Emergency Situations Ch 26

Blood pressure may not be a good indicator of tissue perfusion as compensation for hypovolemia does not occur until ______% of blood loss has occurred. 30 20 25 15

30 Remember, the blood pressure is not a good predictor of tissue perfusion because the patient may compensate for hypovolemia until up to 30% of blood volume has been lost (American College of Surgeons, 2012).

Approximately how long should an examiner take to conduct a primary assessment of the stable patient? 5 minutes 2 minutes 30 seconds 60 seconds

30 seconds The primary survey or initial assessment is completed very rapidly. With a stable patient, it may take only 30 seconds.

Until life-threatening conditions of a child older than 1 year are stabilized, which formula can you use to approximate the expected systolic blood pressure? 90 − Child's age in years 80 + (2 × Child's age in years) Child's pulse divided by 2 70 + Child's respiratory rate

80 + (2 × Child's age in years) The approximate expected systolic blood pressure for a child older than 1 year: 80 + (2 × Child's age in years).

A patient presents to the emergency department (ED) with complaints of blurred vision, pain and redness in the left eye, a severe headache, and sensitivity to light. What do you suspect is occurring in this patient? Pink eye Migraine headache Acute glaucoma Retinal detachment

Acute glaucoma Symptoms of acute glaucoma are severe throbbing pain in and around one bloodshot eye, blurred or acute loss of vision in the affected eye, headache, eyeball both tender and firm to the touch, photosensitivity, and a fixed and dilated pupil.

During the primary assessment, the examiner asks the patient, "Can you tell me who you are?" Which factor is the examiner assessing? Respiratory efficiency Cerebral blood flow Cardiac output Airway patency

Airway patency The patency of the upper airway is assessed at the start by asking the patient a question. If the patient answers, the patient is responsive and the airway is open at this time. Keep the patient talking so that you know the airway is maintained.

How would the examiner first check the patency of a patient's airway? Look at the anterior chest to assess its rise and fall. Place an ear next to the patient's nose and mouth to detect air movement. Place a hand below the patient's nostrils to assess for exhalation. Ask the patient a question.

Ask the patient a question. The patency of the upper airway is assessed at the start by asking the patient a question.

Mr. Jones presents to the emergency department. You suspect poor peripheral perfusion. Which finding supports your suspicion? Palpable radial pulse Dorsalis pedis pulse with 3+ amplitude Rapid heart rate Capillary refill greater than 2 seconds

Capillary refill greater than 2 seconds A capillary refill time in excess of 2 seconds indicates poor perfusion unless an extremity is cold.

An examiner must be alert to the possibility of which additional problem when treating a patient with a burn injury? Carbon monoxide poisoning Increased bleeding Cardiac contusions Abdominal pain

Carbon monoxide poisoning Burns should alert the examiner to the possibilities of smoke, heat, and toxic chemical inhalation and carbon monoxide poisoning causing airway inflammation.

At the scene of a motor vehicle accident, examination of the vehicle indicates that there is a bent steering wheel with a bull's-eye fracture of the windshield. For which blunt trauma injury should the emergency care provider be alert? Myocardial contusion Cervical strain Fractured acetabulum Cervical spine injury

Cervical spine injury A bull's-eye fracture of the windshield may be associated with a cervical spine injury and brain injury.

During the primary assessment of a patient brought to the emergency department after a construction accident, you find an open chest wound. What is your immediate action? Palpate the femoral pulse. Cover the opening with your hand. Check oxygen saturation. Apply an occlusive dressing.

Cover the opening with your hand. Cover open chest wounds immediately with a hand to minimize the entry of atmospheric air into the chest until definitive treatment is available, then apply an occlusive dressing taped on three sides.

You are on duty in the emergency department. A patient has presented after an auto accident. Which finding is consistent with abdominal hemorrhage? Increased bowel sounds Hyperresonance with percussion Auscultation of the mesenteric artery Distention and pain

Distention and pain Hollow organs in the abdomen are often ruptured with blunt trauma and result in occult hemorrhage; pain and distention may indicate an underlying hemorrhage.

You are on the scene of an accident and have completed your primary assessment. After the initial primary assessment is conducted, how often should it be repeated? Every time the patient's condition changes Every 30 seconds Every 5 minutes Every 2 minutes

Every 5 minutes Perform the primary survey every 5 minutes and compare the results with those obtained in previous assessments.

Mike complains of severe rib pain. His coworkers state that he was hurt on the job when a large pipe struck him across the chest. Given this history, which type of problem should be considered during the secondary assessment? Flail chest Pulmonary embolus Rebound tenderness Pupillary constriction

Flail chest Flail chest is a condition in which a section of the chest is disconnected from the bony structure as may occur with multiple rib fractures. A flail chest also indicates an underlying lung injury (pulmonary contusion). Paradoxical chest movement may occur with a flail chest.

You arrive on the scene of a bicycle accident. To assess the patient, you need to remove the helmet. Which is the correct way to remove the helmet? Lift the client's head, unbuckle the neck strap, and slip it off while someone else lifts the head. Have someone stabilize the neck, while you expand the helmet and remove it. Use the chin-lift technique to remove the strap, and hold the head steady while someone else removes the helmet. Have someone hold down the patient, while you remove the helmet.

Have someone stabilize the neck, while you expand the helmet and remove it. Be certain that the neck is manually maintained in neutral position until radiographic studies confirm the absence of cervical injury.

A patient from a motor vehicle accident presents with a suspected neck injury. Which of the following actions by the examiner is clearly not appropriate? Providing airway support Logrolling the patient to assess his back Hyperextending the neck to establish an airway Assessing peripheral pulses

Hyperextending the neck to establish an airway Do not hyperextend, hyperflex, or rotate the patient's head and neck to establish or maintain an airway.

Mrs. Black brings in her 3-year-old son after he has fallen from a tree. Which of the following findings suggests a serious problem? Crying Lethargy Pulse rate of 164 Respiratory rate of 38

Lethargy Changes in mental status, lethargy, irritability, and slowed responsiveness occur with hypoxemia (severely reduced blood oxygen levels in major organs) and may progress to stupor or coma.

Mr. Wolf presents with a complaint of sudden flashes of light in the field of vision. What other symptom commonly accompanies this primary symptom? Severe pain to the eye Severe nausea and vomiting Partial loss of vision Intense dizziness

Partial loss of vision Flashes of light in the field of vision of one eye is a primary symptom of retinal detachment. Other symptoms include partial loss of vision spreading as a curtain-like shadow from the top or one side of the eye.

Mr. Harris presents to the emergency department. On examination, you note crepitation. For which of the following clinical problems would crepitation be an expected finding? Cardiovascular accident Pneumothorax Myocardial infarction Blunt abdominal trauma

Pneumothorax Palpate the upper chest and neck for crepitation, a sign of air leakage into soft tissue. Bruising should alert you to the possibility of a pulmonary contusion (bruising of the lung tissue caused by the energy of an external impact transmitted through the chest wall). This injury may result in a pneumothorax.

A child is struck by a car while riding his bike. On arrival at the hospital, the child is not breathing. How should the examiner proceed? Determine appropriate action based on the degree of cyanosis observed by the examiner. Conduct a primary assessment; support breathing before starting a secondary assessment. Stop the primary assessment as soon as the apnea is recognized to resuscitate. Conduct a primary and secondary assessment before deciding what care to provide.

Stop the primary assessment as soon as the apnea is recognized to resuscitate. As with the serious injuries, the advanced cardiac life support survey is interrupted to manage a life-threatening physiologic condition as soon as it is detected. For example, if a patient is not breathing, rescue breaths, oxygen, and assisted ventilation must be provided before the assessment continues.

Which of the following determinations is it possible for you to make if you are examining a child in an emergency situation who is crying? The child is hypoxic. The child is in pain. The child is alert and oriented. The child has a patent airway.

The child has a patent airway. A crying or talking child has, at that moment, a patent airway.

Mr. Black is a 45-year-old patient who presents in the emergency department with a history of vomiting black or dark brown material. This history is suggestive of: a bleeding duodenal ulcer. ingestion of a poisonous substance. pulmonary embolus. appendicitis.

a bleeding duodenal ulcer. Vomiting blood or black or dark brown material that resembles coffee grounds indicates bleeding ulcer of the stomach or duodenum or bleeding from esophageal varices.

Cardiac arrest in children is typically: accompanied by respiratory alkalosis. caused by carbon dioxide poisoning. a result of cardiac trauma. a secondary event resulting from respiratory and ventilatory failure.

a secondary event resulting from respiratory and ventilatory failure. Cardiac arrest is rarely a primary event in children as it is in adults; however, some children do experience ventricular fibrillation and cardiac arrest. The child more commonly experiences respiratory and ventilatory failure or shock that progresses to respiratory arrest and subsequent cardiac arrest (American Heart Association, 2016).

Mr. Torres is brought to the emergency department after an auto accident. You suspect that he has a cervical spine injury. You can rule out this possibility by: examining peripheral motor and sensation. acquiring x-ray films of all cervical vertebrae. assessing the level of consciousness. assessing for pain and deformity.

acquiring x-ray films of all cervical vertebrae. Once the patient's vital functions are more stable, radiologic imaging of all seven cervical vertebrae is often obtained to diagnose the presence or absence of cervical spine injury.

The secondary assessment begins: after all life-threatening conditions have been stabilized. when pain has been controlled. after the primary assessment has been completed twice. immediately after the primary assessment.

after all life-threatening conditions have been stabilized. Once the basic life support survey has been completed and the patient is conscious, additional assessment is needed.

During the primary assessment, the "A" component of the assessment stands for: airway management. ambulatory. auscultation of breath sounds. alert and oriented.

airway management. The patency of the upper airway is assessed at the start by asking the patient a question.

During the primary assessment, the examiner notes dampness inside a trauma victim's dark-colored coat. It is important for the examiner to determine whether this dampness is caused by: urine. intravenous (IV) fluids. severe sweating. blood.

blood. Perform a quick total body appraisal for bleeding sites, being especially careful to look and feel for dampness in dark clothing that may hide hemorrhage.

The historical information gathered during the primary assessment is basically limited to the: current medical history. chief complaint. drug allergies. family history.

chief complaint. The patient history obtained during the primary survey is often limited to the chief concern (e.g., the mechanism of injury).

An indicator of hemorrhage in an individual who is wearing dark clothing may be: respiratory distress. increasing abdominal girth. staining. dampness.

dampness. Perform a quick total body appraisal for bleeding sites, being especially careful to look and feel for dampness in dark clothing that may hide hemorrhage.

A capillary refill time of more than 2 seconds is a(n): expected finding. indicator of peripheral hemorrhage. indicator of poor perfusion. direct indicator of increased heart rate.

indicator of poor perfusion. Capillary refill time of greater than 2 seconds is a marker for poor tissue perfusion

Occult hemorrhage in the abdominal area, which may become a life-threatening condition, is associated with: abdominal bruising. pelvic fracture. abdominal aneurysm. solid abdominal organs.

pelvic fracture. Pelvic fractures are associated with occult hemorrhage, which may become a life-threatening condition.

A skull fracture may be indicated by the presence of: raccoon eyes. Cullen sign. crepitus. Kernig sign.

raccoon eyes. Bruising around the eyes (raccoon eyes) is indicative of a basilar skull fracture.

The jaw thrust is primarily used to: maintain the neck in neutral position. dislodge any foreign objects. raise the tongue. prevent aspiration.

raise the tongue. If the airway is obstructed and the patient is supine, use a chin lift or jaw thrust (if any potential injury to the cervical spine has occurred) to raise the tongue (the most common cause of airway obstruction) out of the oropharynx.

A man is shot and critically wounded in a domestic dispute. From a legal standpoint, the health care providers must: call the police before providing care. obtain written consent from the patient before providing care. determine whether the man has advance directives before providing care. save all items from the patient for law enforcement personnel while providing care.

save all items from the patient for law enforcement personnel while providing care. Any such injuries must be reported to legal authorities. All items, such as bullets and clothing, must be saved for law enforcement personnel, with a documented chain of possession by health professionals.

In most penetrating traumatic injuries, the most important factor in determining injury from energy transfer and thus the degree of injury is related to the: speed of the missile. distance traveled by the missile. size of the missile. region of the body sustaining injury.

speed of the missile. Energy transfer is also determined by the rate or change in speed once the missile is inside the patient's body.

Bruising, a sign of pulmonary contusion, has the potential to result in a: spontaneous pneumothorax. pleural friction rub. pulmonary embolus. flail chest.

spontaneous pneumothorax. Palpate the upper chest and neck for crepitation, a sign of air leakage into soft tissue. Bruising should alert you to the possibility of a pulmonary contusion (bruising of the lung tissue caused by the energy of an external impact transmitted through the chest wall). This injury may result in a pneumothorax. A flail chest also indicates an underlying lung injury (pulmonary contusion).