Paramedic Plus Review: Trauma Emergencies Latest Update Graded A

Paramedic Plus Review: Trauma Emergencies Latest Update Graded A Which one of the following injuries should be treated with an occlusive dressing? Knife injury to the neck An alert 66 year old male complains of trouble breathing after he fell and injured his left chest. His skin is slightly cyanotic, and you palpate crepitus over his left ribs. After administering oxygen by non-rebreather mask, you should administer a pain medication. Paramedics have initiated fluid resuscitation for a stabbing victim who has signs of severe shock, including pale, waxy skin, tachycardia, and hypotension. After receiving the first liter of fluid, his vital signs return to normal. The goal should now be to: titrate IV fluids to maintain a BP of 90 mm Hg systolic and a heart rate less than 120. For a rapid response following fluid resuscitation in trauma (improvement after initial treatment), the goal is to maintain normal vital signs, which is defined as a BP of 90 and heart rate less than 120. While en route to the hospital with a trauma patient, the patient remains unresponsive with a heart rate of 134, blood pressure 82/60, and a respiratory rate 28 and shallow. As your partner tends to the airway and oxygen status, you intend to start an IV with what type of solution? 0.9% sodium chloride The preferred solution for resuscitation of a volume-depleted patient is an isotonic crystalloid. In the prehospital environment that would mean either 0.9% sodium chloride (normal saline) or Ringer's lactate solution. A 180-pound male patient with an external hemorrhage presents with a heart rate of 114/minute, blood pressure at 102/88, respirations at 20/minute, weak peripheral pulses, diaphoresis, and anxiety. Given this presentation, the patient has lost approximately how much blood? 1,100 mL Given the clinical presentation (anxious, narrow pulse pressure, tachycardia, etc), this patient displays findings consistent with 15% - 30% blood loss. You are the backup ALS unit for a trauma victim being cared for by first responders. They tell you the patient had a weak pulse, but the patient arrested just as you arrived. They are currently doing CPR and mouth-to-mask ventilations. What should be the paramedic's first action? Reassess for a pulse and check breathing A 36 year old female was stabbed in the back with a knife. She has absent motor and light touch findings on her right side, but she can still feel pain. Her left-sided extremities have normal motor and light touch findings, but she cannot feel pain. You should suspect Brown-Sequard syndrome She is demonstrating the classic mechanism and clinical findings of an incomplete spinal cord injury. The absence of motor and light touch on one side indicates the corticospinal and posterior columns on the right have been damaged, but since pain perception ascends up the opposite side of the cord from where it enters in the spinothalamic tract, she still has pain perception on the injured side. You are transporting 23 year old male who has 45% TBSA partial-thickness burns from the scene. His vital signs are P 94, R 16, BP 112/72, and SpO2 96% on oxygen by nasal cannula. He weighs 150 pounds. Using the Parkland formula, how much fluid should you administer during the first hour after his injury? 767 mL The formula is "4 mL x patient's weight kg x BSA% burned." Half of this amount is administered over the first eight hours, with the remaining half administered over the next 16 hours. The math is as follows: 4 mL x 68.18 kg x 45% = 12,272.72 mL total fluid. That means 6,136.36 mL (50%) is given over the first eight hours. Since transport time is one hour, 6,136.36 mL divided by eight hours is 767 mL/hour. You are managing a patient with significant chest wall contusions, deformity, structural instability, and diminished breath sounds. Of the potential injuries listed below, which your patient could have sustained, choose the one that would benefit most from positive pressure ventilation (PPV). Flail segment The loss of chest wall integrity in a flail segment contributes to significant ventilation inadequacy. The provision of positive pressure ventilation (PPV) to these patients as a form of "internal stabilization" is therefore of paramount importance. Which of the following is least likely to cause jugular venous distention (JVD)? Hemothorax Hemothorax is likely to cause hypovolemia and therefore not present with JVD. Visceral pain originating from abdominal organs is stimulated by all of the following EXCEPT Tearing Visceral pain originating from organs is caused by stretching, ischemia and inflammation--not to trauma such as tearing. This is one of the reasons abdominal pain is diffuse and difficult to localize in traumatic and medical conditions until peritoneal contact or irritation occurs to stimulate somatic (parietal) pain. The diaphragm is primarily innervated by the Phrenic nerve The phrenic nerve is the primary innervation for the diaphragm. It originates from the 4th cervical nerve with contributions from the 3rd and 5th cervical nerve. This is important when determining the level of cervical spine injury. The saying "C3, C4, C5 helps keep the diaphragm alive" will help you remember this. What type of fracture is shown in the radiograph? Colles' fracture Look at the position of the lower arm and hand. This is a Colles' fracture--also known as a dinner fork or silver fork fracture because of the appearance. Angiotensin is secreted by the kidneys of a shock patient in order to: constrict blood vessels. Angiotensin is secreted by the kidneys during shock to constrict blood vessels and increase pressure within the cardiovascular system. An 80 year old female has an upper arm laceration after a car crash. She is alert but anxious. You judge her blood loss to be severe. Her vital signs are P 88, R 28, and BP 90/64. You should suspect that her pulse is slow because she is taking a beta blocker medication. Beta blocker use is very common among older patients and can often influence compensatory responses to shock. In this case you would expect a tachycardia but the heart rate is in fact normal. What is the best needle to use when performing a needle thoracocentesis (needle decompression) in a patient with a tension pneumothorax? 14 gauge, 3.0 inches Hemostasis would best be defined as the: blood vessel processes that stop bleeding and clot holes. Hemostasis refers to the clotting process blood vessels use to stop blood loss and clot holes. Homeostasis refers to the body's tendency toward normalcy. You are caring for a female patient who was thrown off a horse at a county fair, landing on her back and hyperflexing her neck, which caused a spinal-cord injury. She is presently struggling to breathe, but you notice no intercostal muscle contraction with each breath. Lung sounds are clear. There is no thoracic injury. Where would you suspect the spinal injury to be? Thoracic vertebrae around T1 The probable site of injury is between C7 and T1 if the intercostal muscles are paralyzed. This is because the spinal nerve that innervates the intercostal muscles exits the spinal cord at the level it innervates. Your patient is experiencing hypotension as a result of anaphylaxis. This is which type of shock? Distributive Anaphylaxis causes loss of vascular tone and increased vascular permeability. The amount of blood is unchanged--it is distributed differently. Cardiac tamponade or pulmonary embolus are examples of obstructive shock. Cardiogenic shock (MI) and hemorrhagic shock are the other types of shock. Which one of the following injuries would most likely be associated with shearing caused by the ligamentum arteriosum? Traumatic aortic disruption The ligamentum arteriosum tethers the aorta in place and is often the culprit behind devastating shear injuries as a result of deceleration. Three weeks after cast removal, the parents of an eight-year-old have called the ambulance because their son is complaining of increased ankle pain and difficulty walking. Assessment reveals the following data: pain, redness, and swelling to the ankle and foot with decreased mobility and painful range of motion. Distal pulses are present. The child's temperature is 100.4, and he is listless and pale. Which one of the following conditions is suspected? Osteomyelitis These are the classic signs and symptoms associated with a systemic infection, particularly the pale and listless presentation. A 12 year old male was struck by a car and is unresponsive. He has obvious chest, abdomen, and pelvic injuries. His vital signs are P 130, R 30, and BP 60/38. You should first initiate rapid transport to a trauma center. The most important priority with this patient is immediate transport. Advanced airway management and fluid resuscitation may be important but should be accomplished on the way to the hospital. This radiograph shows a fracture of the Patella (Knee Cap) You are called to a motor-vehicle crash in which a drunk driver hit a steel utility pole at a high rate of speed. You find the patient ejected from the car, lying supine, about 10 feet away. Your primary assessment reveals blood and broken teeth in the airway, a large flail segment to the right thorax, and a markedly distended abdomen from a suspected intra-abdominal bleed. What is your treatment priority? Maintenance of the airway Which one of the following findings in a burn patient would be most suggestive of potential instability? Stridorous breathing All the findings suggest a potential airway injury, but the one that clearly identifies a critical airway burn resulting in airway closure is stridorous sounds.