QUESTIONS | WITH COMPLETE SOLUTIONS.
1 of 100
Term
A 19-year-old male was assaulted and has trauma to multiple body
systems. After performing your primary assessment and treating any
immediate life-threatening injuries, you should:
A:fully immobilize his spine and transport.
B:obtain a full set of baseline vital signs.
C:transport at once and intercept with ALS.
D:perform a rapid head-to-toe assessment.
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,B;
Reason:
If two or more ribs are fractured in two or more places or if the
sternum is fractured along with several ribs, a segment of chest wall
may be detached from the rest of the thoracic cage. This injury is
called a flail chest. In a flail chest, the detached portion of the chest
wall moves opposite of normal. It moves in during inhalation and out
during exhalation (paradoxical motion). Isolated (single) rib fractures
are not
associated with paradoxical motion because they are usually only
fractured in one place. In a pneumothorax, the patient's respirations
are often labored; in severe cases, an entire side of the chest may not
move at all (asymmetrical chest movement). A pulmonary contusion
(bruising of the lung tissue) does not cause paradoxical chest motion
unless associated with a flail chest.
C;
Reason:
Some patients with blunt trauma to the eyeball (globe) may present
with a hyphema, or bleeding into the anterior chamber of the eye, that
obscures a portion of or the entire iris. This condition may seriously
impair vision and should be considered a sight-threatening emergency.
A fracture of the orbital floor (blowout fracture) is characterized by
double vision and an inability of the patient to move his or her eyes
above the midline (paralysis of an upward gaze) following blunt facial
trauma. In an orbital blowout fracture, fragments of fractured bone can
entrap some of the muscles that control eye movement. Anisocoria is
the term used to describe unequal pupils. Unequal pupils following
head trauma indicates increased intracranial pressure.
, C;
Reason:
Hemoptysis (coughing up blood) is a finding that suggests injury to or
bleeding within the lungs. Vomiting of bright or dark red blood
(hematemesis) suggests gastrointestinal bleeding. Intraabdominal
blee d in g presents with signs of shock as well as a rigid, bruised, or
D ;
distended abdomen. Damage to the myocardium typically does not
cau s e h e m o t ysi s unless it is associated with lung injury.
R e a so n :
After treating all life-threatening conditions found in the primary
assessment, you should perform a rapid head-to-toe assessment
(rapid body scan) to look for and treat other life threats. In many
cases, patients with trauma to multiple body systems have
other life-threatening injuries that are not readily apparent
during the
primary assessment. You should obtain baseline vital signs as
soon as possible; however, this should not delay or interrupt your
primary or rapid head-to-toe assessments. After performing the
primary and rapid head-to-toe assessments, fully immobilize the
patient's spine and transport to an appropriate hospital. Consider
an advanced life support (ALS) intercept, as long as it does
not cause a significant delay in transport.
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2 of 100
Term
When caring for a critically injured patient, it is MOST appropriate to
perform your secondary assessment:
A:immediately following the primary
assessment. B:while you are en route to the
hospital.
, C:immediately after taking baseline vital signs.
D:after all life threats have been ruled out.
Give this one a try later!
B:while you are en route to the hospital.
The secondary assessment is a detailed exam of the patient; it focuses on
detecting and correcting injuries or conditions that were not grossly
obvious during the primary assessment. Because the secondary
assessment can be time-consuming, it should be performed en route to the
hospital if your patient is critically ill or injured. The only actions that you
should perform at the scene of a critically ill or injured patient are the
primary
assessment, correction of immediate life-threats (eg, problems with the
ABCs), and spinal precautions if necessary. The quicker you begin
transport of a critically ill or injured patient, the quicker the patient will
receive definitive care at the hospital. In some patients, you may not have
time to perform a secondary assessment; this is especially true with
critically ill or
injured patients who have ongoing problems with airway, breathing,
or circulation.
D;
Reason:
Your physical exam of a patient who fell should focus on determining if the
patient is injured and what happened prior to the fall. Did the patient simply trip
and fall or experience a syncopal episode (fainting) and then fall? If the patient
fainted and then fell, you should suspect both a medical problem (caused the
fall) and a traumatic injury (resulted from the fall). When assessing a patient who
fell, do not be so quick to label him or her as a trauma patient before performing
a thorough assessment; an underlying medical problem (eg, stroke,
hypoglycemia, cardiac event) may have caused the fall. Determining if the
patient has fallen before, which may help to establish a pattern, is pertinent and
should be established. However, your initial priority should be to determine why
the patient fell and whether or not the fall caused an injury.