FISDAP TRAUMA EMT TEST QUESTIONS & ANSWERS LATEST UPDATED

When to apply tourniquet - Answer When direct pressure and all other bleeding control methods have failed, apply tourniquet. Tourniquet Placement - Answer Place tourniquet approximately 2 inches above the wound. Used on extremity injuries only. Jaw Thrust Manuever - Answer Opening the airway of patient with suspected spinal injury, use Jaw Thrust Maneuver. Used in trauma to neck, head, or spinal injury. Crepitus - Answer A grinding sensation caused by fractured bone ends or joints rubbing together. Referred Pain - Answer Pain felt in a place other than where the pain originated. External Bleeding Control - Answer Most common and effective way to control external bleeding is Direct Pressure. External Bleeding Care - Answer *Direct pressure on wound *Elevate wound. *Pressure dressing with direct pressure. *Tourniquet if direct pressure has not stopped bleeding. *Apply oxygen, maintain airway, care for shock. Ecchymosis - Answer Bruise, contusion. A discoloration of the skin resulting from bleeding. 3 Types of External Bleeding - Answer Arterial Bleeding (Arteries) Venous Bleeding (Veins) Capillary Bleeding (Capillaries) Arterial Bleeding - Answer Spitting blood Bright red color Pulsating flow Venous Bleeding - Answer Dark red color Steady, slow flow Capillary Bleeding - Answer Slow, even flow Oozing Scalp Injury Care - Answer Control scalp bleeding by applying direct pressure. Dress and bandage as you would other soft tissue injuries. Bone fragments showing, Contusion - Answer A bruised brain, or brain contusion. Concussion - Answer Force against the brain from hitting the skull. Patient hits their head, or struck by blunt object. Open Chest Wound - Answer Chest wall is penetrated, skin is broken. Example: A Bullet or knife Open Chest Wound Care - Answer *Apply 3 sided occlusive dressing *Maintain open airway *High concentration of oxygen 15 LPM *Care for shock Rapid transport Pneumothorax - Answer Air in the chest cavity, possibly causing collapse of a lung. Tension Pneumothorax - Answer A type of pneumothorax in which air that enters the chest cavity is prevented from escaping. Most often found in a closed chest injury, or after a sealed occlusive dressing has been applied to an open chest wound. Pneumothorax Signs and Symptoms - Answer Diminished or absent lung sounds on the affected side. Tension Pneumothorax Signs and Symptoms - Answer Jugular Vein Distention Signs of shock Spine Injury Suspected - Answer Whenever skull or brain injury is suspected, suspect spine injury. Flail Chest - Answer Closed chest injury. Defined as a fracture of two or more consecutive ribs in two or more places. Head Tilt-Chin Lift - Answer Tilting the head and lifting the chin back, free passage of air. Correcting blockage of the airway. Used when no trauma or injury is suspected. Sucking Chest Wound Signs and Symptoms - Answer *Patient has open wound to the chest *Patient gasping for air Each time patient breaths, air sucked into the opening OPEN WOUNDS - Answer Avulsion Laceration Amputation Punctures Abrasion Avulsion - Answer An injury in which soft tissue is torn completely loose or is hanging as a flap. Impaled Object - Answer *Do not remove object, unless needed to for example CPR. *Stabilize with bulky dressing and bandage in place. Ecchymosis - Answer Bruise, contussion. A discoloration in the skin resulting from bleeding. Indications for Spinal Immobilization - Answer Car accidents, Fall, or high impact collision. Abrasions - Answer A scratch or scrape. Laceration - Answer A cut Treat Amputations - Answer *Apply pressure dressing over stump. *Use pressure points to control bleeding. Apply tourniquet if indicated. *Wrap or bag amputated part in a plastic bag and keep cool by cool packs. Impaled Object in Cheek - Answer *Examine wound site. *Remove object if you can see both ends. *If there is difficulty, do not remove object Impaled Object in Eye - Answer *Stabilize the object. Place gauze on either side of object. *Apply rigid protection. Fit a paper cup over the object. *Dress and bandage uninjured eye. *Provide oxygen and care for shock. Treating Avulsions - Answer *Clean wound surface. *Fold skin back into normal position as gently as possible. *Control bleeding with direct pressure and dress with bulky sterile dressings. Thermal Burn Care - Answer *Remove clothing or jewelry. *Wrap with dry sterile dressing. Treat Open Wounds - Answer *Expose wound. *Clean wound surface. *Control bleeding with direct pressure. *Use sterile dressing. *Apply bandage after bleeding has been controlled. *Rapid transport and care for shock (Oxygen and maintain airway). Treat Thermal Burn - Answer *Remove clothing or jewelry. *Wrap with dry sterile dressing. Burns - Answer *Superficial: Outer layer burned. *Partial Thickness: Outer layer and second layer burned. Blisters. *Full Thickness: All layers burned. Commotio Cordis - Answer *Patient hit in center of chest. *Disturbance of heart. *Causes V-Fib Treat Commotio Cordis *Defibrillation and CPR quickly. Treat Abdominal Evisceration - Answer *Administer high concentration of oxygen 15 LPM. *Expose wound site. *Apply bulky moistened sterile dressing with direct pressure and bandage. *Flex patient legs at knees, to reduce pain on abdomen. (Supine). *Rapid transport and care for shock. Be alert for vomiting and monitor vital signs. TBI Signs and Symptoms - Answer Battle signs behind ears. Unequal pupils Raccoon eyes Blood or cerebral spinal fluid from ears Deformity of skull $$$$ - Somebody pulled out of fire complaining of face and neck pain - Answer GIVE NARCOTICS TO PT What are the solid organs? - Answer Kidney Liver Spleen Pancreas Ovaries Adrenal Glands What are the hollow organs? - Answer Stomach Intestines Gallbladder Urinary Bladder Uterus Appendix (Aorta) S&S of GI Bleed - Answer - Vomiting - "Coffee ground emesis" - Tarry stool S&S of ruptured diaphragm - Answer -Can occur in both high-energy blunt and penetrating trauma -Abdominal organs may herniate into thoracic cavity -May cause bowel strangulation or necrosis -Dyspnea -Hypoxia -Hypotension -JVD -Abdomen man appear hollow and gastric sounds in thorax -Pt may complain of upper ab pain S&S of splenic injury - Answer -Perfuse bleeding (b/c its a solid organ) -Typically injured with severe abdominal compression, blunt left flank trauma, or penetrating injury to its location -Occasionally, blood loss can occumulate against the diaphragm (esp. in supine pt) and result in referred pain to left shoulder region - Kehr's sign S&S of infection (abdominal) - Answer S&S of hemorrhagic shock - Answer Classes of Hemorrhagic shock: 1. <15% blood loss 2. 15-30% blood loss - breathing increase, pulse weakening 3. 30-40% - major vasoconstriction and pulse increase, major respiratory rate increase, shallow breathing, BP starts to fall here 4. 40%> - vasodilation, pulse rate variable, pulse strength major decrease, major decrease in BP, resp. rate slow and shallow. S&S -anxiety -blue lips and fingernails -low or no urine output -profuse (excessive) sweating -shallow breathing -dizziness -confusion -chest pain -loss of consciousness -low blood pressure -rapid heart rate -weak pulse Signs of internal hemorrhaging include: -abdominal pain -blood in the stool -blood in the urine -vaginal bleeding (heavy, usually outside of normal menstruation) -vomiting blood -chest pain -abdominal swelling Treating a distracting injury - Answer - prioritization (do not get distracted) Treating an abdominal evisceration - Answer -Cover any exposed (eviscerated) abdominal organs with a dressing moistened with sterile saline. -Be careful to keep the region clean and do not replace any exposed organs. -Cover the wet dressing with a sterile, occlusive dressing (to keep sign clean and retain moisture). - If transport lengthy, check dressing and remoisten. Treating Hemorrhagic shock - Answer -AIRWAY AND BREATHING SUPPORT -O2 if cap or sat says so - Nasal or oral adjuncts - Intubate if unresponsive - Look for vomit, suction if needed - Capnography best confirmation of ET tube placement - Consider PEEP or CPAP (if pulmonary edema suspected) use -Needle decompression if tension pneumo suspected - 2nd intercostal space, mid-clavicular - If NO carotid pulse, initiate CPR, attach AED, and employ ACLS -HEMORRHAGE CONTROL - Decompensated shock - Answer -Late stage of shock. Begins when compensatory mechs become unable to respond to a continuing blood loss. -Pulse becomes unpalpable -BP drops significantly -Pt becomes unconscious -Resp. slow or cease -Brain hypoxic > rapid level of consciousness decrease Compensated shock - Answer -Early stage of shock. In this stage the body is capable of meeting its critical metabolic needs through a series of progressive compensating actions. (ie. vasoconstriction, pulse rate increase, resp. rate increase, etc.) -Pt pale,cool,clammy. -Narrowing pulse pressures is the first definitive sign. -Pt becomes anxious at end of this stage and may complain of thirst or weakness. May experience air hunger and tachypnea (quick resp. rate) Organs of the peritoneum - Answer Liver Peritoneum Ascending colon Diaphragm Stomach Spleen Transverse colon Organs in the retroperitoneal space - Answer Vena cava Duodenum Kidney Ureters Aorta Pancreas Kidney Descending colon Organs in pelvis - Answer Iliac vessels Uterus Rectum Sigmoid colon Bladder Baroreceptor reflex - Answer -Body's homeostatic mechanisms that helps to maintain blood pressure at nearly constant levels - Provides a rapid negative feedback loop in which an elevated blood pressure reflexively causes the heart rate to decrease and also causes blood pressure to decrease - Decreased blood pressure decreases baroreflex activation and causes heart rate to increase and to restore blood pressure levels Indication for fluid resuscitation - Answer Hering-breuer Reflex - Answer The Hering-Breuer inflation reflex is a reflex triggered to prevent over-inflation of the lung. Pulmonary stretch receptors present in the smooth muscle of the airways respond to excessive stretching of the lung during large inspirations. Indications for an occlusive dressing - Answer -Sucking chest wound -eviscerated bowels (sterile bandage soaked in saline and applied under occlusive dressing) - S&S of an internal hemorrhage - Answer -associated with almost all serious blunt and penetrating trauma -blood can accumulate in interstitial spaces, forming a visible or hidden contusion, or it can form a pocket of blood called HEMATOMA -Humerus and tibia/fibula fractures can have 500-750mL of loss -Femur may have 1500mL of blood loss -trauma to chest,abdomen, pelvis will continue to bleed uncontrolled; immediate transport for surgical intervention is BEST ACTION - Multi-systems trauma pt is BEST TREATED by immediate backboard immobilization and transportation Identification of Beck's Triad - Answer -Cardiac tamponade 1.Low arterial blood pressure 2. Distended neck veins 3. Muffled heart sounds (due to fluid around heart) -Pericardial fluid accumulation -Pressure on heart creates backup in systemic circulation > decrease in bloodflow out to lungs (ng distended neck veins) >decreased flow to Rest of Body ( arterial pressure) - RAPID TRANSPORT IS BEST TREATMENT S&S of a pneumothorax - Answer - Simple pneumo (closed pneumo); occurs when air leaks into pleural space. -Air accumulation in pleural space > lung collapse > alveoli collapse (atelectasis) > blood flow past alveoli does NOT exchange O2 or CO2 > lower blood O2 levels > higher blood CO2 levels (acidosis) - Penetrating or blunt trauma can cause. Blunt can be from impact while glottis is closed (paper bag effect) - Open pneumo (sucking chest wound); may produce frothy blood. - Pt likely to experience increasing dyspnea and possibly hypovolemia with blood loss. SIGNS AND SYMPTOMS **Pentrating chest trauma **Sucking chest wound **Dyspnea **Hypovolemia - IF SUCKING CHEST WOUND, 3 SIDED OCCLUSIVE DRESSING IS BEST TREATMENT? S&S of a tension pneumothorax - Answer -MOI causes one way valve into pleural space -Increasing thoracic pressure build up > lung collapse > vena cava crimping > reduced venous return > reduced cardiac output > increase in venous pressure > JVD is caused > narrows pulse pressure -Tracheal shift is LATE SIGN - Increasing pressure may cause intracostal tissues to bulge outward - NEEDLE DECOMPRESSION OF PLEURAL SPACE IS BEST TREATMENT - 2nd intercostal space, mid-clavicular, above rib **Chest trauma **Severe dyspnea **ventilation/perfusion mismatch **Hypoxemia **Hyperinflation of affected side of chest **HYPERRESONANCE of affected side of chest **Diminished/absent breath sounds **Cyanosis **Diaphoresis **AMS **JVD **Hypotension **Hypovolemia Atelectasis - Answer The collapse or closure of a lung resulting in reduced or absent gas exchange. Contralateral - Answer relating to or denoting the side of the body opposite to that on which a particular structure or condition occurs Ipsilateral - Answer belonging to or occurring on the same side of the body Treating a penetrating injury - Answer -Bulky dressing -Secure object and do not remove - Treating a tension pneumothorax - Answer - Needle decompression Treating an open chest wound - Answer - GLOVED HAND FIRST - 3 sided occlusive dressing Normal expiratory CO2 levels are between? - Answer - 35-45 mmHg and should not drop below 30 mmHg - above 45 mmHg suggests hypoventilation and need for faster and/or deeper ventilations Cushing's Triad - Answer BP UP PULSE DOWN IRREGULAR RESPIRATIONS Cerebral contusion - Answer Blunt trauma to local brain tissue that produces capillary bleeding into brain's substance; causes prolonged confusion Mannitol - Answer -Osmotic diuretic that draws water from interstitial space into vascular system -REDUCES ICP -REDUCES BP Coup injury - Answer -Tissue disruptions directly at point of contact -Happen most often in frontal region Contrecoup injury - Answer -Produce tissue damage away from the impact point due to brain "slosh" Epidural hematoma - Answer Fast bleed between dura mater and skull's interior -ICP increase > reduction in cerebral perfusion pressure - "classic sign in immediate loss of consciousness, then period of lucidity, then unconsciousness" Subdural hematoma - Answer -Slow bleed beneath the dura mater - Changes in consciousness over time and headache Intracerebral Hemorrhage - Answer - Results from ruptured blood vessel (most freq. artery) - Blood loss minimal; DAMAGE HIGH - Stroke like symptoms Diffuse axonal injury - Answer - Mild (concussion) to severe damage to axons; more generally spread out - Care involves frequent mentation checks, ABC's - Moderate DAI is commonly with basilar fracture: S&S include - Severe DAI: Prolonged unconsciousness, ICP up, Cushing's response,Decerebrate or decorticate posturing Frontal Lobe - Answer Lobe of brain associated with reasoning, planning, parts of speech, movement, emotions, and problem solving Parietal Lobe - Answer part of brain associated with movement, orientation, recognition, perception of stimuli Occipital Lobe - Answer associated with visual processing Temporal Lobe - Answer Associated with perception and recognition of auditory stimuli, memory, and speech S&S of a traumatic brain injury - Answer -Altered level of consciousness - Altered level of orientationg -Personality changes - Amnesia - Cushing's Triad (BP UP, PULSE DOWN, IRREGULAR RESPIRATIONS) - Vomiting (w/o nausea) - Body temp changes - Changes in reactivity of pupils - Decorticate posturing Complication of an open neck wound - Answer - Jugular venous air embolism S&S of traumatic asphyxiation - Answer - Occurs when severe compressive force applied to thorax - Results in reverse blood flow from right heart into superior vena cava and into venous vessels of the upper extremities - More vascular issue than respiratory issue - Blood backflow damaging - Petechiae Treating traumatic asphyxiation - Answer - Administer O2, support airway and respiration - May require PPV use of BVM while entrapped - Est. IV's for rapid crystalloid infusion - Transport ASAP after release from entrapment - Consider sodium bicarb if prolonged extrication Cullen's sign - Answer Lap belt bruising (seatbelt sign) CUPS - Answer C - Critical U - Unstable P - Potentially Unstable S - Stable $$ - Knowing the difference in sound between hemo and pneumo - Answer Hemo - Hypo resonant Pneumo - Hyper resonant Treating an eye injury - Answer - cover both eyes w/ sterile gauze, cups, etc. Complications of a crush injury - Answer - Hemorrhage may be internal, external or mixed - May be further complicated by length of crushed time - Pressure can disrupt blood flow to and through limb causing anaerobic metabolism and some tissue death > causes buildup of toxins in the crushed limb - If blood flow returned, these toxins may be carried through central circulation > may cause cardiac arrhythmias or seriously damage kidneys - Separate complication may be extreme hemorrhage -SODIUM BICARB USED TO COMBAT EFFECTS OF ACIDOSIS, LIMIT DAMAGE, AND IMPROVE KIDNEY FUNCTION. - Rhabdo: Digestion of muscle tissue; kidney cannot handle -Enteral Identify and treat supine hypotensive syndrome - Answer Characterized by pallor, bradycardia, sweating, nausea, hypotension and dizziness and occurs when a pregnant woman lies on her back and resolves when she is turned on her side. The aorta and inferior vena cava are central vessels, the largest artery and vein. Brown-Sequard Syndrome - Answer - Caused by damage to one half of the spinal cord, resulting in paralysis and loss of proprioception on the same (or ipsilateral) side as the injury or lesion, and loss of pain and temperature sensation on the opposite (or contralateral) side as the lesion. Treating a victim of a prolonged extrication - Answer - Crush injury - 115 - Compartment syndrome- 116 - Rhabdomyolysis Complications from a long bone fracture - Answer - Compartment syndrome: - Lack of perfusion: - Movement causing further damage/bleeding: S&S of multiple rib fractures - Answer -Flail chest (3 or more adjacent ribs broken in 2 or more places) -Most serious chest injury b/c is often associated w/ severe underlying pulmonary injury (contusion) -Reduces respiratory volume while increasing resp. effort -Typically caused by blunt traumas -Paradoxical motion -Flail segment OUT while rest of chest pulls IN ; During EXPIRATION (due to intrathoracic pressure increase) - PPV IS MOST IMPORTANT TREATMENT Treating a pt with a pulseless extremity - Answer Dislocation : 1 attempt at traction Laceration: Treatment of an amputated extremity - Answer - Direct pressure, large bulky dressing; consider tourniquet just above point of severance - If limb crushed, tourniquet - Do not delay transport for severed limb - Place part in plastic bag wrapped in moistened gauze with lactated ringers or saline and immerse bag in cold water, NOT ICE Calculating a glascow coma score (GCS) - Answer Eyes: (NPVS) 4. Spontaneous 3. Verbal 2. Pain 1. No response Verbal: ("No Inc IDO") 5. Oriented and converses 4. Disoriented and converses 3. Inappropriate words 2. Incomprehensible sounds 1. No response Motor: ("No Ex AbFlex WLO") 6.Obeys verbal commands 5. Localizes pain 4. Withdraws from pain (flexion) 3. Abnormal flexion to pain (decorticate) 2. Extension to pain (decerebrate) 1. No response Decorticate - Answer Flexion inward (toward the core) Decerebrate - Answer Extension away from body Calculating total body surface area burnt - Answer Adult - Rule of 9's -Head and neck - 9% Total -Upper Back - 9% -Anterior Chest - 9% -Each Upper Extremity - 9% total -Anterior abdomen - 9% -Lower back- 9% -External genitalia - 1% -Each lower extremity - 9% anterior, 9% posterior Pediatric - Head and Neck - 9% front 9% back - Legs - 13.5% total - Everything else is same as adult First Degree burns - Superficial - Answer Skin color: Red Skin: Dry with no blisters Sensation: Painful Healing: 3-6 days Depth: Epidermis and upper dermis Second Degree burns - Partial Thickness - Answer Skin color: Mottled Red Skin: Blisters w/ weeping Sensation: Painful Healing: 2-4 weeks Depth: Most Dermis Third Degree burns - Full Thickness - Answer Skin color: Pearly white and/or charred, translucent, and parchment like Skin: Dry w/ thrombosed blood vessels Sensation: Anesthetic Healing: May require skin grafting Depth: through subcutaneous Treatment of an actively burning pt - Answer - STOP BURNING FIRST - remove clothing Treatment of an open neck wound - Answer - Gloved hand - Occlusive dressing Le Forte fractures - Answer 1. A slight instability involving the maxilla alone, usually presents with no associated displacement 2. Fracture of both maxilla and nasal bones and results in instability of the maxilla and nasal region 3. Involve the entire facial region below the brow ridge, including zygoma, nasal bone, and maxilla 1&2 typically result in CSF leakage and endanger airway patency. Subcutaneous emphysema - Answer is typically located right above trauma - Leads to pneumo Diseminating Intravascular Coagulation (DIC) - Answer In disseminated intravascular coagulation, abnormal clumps of thickened blood (clots) form inside blood vessels. These abnormal clots use up the blood's clotting factors, which can lead to massive bleeding in other places. Causes include inflammation, infection, and cancer. Aortic Rupture - Answer - Tearing pain in abdomen or back - unequal BP in arms due to bleed in line - Transport gently to hospital Left shoulder pain (Kehr's sign) - Answer Spleen rupture - abdominal bruising Neuro shock with spinal cord injury - Answer BP same or lower Neuro shock with head injury - Answer BP up Septic shock - Answer BP low Temp up Heat exhaustion - Answer Temp over 100F (37.8C) Heat Stroke - Answer Temp over 105F Hypothermia - Answer Mild - 90F-95F Moderate - 82F - 90F Severe - 82F or lower $$$ - BEST treatment for Increasing ICP - Answer Oxygen supplemented Hyperventilation to vasoconstrict Simple stab - Answer Cover w/ occlusive dressing Tension pneumo - Answer Causes shortness of breath whereas simple pneumo does not More mass - Answer = more kinetic energy Trauma level 1 - Answer ALL Trauma Emergencies Trauma level 2 - Answer MOST trauma emergencies important factors for mechanism of injury - Answer is the way in which traumatic injuries occurs; it describes the forces (or energy transmission) acting on the body that cause injury. Three concepts of energy are associated with injury are potential energy, kinetic energy, and the energy work. energy can be neither created nor destroyed, but you can only converted or transformedm airway adjuncts for an unconscious trauma patient - Answer Jaw-thrust maneuver indications to suction an airway - Answer If airway has visible secretion, if patients is treatment for a penetrating eye injury - Answer Prepare the doughnut ring by wrapping a 2-inch gauze around your fingers and thumb seven or eight times. Adjust the diameter by spreading your fingers or squeezing them together remove the gauze from your hand and wrap the reminder of the gauze roll radially around the ring that you have created work around the entire ring to form a doughnut Place the dressing over the eye and impaled object to hold the impaled object in place, and then secure it with a roller bandage. identify and treat hemorrhagic shock - Answer indications to perform a rapid extrication - Answer When a patient is experiencing a significant MOI and the patient is considered to be in serious or critical condition indications for removing a helmet - Answer If there is a pending injury under the helmet It makes assessing or managing airway problems difficult and removal of a face guard to improve airway access is not possible If it is a full-face helmet It prevents you from properly immobilizing the spine It allow excessive head movement If a patient is in cardiac arrest treatment of an abdominal evisceration - Answer Never try to replace an organ that is protruding from an abdominal laceration. Cover it with sterile dressing moistened with sterile saline solution and secure with a bandage and tape. keep the organs moist and warm treat for shock by keeping the patient warm an placing the patient in the supine position provide high-flow oxygen location of the organs within the abdomen - Answer upper right quadrant liver- far right (solid organs) gallbladder- next to liver (hollow organs) kidney- back of abdomen (solid organ) large intestine