Chapter 28 EMT Study Questions
3.A patient who experiences an immediate loss of consciousness followed by a lucid interval has a(n): A.epidural hematoma. B.subdural hematoma. C.concussion. D.contusion.
Answer: A Rationale: Epidural hematomas are caused by injury to an artery—usually the middle meningeal artery—that lies in between the skull and brain. Patients with an epidural hematoma typically experience an immediate loss of consciousness followed by a brief period of consciousness (lucid interval) as intracranial pressure increases. Subdural hematomas are the result of injury to a vein; therefore, they tend to bleed slowly and usually cause a progressive decline in level of consciousness. Concussions and contusions may cause a loss of consciousness, but it is typically brief.
1.The brain, a part of the central nervous system (CNS), is divided into the: A.cerebrum, cerebellum, and brain stem. B.cerebrum, brain stem, and spinal cord. C.cerebellum, cerebrum, and spinal cord. D.spinal cord, cerebrum, and cerebral cortex.
Answer: A Rationale: The brain and spinal cord comprise the central nervous system (CNS). The brain is divided into three major regions: the cerebrum (the largest portion), the cerebellum, and the brain stem. Each region of the brain carries out specific functions.
4.A 44-year-old man was struck in the back of the head and was reportedly unconscious for approximately 30 seconds. He complains of a severe headache and "seeing stars," and states that he regained his memory shortly before your arrival. His presentation is MOST consistent with a(n): A.contusion. B.concussion. C.subdural hematoma. D.intracerebral hemorrhage.
Answer: B Rationale: A concussion occurs when the brain is jarred around inside the skull. It may result in a brief loss of consciousness and occasionally, amnesia. Seeing stars is a common finding following trauma to the back of the head (occiput), as this region is primarily responsible for vision. A concussion—the least severe of all closed head injuries—typically does not result in physical damage to the brain. Compared to a concussion, a contusion, subdural hematoma, and intracerebral hemorrhage are usually associated with a more prolonged loss of consciousness.
2.As you are assessing a 24-year-old man with a large laceration to the top of his head, you should recall that: A.the scalp, unlike other parts of the body, has relatively fewer blood vessels. B.blood loss from a scalp laceration may contribute to hypovolemic shock in adults. C.any avulsed portions of the scalp should be carefully cut away to facilitate bandaging. D.most scalp injuries are superficial and are rarely associated with more serious injuries.
Answer: B Rationale: Although the scalp is highly vascular and tends to bleed heavily when injured, scalp injuries are rarely the sole cause of hypovolemic shock in adults. However, they can contribute to hypovolemia caused by injuries elsewhere in the body. Scalp lacerations, whether deep or superficial, should prompt you to look for more serious underlying injuries, such as a skull fracture. If the injury involves an avulsion, the avulsed flap of skin should be carefully replaced to its original position, not cut away.
7.During immobilization of a patient with a possible spinal injury, manual stabilization of the head must be maintained until: A.an appropriate-size extrication collar has been placed. B.the patient is fully immobilized on a long backboard. C.a range of motion test of the neck has been completed. D.D. pulse, motor, and sensory functions are found to be intact.
Answer: B Rationale: Manual stabilization of the patient's head must be maintained until he or she is fullysecured to the long backboard. This includes the application of an extrication collar, straps, and lateral immobilization (head blocks). Pulse, motor, and sensory functions must be checked before and after the immobilization process. Do notassess range of motion in a patient with a possible spinal injury; this involves moving the patient's neck and may cause further injury.
8.Your patient is a 21-year-old male who has massive face and head trauma after being assaulted. He is lying supine, is semiconscious, and has blood in his mouth. You should: A.insert a nasal airway, assess his respirations, and give 100% oxygen. B.suction his airway and apply high-flow oxygen via a nonrebreathing mask. C.manually stabilize his head, log roll him onto his side, and suction his mouth. D.apply a cervical collar, suction his airway, and begin assisting his ventilations.
Answer: C Rationale: Blood or other secretions in the mouth place the airway in immediate jeopardy and must be removed before they are aspirated. At the same time, you must protect the patient's spine due the mechanism of injury. Therefore, you should manually stabilize the patient's head, log roll him onto his side (allows drainage of blood from his mouth), and suction his mouth for up to 15 seconds. After ensuring that his airway is clear, assess his breathing and give high-flow oxygen or assist his ventilations. Nasal airways should not be used in patients with severe facial or head trauma.
5.A young male was involved in a motor vehicle accident and experienced a closed head injury. He has no memory of the events leading up to the accident, but remembers that he was going to a birthday party. What is the correct term to use when documenting his memory loss? A.Concussion B.Cerebral contusion C.Retrograde amnesia D.Anterograde amnesia
Answer: C Rationale: The term amnesia means loss of memory; it is common in patients who have experienced a cerebral concussion. Amnesia of events leading up to an injury is called retrograde amnesia. Anterograde amnesia—also called posttraumatic amnesia—is the inability to remember events that occurred—or will occur—after the injury.
6.A distraction injury to the cervical spine would MOST likely occur following: A.a diving accident. B.blunt neck trauma. C.hyperextension of the neck. D.hanging-type mechanisms.
Answer: D Rationale: Excessive traction on the neck, such as what occurs during hanging-type mechanisms, can cause a distraction injury of the cervical spine. Distraction injuries can cause separation of the vertebrae and stretching or tearing of the spinal cord.
10.You should NOT remove an injured football player's helmet if: A.a cervical spine injury is suspected, even if the helmet fits loosely. B.the patient has a patent airway, even if he has breathing difficulty. C.he has broken teeth, but only if the helmet does not fit snugly in place. D.the face guard can easily be removed and there is no airway compromise.
Answer: D Rationale: In general, you should leave a helmet on if it fits snugly and does not allow movement of the head within the helmet, the patient's airway is patent, no airway problems are anticipated, and the patient is breathing without difficulty. If you can easily remove the face guard (often the case with football helmets) and there are no airway problems, do so but leave the helmet on. If the helmet is loose, the airway is in anyway compromised, or the patient has difficulty breathing or is in cardiac arrest, the helmet must be removed.
9.A man is found slumped over the steering wheel, unconscious and making snoring sounds, after an automobile accident. His head is turned to the side and his neck is flexed. You should: A.gently rotate his head to correct the deformity. B.carefully hyperextend his neck to open his airway. C.apply an extrication collar with his head in the position found. D.manually stabilize his head and move it to a neutral, in-line position.
Answer: D Rationale: The patient's snoring sounds indicate an airway problem, which must be corrected or he may die. Manually stabilize his head; carefully move it to a neutral, in-line position; and reassess his breathing. Do not rotate or hyperextend the neck of a patient with a possible spinal injury; the results could be disastrous.