NREMT - TRAUMA
Patients with significant closed head injuries often have pupillary abnormalities and:
A:paralysis.
B:tachycardia.
C:hypertension.
D:paresthesia.
C;
Reason:
Closed head injuries can cause a variety of signs and symptoms. In addition to pupillary abnormalities (ie, unequal
pupils, sluggishly reactive pupils), a classic finding that indicates a significant increase in intracranial pressure is
called Cushing's triad, a trio of findings that includes hypertension; bradycardia; and abnormal breathing, which can
vary from slow and irregular to rapid and deep.
The pneumatic antishock garment may be indicated for patients with:
A:any severe injury above the nipple line.
B:blunt chest trauma and hypotension.
C:femur fractures and crackles in the lungs.
D:pelvic instability and signs of shock.
D;
Reason:
For the most part, the pneumatic antishock garment (PASG) is no longer routinely used in EMS. However, it may be
useful to stabilize pelvic fractures, especially if the patient has accompanying signs of shock. Commercial pelvic
binders are now available for this purpose as well. In general, the PASG should not be used for patients with blunt or
penetrating trauma to the head, chest, or abdomen. Under NO circumstances should the device be used on any
patient with pulmonary edema, as evidenced by shortness of breath, crackles in the lungs, or a history of left-side
congestive heart failure. Follow your local protocols regarding use of the PASG if your EMS system still carries them
on the ambulance.
A 40-year-old man has burns to the entire head, anterior chest, and both anterior upper extremities. Using the adult
Rule of Nines, what percentage of his total body surface area has been burned?
A:45%
B:18%
C:36%
D:27%
D;
Reason:
Using the adult Rule of Nines, the head accounts for 9% of the total body surface area (TBSA), the anterior chest for
9% (the entire anterior trunk [chest and abdomen] accounts for 18%), and the anterior upper extremities for 4.5%
,each (each entire upper extremity is 9% of the TBSA). On the basis of this, the patient has sustained 27% TBSA
burns.
A 33-year-old male struck a parked car with his motorcycle and was ejected from the motorcycle. He was not wearing
a helmet. He is unresponsive, has a depressed area to his forehead, bilaterally deformed femurs, and widespread
abrasions with capillary bleeding. Which of the following statements regarding this patient is false?
A:You must stop the bleeding from his abrasions immediately or he will die from hypovolemic shock.
B:You should suspect that the patient has a skull fracture and increased intracranial pressure.
C:Internal hemorrhage cannot be controlled in the field and requires prompt surgical intervention.
D:Femur fractures are a common injury when a motorcyclist is ejected from his or her motorcycle.
A; This is correct!
Reason:
The patient's abrasions (road rash) and capillary bleeding are the least of his problems. Capillary bleeding, blood that
oozes from the capillary beds, is the least severe type of external bleeding and will not kill your patient. Wasting time
at the scene to cover his abrasions, however, will delay definitive care at a trauma center; this may kill him! The
patient likely has a depressed skull fracture, and the fact that he is unresponsive indicates a traumatic brain injury
with increased intracranial pressure. When a motorcyclist is ejected from his or her motorcycle, the femurs typically
strike the handlebars, resulting in unilateral or bilateral fractures. You cannot control internal hemorrhage in the field,
regardless of your level of training. Internal bleeding requires surgical intervention; therefore, you must transport the
patient without delay.
Shock following major trauma is MOST often the result of:
A:spinal injury.
B:long bone fractures.
C:head injury.
D:hemorrhage.
D;
Reason:
Shock following major trauma is usually caused by hemorrhage (bleeding), which can be external and obvious
(gross), internal and hidden (occult), or both. Trauma to the chest and/or abdomen and multiple long bone fractures
are common causes of hemorrhage that result in shock. An isolated head injury usually does not cause shock; it
causes increased intracranial pressure. If the patient with a seemingly isolated head injury has signs of shock, look
for other injuries. Major trauma may also be associated with spinal injury. If the spinal cord is injured, the patient may
develop shock because the nerves that control the diameter of the blood vessels are damaged, resulting in
widespread vasodilation (neurogenic shock).
Despite direct pressure, a large laceration to the medial aspect of the arm continues to bleed profusely. You should:
A:pack the inside of the laceration with sterile gauze.
B:locate and apply pressure to the brachial artery.
C:continue direct pressure and elevate the extremity.
D:quickly apply a tourniquet proximal to the injury.
D;
,Reason:
In most cases, external bleeding can be controlled with direct pressure. However, if a wound continues to bleed
profusely despite direct pressure, a proximal tourniquet should be applied without delay. If the external bleeding is
that severe, elevating the extremity would be of little help. You should not pack anything inside an open wound.
Evidence has shown that locating and applying adequate pressure to an arterial pressure point is difficult and time-
consuming. If not promptly controlled, severe external bleeding will result in hemorrhagic shock and death.
Which of the following sets of vital signs is MOST suggestive of increased intracranial pressure in a patient who has
experienced a traumatic brain injury?
A:BP, 92/60 mm Hg; pulse, 120 beats/min; respirations, 24 breaths/min
B:BP, 84/42 mm Hg; pulse, 60 beats/min; respirations, 32 breaths/min
C:BP, 176/98 mm Hg; pulse, 50 beats/min; respirations, 10 breaths/min
D:BP, 160/72 mm Hg; pulse, 100 beats/min; respirations, 12 breaths/min
C;
Reason:
The body responds to a significant traumatic brain injury by shunting more oxygenated blood to the injured brain; it
does this by increasing systemic blood pressure. In response to an increase in blood pressure, the pulse rate
decreases. Pressure on the brain stem often causes an irregular breathing pattern that is either slow or fast.
Therefore, patients with increased intracranial pressure present with hypertension, bradycardia, and irregular
respirations that are fast or slow (Cushing's triad). Vital signs representative of shock (eg, hypotension, tachycardia)
are not common in patients with an isolated head injury and increased intracranial pressure. If the patient with a
seemingly isolated head injury is hypotensive and tachycardic, look for other injuries; internal or external bleeding is
likely occurring elsewhere.
A soft-tissue injury that results in a flap of torn skin is called a/an:
A:incision.
B:abrasion.
C:laceration.
D:avulsion.
D;
Reason:
An avulsion is a soft-tissue injury in which a portion of the skin is torn away, leaving a flap of skin. A laceration is a
jagged soft-tissue injury that can be caused by glass or other sharp objects. An abrasion is the scraping away of the
epidermis, causing oozing of serous fluid from the capillary bed. Road rash is a classic example of an abrasion. An
incision is similar to a laceration, but has smooth edges. Scalpels or knives are examples of instruments that would
make an incision.
You are assessing a young male who was stabbed in the right lower chest. He is semiconscious and has labored
breathing, collapsed jugular veins, and absent breath sounds on the right side of his chest. This patient MOST likely
has a:
, A:ruptured spleen.
B:pneumothorax.
C:hemothorax.
D:liver laceration.
C;
Reason:
You should suspect a hemothorax if a patient with chest trauma presents with shock, especially if the injury was
caused by penetrating trauma. Hemothorax occurs when blood collects in the pleural space and compresses the
lung, resulting in shock and respiratory compromise. Other signs include collapsed jugular veins (due to low blood
volume), labored breathing, and decreased or absent breath sounds on the side of the injury. A pneumothorax (air in
the pleural space) is also associated with difficulty breathing and unilaterally decreased or absent breath sounds;
however, the jugular veins are usually not collapsed. If excessive air accumulates within the pleural space, however,
pressure will shift across the mediastinum and affect the uninjured lung (tension pneumothorax); if this occurs, the
jugular veins may become engorged (distended). Splenic injury is unlikely; the patient's injury is on the right side and
the spleen is on the left. A liver laceration can cause severe shock; however, it is not associated with unilaterally
decreased breath sounds or labored breathing.
A 30-year-old woman has an open deformity to her left leg and is in severe pain. She is conscious and alert, has a
patent airway, and is breathing adequately. Your primary concern should be:
A:controlling any external bleeding.
B:administering high-flow oxygen.
C:covering the wound to prevent infection.
D:assessing pulses distal to the injury.
A; This is correct!
Reason:
Initial care for any open injury involves controlling external bleeding. Further care involves manually stabilizing the
injury site; applying a sterile dressing to keep gross contaminants from entering the wound; assessing distal perfusion
(eg, a pulse), motor, and sensory functions; and stabilizing the injury with an appropriate splint. The patient in this
scenario is conscious, alert, has a patent airway, and is breathing adequately. Depending on other assessment
findings, oxygen may be indicated. Your primary concern, however, should be to ensure that all external bleeding has
been controlled.
Which of the following questions is of LEAST pertinence initially when assessing a responsive 40-year-old woman
who fell from a standing position?
A:Can you move your hands and feet?
B:Did you hit your head?
C:Did you faint before you fell?
D:Have you fallen before?
D;
Reason:
Patients with significant closed head injuries often have pupillary abnormalities and:
A:paralysis.
B:tachycardia.
C:hypertension.
D:paresthesia.
C;
Reason:
Closed head injuries can cause a variety of signs and symptoms. In addition to pupillary abnormalities (ie, unequal
pupils, sluggishly reactive pupils), a classic finding that indicates a significant increase in intracranial pressure is
called Cushing's triad, a trio of findings that includes hypertension; bradycardia; and abnormal breathing, which can
vary from slow and irregular to rapid and deep.
The pneumatic antishock garment may be indicated for patients with:
A:any severe injury above the nipple line.
B:blunt chest trauma and hypotension.
C:femur fractures and crackles in the lungs.
D:pelvic instability and signs of shock.
D;
Reason:
For the most part, the pneumatic antishock garment (PASG) is no longer routinely used in EMS. However, it may be
useful to stabilize pelvic fractures, especially if the patient has accompanying signs of shock. Commercial pelvic
binders are now available for this purpose as well. In general, the PASG should not be used for patients with blunt or
penetrating trauma to the head, chest, or abdomen. Under NO circumstances should the device be used on any
patient with pulmonary edema, as evidenced by shortness of breath, crackles in the lungs, or a history of left-side
congestive heart failure. Follow your local protocols regarding use of the PASG if your EMS system still carries them
on the ambulance.
A 40-year-old man has burns to the entire head, anterior chest, and both anterior upper extremities. Using the adult
Rule of Nines, what percentage of his total body surface area has been burned?
A:45%
B:18%
C:36%
D:27%
D;
Reason:
Using the adult Rule of Nines, the head accounts for 9% of the total body surface area (TBSA), the anterior chest for
9% (the entire anterior trunk [chest and abdomen] accounts for 18%), and the anterior upper extremities for 4.5%
,each (each entire upper extremity is 9% of the TBSA). On the basis of this, the patient has sustained 27% TBSA
burns.
A 33-year-old male struck a parked car with his motorcycle and was ejected from the motorcycle. He was not wearing
a helmet. He is unresponsive, has a depressed area to his forehead, bilaterally deformed femurs, and widespread
abrasions with capillary bleeding. Which of the following statements regarding this patient is false?
A:You must stop the bleeding from his abrasions immediately or he will die from hypovolemic shock.
B:You should suspect that the patient has a skull fracture and increased intracranial pressure.
C:Internal hemorrhage cannot be controlled in the field and requires prompt surgical intervention.
D:Femur fractures are a common injury when a motorcyclist is ejected from his or her motorcycle.
A; This is correct!
Reason:
The patient's abrasions (road rash) and capillary bleeding are the least of his problems. Capillary bleeding, blood that
oozes from the capillary beds, is the least severe type of external bleeding and will not kill your patient. Wasting time
at the scene to cover his abrasions, however, will delay definitive care at a trauma center; this may kill him! The
patient likely has a depressed skull fracture, and the fact that he is unresponsive indicates a traumatic brain injury
with increased intracranial pressure. When a motorcyclist is ejected from his or her motorcycle, the femurs typically
strike the handlebars, resulting in unilateral or bilateral fractures. You cannot control internal hemorrhage in the field,
regardless of your level of training. Internal bleeding requires surgical intervention; therefore, you must transport the
patient without delay.
Shock following major trauma is MOST often the result of:
A:spinal injury.
B:long bone fractures.
C:head injury.
D:hemorrhage.
D;
Reason:
Shock following major trauma is usually caused by hemorrhage (bleeding), which can be external and obvious
(gross), internal and hidden (occult), or both. Trauma to the chest and/or abdomen and multiple long bone fractures
are common causes of hemorrhage that result in shock. An isolated head injury usually does not cause shock; it
causes increased intracranial pressure. If the patient with a seemingly isolated head injury has signs of shock, look
for other injuries. Major trauma may also be associated with spinal injury. If the spinal cord is injured, the patient may
develop shock because the nerves that control the diameter of the blood vessels are damaged, resulting in
widespread vasodilation (neurogenic shock).
Despite direct pressure, a large laceration to the medial aspect of the arm continues to bleed profusely. You should:
A:pack the inside of the laceration with sterile gauze.
B:locate and apply pressure to the brachial artery.
C:continue direct pressure and elevate the extremity.
D:quickly apply a tourniquet proximal to the injury.
D;
,Reason:
In most cases, external bleeding can be controlled with direct pressure. However, if a wound continues to bleed
profusely despite direct pressure, a proximal tourniquet should be applied without delay. If the external bleeding is
that severe, elevating the extremity would be of little help. You should not pack anything inside an open wound.
Evidence has shown that locating and applying adequate pressure to an arterial pressure point is difficult and time-
consuming. If not promptly controlled, severe external bleeding will result in hemorrhagic shock and death.
Which of the following sets of vital signs is MOST suggestive of increased intracranial pressure in a patient who has
experienced a traumatic brain injury?
A:BP, 92/60 mm Hg; pulse, 120 beats/min; respirations, 24 breaths/min
B:BP, 84/42 mm Hg; pulse, 60 beats/min; respirations, 32 breaths/min
C:BP, 176/98 mm Hg; pulse, 50 beats/min; respirations, 10 breaths/min
D:BP, 160/72 mm Hg; pulse, 100 beats/min; respirations, 12 breaths/min
C;
Reason:
The body responds to a significant traumatic brain injury by shunting more oxygenated blood to the injured brain; it
does this by increasing systemic blood pressure. In response to an increase in blood pressure, the pulse rate
decreases. Pressure on the brain stem often causes an irregular breathing pattern that is either slow or fast.
Therefore, patients with increased intracranial pressure present with hypertension, bradycardia, and irregular
respirations that are fast or slow (Cushing's triad). Vital signs representative of shock (eg, hypotension, tachycardia)
are not common in patients with an isolated head injury and increased intracranial pressure. If the patient with a
seemingly isolated head injury is hypotensive and tachycardic, look for other injuries; internal or external bleeding is
likely occurring elsewhere.
A soft-tissue injury that results in a flap of torn skin is called a/an:
A:incision.
B:abrasion.
C:laceration.
D:avulsion.
D;
Reason:
An avulsion is a soft-tissue injury in which a portion of the skin is torn away, leaving a flap of skin. A laceration is a
jagged soft-tissue injury that can be caused by glass or other sharp objects. An abrasion is the scraping away of the
epidermis, causing oozing of serous fluid from the capillary bed. Road rash is a classic example of an abrasion. An
incision is similar to a laceration, but has smooth edges. Scalpels or knives are examples of instruments that would
make an incision.
You are assessing a young male who was stabbed in the right lower chest. He is semiconscious and has labored
breathing, collapsed jugular veins, and absent breath sounds on the right side of his chest. This patient MOST likely
has a:
, A:ruptured spleen.
B:pneumothorax.
C:hemothorax.
D:liver laceration.
C;
Reason:
You should suspect a hemothorax if a patient with chest trauma presents with shock, especially if the injury was
caused by penetrating trauma. Hemothorax occurs when blood collects in the pleural space and compresses the
lung, resulting in shock and respiratory compromise. Other signs include collapsed jugular veins (due to low blood
volume), labored breathing, and decreased or absent breath sounds on the side of the injury. A pneumothorax (air in
the pleural space) is also associated with difficulty breathing and unilaterally decreased or absent breath sounds;
however, the jugular veins are usually not collapsed. If excessive air accumulates within the pleural space, however,
pressure will shift across the mediastinum and affect the uninjured lung (tension pneumothorax); if this occurs, the
jugular veins may become engorged (distended). Splenic injury is unlikely; the patient's injury is on the right side and
the spleen is on the left. A liver laceration can cause severe shock; however, it is not associated with unilaterally
decreased breath sounds or labored breathing.
A 30-year-old woman has an open deformity to her left leg and is in severe pain. She is conscious and alert, has a
patent airway, and is breathing adequately. Your primary concern should be:
A:controlling any external bleeding.
B:administering high-flow oxygen.
C:covering the wound to prevent infection.
D:assessing pulses distal to the injury.
A; This is correct!
Reason:
Initial care for any open injury involves controlling external bleeding. Further care involves manually stabilizing the
injury site; applying a sterile dressing to keep gross contaminants from entering the wound; assessing distal perfusion
(eg, a pulse), motor, and sensory functions; and stabilizing the injury with an appropriate splint. The patient in this
scenario is conscious, alert, has a patent airway, and is breathing adequately. Depending on other assessment
findings, oxygen may be indicated. Your primary concern, however, should be to ensure that all external bleeding has
been controlled.
Which of the following questions is of LEAST pertinence initially when assessing a responsive 40-year-old woman
who fell from a standing position?
A:Can you move your hands and feet?
B:Did you hit your head?
C:Did you faint before you fell?
D:Have you fallen before?
D;
Reason:
