debris and bodily contents out of the wound.
C. damage by the bullet and the cavitational wave.
A "whiplash"-type neck injury is most often observed with which type of collision? A. Rollover B. Frontal impact C. Rear-end impact D. Ejection
C. Rear-end impact
Two cars have collided head-on. One car was traveling at a speed of 55 mph and the other at 35 mph. The total speed of impact would be: A. 55 mph B. 20 mph C. 35 mph D. 90 mph
D. 90 mph
Which definition would accurately describe a Level III trauma center? A. A facility that has surgical care capability available at all times for incoming trauma patients and can handle all but the most seriously injured specialty and multisystem trauma patients B. Usually a university teaching center that is prepared and committed to handle all types of specialty trauma and can provide neurosurgery, microsurgery, pediatric care, and care for multisystem trauma C. A general hospital with some surgical capability and a commitment to special staff training and resource allocation for trauma patients D. A facility where seriously injured trauma patients may be taken for stabilization and care before transport, often by helicopter, to a more distant, higher-level trauma center
D. A facility where seriously injured trauma patients may be taken for stabilization and care before transport, often by helicopter, to a more distant, higher-level trauma center
A 27-year-old male was involved in an altercation and was struck in the ribs with a baseball bat. Assessment reveals intact skin with bruising to the right lateral chest. When palpating this area, pain, instability, and crepitus are all observed. The patient also complains of difficult and painful breathing. The EMT would recognize: A. Pulmonary injury caused by penetrating trauma B. Thoracic injury secondary to penetrating trauma C. Chest wall injury caused by acceleration forces D. Chest injury caused by blunt trauma
D. Chest injury caused by blunt trauma
You are responding to a call for a 4-year-old child hit by a car. When assessing this child, which injury patterns would you recognize as typical based on the child's age and mechanism of injury? A. Bilateral ankle deformity, contusions to the back, and face trauma B. Left arm and leg deformities, and head injury C. Head injury with deformities to both upper arms and neck trauma D. Deformed femurs, bruises to the chest and abdomen, and head injury
D. Deformed femurs, bruises to the chest and abdomen, and head injury
A teenage female patient was ejected from a car as it rolled down a hill after she ran off the road. She is responsive, but with signs of early shock and respiratory distress. She has bruising to her anterior abdomen and chest, a laceration to her left temple, and deformity to her left wrist. At which point should the wrist injury be splinted? A. Prior to full spinal motion restriction precautions being provided B. Just before leaving the scene C. Before transferring the patient to the stretcher D. En route to the hospital
D. En route to the hospital
What is the term for maintaining suspicion about the types of injuries a patient may have even though the patient presents as very stable? A. Sense of injury potential B. Interpretation of bodily forces C. Mild feeling of certainty D. High index of suspicion
D. High index of suspicion
A car has been hit head-on by another vehicle at a moderate rate of speed. Seat belts were in place and the air bags deployed. The patient complains of chest pain. Quick observation reveals a bruise to his sternum. The EMT should immediately: A. Check the windshield for starring B. Deflate the air bag to get breath sounds C. Suspect an injury related to the air bag D. Lift the air bag and check for steering wheel deformity
D. Lift the air bag and check for steering wheel deformity
Which of the statements concerning trauma is most accurate? A. A "spider web" or "star" pattern of cracks on the windshield means the patient impacted the windshield with his head B. The mechanism of injury is the best predictor of patient outcome C. Falls are the leading cause of trauma deaths D. Multisystem trauma has a higher mortality rate than single-system injuries
D. Multisystem trauma has a higher mortality rate than single-system injuries
An unrestrained driver of a car that has struck a tree at 45 mph has suffered a contusion to his heart. The EMT would recognize that this injury occurred during which impact of the collision? A. Body collision B. Vehicle collision C. Physiological collision D. Organ collision
D. Organ collision
A 49-year-old male has been stabbed in the lower right chest. Police tell you that the patient got into an argument with an unidentified man, who then stabbed him before fleeing the scene. After assessing the patient, you are suspicious that the knife punctured the lung and is causing internal bleeding. In this situation, the mechanism of injury would be: A. Penetrating trauma to the lungs B. Assailant with a knife C. Internal hemorrhage D. Stab wound to the right chest
D. Stab wound to the right chest
A male patient has sustained gunshot wounds to the neck and abdomen. He is unresponsive and has gurgling respirations. Your immediate action would be to: A. Place a cervical collar and position the patient on a long board B. Start positive pressure ventilation and then place a cervical collar and maintain manual spine motion restriction C. Insert a nasal airway and place the patient on a long backboard D. Suction the airway while providing manual spine motion restriction
D. Suction the airway while providing manual spine motion restriction
When teaching Emergency Medical Responders about air bags, which point would you emphasize? A. Air bags are effective in decreasing injury in a rollover-type collision B. Air bags prevent broken glass from striking the occupant C. Properly placed air bags eliminate the need for seat belts D. The benefit of air bags is lessened in a multiple-vehicle collision impact
D. The benefit of air bags is lessened in a multiple-vehicle collision impact
In a frontal collision, at what rate does the occupant continue forward? A. None, since the driver has already stopped B. A rate slower than that of the vehicle C. A rate faster than that of the vehicle D. The rate of the vehicle
D. The rate of the vehicle
What is the best description of the "platinum 10 minutes" as it applies to care of the trauma patient? A. The time it should take the transporting ambulance to get the trauma patient to the closest medical facility B. The goal for total amount of time from the actual injury to arrival of EMS at the scene C. The target maximum time that the multisystem trauma patient should spend in the emergency department before being transferred to surgery D. The target maximum scene time for EMS as it applies to the seriously injured trauma patient
D. The target maximum scene time for EMS as it applies to the seriously injured trauma patient
Acceleration and deceleration are measures of: A. energy. B. mass. C. velocity. D. rate.
D. rate.
The "platinum 10 minutes" refers to limiting: A. response time. B. assessment time. C. transport time. D. scene time.
D. scene time.
Vehicle collisions are a common mechanism of injury. It is important to remember: A. that high-speed collisions do not result in any more serious injuries than medium- or low-speed collisions. B. that mass is a key factor in mechanism of injury. C. that the death of an occupant of a vehicle usually means that the occupant absorbed most of the energy and other occupants will be less seriously injured. D. to maintain a high index of suspicion if any passenger appears confused.
D. to maintain a high index of suspicion if any passenger appears confused.
The EMT understands the importance of evaluating the mechanism of injury when he states: A. "Evaluating the mechanism of injury is important because it determines whether emergency transport to the hospital is needed." B. "The mechanism of injury is useful in determining the exact injuries the patient has sustained." C. "The mechanism of injury is a useful tool in determining whether the patient's outcome will be good or bad." D. "The mechanism of injury can be used to guide the EMT's injury assessment and treatment of the patient."
D. "The mechanism of injury can be used to guide the EMT's injury assessment and treatment of the patient."
Head injuries and chest injuries such as flail chest, blunt cardiac injury, and aortic tears commonly result from which pathway in an automobile collision? A. Restrained pathway B. Ejection pathway C. Down-and-under pathway D. Up-and-over pathway
D. Up-and-over pathway