Chp 15,29,30,34,35,36
What size ET tube would be MOST appropriate to use for a 4 year old child
5.0
A convenience store clerk was stabbed during a robbery attempt. He is semiconscious with shallow breathing and weak radial pulses. During the rapid assessment, you find a single stab wound to his left anterior chest. His jugular veins are diminished but equal. The MOST appropriate treatment for this patient involves
Covering the stab wound with an occlusive dressing, assisting ventilations, transporting at once, and establishing large-bore IV lines en route
Signs of neurogenic shock include all of the following EXCEPT A) bradycardia B) flushed skin C) diaphoresis D) hypothermia
Diaphoresis
ANy noramotensive patient with a sternal fracture should recieve
ECG monitoring
A patient with hemorrhagic shock would be expected to have B) warm, flushed skin Flattened jugular veins C) widened pulse pressure D) an increased hematocrit
Flattened jugular veins
When looking inside a patient's mouth, you cannot see the posterior pharynx and only the base of the uvula is exposed. This is indicative of a Mallampati Class
III
After inserting the Combitube to the proper depth, you should next
Inflate the pharyngeal cuff with 100 mL of air
Which of the following conditions would MOST likely cause laryngeal spasm and edema A) croup B) inhalation injury C) Viral pharyngitis D) Mild asthma attack
Inhalation injury
After inserting the needle into through the cricothyroid membrane, you should next:
Insert the needle about 1 cm farther and then aspirate with the syringe
A 19-year old woman ingested a large quantity of Darvon. She is responsive to pain only and has slow, shallow respirations. The Most appropriate airway managment for this patient involves
Inserting a nasal airway and assisting ventilations with a bag-mask device
A 19 year old woman fell from a second story window and landed on her head. She is unconscious with a blood pressure of 168/104 mm Hg, Heart rate of 56 bpm, and irregular respirations of 8 bpm. Further assessment reveals blood draining from her nose and bilaterally dilated pupils that are slow to react. In addition to employing full spinal precautions, the MOST appropriate treatment for this patient involves
Intubating her trachea after preoxygenating her for 2 to 3 minutes with a bag-mask device, transporting immediately, starting at least one large-bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessment
Which of the following statement regarding multilumen airways is correct A) Multilumen airways can be used safely in pediatric patients if ET intubation is unsuccessful B) To ensure proper placement, multilumen airways should be inserted under direct laryngoscopy C) Multilumen airways are equipped with an oropharyngeal cuff, which eliminates the need for a mask seal D) Compared with esophageal airways, multilumen airway devices have not been shown to provide better ventilation
Multilumen airways are equipped with an oropharyngeal cuff, which eliminates the need for a mask seal
Following blunt trauma to the anterior chest, a 44 year old woman presents with restlessness, respiratory distress, perioral cyanosis, and tachycardia. Further assessment reveals a midline trachea, engorged jugular veins, and absent breath sounds on the right side of her chest. you should
Perform an immediate needle thoracentesis to the right side of the chest
common clinical findings associated with a subdural hematoma include all of the following except A) rapidly increasing intracranial pressure B) an underlying skull fracture C) a fluctuating level of consciousness D) unilateral hemiparesis or slurred speech
Rapidly increasing intracranial pressure
Which of the following mechanisms of injury poses the LEAST threat for significant injury A) rear-end collision with restrained driver B) Death of an occupant in the same vehicle C) motorcycle crash at greater than 20 mph D) Vehicular intrusion of greater than 12 inches
Rear-end collision with restrained driver
Which of the following assessment findings is MOST suggestive of intra-abdominal hemorrhage A) signs of shock B) palpable pain C) diffuse tenderness D) Nausea and vomiting
Signs of shock
Cerebrospinal fluid drainage from the ears is MOST indicative of
a skull fracture
An intubated 33-year-old man is becoming agitated and begins moving his head around. Your estimated time of arrival at the hospital is 15 minutes. You should
administer a sedative medication
A 50 year old man was working on his car when the jacks collapsed and the car landed on his chest. Your assessment reveals profound cyanosis and swelling to his chest and face, agonal respirations, and a weak carotid pulse. This patient will benefit MOST from
aggressive airway management and rapid transport
Negative-pressure ventilation occurs when
air is drawn into the lungs when intrathoracic pressure decreases
pneumothorax is MOST accurately defined as
air or gas within the pleural cavity
A pulmonary contusion following blunt chest trauma results in
alveolar and capillary damage with intraparenchymal lung hemorrhage
A 17 year old high school football player was struck in the abdomen by another player during a tackle. Your assessment reveals signs of shock and pain to the patient's left shoulder, which is unremarkable for trauma. Examination of the patients abdomen is also unremarkable for obvious injury. Based on your assessment findings and the patient's clinical presentation, you should be MOST suspicious of
an injury to the spleen
the exchange of oxygen and carbon dioxide between the alveoli and the blood the pulmonary capillaries is called
external respirations
compared to a handgun a rifle
fires at a higher velocity
Grey Turner Sign is defined as ecchymosis to the ___________ and is indicative of ______________
flank, retroperitoneal bleeding
a 40 year old man fell 20 feet from a tree while trimming branches. your assessment reveals that he is unresponsive. You cannot open his airway effectively with the jaw-thrust maneuver. You should
carefully open his airway with the head tilt-chin lift maneuver
Inserting a nasopharyngeal airway in a patient with CSF drainage from the nose following head trauma may
cause the device to enter the brain through a hold caused by a fracture
Following a traumatic brain injury, initial swelling of the brain occurs due to
cerebral vasodilation
Which of the following signs of a basilar skull fracture would MOST likely observed in the prehospital setting
cerebrospinal fluid drainage from the ear
The hypoxic drive stimulates breathing in patients with
chronically decreased PaO2 levels
Orotracheal intubation should be performed with the patient's head
in the sniffing position
You are intubating a 60 year-old-man in cardiac arrest and have visualized the ET tube passing between the vocal cords. After removing the laryngoscope blade from the patient's mouth, manually stabilizing the tube, and removing the stylet, you should
inflate the distal cuff with 5 to 10 mL of air
After properly positioning the patient's head for intubation, you should open his or her mouth and insert the laryngoscope blade
into the right side of the mouth and sweep the tongue to the left
Crackles or rales in the lungs following a myocardial contusion would MOST likely result from
left ventricular dysfunction
When assessing the severity of a traumatic brain injury, the MOST important assessment parameters is the patient's
level of consciousness
Which of the following types of skull fracture would be LEAST likely to present with gross physical signs A) open fracture B) depressed fracture C) basilar fracture D) line fracture
linear fracture
Fractures of the lower rib cage should make you MOST suspicious for injuries to the
liver or spleen
Hypotension that is associated with neurogenic shock is the result of
loss of alpha receptor stimulation
In contrast to a curved laryngoscope blade, a straight laryngoscope blade is designated to
extend beneath the epiglottis and lift it up
Penetrating abdominal trauma MOST commonly results from
low-velocity gunshot or stab wounds
A 21 year old woman was thrown from a horse and landed on her head. Upon arrival at the scene, you find the patient lying supine. She is conscious and has her head turned to the side. As you attempt to move her head to a neutral in-line position, she screms in pain. You should
maintain her head in the position found and continue with your assessment
a 45 year old unrestrained man was ejected from his small truck when it struck a tree. The patient is found approximately 20 feet from the wreckage. Your primary assessment reveals that he is unresponsive and has sonorous respirtation and a rapid pulse. Your initial actions should include
manually stabilizing his head and opening his airway with the jaw-thrust maneuver
You should insert the ET tube between the vocal cords until the
proximal end of the cuff is 1 to 2 cm past the vocal cords
EMS providers can have the MOST positive impact on mortality and mobidity from abdominal trauma by
recognizing the need for rapid transport
periumbilical eccymosis
referred to as Cullen sign and may take several hours to develop following abdominal trauma
The preferred site for performed a needle thoracenteis is
superior to the third rib into the intercostal space at the midclavicular line
If the pleural space becomes filled with air or blood
surface tension is lost and the lung collapses
A motorcycle or football helmet should be removed if
the patient is breathing shallowly and access to the airway is difficult
During a frontal collision, MOST penumothoraces occur when
the patient takes a deep breath just before impact and the lungs rapidly decompress at the time of impact
The ______ is an anatomic space located between the base of the tongue and epiglottis
vallecula
A trauma patient with suspected internal hemorrhage and inadequate breathing requires
ventilation assistance and rapid transport
According to the most current guidelines for emergency cardiac care, the most reliable method for monitoring correct endotracheal tube placement is
waveform capnography
The King airway should NOT be used in patients
with known esophageal disease
Which of the following factors would MOST likely produce a falsely normal pulse oximetry reading
carboxyhemoglobin
An epidural hematoma typically causes rapid deterioration in the patient's condition because
it is associated with brisk arterial bleeding
Which of the following clinical signs may not be present in a patient with a tension pneumothorax and associated internal bleeding A) tachycardia B) jugular vein distention C) mediastinal shift D) contralateral tracheal deviation
jugular vein distention
The major complication associated with hollow organ injury is
peritonitis caused by rupture and spillage of toxins
You have successfully controlled a large arterial hemorrhage from a 42 year old mans leg with direct pressure and a pressure dressing. He is conscious, but restless. His nblood pressur is 84/58 mm Hg, pulse is 120 beats/min, and RR 24 bpm. You should
Administer high-flow oxygen, keep him warm, transport, and establish two large-bore IV lines en route
A construction worker fell approximately 15 feet and landed on his head. He is semiconscious. His respiratory rate is 14 breaths/min with adequate depth. Further assessment reveals blood draining from his nose. You should
Administer oxygen via nonrebreathing mask and continue your assessment
All of the following statements regarding front air bags are correct EXCEPT A) small children riding in the front seat can be killed when the air bag deploys B) Air bags will provide protection from both initial and secondary impacts C) Without the use of a seat belt, front air bags are insufficient in preventing ejection D) front air bags will not activate in side impacts or impacts to the front quarter panel
Air bags will provide protection from both initial and secondary impacts
Which of the following patients may benefit from CPAP A) Alert patient with respiratory distress following submersion in water B) Comatose patient with shallow breathing after overdosing on heroin C) Trauma patient with labored breathing and extensive chest wall bruising D) patient with pulmonary edema who is unable to follow verbal commands
Alert patient with respiratory distress following submersion in water
Which of the following signs would you MOST likely observe in a patient with compensated shock A) anxiety or agitation B) dilation of the pupils C) absent peripheral pulses D) response to painful stimuli
Anxiety or agitation
You are treating a 20 year old woman with a large laceration involving the brachial artery. The patient is confused, is pale, and has weak peripheral pulses. your initial attempts to control the bleeding have failed. You should
Apply a proximal tourniquet, administer high-flow oxygen, transport, and establish vascular access en route.
secondary brain injuries include all of the following EXCEPT A) axonal injury B) cerebral edema C) cerebral ischemia D) intracranial hemorrhage
Axonal injury
What spinal cord injury Is characterized by motor loss on the same side as the injury, but below the lesion
Brown-Sequard syndrome
Which of the following general statements regarding gunshot wounds is correct A) the most important factor for the seriousness of a gunshot wound is the type of tissue through which the projectile passes B) injuries from a shotgun blast are more devastating when the distance between the gun and the target is less than 100 yards Wounds to lower extremities that are not associated with a fracture or neurovascular compromise are always explored surgically C) Wounds to lower extremities that are not associated with a fracture or neurovascular compromise are always explored surgically D) Tissue of high elasticity, such as muscle, is less able to tolerate temporary cavitation than tissue of low elasticity, such as the liver
The most important factor for the seriousness of a gunshot wound is the type of tissue through which the projectile passes
The MOST disastrous consequence of a severe traumatic brain injury
a decrease in cerebral perfusion pressure
a free-floating segment of fractured ribs
a flail chest
A 39 year old man sustained an abdominal evisceration after he was cut in the abdomen with a machete. The patient is semiconscious and is breathing shallowly. You should
assist ventilations with a bag-mask device; cover the exposed bowel with moist, sterile dressings and protect them from injury; transport at one; and initiate IV therapy enroute
If the mechanism of injury indicates that your patient may have sustained a spinal cord injury
assume that a spine injury exists, regardless of the neurologic findings
In contrast to secondary spinal cord injury primary spinal cord injury occurs:
at the moment of impact
A 16 year old boy collapsed after being struck in the center of the chest by a line drive during a high school baseball game. Your assessment reveals that he is pulseless and apneic. As your partner initiates one-rescuer CPR, your MOST important action should be to
attach the ECG leads and be prepared to defibrillate
When ventilating a patient with facial injuries it is MOST important to
be alert for changes in ventilation compliance
A disadvantage of ET intubation is that it
bypasses the upper airway's physiologic functions of warming, filtering, and humidifying
A 59 year old construction worker collapsed on the job and fell into a pile of steel rods. Your assessment reveals that he is pulseless and apneic, and has a 12 inch steel rod impaled in his epigastrium. As your partner and an emergency medical responder begin CPR, you should
control any external bleeding, stabilize the rod in place with bulky dressings, apply the cardiac monitor, and start at least one large-bore IV line en route to the hospital
Neuromuscular blocking agents
convert a breathing patient with a marginal airway into an apneic patient with no airway
Immediate treatment for an open pneumothorax involves
converting the pneumothorax to a closed injury
Dysrthymias following a myocardial contusion are usually secondary to
damage to myocardial tissue at the cellular level
The third phase of a motor vehicle accident involves
deceleration of internal organs
extension of the arms and extension of the legs
decerebrate posturing
What type of skull fracture is MOST common following high-energy direct trauma to a small surface area of the head with a blunt object
depressed fracture
involves stretching shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the cell body
diffuse axonal injury
Sudden deceleration of a motor vehicle that is traveling at 60 mph
dissipates tremendous forces and causes major injuries
Early signs and symptoms of increased intracranial pressure include
headache and vomiting
Common clinical findings associated with a traumatic asphyxia include all of the following EXCEPT A) hyphema B) exopthalmos C) facial cyanosis D) tongue swelling
hyphema
the "platinum 10 minutes" refers to the
maximum time spent at a scene for a trauma patient
In contrast to negative-pressure ventilation, positive-pressure ventilation
may impair blood return to the heart
During tracheobronchial suctioning, it is MOST important to
monitor the patient's cardiac rhythm and oxygen saturation
All of the following factors would increase a person's respiratory rate EXCEPT A) narcotic analgesic use B) increased metabolism C) the use of amphetamines D) a rise in body temperature
narcotic analgesic use
The cricothyroid membrane is the ideal site for making a surgical opening into the trachea because
no important structures lie between the skin covering the cricothyroid membrane and the airway
Before securing the ET tube in place with a commercial device, you should
note the centimeter marking on the ET tube at the patient's teeth
changes in the rate and depth of breathing are regulated primarily by the
pH of the CSF fluid
Under normal conditions, the central chemoreceptors in the brain increase the rate and depth of breathing when the
pH of the CSF increases
endotracheal intubation is MOST accurately defined as
passing an ET tube through the glottic opening and seal off the trachea
The circulation of blood through an organ or tissue in amounts adequate to meet the body's demands
pefusion
Which of the following types of shock is caused by poor blood vessel function A) septic B) cardiogenic C) hypovolemic D) hemorrhagic
septic
truamatic injuries to the aorta are MOST commonly the result of
shearing forces
During abrupt deceleration
shearing or rupturing of internal organs can occur
Which of the following factors does NOT contribute to the extent of injury from a gunshot wound to the abdomen A) size of the patient B) profile of the bullet C) trajectory of the bullet D) distance of the bullet traveled
size of the patient