EMS Trauma & Life Support Procedures 3 — Questions and Answers
Question 1: A patient struck by a vehicle has periorbital ecchymosis (raccoon eyes) and Battle's sign. These findings suggest:
- Orbital blowout fracture
- Basilar skull fracture (Correct answer)
- Subdural hematoma
- Zygomatic arch fracture
Correct answer: Basilar skull fracture
Raccoon eyes and Battle's sign (mastoid ecchymosis) are classic delayed signs of basilar skull fracture.
Question 2: During rapid trauma assessment of an unresponsive patient, you find clear fluid draining from the nose. This is most concerning for:
- Allergic rhinitis exacerbated by trauma
- Cerebrospinal fluid leak from basilar skull fracture (Correct answer)
- Nasal fracture with sinus drainage
- Aspiration of IV fluid administered en route
Correct answer: Cerebrospinal fluid leak from basilar skull fracture
Clear fluid from the nose or ears after head trauma may represent CSF leakage, indicating a basilar skull fracture.
Question 3: You are ventilating an apneic trauma patient with a BVM. Which sign would alert you to possible tension pneumothorax?
- Increasing ease of ventilation with each breath
- Bilaterally equal and diminishing breath sounds
- Increasing resistance during BVM ventilation with absent breath sounds on one side (Correct answer)
- Cyanosis of the fingernails only
Correct answer: Increasing resistance during BVM ventilation with absent breath sounds on one side
Progressively increasing resistance to BVM ventilation combined with unilateral absent breath sounds is a key sign of tension pneumothorax.
Question 4: A construction worker fell 20 feet and landed on his feet. After managing immediate life threats, which additional injuries should you specifically assess for?
- Skull fracture and cervical spine injury only
- Calcaneal fractures, lumbar compression fractures, and wrist fractures (Correct answer)
- Pulmonary contusion and cardiac tamponade
- Distal radius fractures and rotator cuff tears
Correct answer: Calcaneal fractures, lumbar compression fractures, and wrist fractures
A fall landing on the feet (Don Juan mechanism) classically causes calcaneal fractures, lumbar compression fractures, and wrist fractures from outstretched arms.
Question 5: When performing cricothyrotomy (surgical airway), you identify the cricothyroid membrane by locating it:
- Superior to the thyroid cartilage between the hyoid bone and thyroid
- Between the thyroid and cricoid cartilages in the midline (Correct answer)
- Inferior to the cricoid cartilage above the first tracheal ring
- Lateral to the trachea, between the carotid sheath and trachea
Correct answer: Between the thyroid and cricoid cartilages in the midline
The cricothyroid membrane lies between the thyroid cartilage superiorly and the cricoid cartilage inferiorly in the midline of the neck.
Question 6: A patient with blunt abdominal trauma reports referred pain to the left shoulder with palpation of the left upper quadrant. This finding (Kehr's sign) most suggests injury to the:
- Left kidney
- Descending colon
- Spleen (Correct answer)
- Stomach
Correct answer: Spleen
Kehr's sign is left shoulder pain caused by diaphragmatic irritation from blood pooling under the left hemidiaphragm, classically associated with splenic injury.
Question 7: During CPR, you note that chest compressions are causing a palpable pulse but the monitor shows ventricular fibrillation. Your immediate next action is:
- Continue CPR and withhold defibrillation since there is a pulse
- Deliver defibrillation as soon as possible after confirming the rhythm (Correct answer)
- Switch to ventilation-only rescue breaths since compressions are adequate
- Administer atropine 1 mg IV for the bradycardic rhythm
Correct answer: Deliver defibrillation as soon as possible after confirming the rhythm
Ventricular fibrillation requires immediate defibrillation regardless of pseudo-pulses generated by CPR; the palpable pulse is from compressions, not cardiac output.
EMS Trauma & Life Support Procedures 3
A patient struck by a vehicle has periorbital ecchymosis (raccoon eyes) and Battle's sign.
These findings suggest: