EMC 320 Final Review
Your patient is a 15-year-old male who was struck in the chest with a baseball. He is unresponsive, pulseless, and apneic. The monitor shows ventricular fibrillation. This condition is most accurately described as: pericardial tamponade. blunt cardiac injury. commotio cordis. traumatic asphyxia.
commotio cordis.
Heat loss from direct contact of the body's surfaces with another, cooler object is called: convection. conduction. radiation. evaporation.
conduction.
Signs and symptoms of high altitude pulmonary edema include: coughing producing frothy sputum. decreased urine output. abdominal pain. severe vomiting.
coughing producing frothy sputum
Dysrhythmias following a myocardial contusion are usually secondary to: excess tachycardia that accompanies the injury. damage to myocardial tissue at the cellular level. aneurysm formation caused by vascular damage. direct damage to the vasculature of the epicardium.
damage to myocardial tissue at the cellular level.
When caring for the patient with thoracic injuries, you should remember that: diaphragmatic rupture presents with signs and symptoms similar to tension pneumothorax. traumatic esophageal rupture is a common complication of blunt thoracic trauma. intermittent positive-pressure ventilation will greatly improve the condition of the patient with disruption of the trachea. traumatic asphyxia occurs when severe compressive force is applied to the trachea, crushing the structure.
diaphragmatic rupture presents with signs and symptoms similar to tension pneumothorax.
Signs and symptoms of a hemothorax include: dull percussive sounds. hypertympany. paradoxical chest wall movement. muffled heart sounds.
dull percussive sounds
Management of the chest injury patient focuses on: using an occlusive dressing on the pneumothorax. chest decompression. ensuring a patent airway and adequate oxygenation. monitoring alveolar exchange.
ensuring a patent airway and adequate oxygenation
The only initial evidence of a chest injury may be: paradoxic motion. erythema. respiratory insufficiency. distant breath sounds.
erythema.
Paradoxical chest wall motion is seen in the patient with: COPD. pneumothorax. flail chest. dislocation at the sternoclavicular joint.
flail chest.
Coup injuries commonly occur in which region of the brain? Frontal region Occipital region Temporal region Neuronal region
frontal region
The 11th and 12th ribs are often termed "floating ribs" because they: have no posterior attachment. have no anterior attachment. have neither anterior or posterior attachment; only to other ribs. form the xiphoid process and are attached only to the sternum.
have no anterior attachment.
Your patient has sustained a blunt trauma to the chest. He is dyspneic and is showing signs and symptoms of shock. You note dull percussive sounds over the site of the injury. You suspect: hemothorax. simple pneumothorax. tension pneumothorax. traumatic asphyxia.
hemothorax
The portion of the brain responsible for temperature regulation is the: pituitary gland. sternomastoid. hypothalamus. pineal gland.
hypothalamus.
Minute volume equals tidal volume multiplied by: residual volume. heart rate. respiratory rate. sixty seconds.
respiratory rate
f the normal tidal volume for the average 70-kg adult, what amount of air (in mL) is NOT available for gas exchange? 50 100 150 250
150
Which of the following trauma situations would automatically be approved for c spine clearance? 26 year old alert male who had 2 beers an hour ago. 42 year old female with an open fracture of the wrist. 8 year old male with abdominal pain and vomiting. 66 year old female with tingling in your left arm.
26 year old alert male who had 2 beers an hour ago.
Closed bilaterally fractured femurs can result in internal blood loss of up to: 1,000 mL. 1,500 mL. 2,000 mL. 3,000 mL.
3,000 mL.
You are dispatched to a structure fire at which there is a report of a burned person. Your patient is a 32-year-old man with blisters on his anterior chest and circumferential superficial burns to both lower extremities. Using the "rule of nines," the percentage of burn is: 54. 27. 36. 45.
45
You are caring for a patient with 30 percent full and partial thickness burns. He is an 80 kg man. According to the Parkland formula, he should receive ________ liters of fluid over 24 hours, with ________ liters infused in the first 8 hours. 9.6; 4.8 5; 3 8.2; 2 4.5; 1.25
9.6; 4.8
Which of these is NOT a step in performing field extubation? Advance the straight blade gently into the esophagus. Suction the patient's oropharynx. Remove the ETT upon cough or expiration. Position patient on side if possible.
Advance the straight blade gently into the esophagus.
During your assessment of a patient with a femur fracture, you find a rapidly expanding hematoma on the medial aspect of his thigh. He is in moderate pain. Distal pulses are present but weak. What should you suspect? Fasciitis Arterial injury Venous thrombus Compartment syndrome
Arterial injury
This syndrome presents with sudden hypertension, as high as 300 mmHg, bradycardia, pounding headache, blurred vision, and sweating and flushing of the skin above the point of injury and occurs well after the primary spinal injury. Autonomic hyperreflexia syndrome Brown Sequard syndrome Anterior cord syndrome Central cord syndrome
Autonomic hyperreflexia syndrome
Which type of radiation particle can travel through 6 to 10 feet of air, penetrate a few layers of clothing, and cause external and internal injuries? Gamma Alpha Neutron Beta
Beta
What spinal cord injury is characterized by motor loss on the same side as the injury, but below the lesion? Central cord syndrome Brown-Séquard syndrome Anterior cord syndrome Posterior cord syndrome
Brown-Séquard syndrome
The only area of the spine that allows for significant rotation is: C1-C2. C2-C4. C6-C7. T1-T2.
C1-C2
Following a spinal injury, a patient presents with abdominal breathing and use of the accessory muscles in the neck. This suggests injury at or above: C1-C2. C3-C4. T1-T4. T2-T5.
C3-C4.
In which of the following situations would you expect end-tidal carbon dioxide levels to be very low, despite a patent airway? Room air PPV Hyperthermia Hypoventilation Cardiac arrest
Cardiac arrest
A patient presents with abnormal motor findings after falling out of a tree. You note that he can walk but is unable to use his arms. This motor finding is most characteristic of what injury? Posterior cord syndrome Lateral cord syndrome Central cord syndrome Anterior cord syndrome
Central cord syndrome
In which of the following situations would it be MOST appropriate to apply a vest-type extrication device or a short backboard to a patient who is seated in his or her crashed motor vehicle? Conscious with bilateral femur fractures Unconscious with obvious spinal deformity Confused with lower back pain and tachycardia Conscious with neck pain and stable vital signs
Conscious with neck pain and stable vital signs
Which of the following statements regarding open-book pelvic fractures is correct? Bleeding into the pelvic cavity is generally less than 1 liter. Despite IV fluids, patients may remain hypotensive in the field. Prehospital treatment should focus on relieving the patient's pain. Stabilization involves applying lateral pressure to the iliac crests.
Despite IV fluids, patients may remain hypotensive in the field.
Which of the following is typically the first complaint in a patient who is developing compartment syndrome? Absent distal pulses Numbness and tingling Pallor to the extremity Disproportionate pain
Disproportionate pain
Which of the following is an objective technique to verify proper endotracheal tube placement? Direct visualization End Tidal monitoring Tube misting Auscultation
End Tidal monitoring
Your patient has circumferential full thickness burns of the thorax. He is intubated, and you have noticed an increase in resistance as you bag him. His skin is very tight and inflexible as you try to ventilate. Which of the following is required to improve this patient's ventilatory status? IV sedation Needle thoracostomy Escharotomy Fasciotomy
Escharotomy
Which of the following best suggests an esophageal intubation? Color change from purple to yellow with a colorimetric ETCO2 detector Failure to see a wave form on your end tidal monitor Gurgling sounds over the epigastrium with each ventilation delivered Maintaining a pulse oximetry reading of 80 to 85 percent
Failure to see a wave form on your end tidal monitor
The damage caused by high-energy bullets rarely extends beyond the actual track of the projectile. True False
False
The pressure shock wave is the damage done as the projectile strikes tissue, contuses and tears that tissue, and pushes the tissue out of its way. True False
False
Which of the following agents is the best choice for analgesia in a patient with 9 percent partial thickness burns involving the right lower extremity? Naproxen sodium Ketorolac Acetaminophen Fentanyl
Fentanyl
During spontaneous breathing, which of the following reflexes prevents overexpansion of the lungs? Cheyne-Stokes Hering-Breuer Apneustic Cushing's
Hering-Breuer
Which of the following vital signs would most likely indicate a potential spinal cord injury? Hypotension, bradycardia, and shallow respirations Hypertension, bradycardia, and shallow respirations Hypotension, tachycardia, and deep respirations Hypertension, tachycardia, and deep respirations
Hypotension, bradycardia, and shallow respirations
Which of the following has contributed most significantly to the decline in U.S. burn mortality? Public service announcements on radio, television, and billboards Paramedic involvement in public education Visits to elementary schools by firefighters Improved building codes and construction and sprinkler and smoke detector use
Improved building codes and construction and sprinkler and smoke detector use
In which stage of shock are the body's cells are so badly injured and die in such quantities that organs no longer are able to function normally? Decompensated Irreversible Compensated Class I
Irreversible
Which of the following statements regarding the hangman's fracture is correct? Hangman's fractures occur when the patient's skull rapidly accelerates. Most hangman's fractures occur during a fall from greater than 10 feet. It is a fracture of C2 that is secondary to significant distraction of the neck. Severe hyperflexion of the neck commonly results in a hangman's fracture.
It is a fracture of C2 that is secondary to significant distraction of the neck.
Which of the following most accurately characterizes simple pneumothorax? Untreated, it will lead to mediastinal shift and compression of the contralateral lung. It is a problem of ventilation—perfusion mismatch. It results from air entering the pleural cavity through a defect in the chest wall. It results from the creation of a one-way valve that continues to allow air into, but not out of, the pleural cavity.
It is a problem of ventilation—perfusion mismatch.
Which of the following parameters should be used to guide the oxygenation and ventilation of the patient with a traumatic brain injury? Maintain an oxygen saturation level of at least 96 percent and a capnography reading between 35 and 40 mmHg. Maintain an oxygen saturation level of at least 90 percent and a capnography level < 45 mmHg. Maintain an oxygen saturation level of at least 98 percent and a capnography reading > 45 mmHg. Maintain an oxygen saturation level of at least 90 percent and a capnography reading < 35 mmHg.
Maintain an oxygen saturation level of at least 96 percent and a capnography reading between 35 and 40 mmHg.
Which of the following may improve breathing in the patient with isolated rib fractures? Nitrous oxide Taping circumferentially around the chest Morphine sulfate None of the above
Morphine sulfate
A 68-year-old woman presents with an acute onset of dyspnea and sharp chest pain. Her medical history is significant for a hip fracture repair 2 weeks ago. The patient is conscious and alert, with a blood pressure of 112/58 mm Hg, pulse rate of 90 beats/min and irregular, and respirations of 22 breaths/min and labored. Which of the following treatment interventions is MOST appropriate for this patient? Pharmacologically assisted intubation and IV therapy Oxygenation and ventilation support and rapid transport 324 mg of aspirin and ventilation support with a bag-mask Supplemental oxygen and elevation of the lower extremities
Oxygenation and ventilation support and rapid transport
A spinal cord lesion may result in paralysis of both lower extremities. This condition is known as: hemiplegia. hemiparesis. quadriplegia. paraplegia
Paraplegia
Which classification of burn is characterized mainly by blisters? Full thickness Superficial Partial thickness Minor
Partial thickness
Which of the following is NOT one of the 6 Ps of musculoskeletal injury assessment? Pallor Parasthesias Pulselessness Passive extension
Passive extension
Which of the following is NOT an intervention the paramedic can perform to help reduce the risk of long-term disability following a musculoskeletal injury? Prehospital fracture reduction Prevention of gross contamination Pain reduction with cold and analgesia Transport to an appropriate medical facility
Prehospital fracture reduction
Which of the following best describes the goals of manual cervical spine stabilization? Preventing movement of the head in any direction; prevent any flexion/extension, rotation, or lateral bending Keeping the head in an "eyes forward" position; applying enough traction to cause axial unloading, which is 18 to 22 pounds in the average adult Preventing rotation of the head; avoiding any upward lifting or downward pressure on the cervical spine Preventing movement of the head in any direction; applying gentle axial pressure to stabilize the vertebral column
Preventing movement of the head in any direction; prevent any flexion/extension, rotation, or lateral bending
In responding to a trauma patient at the scene of a motor vehicle crash, which of the following is an early sign or signs of shock you might encounter during the primary assessment? Rapid heart rate and anxiety Rapidly dropping blood pressure Rapid breathing and air hunger Rapidly dropping level of responsiveness
Rapid heart rate and anxiety
Your patient is a 16-year-old male who attempted suicide. He is unconscious and apneic, lying supine on a garage floor. The family states they found the patient unconscious in the front seat of a car that was running in an enclosed garage. HR = 70, BP = 100/60, RR = 0. In addition to an IV of normal saline, which of the following is the most appropriate? Intubate, remove the patient from the garage, and transport to a hospital with a hyperbaric chamber. Remove the patient from the garage, initiate BVM ventilations with 100 percent oxygen, intubate, and transport to a hospital with a hyperbaric chamber. Remove the patient from the garage, initiate BVM ventilations with 100 percent oxygen, intubate, and transport to the nearest facility. Remove the patient from the garage, intubate, and transport to the nearest hospital.
Remove the patient from the garage, initiate BVM ventilations with 100 percent oxygen, intubate, and transport to a hospital with a hyperbaric chamber.
Which of the following is the BEST example of an indirect injury? Patellar fracture after the knee strikes an automobile's dashboard Shoulder dislocation secondary to falling on an outstretched hand Fractured ankle after stepping in a hole and twisting the lower leg Dislocated olecranon process following direct trauma to the elbow
Shoulder dislocation secondary to falling on an outstretched hand
What is visualized with a class 3 Mallampati score? Entire tonsil Upper half of the tonsil fossa Soft and hard palate Only the hard palate
Soft and hard palate
You are managing a 29-year-old male patient who was shot in the head. There is a gurgling noise in the airway. The patient is breathing spontaneously at 42 breaths per minute and has a heart rate of 110 and a systolic and diastolic pressure of 102/82. What airway intervention should be performed first on this patient? Modified jaw thrust Suctioning the airway Insertion of an oropharyngeal airway Endotracheal intubation
Suctioning the airway
In which of the following situations would spinal motion restriction precautions likely NOT be necessary? Syncopal episode in which the patient was already seated or supine Unrestrained occupant of moderate- to high-speed motor vehicle crash Isolated head injury without gross signs or symptoms of a spinal injury Vehicular damage with compartmental intrusion of greater than 12 inches
Syncopal episode in which the patient was already seated or supine
Which of the following is NOT a complication of crush injury? Renal failure Difficult-to-control hemorrhage Cardiac arrhythmias Systemic alkalosis
Systemic alkalosis
Which of the following interferes with ventilation in the presence of a flail segment? The ability to generate positive intrathoracic pressure is impaired. Intrathoracic pressure increases on the affected side. Intrathoracic pressure decreases on the affected side. The ability to generate negative intrathoracic pressure is impaired.
The ability to generate negative intrathoracic pressure is impaired.
Which of the following impairs blood clotting? Hyperthermia The giving of IV fluids Administration of low flow oxygen a pH of 7.38
The giving of IV fluids
Which of the following statements regarding central cord syndrome is correct? The patient typically presents with greater loss of function in the upper extremities than in the lower extremities. Central cord syndrome is almost always associated with a vertebral fracture and has an overall poor prognosis. Patients with cervical spondylosis or stenosis are at a lower risk for central cord syndrome following an injury. Central cord syndrome typically causes complete paralysis of the lower extremities and decreased proprioception.
The patient typically presents with greater loss of function in the upper extremities than in the lower extremities
Which of the following provides evidence that a patient is using accessory muscles to breathe? The patient is using his diaphragm with inspiration. The patient's lips are pursed. There is noticeable contraction of the intercostal muscles. The patient is sitting up, leaning forward to breathe.
There is noticeable contraction of the intercostal muscles.
Which of the following is the most common cause of airway obstruction? Vomitus Food Blood Tongue
Tongue
Bullets follow a curved path once fired from a gun. True False
True
Damage caused by low-velocity wounds is limited to the object's path of travel. True False
True
Handguns and rifles are considered medium-velocity weapons. True False
True
Low-velocity projectiles do NOT produce either a pressure shock wave or cavitation. True False
True
Which of the following may occur from watching arc welding without proper protection? Hyphema Retinal detachment Ultraviolet keratitis Radial keratotomy
Ultraviolet keratitis
Which of the following serves as an important visual landmark when performing endotracheal intubation under direct visualization? Cricothyroid membrane Vocal Cords Thyroid cartilage Posterior cartilages
Vocal Cords
A pathologic fracture occurs when: a hidden medical condition causes abnormal bone weakness. greater-than-usual forces are required to fracture a large bone. a particular mechanism of injury cannot be identified readily. underdeveloped bones sustain a low-impact traumatic injury
a hidden medical condition causes abnormal bone weakness.
A subluxation occurs when: a joint is partially dislocated. a dislocation spontaneously reduces. a fracture occurs through both cortices. dislocated bones are locked in position.
a joint is partially dislocated.
During a respiratory assessment, the absence of breath sounds may indicate: a pneumothorax. a pulmonary embolism. flail chest. bronchitis
a pneumothorax
An axial loading fracture of the cervical spine would MOST likely occur following: a direct blow to the occipital region of the skull. rapid acceleration following a motor vehicle crash. axial loading after a patient falls and lands feet first. a significant fall in which the patient lands head first
a significant fall in which the patient lands head first
The respiratory rate may be greater than normal because of: alcoholic beverage ingestion. the use of medications such as diazepam or morphine. being asleep or nearly asleep. acidosis.
acidosis.
A 60-year-old woman slipped and fell on an icy sidewalk and landed on her outstretched hand. Your assessment reveals that she has an obvious Colles fracture. The patient denies any other injuries and is conscious and alert. Her vital signs are stable and she describes her pain as a 2 on a scale of 0 to 10. Given this patient's current status, the MOST appropriate way to treat her injury involves: gently straightening the fracture site and then applying a splint. administering analgesia and then properly splinting her injury. giving her a sedative for pain relief and then applying an air splint. manually stabilizing her wrist as your partner applies a vacuum splint.
administering analgesia and then properly splinting her injury.
Shallow, slow, or infrequent breathing, indicating severe ICP buildup and brain anoxia, is known as: Kussmaul's respirations. grunting. Biot's respirations. agonal respirations.
agonal respirations.
Displacement of bony fragments into the anterior portion of the spinal cord results in: central cord syndrome. anterior cord syndrome. Brown-Séquard syndrome. complete spinal cord injury
anterior cord syndrome.
A 17-year-old man jumped from a second-story balcony and landed on his feet. He complains of pain to both of his heels and knees. Your assessment reveals swelling and ecchymosis to both of his feet. His vital signs are stable and he is breathing without difficulty. In addition to caring for his lower-extremity injuries, it is MOST important that you: administer high-flow supplemental oxygen. apply spinal motion restriction precautions. try to determine why he jumped from the balcony. start a large-bore IV line of an isotonic crystalloid
apply spinal motion restriction precautions.
The most important factor in determining the respiratory rate is: arterial pCO2. arterial pO2. alveolar pCO2. alveolar pO2.
arterial pCO2
In contrast to secondary spinal cord injury, primary spinal cord injury occurs: from progressive swelling. at the moment of impact. from penetrating mechanisms. within 24 hours of the injury.
at the moment of impact.
When assessing a multisystems trauma patient, it is MOST important to: administer an analgesic promptly to minimize pain. avoid being distracted by visually impressive injuries. splint swollen, painful extremities as soon as possible. only splint fractures involving long bones at the scene.
avoid being distracted by visually impressive injuries.
Cardiac arrhythmias and kidney damage can occur with crush injuries due to: hypotension. decreased cardiac output. buildup of toxins in the crushed limb. increased capillary pressure in the crushed limb.
buildup of toxins in the crushed limb.
When a person jumps from a height and lands on his or her feet, direct trauma occurs to the: tarsals. malleolus. calcaneus. metatarsals.
calcaneus.
Knives and arrows are objects that: cause low-energy/low-velocity wounds. are considered medium-velocity projectiles. produce pressure shock waves and cavitation just as bullets do. generally cause little internal damage.
cause low-energy/low-velocity wounds.
A spinal cord concussion is: caused by a short-duration shock or pressure wave within the cord. a condition that results in a permanent loss of neurologic function. characterized by temporary dysfunction that lasts for up to 1 week. the result of direct trauma and is associated with spinal cord edema.
caused by a short-duration shock or pressure wave within the cord.
The MOST lethal explosions are those: causing structural collapses. in confined spaces. involving volatile chemicals. creating a blast wind.
causing structural collapses.
The BEST way to detect deformity or any other abnormality in an injured extremity is to: gently palpate the entire length of the extremity. compare it to the extremity on the opposite side. manipulate the extremity to assess for false motion. reduce any swelling with ice before performing the exam
compare it to the extremity on the opposite side.
When assessing distal pulses in a patient with a lower extremity injury, it is MOST important to: suspect severe shock if a unilateral pulse deficit is present. compare the strength of the pulses in both lower extremities. remember that most people do not have a palpable pedal pulse. count the pedal pulse rate and compare it to the radial pulse rate.
compare the strength of the pulses in both lower extremities.
All of the following are signs or symptoms of spinal shock except priapism. cool, clammy skin loss of bladder control. flaccid paralysis.
cool, clammy skin
One of the three factors associated with the results inflicted by the damage pathway of a projectile wound is: indirect injury. secondary impact. creation of a temporary cavity. fragmentation.
creation of a temporary cavity.
Based on total body surface area and burn depth, you have determined that an 88-year-old woman has a moderate burn. Considering the age of the patient, this burn is classified as: critical. significant. fatal. moderate.
critical
The MOST reliable sign of a fracture is: deformity. ecchymosis. localized pain. severe edema
deformity.
The FIRST step in any neurologic assessment involves: obtaining an initial Glasgow Coma Scale score. asking the patient if he or she can feel or move. determining the patient's level of consciousness. assessing the pupils for size, equality, and reactivity.
determining the patient's level of consciousness.
Signs of neurogenic shock include all of the following, EXCEPT: bradycardia. flushed skin. diaphoresis. hypothermia
diaphoresis.
The movement of oxygen from the alveoli to the blood in the pulmonary capillaries depends on: facilitated transport by way of the hemoglobin molecule. active transport of oxygen from an area of lower concentration to an area of higher concentration. diffusion of oxygen from an area of higher concentration to an area of lower concentration. osmosis of the H2O molecule across the respiratory membrane, where oxygen dissociates from hydrogen.
diffusion of oxygen from an area of higher concentration to an area of lower concentration.
The goal of prehospital pain control in a patient with a musculoskeletal injury should be to: use ice therapy instead of narcotic analgesics. sedate the patient with diazepam or lorazepam. diminish the patient's pain to a tolerable level. give enough analgesia to remove pain sensation.
diminish the patient's pain to a tolerable level.
The damage done as a projectile strikes tissue, contuses and tears that tissue, and pushes the tissue out of its way is called: the pressure shock wave. direct injury. cavitation. zone of injury.
direct injury.
The frontal impact is the MOST common type of impact in motor vehicle crashes. One of the pathways of patient travel during a frontal impact is: around-and-through. down-and-under. through-and-out. up-and-out.
down-and-under.
An injury process frequently associated with steering column impact is the "paper bag" syndrome in which the: driver yells just before impact, and the impact with the steering wheel presses all of the residual air from the lungs. driver "gulps" air into the stomach, and the stomach ruptures when the abdomen impacts the steering wheel. driver takes a deep breath in anticipation of the collision, and lung tissue ruptures when the chest impacts the steering wheel. car seat breaks loose and comes forward, crushing the patient between the seat and the steering wheel much like an inflated paper bag caught between clapping hands.
driver takes a deep breath in anticipation of the collision, and lung tissue ruptures when the chest impacts the steering wheel.
The law of energy conservation states that ______ can neither be created or destroyed. inertia energy momentum motion
energy
Physiologically, the term respiration refers to the: exchange of gases at the alveolar-capillary interface. mechanical process that moves air into and out of the lungs. exchange of all gases, nutrients, and wastes at the cellular level. exchange of gases at the cellular level.
exchange of gases at the cellular level.
Capnometry measures the partial pressure of CO2 in: venous blood. arterial blood. expired air. inspired air.
expired air.
Spinal cord injuries that cause neurogenic shock generally produce: cool, clammy skin distal to the site of the spinal cord injury. reflex tachycardia due to sympathetic nervous system stimulation. flaccid paralysis and complete loss of sensation distal to the injury. signs and symptoms that are identical to those of hypovolemic shock
flaccid paralysis and complete loss of sensation distal to the injury.
A 40-year-old woman has an unstable pelvis following a motor vehicle crash. She is conscious but confused. Her blood pressure is 80/50 mm Hg, pulse is 120 beats/min and weak at the radial arteries, and respirations are 24 breaths/min and shallow. After starting at least one large-bore IV line, you should: run it wide open until her systolic blood pressure is greater than 100 mm Hg. administer a 250-mL normal saline bolus and then reassess her blood pressure. set the IV flow rate to keep the vein open unless her systolic blood pressure falls below 70 mm Hg. give enough isotonic crystalloid fluids to improve her mental status and radial pulse quality.
give enough isotonic crystalloid fluids to improve her mental status and radial pulse quality.
Rear-impact collisions usually result in limited injuries, especially if the: head rest is positioned properly. airbags deploy immediately at the time of impact. both a shoulder and lap seatbelt are worn. combined speed of the two vehicles involved is not significant.
head rest is positioned properly.
The simplest airway management technique in a patient without suspected cervical spine injury is the: head-tilt/chin-lift maneuver. modified jaw-thrust maneuver. use of an oropharyngeal airway. Sellick's maneuver.
head-tilt/chin-lift maneuver.
Correctly splinting an injured extremity: typically provides complete pain relief without the need to administer narcotic analgesia. effectively reduces swelling and inflammation by shunting blood away from the injured area. eliminates the need to elevate the extremity because immobilization causes blood stasis. helps to control internal bleeding by allowing clots to form where vessels are damaged.
helps to control internal bleeding by allowing clots to form where vessels are damaged.
An injured patient's head should be secured to the long backboard only after: you have placed padding under the shoulders. his or her torso has been secured adequately. both of the legs are secured to the board properly. a vest-style immobilization device has been applied.
his or her torso has been secured adequately.
The natural tendency of the body to maintain a steady and normal internal environment is called: homeostasis. stability. homeopathy. normostasis.
homeostasis.
Swelling and inflammation associated with musculoskeletal injuries are reduced: if cold packs are applied during the early stages of the injury. if an appropriate dose of a narcotic analgesic is administered. when heat therapy is used within 6-12 hours after the injury. if a vasodilator drug is given within 12 hours following the injury.
if cold packs are applied during the early stages of the injury.
A young man has an isolated injury to his left lower leg. Your assessment reveals obvious deformity and ecchymosis. Distal circulation, as well as motor and sensory functions, are intact, and the patient is hemodynamically stable. In addition to stabilizing the suspected fracture site, you should: carefully palpate to elicit crepitus. immobilize the knee and the ankle. apply a traction splint for pain relief. place a chemical heat pack over the injury.
immobilize the knee and the ankle.
The tip of a curved laryngoscope blade is placed correctly: at the junction of the hard and soft palates. at the glottic opening. under the epiglottis. in the vallecular.
in the vallecular.
The main disadvantage of using a scoop stretcher to transfer a patient to a long backboard is: inability to conduct a visual exam of the back for injuries. patient discomfort due the cold metal frame of the scoop. unnecessary patient movement and the risk for further harm. inability to properly secure the spine from movement.
inability to conduct a visual exam of the back for injuries.
As the thoracic cavity begins to expand, the intrathoracic pressure: does not change. is greater than atmospheric pressure. is the same as atmospheric pressure. is less than atmospheric pressure.
is less than atmospheric pressure.
Damage caused by low-velocity objects: can create a pressure shock wave. is usually restricted to tissue the object actually contacts. may include creation of a "blown-out" appearing exit wound. is usually very obvious by the size of the entrance wound.
is usually restricted to tissue the object actually contacts.
Spinal shock is a condition that: generally affects the sensory nerves but spares the motor nerves. is usually temporary & results from a temporary injury of the spinal cord. typically manifests within 24 to 36 hours following a spinal injury. results in permanent neurologic deficits in the majority of patients.
is usually temporary & results from a temporary injury of the spinal cord.
Advantages of a nasopharyngeal airway include all of the following, EXCEPT: it isolates the trachea. it can be suctioned through. it can be inserted with an intact gag reflex. it can be placed blindly and safely
it isolates the trachea.
The formula "mass multiplied by velocity squared, divided by two" equals: acceleration. force. deceleration. kinetic energy.
kinetic energy.
A patient standing with his left shoulder shifted forward MOST likely has a fracture of the: right clavicle. left shoulder. left clavicle. right shoulder.
left clavicle.
The connective tissue(s) that hold bones together at a joint articulation is/are called tendons. cartilage. bursal tissue. ligaments.
ligaments.
Contact with strong alkalis results in burns involving ________ necrosis of the tissue. coagulation liquefaction thermal ischemic
liquefaction
You have applied board splints to a suspected lower leg fracture in a young woman and have given her fentanyl for pain. En route to the hospital, the patient states that the pain is excruciating. Further narcotics fail to relieve the pain. Reassessment of the injured area reveals that the overlying skin is taut and the pedal pulse is weak. You should: start a second IV line and administer 1 mEq/kg of sodium bicarbonate. remove the splint to prevent excessive swelling of the extremity. loosen the splint, elevate the leg, apply ice, and notify the hospital. remove the board splints, apply an air splint, and then reassess her.
loosen the splint, elevate the leg, apply ice, and notify the hospital.
Hypotension that is associated with neurogenic shock is the result of: loss of autonomic stimulation. concomitant internal hemorrhage. increased peripheral vascular tone. profound peripheral vasoconstriction.
loss of autonomic stimulation.
The risk of a pulmonary embolism following musculoskeletal trauma is HIGHEST in patients with: upper extremity fractures that result in lengthy hospital admissions. lower extremity injuries that lead to prolonged immobilization. numerous rib fractures who are taking anticoagulant medications. any proximal long bone fracture that occurred greater than 72 hours prior to medical intervention.
lower extremity injuries that lead to prolonged immobilization.
The MOST common and serious trauma associated with explosions is: head injury. abdominal injury. lung injury. airway blockage.
lung injury.
The primary management objective in a patient with a suspected spinal cord injury, as evidenced by vertebral instability, pain, and loss of appropriate motor and sensory function, is to _________. administer medications to prevent further paralysis. apply a cervical collar independent of spinal stabilization. initiate mechanical stabilization followed by manual immobilization. maintain the patient in a neutral, in-line position as well as possible.
maintain the patient in a neutral, in-line position as well as possible.
Prior to immobilizing an anxious patient with a suspected spinal injury on a backboard, it is important to: ask the patient to pull against your hands with his or her feet. make note of any neurologic deficits or gross injuries up to that point. administer the appropriate dose of a sedative to facilitate patient compliance. apply a cervical collar to free up the medic that is holding the patient's head.
make note of any neurologic deficits or gross injuries up to that point.
You arrive at the scene of a motorcycle crash and find the rider lying supine approximately 20 feet from his bike; he is still wearing his helmet. As you approach him, you note that he has bilaterally deformed femurs. You should FIRST: immediately stabilize both lower extremities. remove his helmet and provide high flow oxygen. manually stabilize his head and assess his airway. carefully straighten his legs and assess his airway.
manually stabilize his head and assess his airway.
The MOST common indication for a surgical cricothyrotomy is: massive facial or neck trauma. failed rapid sequence intubation. status seizures with trismus. foreign body airway obstruction.
massive facial or neck trauma.
A dislocation is considered an urgent injury because of its potential to cause: neurovascular compromise. significant internal bleeding. severe hemodynamic instability. proximal sensory and motor loss.
neurovascular compromise.
Although the physiology of freshwater and saltwater drownings differs, there is ______ difference in the end metabolic result or in prehospital management. no only a slight somewhat of a considerable
no
An example of diffusion in the respiratory system is movement of: oxygen from the alveoli into the pulmonary capillaries. air from the outside environment into the lungs. oxygen from the tissues into the systemic capillaries. carbon dioxide from the alveoli into the pulmonary capillaries.
oxygen from the alveoli into the pulmonary capillaries.
The extent of damage that a penetrating projectile causes varies with the particular type of tissue it encounters. One important point to remember about tissues in relation to penetrating wounds is that: solid organs have the resiliency of muscle and other connective tissues. muscles, the skin, and other connective tissues are thin, delicate tissues. when muscle tissue is penetrated, the wound track closes and serious injury is limited. penetrating injury to lung tissue is generally less extensive than can be expected with any other body tissue.
penetrating injury to lung tissue is generally less extensive than can be expected with any other body tissue.
Compartment syndrome occurs when: metabolic waste products accumulate within a large hematoma that develops near a fracture site. yellow and red bone marrow seep from a fractured bone, resulting in excessive soft tissue swelling. blood accumulates in the medullary canal of a bone, resulting in decreased oxygenation of the bone tissue. pressure in the fascial compartment leads to impaired circulation, sensory changes, and progressive muscle death.
pressure in the fascial compartment leads to impaired circulation, sensory changes, and progressive muscle death.
The MOST significant complication associated with prolonged immobilization of a patient on a long backboard is: pressure necrosis development. compression of the vena cava. increased intracranial pressure. patient discomfort and frustration.
pressure necrosis development.
Treatment for a patient with neurogenic shock may include all of the following, EXCEPT: a vagolytic medication. a vasopressor medication. prevention of hyperthermia. fluid volume to maintain perfusion.
prevention of hyperthermia.
A fine, bubbling sound heard on inspiration and associated with fluid in the alveoli and terminal bronchioles is called: bronchovesicular sounds. rales (crackles). rhonchi. pleural friction.
rales (crackles)
Flexion injuries to the spine would MOST likely result from: rapid acceleration forces. rapid deceleration forces. a rear-end motor vehicle crash. a direct blow to the frontal lobe.
rapid deceleration forces.
The reading obtained by the use of a pulse oximeter reflects the: amount of saturated hemoglobin per deciliter of blood. amount of oxygen dissolved in the blood. of unsaturated hemoglobin to saturated hemoglobin. partial pressure of oxygen in capillary blood.
ratio of unsaturated hemoglobin to saturated hemoglobin.
Osteoporosis is MOST accurately defined as a(n): progressive loss of bone marrow. reduced range of motion in the joints. estrogen-related change in bone strength. significant decrease in bone density.
significant decrease in bone density.
The MOST effective way for the paramedic to minimize further injury in a patient with a spinal injury is: prompt transport of the patient to a receiving center. rapid administration of corticosteroid medications. aggressive administration of IV crystalloid solutions. spinal motion restriction and prevention of heat loss
spinal motion restriction and prevention of heat loss
The preferred depolarizing neuromuscular agent for rapid sequence intubation is: pancuronium. midazolam. succinylcholine. vecuronium
succinylcholine
One way to improve airway management and ventilation is to make sure that: the ear-to-sternal notch axis is aligned. the BVM is squeezed as fully as possible. oxygen is not administered to COPD patients. a patient is never put in the "ramped" position.
the ear-to-sternal notch axis is aligned.
Insertion of an endotracheal tube too far is likely to result in ventilation of: the right lung only. the left lung only. only the lower lobes of both lungs. neither lung.
the right lung only.
The amount of air moved in and out of the lungs during a normal, quiet respiration is called: tidal volume. dead space volume. inspiratory capacity. functional reserve capacity.
tidal volume.
When correctly placed, the tip of a straight laryngoscope blade should be: under the epiglottis. at the uvula. at the soft palate. in the vallecula.
under the epiglottis
The CORRECT sequence for intubating an apneic patient is: ventilation, positioning, visualization, tube placement, and verification of tracheal insertion. visualization, tube placement, positioning, verification of tracheal insertion, and ventilation. tube placement, visualization, positioning, verification of tracheal insertion, and ventilation. verification of tracheal insertion, tube placement, visualization, positioning, and ventilation.
ventilation, positioning, visualization, tube placement, and verification of tracheal insertion.
The major weight-bearing component of a vertebra is the pedicle. laminae. vertebral body. spinal canal.
vertebral body.
The relationship between mass and velocity explains why: very small and relatively light bullets have a potential to do great harm. if you double the speed of an object, its kinetic energy also doubles. handguns and shotguns are considered low-energy/low-velocity weapons. a high-energy rifle bullet's kinetic energy is the same as that of a medium-energy handgun bullet.
very small and relatively light bullets have a potential to do great harm.
The morbidity associated with simple pneumothorax is primarily due to which of the following? Occlusion of pulmonary circulation Increased intrathoracic pressure Loss of chest wall integrity Ventilation/perfusion mismatch
ventilation/perfusion mismatch
Signs and symptoms of a tension pneumothorax include: hyporresonance of the uninjured side of the chest. flat jugular veins. hypertension. ventilation/perfusion mismatch.
ventilation/perfusion mismatch.
Thoracic trauma is classified into two major categories by mechanisms that are: crush and impact. flat and sharp. blunt and penetrating. sudden and prolonged.
blunt and penetrating.
Signs and symptoms including bruising to the chest wall; a weak, rapid, irregular heart rate; sweating; and a severe nagging chest pain NOT relieved by rest are indicative of: hemothorax. pulmonary contusion. tension pneumothorax. blunt cardiac injury.
blunt cardiac injury.
When assessing a patient with a crush injury, which of the following findings would indicate that toxins have entered the central circulation? Hot, red skin Increased urine output Cardiac arrhythmia Central hyperventilation syndrome
cardiac arrhythmia
The trachea divides into the right and left mainstem bronchi at the: carina. hilum. lingual. thoracic inlet.
carina
The formation of a shock wave and subsequent cavity within a semifluid medium is called: trajectory. drag. cavitation. expansion.
cavitation.
As a patient with hemorrhagic blood loss becomes more acidotic, what homeostatic process is usually impaired? Coagulation Hemoptysis Vascular phase Aerobic metabolism
coagulation
Which of the following physical findings indicates the need for immediate transport? 18 year old male, systolic blood pressure 80, respiratory rate 8 25 year old female Glasgow Coma Scale score of 15 Second-degree burns over 9% of body surface area in a 40 year old. Fractured right femur in a 38 year old male
18 year old male, systolic blood pressure 80, respiratory rate 8
For the head injury patient without signs of herniation, adjust ventilation rates to maintain a capnography reading of between: 15 and 20 mmHg. 25 and 30 mmHg. 45 and 50 mmHg. 35 and 40 mmHg.
35 and 40 mmHg
The pericardial space typically contains: nothing. a small air pocket. the heart. 35 to 50 mL of fluid.
35 to 50 mL of fluid.
The MOST commonly fractured ribs are the: 1st through 4th. 4th through 8th. 5th through 8th. 9th through 12th.
4th through 8th
If rescue personnel must go into the water to rescue a patient, they should wear protective clothing if water temperature is less than: 90°F. 87°F. 83°F 70°F.
70°F.
When the core temperature of the body drops to below ______, an individual is considered to be hypothermic. 99°F 98.6°F 97°F 95°F
95°F
Which of the following patients does NOT require specialty-center capabilities beyond that offered by a trauma center? A 67-year-old with second- and third-degree burns over 50 percent of the body A 25-year-old with amputation of three fingers A 4-year-old with a closed-head injury A 22-year-old with bilateral open femur fractures
A 22-year-old with bilateral open femur fractures
Which of the following requires immediate transport to a trauma center? A 40-year-old who fell 12 feet from a garage roof with a radius fracture A 36-year-old woman in a motor vehicle crash who has a blood pressure of 100/60 A 22-year-old soccer player with lower leg pain A 47-year-old involved in a motor vehicle crash that resulted in the death of his passenger
A 47-year-old involved in a motor vehicle crash that resulted in the death of his passenger
Your patient, a 23-year-old woman who is 6 months pregnant, was the unrestrained driver of a vehicle that rear-ended a parked car. The air bag deployed. Considering the likelihood of organ collision, for which of the following injuries should you maintain a high index of suspicion? Cardiac contusion Anterior flail segment Abruptio placentae Fractured sternum
Abruptio placentae
Which of the following can reduce the potential for abdominal injury? Proper placement of automobile lap belts in adults Side-impact airbags Proper placement of automobile lap belts in children All of the above
All of the above
You are caring for a 20-year-old skateboarder who crashed into a brick retaining wall at the bottom of a steep hill. He has blunt trauma to his face with nose deformity, loose teeth, and bleeding from the nose and mouth. Although you have answered him several times, he keeps repeating to you, "What happened? It seems like I'm having a bad day." This is most indicative of which of the following? Aphasia Retrograde amnesia Decorticate disorientation Anterograde amnesia
Anterograde amnesia
A patient who has dived into a shallow pool and hit his head on the bottom is MOST likely to have which of the following types of injuries? Cervical hyperextension Cervical hyperflexion Axial distraction Axial loading
Axial loading
Your alert patient has received blunt facial trauma due to an assault. For which of the following injuries should you maintain a high index of suspicion? Airway obstruction CSF in the ears Basilar skull fracture Lumbar spine trauma
Basilar skull fracture
Your patient is a 27-year-old man with one stab wound at the fifth intercostal space posteriorly, on the right. He is ambulatory at the scene, but dyspneic and has air movement at the site of the injury. Which of the following should you do first? Apply oxygen by nonrebreather. Cover the wound with your gloved hand. Prepare an occlusive dressing. Perform a needle thoracostomy
Cover the wound with your gloved hand.
Your patient is an 18-year-old man who was slashed across the abdomen with a machete. He has a mass of adipose and small bowel protruding from the wound. Which of the following is your primary concern with this patient? Immediately covering the wound with an occlusive dressing, using your gloved hand if nothing else is available Irrigating the exposed organs with sterile saline to remove debris and gently tucking them back into the opening to keep them warm and moist and to prevent further contamination Covering the wound with a sterile, saline-moistened dressing covered by an occlusive dressing Having the patient hold the bowel and placing him on the stretcher in a position of comfort to transport rapidly
Covering the wound with a sterile, saline-moistened dressing covered by an occlusive dressing
Your patient is a 23-year-old man with a gunshot wound to the abdomen and an exit wound in the right flank. He responds to verbal stimuli; has pale, cool, diaphoretic skin; and has a heart rate of 128, respirations at 24, and a blood pressure of 82/60. These findings indicate which of the following kind of shock? Compensated Irreversible Decompensated Neurogenic
Decompensated
Which of the following occurs during the onset of inspiration? Intrathoracic pressure increases and venous return to the heart is impeded. Intrathoracic pressure increases and venous return to the heart is facilitated. Intrathoracic pressure decreases and venous return to the heart is impeded. Intrathoracic pressure decreases and venous return to the heart is facilitated.
Intrathoracic pressure decreases and venous return to the heart is facilitated.
Your patient is a 45-year-old man who has received several stab wounds to the chest and abdomen. The patient is agitated and confused, pale, diaphoretic, and cool to the touch. His carotid pulse is weak and rapid. Respirations are 28 and shallow. Which of the following is certain with this patient? He is in irreversible shock. He is in decompensated shock. He is in compensated shock. None of the above is certain.
He is in decompensated shock.
Which of the following findings MOST differentiates a simple pneumothorax from a tension pneumothorax? Decreased breath sounds on the affected side Hemodynamic compromise Absent breath sounds on the affected side An open defect in the chest wall
Hemodynamic compromise
Your patient is a 38-year-old woman with one gunshot wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and difficulty breathing. Your partner has applied oxygen by nonrebreather mask and placed an occlusive dressing over the entry wound before your arrival. The patient's level of consciousness decreases. She responds to verbal stimuli. Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side. The patient lacks a radial pulse, and her chest percussion is dull. Which of the following best explains the presentation of this patient? Simple pneumothorax Tension pneumothorax Pericardial tamponade Hemothorax
Hemothorax
Your patient is a 24-year-old man who was struck just below the left scapula with a 3-inch-diameter metal pipe. He is awake but having difficulty breathing. His pulse is 112 at the radial artery, and his respiratory rate is 28 per minute and shallow. His breath sounds are present bilaterally but diminished on the left. He has a blood pressure of 108/68. The patient is coughing up some bloody sputum. He has no other complaints, and a rapid trauma survey reveals no additional life-threatening injuries. Which of the following represents the best sequence of interventions for this patient? Begin transport immediately, positive pressure ventilation, a large-bore IV of isotonic solution to maintain a systolic blood pressure of 120 mmHg or greater. High-concentration oxygen by nonrebreather mask, begin transport, a 16-gauge IV at a keep-open rate. Positive-pressure ventilation, a large-bore IV of normal saline solution at a keep-open rate, transport. High-concentration oxygen by nonrebreather mask, begin transport, two 14-gauge IVs of 50 percent dextrose solution wide open.
High-concentration oxygen by nonrebreather mask, begin transport, a 16-gauge IV at a keep-open rate.
Which of the following statements about the administration of dextrose to the patient with a traumatic brain injury is TRUE? Hypoglycemia is associated with a poorer neurologic outcome; if the blood glucose level is less than 60 mg/dL, administer 25 grams of dextrose. Hypoglycemia is inconsequential to neurologic outcome; assessing the blood glucose level is not a priority. Hyperglycemia is associated with a poorer neurologic outcome; never administer dextrose to a patient with traumatic brain injury. Hypoglycemia is associated with a poorer neurologic outcome. All patients with suspected traumatic brain injury who have an altered mental status should receive 25 grams of dextrose intravenously.
Hypoglycemia is associated with a poorer neurologic outcome; if the blood glucose level is less than 60 mg/dL, administer 25 grams of dextrose.
Which of the following is a common complication of positive-pressure ventilation in the patient with significant chest trauma? Pulmonary contusion Atelectasis Exacerbation of flail chest Impaired venous return to the heart
Impaired venous return to the heart
Which of the following guidelines applies to prehospital fluid resuscitation of hypotensive patients with intraabdominal hemorrhage? In most cases, fluid administration should be limited. IV access should be obtained using a saline lock, but fluid resuscitation is contraindicated in the prehospital setting. Fluid administration rate should be titrated to maintain a systolic blood pressure of 60 mmHg. The first liter of fluid is always delivered at a wide open rate.
In most cases, fluid administration should be limited.
Which of the following is TRUE regarding chest wall contusion? Chest wall contusion is the most common injury encountered in penetrating chest trauma. The most noticeable sign/symptom of chest wall contusion is rib fracture. The pain from a chest wall contusion does not change with inspiration. In the pediatric patient, you may find chest wall contusion and internal injury without rib fracture.
In the pediatric patient, you may find chest wall contusion and internal injury without rib fracture.
Your patient is an 80-year-old man who was the unrestrained driver of a vehicle without airbags that was involved in a frontal collision with a parked car. He is dyspneic and tachycardic. He is awake but unable to respond to questions. The patient has paradoxical movement of the sternum with breathing, along with crepitus and subcutaneous air noted on palpation. Chest excursion is limited, and the patient has cyanosis of his lips, ears, and nail beds. Which of the following is most needed in this patient? Infusion of isotonic crystalloid solution using a large-bore IV Application of bulky dressings over the site of paradoxical motion Being placed in a prone position to stabilize the chest wall Intubation and positive-pressure ventilation
Intubation and positive-pressure ventilation
Which of the following best describes the finding of tracheal shift in the trauma patient? Its absence rules out tension pneumothorax. It is the earliest sign of tension pneumothorax. It is a rare finding in patients with tension pneumothorax. It is a contraindication to needle thoracostomy in tension pneumothorax.
It is a rare finding in patients with tension pneumothorax.
One emergency a diver may experience is "nitrogen narcosis." Which of the following is TRUE regarding this condition? It is commonly called "the bends" and causes severe pain. It is caused by the development of nitrogen bubbles within body tissues. It is a state of stupor due to nitrogen's effect on cerebral function. The most serious effect is pulmonary overpressure.
It is a state of stupor due to nitrogen's effect on cerebral function.
Which of the following best describes the effect of hyperventilation in the brain-injured patient? It is beneficial, because vasodilation results in increased cerebral blood flow. It is detrimental, because vasodilation causes an increase in tissue edema. It is beneficial, because vasoconstriction results in decreased tissue edema. It is detrimental, because vasoconstriction results in decreased cerebral perfusion.
It is detrimental, because vasoconstriction results in decreased cerebral perfusion.
You have just inserted a large-bore catheter into the chest of a patient with a tension pneumothorax and received a return of air. Which of the following should NOT be done? Insert a second catheter if the patient is symptomatic, despite the release of air. Leave the catheter in place, and create a flutter valve. Leave the catheter in place and open to air. Remove the catheter.
Remove the catheter.
Which of the following describes definitive care of the patient with traumatic intraabdominal hemorrhage? Admission to the ICU for observation Aggressive oxygenation and fluid resuscitation Administration of blood or blood products Rapid surgical intervention
Rapid surgical intervention
You are treating a patient whose open chest wound has been sealed by EMTs on the scene before your arrival. During transport the patient becomes more dyspneic, tachycardic, and hypotensive. There are no breath sounds on the affected side, and the patient has JVD. Which of the following is the best action? Reinforce the dressing with additional tape, using tincture of benzoin, if necessary, to improve the seal. Perform a needle thoracostomy at the second intercostal space in the midclavicular line. Perform a needle thoracostomy at the fourth intercostal space in the midaxillary line. Remove the dressing and see if the patient's clinical status improves, then replace the dressing.
Remove the dressing and see if the patient's clinical status improves, then replace the dressing.
Which of the following is TRUE of the patient with a suspected penetrating injury to or rupture of the diaphragm? This is the only abdominal injury for which removal of an impaled object is recommended. Your patient should be transported in the prone position. Shallow respirations may be due to abdominal contents in the thorax. Breathing is not impaired unless abdominal organs migrate into the thoracic cavity.
Shallow respirations may be due to abdominal contents in the thorax.
Which of the following is MOST likely to occur as a result of rapid deceleration without actual contact between the patient's body and the interior of the vehicle? Blunt trauma to the pancreas Rupture of the colon Kidney contusion Shearing injury of the liver
Shearing injury of the liver
Your patient is a 30-year-old pregnant woman at 36 weeks' gestation. She was injured in a fall from a horse and is complaining of painful contractions. Her abdomen is tender to palpation over the uterus, and the uterus becomes firm with contractions, but she denies vaginal bleeding. The patient is anxious, but her skin is warm and dry. Her blood pressure is 112/70, her heart rate is 92, and her respirations are 24. Which of the following statements best describes this situation? The mechanism and patient complaints are suspicious for abruptio placentae. The mother's condition is not life threatening, but fetal demise has most likely already occurred. The mechanism and patient complaints are consistent with placenta previa. The mother is stable, but the fetus is in jeopardy. The mechanism and patient complaints are consistent with uterine rupture. Both the mother and fetus are in jeopardy. The mechanism and patient complaints are suspicious for abruptio placentae. Both the mother and the fetus are in jeopardy.
The mechanism and patient complaints are suspicious for abruptio placentae. Both the mother and the fetus are in jeopardy.
Which of the following are the two most important prehospital considerations for head injury patients? Cervical spine immobilization and ventilation ICP monitoring and administering corticosteroids Ventilation and administering corticosteroids Ventilation and maintaining adequate blood pressure
Ventilation and maintaining adequate blood pressure
Which of the following is the preferred in-hospital fluid for resuscitation in hemorrhagic shock? Fresh frozen plasma Lactated Ringer's Whole blood Normal saline
Whole blood
Treatment for heat exhaustion should NOT include: supine positioning. fanning the patient. administering salt tablets. administering sports drink.
administering salt tablets.
Efforts to cool the body temperature of a pediatric patient with a fever should include: immersion in cool water. rubbing-alcohol sponge bath. cold packs in the armpits and groin. administration of an antipyretic medication.
administration of an antipyretic medication
Management of the patient with traumatic asphyxia includes: consideration of administering sodium bicarbonate if the patient remains entrapped for a prolonged time. establishing two large-bore IV lines for rapid infusion of crystalloid in anticipation of hypovolemia. preparation for immediate transport after release from entrapment. all of the above.
all of the above.
Aortic dissection and rupture are extremely life-threatening injuries. When caring for a patient with either of these, you would expect: that the aorta is most commonly injured by penetrating trauma. aortic injury carries an overall mortality of 85 to 95 percent. unlike myocardial rupture, very few, possibly as little as 5 percent, of the victims will survive the initial insult and aneurysm. that the aorta is relatively fixed at only one point, the aortic annulus.
aortic injury carries an overall mortality of 85 to 95 percent.
During the rapid trauma assessment of the patient with a thoracic injury, you should: splint all suspected fractures. auscultate all lung lobes, both anteriorly and posteriorly. administer positive-pressure ventilations with 100 percent oxygen. initiate two large-bore IV lines and run wide open.
auscultate all lung lobes, both anteriorly and posteriorly.
The rate at which the body consumes energy just to maintain stability is called the: basal metabolic rate. homeostatic rate. normostatic rate. thermoregulatory rate.
basal metabolic rate.
Hemothorax is primarily a problem of: blood loss. impaired ventilation. ventilation/perfusion mismatch. increased intrathoracic pressure.
blood loss
Hollow organs are muscular containers holding fluid. When considering a penetrating injury to a hollow organ, remember that: if the container is filled with fluid at the time of impact, the energy can tear the organ apart explosively. if the container is filled with fluid at the time of impact, the energy is dispersed in the fluid, and little damage is done to the organ. a penetrating wound to the heart may result in pericardial tamponade, which results in a sudden release of blood into the thorax. if a hollow organ holds air, the air compresses with the passage of the pressure, resulting in explosive tissue damage and hemorrhage.
if the container is filled with fluid at the time of impact, the energy can tear the organ apart explosively.
Deceleration injuries occur when the body is in motion and: suddenly accelerates at a high rate of speed. impacts a fixed object. gradually slows to a stop. partially impacts an object causing it to drastically change direction.
impacts a fixed object.
Thermoregulatory thermogenesis is the production of heat resulting from the: high environmental temperatures. increase in the rate of cellular metabolism. exercise of muscles working effectively. processing of food and nutrients.
increase in the rate of cellular metabolism
Rapid ascent is the common cause of barotrauma accidents, particularly from depths of: over 20 feet. less than 6 feet. 70 to 100 feet. over 200 feet
less than 6 feet.
The self-splinting effect observed in patients with chest wall trauma: allows the body to compensate for the injury. may cause atelectasis, hypoxemia, or pneumonia. is often accompanied by subcutaneous emphysema. is characterized by a markedly increased tidal volume.
may cause atelectasis, hypoxemia, or pneumonia.
The appearance of the entrance wound caused by a bullet: is always the size of the bullet's profile. will often have a "blown-out" look. may indicate signs of subcutaneous emphysema if the shot was fired at very close range. may accurately reflect the potential for damage caused by the bullet's passage.
may indicate signs of subcutaneous emphysema if the shot was fired at very close range.
Pneumothoraces create a ventilation-perfusion mismatch when: concomitant myocardial injury prevents adequate pulmonary perfusion and the lung collapses. perfusion of the involved lung continues while the pneumothorax prevents adequate ventilation. the vasculature of the affected lung is not intact and intrapulmonary gas exchange is impaired. the affected lung continues to expand adequately despite a decrease in pulmonary perfusion.
perfusion of the involved lung continues while the pneumothorax prevents adequate ventilation.
Blood or other fluid in the pericardial sac is called: hemothorax. pleural effusion. cardiac contusion. pericardial tamponade.
pericardial tamponade
The fibrous sac that surrounds the heart is called the: myocardium. epicardium. pericardium. pleuracardium.
pericardium.
During the early care for a patient with a basilar skull fracture in the prehospital setting, which of the following would be an unexpected finding? Periorbital ecchymoses or "raccoon eyes" CSF otorrhea Blood mixed with cerebral spinal fluid flowing from the mouth CSF rhinorrhea
periorbital ecchymoses or "Raccoon eyes"
Management of the chest injury patient includes: the use of sandbags to support a flail segment. the administration of nitrous oxide for pain control of rib fractures. the application of an occlusive dressing to an open pneumothorax, completely sealing it on two sides to prevent tension pneumothorax. placement of a second or third catheter to more rapidly decompress a tension pneumothorax if the patient remains symptomatic.
placement of a second or third catheter to more rapidly decompress a tension pneumothorax if the patient remains symptomatic.
A bullet's profile is the: diameter of a bullet expressed in hundredths of an inch. portion of the bullet you would see if you looked at it as it traveled straight at you. swing or wobble around the axis of a projectile's travel. path a projectile follows.
portion of the bullet you would see if you looked at it as it traveled straight at you.
Your patient exhibits a drop of greater than 10 mmHg in the systolic blood pressure during inspiration. This condition is known as: pulsus paradoxus. orthostatic hypotension. narrowing pulse pressure. the tilt test.
pulsus paradoxus
An unclothed person will lose approximately 60 percent of total body heat at room temperature by the mechanism of: convection. conduction. radiation. evaporation.
radiation
A patient presenting with deep red, purple, or blue skin; petechiae; and subconjunctival hemorrhage is MOST likely suffering from: myocardial infarction secondary to trauma. cardiac contusion. traumatic esophageal rupture. traumatic asphyxia.
traumatic asphyxia
An important point to remember when analyzing vehicle crashes is that: alcohol intoxication is not present in most serious crashes. head trauma accounts for a small number of deaths in vehicle crashes. spider-webbing of the windshield sometimes indicates window frame alteration during impact rather than occupant contact. you should stay focused on analyzing the mechanisms of injury, not on the cause of the crash.
spider-webbing of the windshield sometimes indicates window frame alteration during impact rather than occupant contact.
Another name for an open pneumothorax is: tension pneumothorax. sucking chest wound. flail chest. hemopneumothorax.
sucking chest wound.
All the following are seen in Cushing's triad, EXCEPT: increased blood pressure. irregular respirations. tachycardia. All of the above are seen in Cushing's triad.
tachycardia
The primary difference between a simple pneumothorax and a tension pneumothorax is that the: tension pneumothorax is caused by an open chest wound. simple pneumothorax must be treated by insertion of a large catheter into the chest. simple pneumothorax does not result in dyspnea, whereas the tension pneumothorax does. tension pneumothorax generates and maintains a pressure greater than atmospheric pressure within the thorax.
tension pneumothorax generates and maintains a pressure greater than atmospheric pressure within the thorax.
Isolated rib fractures may result in inadequate ventilation because: the patient often purposely limits chest wall movement. most rib fractures cause paradoxical chest wall movement. the pain associated with the fracture causes hyperventilation. preferential use of the intercostal muscles reduces tidal volume.
the patient often purposely limits chest wall movement.
The volume of air entering or leaving the lungs with each breath is called the: residual volume. inspiratory/expiratory volume. inspiratory reserve volume. tidal volume.
tidal volume
If the cause of submersion is unknown, you should always suspect: suicide. cardiac origin. trauma. foul play.
trauma.
Commotio cordis is a phenomenon in which: ventricular fibrillation is induced following blunt trauma to the chest during the heart's repolarization period. excessive pressure within the pericardial sac impairs cardiac contractility as well as venous return to the heart. penetrating thoracic trauma perforates the atria or ventricles, causing acute rupture and massive hemorrhage. myocardial tissue at the cellular level is damaged by blunt or penetrating trauma, resulting in cardiac arrest
ventricular fibrillation is induced following blunt trauma to the chest during the heart's repolarization period.
