Trauma Fisdap Exam Questions & Answers 100% Solved

Signs and symptoms of a GI bleed - Answer Black/Tarry stool Bright red blood in stool Cramps Tired Pale Shortness of breath Signs and symptoms of a splenic injury - Answer Upper left quadrant pain Confusion Signs and symptoms of an infection - Answer Redness and swelling of a body part fever increased pulse and respiratory rates diarrhea vomiting nausea Anatomy and physiology of hemorrhagic shock - Answer Reduced tissue perfusion resulting in inadequate delivery of oxygen and nutrients to tissue Signs and symptoms hemorrhagic shock - Answer Anxiety Blue lips and fingernails low or no urine output Shallow breathing dizziness confusion Signs and symptoms of an anti coagulation emergency - Answer Coughing up/vomiting blood bleeding that wont stop bright red blood in stool Becks triad - Answer Cardiac Tamponade -hypotension -JVD -muffled heart sounds Signs and symptoms of a cardiac contusion - Answer Extreme pain above ribs Increased heart rate weakness fatigue nausea Treating an open chest wound - Answer Seal the wound with an occlusive dressing assess for underlying cervical, thoracic, or abdominal injuries Traumatic Brain Injury (TBI) - Answer Focal brain damage due to contact injuries. S/S -Nausea -Vomiting -Headache -inability to wake up -Clear fluids from ear Complication of an open neck wound - Answer -Subcutaneous Emphysema -Continued blood loss -expanding hematoma -hypovolemic shock -pulse deficit Signs and symptoms of traumatic asphyxiation - Answer -Also known as Perte's syndrome -Swelling of the face and neck -bluish discoloration of the head and neck -subconjunctival bleeding in the eyes, small spot like hemmorages on the skin of the face, neck, and upper chest. Pathophysiology of shock - Answer -Decreased Blood Volume -Decreased Venous Return -Decreased Stroke Volume -Decreased Cardiac Output -Decreased Tissue Perfusion Identifying the appropriate trauma center for a patient - Answer Trauma 1: controlled safety Trauma 3: for stabilization Life Flight: stabilization and rapid transport Late Stage Hypothermia - Answer Impaired mental status If you see a cracked windshield in a MVC... what will the pt represent with? - Answer Bruised or lacerated head or face. Brain injury, *cervical spine injury (always until proven otherwise), tracheal injury. If you see a deformed steering column in a MVC... what will the pt represent with? - Answer Bruised neck, bruised chest. Sternal or rib fracture, flail chest, myocardial contusion, *pericardial tamponade, pneumo/hemothorax, aortic tear. If you see a deformed dashboard in a MVC... what will the pt represent with? - Answer Bruised abdomen, bruised knee, misplaced kneecap. Ruptured spleen, liver, bowel, diaphragm. Fractured patella, dislocated knee, *femoral fracture, dislocated hip. If you see the rear end of the vehicle is damaged in a MVC... what will the pt represent with? - Answer Secondary anterior injuries, esp if the pt wasn't restrained. "Wiplash" injuries, *coup contrecoup injury. Phases of Deceleration - Answer 1) Deceleration of the vehicle, occurs when the vehicle strikes another object & comes to a stop. 2) Deceleration of occupant, which starts during sudden braking & continues through the whole crash. 3) Deceleration of internal organs, that consist of internal organs that continue forward momentum until they're stopped by anatomical restraints. 4) Secondary collisions, which occur when a vehicle occupant is hit by objects moving within the vehicle (loose objects). 5) Additional impacts, that the vehicle may receive when it is hit by a second vehicle or is deflected into another. Velocity - Answer "Speed kills"- causes more damage than mass. Airbag Injuries - Answer Common injuries include abrasions to the face, chest and arms. Minor corrosive effects can occur because of the cornstarch on the airbag, and it may irritate the skin. Down and Under Pathway - Answer Occupant slides under the steering wheel or the dash. The knees hit the dashboard, and transmit energy up the leg, to the femur/pelvis. If the feet are locked in place, it can cause femur fractures. Up and Over Pathway - Answer Chest hits the steering wheel, head hits the windshield and anterior portion of the throat hits the top of the steering wheel. Can cause significant head and neck injuries. Head on Impact in Motorcycle Crashes - Answer Head on impact- motorcycle strikes another object and stops its forward motion, while the rider continues forward motion until stopped by outside force. This causes the rider to go over the handlebars, which causes femur fractures, and tib fractures. Angular Impact in Motorcycle Crashes - Answer The motorcycle strikes an object, or another vehicle at an angel so that the rider sustains direct crushing injuries to the lower extremity between the object and motorcycle. Motorcycle Crashes - Answer With any motorcycle crash, the helmet should be removed carefully if airway management techniques cannot be performed with the helmet in place or the helmet doesn't fit properly on the riders head. Pedestrian Injuries - Answer Most pedestrian injuries occur at an intersection, at night. First, the pedestrian is hit in the lower extremities with the cars bumpers. Second, the pedestrian is thrown on the top of the car (resulting in brain injuries, and pelvic fractures. Third, the pedestrian hits the ground or some other object after rolling off the top or the side of the vehicle. Waddell Triad - Answer Refers to the pattern of automobile pedestrian injuries in children and people of short stature; 1) bumper hits the pelvis/femur instead of the knees, 2) the chest & abdomen hit the grill or low on the hood of the car (sternal & rib fractures), 3) the pt's face hits the hood, then flies back, and hits the ground. Blunt Trauma - Answer Refers to injuries in which the tissues are not penetrated by an external object. Penetrating Trauma - Answer Involves a disruption of the skin and underlying tissues in a small, focused area. Most common cause of penetrating trauma- GSW. Stab Wounds - Answer Severity of the stab wound depends on the anatomic area involved, depth of penetration, blade length and angle of penetration. GSW - Answer The most important factor for the seriousness of a gunshot wound is the type of tissue through which the projectile passes. Tissues of high elasticity like muscle, is better able to tolerate stretch, rather than the liver. Entry Wound - Answer Characterized by the effects of initial contact & implosion. *As a general rule, the entrance wound (usually funnel shaped), is always smaller than the exit wound. Exit Wound - Answer Occur when the projectile has sufficient energy that is not entirely dissipated along its trajectory through the body. Ricochet - Answer *Don't assume that a bullet followed a straight path between the entrance & exit sights, it may ricochet inside the body, esp off bones, and travel in diff directions. Primary Blast Injury - Answer Injuries due to the wave blast itself, usually causing damage to the lungs, eardrums and other compressible organs (air filled cavities). Burns also may occur. Secondary Blast Injury - Answer Injuries due to missiles being propelled by blast force (struck by flying debris). Tertiary Blast Injury - Answer Injuries due to body impact with another object (when a person is hurled by the force against stationary objects). Arterial Air Embolism - Answer When air enters into the pulmonary vasculature, air bubbles can enter a coronary artery and cause a myocardial injury. These can cause changes in vision, changes in behavior, changes in LOC. Preload - Answer The amount of blood returned to the heart to be pumped out and directly affects the afterload. Afterload - Answer The pressure in the aorta or the peripheral vascular resistance, against which the left ventricle must pump blood. The greater the afterload, the harder it is for the ventricle to eject blood into the aorta. Perfusion - Answer Circulation of blood within an organ or tissue in adequate amounts to meet the cells needs. Autonomic Nervous System - Answer Monitors the body's needs from moment to moment, adjusting the blood flow as required. Maintains homeostasis & is divided into the parasympathetic & sympathetic components that oppose each other and keep vital functions in balance. Sympathetic System - Answer Known as fight or flight, and is your body's response system to stress. Can be external or internal (like an MI). Actions include having a faster/stronger heart contractions, deeper respiration's, bronchodilation, shunting of blood to vital organs, & slowing the cessation of digestive functions. Parasympathetic System - Answer Often referred to as "rest and digest" mode. Slowing the heart rate, slowing the breathing rate, and increase digestive system. (What happens when you sleep). Hypoperfusion - Answer Not enough blood (O2) to meet the cells needs, and the tissue or organ starts to fail & die. Brain and spinal cord: 4-6 minutes. Kidneys: 45 minutes. The body will tolerate only how much blood loss in an adult? - Answer In an adult, the body will only tolerate 20% blood loss, which is approx 1 Liter. Hemostasis - Answer Platelets aggregate at the site of an open bleed and begin plugging the entrance and sealing the injured portions of the vessel. Hypovolemic Shock - Answer Inadequate blood volume/fluid loss. Causes: internal/external hemorrhage, burns, vomiting/diarrhea/sweating. Compensated Shock (Phase 1) - Answer Tachycardia, NORMAL BP, thirst, anxiety, clammy/cool skin. Decompensated Shock (Phase 2) - Answer AMS, DROP IN BP, thready/absent peripheral pulse, labored or irregular breathing. Melena - Answer Black, foul-smelling, tarry stool that contains digested blood; LOWER GI bleeding. Compartment Syndrome - Answer A condition that develops when edema and swelling result in increased pressure in the soft tissues, causing circulation to be compromised, leading to necrosis. Crush Syndrome - Answer Occurs when a part of the body is crushed, preventing tissue function and possibly resulting in permanent tissue death- leading to crush syndrome (renal failure & death). The release of these products does not occur until after the limb is freed from entrapment. Rescuers must intervene before lifting the crushing object off the body. "Smiling death"- cardiac arrest occurs after lifting the object off the body too. Occlusive Dressing - Answer Used when it is important to keep air out of the wound. Tape three sides and leave one open to allow air to escape. Neck/chest openings. Wet Dressing - Answer Used for small, superficial burns. How to care for an Amputation - Answer 1) Rinse off the amputated part. 2) Wrap the part loosely in saline-moistened sterile gauze. 3) Seal the amputated part inside a plastic bag, & place it in a cool container. Keep it cold, but not frozen. *DO NOT place it directly on ice (or dry ice), or in water! Rhabdomyolysis - Answer The destruction of muscle tissue leading to a release of potassium and myoglobin. Animal Bite - Answer Place a dry, sterile dressing on it. If its gross contaminated, you may have to irrigate it before placing a dressing. Splinting an Injury - Answer Even when there are no signs of fracture, can still help control bleeding and pain. Superficial Burns - Answer Involves the epidermis only. The skin is red and swollen and when touched, the color will blanch and return. Usually blisters are not present. (Sunburn). Pt's will experience pain because nerve endings are exposed to the air. Partial- Thickness Burn - Answer Involves the epidermis, and varying degrees of dermis. The skin is often blistered. Painful. Full Thickness Burn - Answer Involves all layers of the skin, down to the subcutaneous tissue. The skin may appear white and waxy, brown and leathery, or charred. There will prob be no pain, but will experience pain in the surrounding area where the nerve endings are still intact. Often requires skin grafting. Inhalation Burn - Answer Can cause rapid and serious airway swelling (laryngeal edema)/problems. Look for- singed nasal hairs, hoarseness in the voice, cough, facial burns, soot around face. How to Treat Burn Patients - Answer Dressings (dry & sterile for large burns, moist for small), fluid resuscitation, airway management (intubation if necessary), and pain management. Morphine and fentanyl. Rule of Nines - Answer Adults- Full arms: 9% (front half/back half- 4.5%). Full legs: 18%, (front half/back half- 9%). Chest/torso- 18%. Groin- 1%. Head: 9% (front/back- 4.5%). Back- 18%. Electrical Burns - Answer Electrical burns have entrance and exit wounds. The entrance wound is often quite small. The exit wound can be extensive and deep. An electric current travels from the contact site into the body causing extensive damage to the tissues in the path. *Dysrhythmias are commonly seen with electrical burns- include A-Fibb & atrial flutter. Lightening Strikes - Answer Can leave a "feathering" affect on the skin. For the cardiovascular lightening acts as a cosmic defibrillator, delivering a massive direct-current counter shock that depolarizes the entire heart. The heart may resume beating spontaneously shortly after shock. *If lightening strikes multiple victims, priority goes to the victims who are not breathing. Le Fort 1 Fracture - Answer From the bottom of the nose down. Involves the mandible and the maxilla. Le Fort 2 Fracture - Answer Involving the nasal bone and the maxilla. Le Fort 3 Fracture - Answer A fracture of all midfacial bones, seperating the entire midface from the cranium. Includes the eyes. Management of Someone with Facial Trauma - Answer Inspect the mouth for fragments of teeth, dentures, or any other foreign bodies. Suction the oropharynx as needed. Do not nasally intubate someone with evidence of nasal trauma, CSF leaking, blood in the nose, or any other midline facial trauma. Open neck wound should be covered with...? - Answer An occlusive dressing. For fear of air entering the neck. When an impaled object is in the neck... you should? - Answer Not remove the object, but try to stabilize it and control the bleeding from it. The ONLY exception for removing the object is if it interferes with your ability to manage the airway. In some cases, an emergency cric may be necessary. atlas - Answer C1 atlatooccipital joint: affixed to occipital bone and permits nodding but does not accommodate any twisting or turning axis - Answer C2 provides pivotal point - rotate side to side Frontal Lobe - Answer (Forehead) Important for voluntary motor action and personality traits. Injury to the frontal lobe may result in seizures or placid reactions (flat affect). Parietal Lobe - Answer Controls the somatic or voluntary sensory and motor functions for the opposite side of the body, as well as memory and emotions. Occipital Lobe - Answer (Back of the head) Responsible for processing visual information. Temporal Lobe - Answer (Side of the head) Speech area, hearing, taste and smell. Meningeal Layers - Answer PAD- pia, arachnoid, dura (from inside to out). Anterior Cord Syndrome - Answer - caused by flexion injuries - occurs when 2/3 of the anterior cord is lost - *motor function, pain, and temperature sensation lost bilaterally below the lesion* (*flaccidity* below the lesion) Central Cord Syndrome - Answer occurs with hyperextension of the cervical area. Symptoms include weakness or paresthesia in the upper extremities but normal strength in lower. Brown-Sequard Syndrome - Answer Hemi-section of the cord - ipsilateral (same side) spastic paralysis and loss of position sense - contralateral (opposite side) loss of pain and thermal sense Cuada Equina Syndrome - Answer Involves peripheral nerves, usually occurring with fractures below L2 resulting flaccid type paralysis Spinal Injuries - Answer C1-C5 : paralysis of muscles used for breathing and of all arm and leg muscles (usually fatal) C5-C6: legs paralyzed, slight ability to flex arms C6-C7: paralysis of legs and part of wrist and hands; shoulder movement and elbow bending C8-T1: legs and trunk paralyzed; eyelids droop; loss of sweating to forehead; arms relatively normal; hands paralyzed T2-T4: legs and trunk paralyzed; loss of feeling below nipples T5-T8: legs and lower trunk paralyzed loss of feeling below ribs T9-T11: legs paralyzed, loss of feeling below groin T12-L1: paralysis and loss of feeling below groin L2-L5: different patterns of leg weakness and numbness S1-S2: different patterns of leg weakness and numbness S3-S5: loss of bladder control; numbness in perineum Cranial Nerves - Answer CN-1: olfactory - responsible for sense of smell CN-2: optic - responsible for image transmission CN-3: occulomotor - eyeball motion, iris constriction, movement of upper eyelid CN-4: trochlear - conjugate gaze CN-5: trigeminal - innervates and receives sensation from facial region and the gums, teeth and palate and controls muscles of chewing CN-6: abducens - moves eye downward CN-7: facial - controls muscles responsible for facial expressions and receives sensation from anterior tongue CN-8: acoustic - innervates the cochlea and vestibule of the ear and responsible for hearing, sense, motion, balance CN-9: Glossopharyngeal - swallowing; monitors baro and chemoreceptors CN-10: vagus - major nerve of parasympathetic monitors and controls heart, respirations, abdominal viscera CN-11: spinal accessory - controls major muscles of neck, swallowing and vocal cords CN-12: hypoglossal - exercises voluntary muscles control over the tongue retrograde amnesia - Answer before event anterograde amnesia - Answer after event Treating a pt with Head Trauma - Answer Lidocaine to reduce ICP, maintain O2 sats above 95%, administer high flow O2 if pt is breathing on their own, avoid hyperventilation, restrict your use of IV fluids (unless hypotensive, then give fluid to keep systolic above 80-90), and do not give dextrose. Diaphragm - Answer Phrenic nerve (C3-C5). Injury occurring at or above C3-C4 may cause diaphragmatic paralysis, that is seen with abdominal breathing and accessory muscle use. GCS Scale - Answer Eyes, Motor, Speech. EYES (4): Spontaneous- 4, To voice- 3, To pain- 2, None- 1. MOTOR (6): Obeys commands- 6, Localizes pain- 5, Withdraws from pain- 4, Decorticate- 3, Decerebrate- 2, None- 1. SPEECH (5): Oriented- 5, Confused- 4, Inappropriate- 3, Sounds (garbled, mumbling, etc)- 2, None, 1. *Your pt will always be 3 or more. trauma score - Answer A score calculated from 1 to 16, with 16 being the best possible score. It relates to the likelihood of patient survival with the exception of a severe head injury. It takes into account the Glasgow Coma Scale (GCS) score, respiratory rate, respiratory expansion, systolic blood pressure, and capillary refill. Levels of ICP - Answer 1)Mild- cheyne-stokes, increased BP, decreased HR, pupils stil reactive, AMS, vomiting. 2)Moderate- widening pulse pressure w/ bradycardia, pupils are non-reactive, hyperventilation, posturing. 3)Severe- blown pupil, biot's respirations, flaccid paralysis, irregular pulse rate, fluctuating BP (usually hypotension). Cheyne- Stokes Respirations - Answer Respirations that are fast and then become slow, with intervening periods of apnea. Common in people with head injuries/ICP. Biots Respirations - Answer Characterized by irregular rate, pattern, and volume of breathing with intermittent periods of apnea. Babinkski Reflex - Answer Occurs when the toes move upward in response to stimulation of the sole of the foot. Under normal circumstances, the toes move downward. Coup - Answer directly at point of impact (frontal) countrecoup injury - Answer damage opposite the site of impact CPP - Answer Cerebral perfusion pressure. The pressure of blood flow through the brain, is the difference between the MAP, and ICP. The minimum CCP should be 60. Autoregulation - Answer The body responds to a decrease in CPP by increasing the MAP. Resulting in cerebral vasodilation and increased cerebral blood flow. However, this is a vicious cycle cause it actually increases ICP. If ICP doesn't resolve... this could happen? - Answer Herniation. The brain is forced through the cranial vault, either through the foramen magnum or over the tentorium. Decorticate - Answer Flexor posturing. Pt's limbs will be facing toward their core, involving flexion of the arms and legs. Decerebrate - Answer Extensor posturing. Pt's limbs will be extending away from the body. Epidural Hematoma - Answer Accumulation of the blood between the skull and dura matter. Usually caused by blunt trauma. Often the Pt loses consciousness immediately after. Subdural Hematoma - Answer Accumulation of blood beneath the dura matter. Usually occurs after falls, and are more common than epidural hematomas. This bleeding is from venous bleeding, so it is more gradual and can take anywhere between 24hrs to 2 weeks. Common in elderly Pt's, Pt's with bleeding diseases, and alcoholics. Intracerebral Hematoma - Answer Involves bleeding within the brain tissue itself. Can follow a penetrating injury to the head. Have a high mortality rate. Hyperpyrexia - Answer Patients with a head injury can develop a high body temperature, which can worsen the condition of the brain. Pneumothorax - Answer Occurs when air leaks into the space between the pleural surfaces from an opening in the chest or the surface of the lung. The lung collapses as the air fills the pleural space. Signs and symptoms of a Pneumothorax - Answer Pt may only report mild dyspnea, and pleuritic chest pain on one side. Diminished or unequal breath sounds may be heard on auscultation. Pt's with larger pneumo's present with severe respiratory compromise and hypoxia- tachycardia, tachypnea, AMS. How to treat a Pneumothorax - Answer If there is an open wound, cover it with an occlusive dressing. Provide high flow O2. *Positive pressure will aggravate this condition, resulting in a tension pneumo. Open Pneumothorax - Answer When a defect in the chest wall allows air to enter the pleural space. GSW, stabbing, or other impaled objects. Aka "sucking chest wound", if blood is involved it might be "bubbling". Occlusive dressing! Sternal Injuries - Answer If the thorax received enough pressure to cause damage to the sternal bone then assume the heart, and great vessels also received damage. JVD - Answer Suggest increased intravenous pressure, can be caused by a tension pneumothorax, volume overload, right sided heart failure, or cardiac tamponade. Flail Chest - Answer A major injury to the chest wall, may result from blunt trauma, like MVC, falls, and assaults. In this injury, two or more ribs are fractured in two or more places. When the Pt breathes, their chest will rise and fall paradoxically. You can also feel crepitus when assessing your Pt. *Positive pressure ventilation is important with this kind of pt! Pulmonary Contusion - Answer An injury to the underlying lung tissue that inhibits normal diffusion of O2 & CO2. Pericardial Tamponade - Answer Causes compression of the heart, and decreased cardiac output. You will see increased HR, muffled heart sounds, hypotension, and JVD. Commotio Cordis - Answer Caused by a impact to the chest right where the heart is. It puts the heart into cardiac arrest. Happens to athletes, esp when playing sports. You may see chest wall contusions, and localized bruising. The Pt will be apneic and pulseless. Traumatic Aortic Disruption - Answer Commonly seen in MVCs, blunt trauma, and falls. High mortality rate. Signs and symptoms are tearing pain behind the sternum or in the scapula. Other signs may be dyspnea, hypovolemic shock, and AMS. *Blood flow to the extremities may be compromised. You will notice a stronger pulse in the right arm then the left. Injuries to Solid Organs - Answer Liver, spleen, kidneys, and pancreas. The organ will release blood into the abdominal cavity after sustaining trauma. Causes hypotension and tachycardia. Spleen Injuries - Answer Most common complaint is left shoulder pain, when the spleen has ruptured. This is known as Kehr Sign. Femur Fractures - Answer Shortening is a common sign of a femur fracture. You would use a traction splint, if time allows. Femur fractures can lead to hypovolemia if the femoral artery was ruptured. sprain - Answer partial tear of ligament Grade 1 - minute and incomplete Grade 2 - swelling and pain moderate Grade 3 - complete tear with severe pain subluxation - Answer partial dislocation of a joint *different from sprain because of joint compromise dislocation - Answer displacement of a bone from its joint complete - danger of entrapping/compressing bursitis - Answer inflammation of a bursa usually caused by a blow or friction bursa - membrane surrounding joints How to Treat Heat Exhaustion - Answer Move the Pt to a cooler area. Remove excess clothing. Sponge, spray, or drip tepid water on the Pt. If anuses and vomiting are present, start a saline line. May want to consider an anti nausea medication (zofran). Pt will still be alert and oriented. Heatstroke - Answer Involves elevated temp above *104. and AMS. One of the earliest signs in changes in behavior (irritable, combative, etc). Pt may have a seizure. Pt will be tachycardia, hyperventilating. Manage the ABC's. Move the Pt to a cool environment. Cooling efforts should continue until temp reaches below *102. Cool as rapidly as possible. Consider ice water immersion, placed ice packs in groin, armpits, etc. Start a line and administer saline. Monitor cardiac rhythm. Frostbite/Frostnip - Answer Get the Pt out of the cold. Do not rub or massage the area. Administer pain medication. Cover blisters with dry, sterile dressing. *Do not attempt rewarming in the field if there is any possibility of refreezing or if the Pt must walk on the frostbitten foot. Frotstbitten parts are usually hard and waxy. Gangrene can occur if the area was frozen. Treating a Pt with Hypothermia - Answer Strip all the wet or cold clothes, and move Pt to a warm place. Begin to rewarm the Pt, with blankets (mild hypothermia less than 95 degrees), heat packs if necessary (moderate hypothermia 87 degrees to 93 degrees), and lastly warm IV fluids for severe hypothermia. Basilar Skull Fracture - Answer Periorbital ecchymosis (racoon eyes), battle sign (ecchymosis behind the ears). Cushing Reflex/Response/Syndrome - Answer Due to ICP. Signs are- increased BP, decreased HR & irregular respirations (Biots breathing!). What is the most likely cause of periorbital ecchymosis? - Answer Basicular skull fracture 18 yo M holding right shin after sports related injury. Deformity and swelling; pedal pulse present. You should? - Answer Apply board splint in position found 81 yo F healthcare facility fell out of bed. Nurse suspects hip fracture. Which medication should concern you the most? - Answer Coumadin A 45 year old male fell asleep outside while doing yard work. His face and lower legs are bright red with small blisters and painful on examination. You should suspect? - Answer Both superficial and partial thickness burns A 35 year old patient has fallen and has a deformed right lower leg. The distal extremity is pulseless and the skin is cool and cyanotic. You should? - Answer Realign the injured extremity *one attempt* 47 male shot in back has cool and clammy skin with arm weakness. BP 130/90, P 76, R 24. You should suspect? - Answer Spinal cord injury A baseball player was hit by a baseball in the left eye and complains for double vision. What should you do? - Answer assess pupillary response First concern with conscious pt who received partial thick burns to the face is treating? - Answer Airway problem 22 yo F had an accident on moped. She is lying on ground; breathing well. Still wearing helmet. You should? - Answer Leave helmet in place while she is stabilized 32 yo M is unconscious after being struck in the head by a baseball bat. Has pulse but breathing is slow. Minor bleeding from a laceration at the left temple. Partner is maintaining manual C-spine stabilization. You should? - Answer check airway and apply high flow oxygen Most important factor with person struck in chest with baseball? - Answer Speed of the ball After securing pt on longboard, you should immediately assess: - Answer pms/cms 75 yo is involved in motor vehicle collision and can't feel legs. BP is 80/40, P 60, R 24, you should suspect? - Answer Neurogenic shock 40 yo M crashed snowmobile, skin cold and pale, BP 198/96, P 48, respiration is slow and irregular. What should you suspect? - Answer Neurogenic shock 42 yo M has metal impaled in lower right leg. Obvious open fracture and no pulse in R foot, what should you do? - Answer stabilize with bulky dressing prior to transport 38 yo M large bruise LUQ, following motorcycle collision. What should you suspect? - Answer Splenic injury Treating abdominal evisceration - Answer Cover with moist sterile dressing 23 yo M received burns to feet while stomping fire. He is still wearing the shoes. The rubber soles and laces melted together. What do you do? - Answer place feet in bucket Adult was pinned between 2 vehicles. Pt is conscious but confused and unable to follow directions. Has bruising on both sides of anterior chest, weak carotid pulse, no peripheral pulse, clear breath sounds, distended neck vein. What should you suspect? - Answer pericardial tamponade Pt with JVD, muffled heart sounds, clear breath sounds. You should suspect: - Answer pericardial tamponade You arrive on the scene of a patient who fell from a ladder. Which of the following information is NOT an important factor in care of the patient? a)Height of the ladder b)Distance the patient fell from c)Surface the patient landed on d)What part of the body hit first - Answer a)Height of the ladder You are at the scene of an MVA, in which there are three patients, all of which have minor visible injuries. Two are refusing treatment and the last is complaining of neck and back pain. How should you proceed? a)Treat all three patients, they are visibly injured and need medical attention b)Obtain signed refusals from the first two patients then proceed to the third c)Treat the third patient, nothing else is needed for the other two d)Have your partner obtain refusals from the two patients who refused treatment, while you treat the last patient. - Answer d)Have your partner obtain refusals from the two patients who refused treatment, while you treat the last patient. Your patient is a 17 year old male found face down in a swimming pool. He is currently being held face up at the surface of the water. He is unconscious but breathing and has a pulse. What is the best course of action for this patient? a)Jump into the pool and begin CPR b)Remove the patient from the pool, immobilize, and transport. c)Apply cervical and spinal immobilization while the patient is still in the pool d)Wait for a trained water rescue team - Answer c)Apply cervical and spinal immobilization while the patient is still in the pool A laceration, spurting bright laceration, spurting bright red blood, most likely means what type of injury? what red blood most likely means a)Venous b)Arterial c)Capillary d)Amputation - Answer b)Arterial Your patient has a laceration to the right leg which has intersected the femoral artery. You have applied direct pressure to the wound, but it continues to soak through the bandages. What should you do next? a)Apply a tourniquet b)Elevate the leg c)Remove the old bandage and apply new ones d)Apply pressure to point just above the injury - Answer b)Elevate the leg Of the two types of energy, which type of energy transfer in a motor vehicle crash (MVC) with frontal impact, non-restrained driver with bent steering wheel, and spidered windshield? a)High velocity penetrating b)Decelerating c)Low velocity penetrating d)Blunt - Answer d)Blunt Any penetrating missile traveling over 2,000 ft/sec would be classified as? a)Low velocity b)Medium velocity c)High velocity d)Decelerating - Answer c)High velocity When there is penetrating trauma there is a permanent cavity which is formed by the projectile contacting the tissues. How is a temporary cavity formed? a)By the twisting of the projectile b)By energy scrubbing off of the projectile c)The wadding entering the body d)Unspent gun powder - Answer b)By energy scrubbing off of the projectile The way a patient is injured is often referred to as the _______________? a)Mechanism of injury b)Nature of illness c)Injury pattern d)Energy transfer - Answer a)Mechanism of injury When approaching a scene of trauma incident, what is your first order of business? a)Airway b)C-Spine control c)Body substance Isolation d)Scene safety - Answer d)Scene safety A large collection of blood under the skin is known as? a)Contusion b)Abrasion c)Hematoma d)Bruise - Answer c)Hematoma Your trauma patient has her left hand caught between rollers on a conveyor belt. Extrication takes 30 minutes. Evaluation of the injury during extrication showed delayed capillary refill distal to the injury. Post extrication shows rapid capillary refill distal to the injury deformity mid-palm. There are no obvious fractures, no lacerations, and minor swelling. Knowing that crush injuries can cause many other problems, which is NOT considered a crush injury complication? a)Compression of tissues b)Fractures c)No injury at all d)Compartment syndrome - Answer c)No injury at all Loss of tissue in a traumatic event can be: just soft tissue, a portion of an extremity, or an entire extremity. If your patient has lost the distal one-third of a lower extremity, what would that injury be called? a)Amplitude b)Avulsion c)Extremity exodus d)Amputation - Answer d)Amputation In any traumatic event where there is tissue damage that caused bleeding, the bleeding needs to be controlled. What are the proper steps to bleeding control? a)Direct pressure, elevation, tourniquet, digital pressure b)Direct pressure, digital pressure, elevation, tourniquet c)Tourniquet, elevation, pressure dressing, direct pressure d)Direct pressure, pressure dressing, tourniquet - Answer b)Direct pressure, digital pressure, elevation, tourniquet Your 16 year old trauma patient has what appears to be a mid-shaft femur fracture. You notice that there is a laceration directly over the suspected fracture. Bleeding is controlled. What type of fracture would this be? a)Greenstick b)Comminuted c)Closed d)Open - Answer d)Open En route to the hospital, you intubate the patient. During your assessment of tube placement, you hear wheezing in the upper lung fields. What is most likely causing this wheezing? a)Inhalation injury to the upper airway b)Inhalation induced cardiac wheezing c)Inhalation induced asthma attack d)Inhalation injury to the lower airway - Answer d)Inhalation injury to the lower airway Following the immobilization of an extremity fracture to the lower right arm, the paramedic should perform what step last? a)Ensuring the splint is applied tightly. b)Placing the hand in the position of function. c)Assessing presence of distal motor, sensory, and perfusion. d)Placing the immobilized extremity below the level of the heart - Answer c)Assessing presence of distal motor, sensory, and perfusion. You are treating a 24-year-old female with a gunshot wound to the right side of the back. No exit wound is visible. She is awake but confused. Her skin is pale and diaphoretic with cyanosis noted to the oral mucosa. Breath sounds are clear and equal bilaterally. Jugular vein distention is present. Blood pressure is 90/78 mmHg, heart rate is 124 beats per minute, and respiratory rate is 28 per minute and labored. Sinus tachycardia is seen on the cardiac monitor. What condition do you think is most likely present with this patient? a)Hemothorax b)Tension pneumothorax c)Pericardial tamponade d)Lacerated aorta - Answer c)Pericardial tamponade