EMT Trauma Practice Test 2

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What is the most common spinal injury associated with improper lifting techniques?

Correct! Wrong!

The most common spinal injury is injury to the cervical spine. Improper lifting techniques, however, often result in lumbar injuries. Common lumbar injures are bulging and/or compressed vertebra. You must remember to lift with your legs and knees and not your back.

Which of the following findings in a crush injury is typically the earliest and most prominent?

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Pain is generally the most obvious sign of a crush injury and tends to present earliest out of all of the other associated signs and symptoms.

While assessing the carotid and radial pulse in your unresponsive patient, you determine that the carotid pulse is weak and rapid, and the peripheral pulses are absent. What other clinical assessment finding would you expect to be present?

Correct! Wrong!

Checking the central and peripheral pulses in the unresponsive patient will give the paramedic a rough estimate of peripheral perfusion. In this instance, where there is no peripheral pulse and a weak central pulse, the inference can be made that there is poor peripheral perfusion. Another expected finding in this patient then would be cool and pale skin from the diminished peripheral blood flow.

You have responded for a 43-year-old male who was involved in an altercation. The patient was reportedly beaten about the face and head with a baseball bat. The patient is unresponsive. Evaluation of the patient's face reveals instability from the orbits to the mandible. Based on this information, how would you definitively manage this patient's airway?

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This patient has an unstable face and an unstable airway. Ultimately, this patient needs to have his airway protected as quickly as possible with an endotracheal tube. With facial instability, it is imperative that an adjunct be placed to ensure that the airway is not occluded by the pressure on the jaw created with the application of the Bag-Valve-Mask.

Following the immobilization of an extremity fracture to the lower right arm, the paramedic should perform what step last?

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The last part of immobilizing the arm fracture (or any suspected fracture for that matter), is the assessment of distal motor, sensory, and perfusion status. This is done to assure there was no additional trauma from the immobilization process, and to assure the splint was not put on incorrectly (for example an air splint inflated too high). If there is a loss in the motor, sensory, perfusion findings following immobilization, the paramedic should immediately reassess the splinting process and correct any errors.

You are treating a 12-year-old male patient who was hit in the nose with a baseball. His nose is deviated to the left with moderate epistaxis. He is complaining of severe pain to his nose. He is alert and oriented with no loss of consciousness. Which of the following treatment sequences would best manage this patient?

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Holding pressure on the nares is the proper technique to control epistaxis while leaning the patient forward to prevent blood from draining down the throat. Leaning the patient forward should not be performed if spinal precautions are necessary.

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. Which of the following treatment regimens would be the most appropriate for this patient?

Correct! Wrong!

Treatment of a gunshot wound to the thorax would include taking necessary spinal precautions. The open wound should be covered with an occlusive dressing. The respiratory distress should be treated with high flow oxygen with consideration of positive pressure ventilation and possible intubation. In addition, an IV should be started for a fluid route if hypotension worsens. Rapid transport is indicated for pericardiocentesis and possible surgery.

Your 26-year-old female patient has been pulled out of a house fire. Her chest and arms have been burned. The area is charred and the patient states she has little pain in the burned area. What is the most likely classification of this patient's burns?

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The patient is most likely experiencing a full thickness burn with disruption of the soft tissue through the nerve root. They are typically painless, with the exception of the penumbra, because of the lack of nerve stimulation.

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?

Correct! Wrong!

Pericardial tamponade causes decreased cardiac output as seen by pale skin and hypotension. In addition, jugular vein distention may be seen along with a narrowed pulse pressure. Other signs and symptoms include tachycardia, respiratory difficulties, and cyanosis of the face, neck, and arms. With tension pneumothorax or a significant hemothorax, decreased or absent breath sounds will be present.

Which of the following patients would be most appropriate for triage to a non-trauma center?

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Of the 4 choices, the patient with a laceration on her thigh has an isolated injury and can be effectively managed by a non-trauma center. The other 3 patients require a more thorough assessment and therefore should be evaluated at a trauma center.

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?

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An inhalation injury inferior to the glottis can result in wheezing and bronchospasm. An inhalation injury superior to the glottis can cause a hoarse voice and stridor. Inhalation of the byproducts of combustion can cause wheezing but this would still be classified as an inhalation injury to the lower airway.

You are called for an elderly female that fell down and hurt her knee. When you find the patient, she tells you she tripped and fell, and landed on her left knee. She denies any loss of consciousness or trauma to her head. The patient is only complaining of pain to the distal portion of her femur. During your assessment, you notice deformity and swelling to the femur, proximal to the knee. The patient has good distal pulses, motor function, and sensation. What would be the most appropriate treatment for this patient?

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The patient with a femur fracture should be secured to a backboard and padded appropriately. Inflating both leg sections of the PASG is not indicated for this patient. Secure femur while helping to tamponade any blood loss. Traction splinting is only appropriate if the femur fracture is mid shaft. Padded board splints will not provide sufficient stabilization.

You respond to the scene of a residential natural gas explosion to find a 36-year-old male patient complaining of a diminished ability to hear, moderate dyspnea, and acute abdominal pain. These symptoms are likely due to what mechanism?

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Primary Blast Injuries are caused by the compression of air filled organs by an overpressure wave, typically affecting the tympanic membranes, lungs, stomach, intestines, and sinuses. Toxic Exposure to Natural Gas may cause nausea, diarrhea, dizziness, headache, and labored breathing, but would not explain diminished hearing or acute abdominal pain. Secondary Blast Injury refers to trauma caused by flying shrapnel or debris, while Tertiary Blast Injury refers to trauma caused when a patient is thrown from the blast area and strikes an object or the ground.

When managing an open fracture, you should do which of the following?

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When bone is exposed, care must be taken to prevent further injury and infection. A good rule of thumb for the use of moist, sterile dressings is as follows: If the protruding part is normally on the inside of the body, cover it with a moist sterile dressing. Do not attempt to reinsert or reduce the exposed bone back into the body.

You have responded to a local residence of a 37-year-old male who had lacerated his leg while using a chainsaw in the back of his house. Prior to your arrival, the patient's wife, who is a nurse, applied pressure to the wound and has the patient in a Trendelenburg position. Your assessment of the patient reveals him to be responsive to painful stimuli with a weak carotid pulse and the blood pressure unobtainable. There is a massive amount of blood surrounding the patient on the ground. The wife tells you that the wound is arterial and the injury occurred about 10 to 15 minutes ago. In addition to oxygen therapy, what are your treatment priorities for this patient?

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Direct pressure and fluids are this patient's best chance for survival and prevention of decompensated shock. ALS should be activated to administer fluids as soon as possible.

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