Free Paramedics Trauma Assessment and Management Questions and Answers

Question 1

A 22-year-old male presents with a single stab wound to the right side of his chest. He is anxious, tachycardic at 130 bpm, and hypotensive at 80/50 mmHg. You note absent breath sounds on the right, jugular vein distention, and tracheal deviation to the left. What is the most critical immediate intervention?

Accepted Answer

Perform needle decompression of the right chest.

Answer

The patient's signs and symptoms (hypotension, JVD, absent breath sounds, and tracheal deviation) are classic for a tension pneumothorax, which is an immediate life-threatening emergency. Needle decompression is the critical intervention to relieve the pressure in the pleural space, allowing the lung to re-expand and relieving pressure on the heart and great vessels.

Question 2

You are treating a 45-year-old female who fell from a ladder. She has a decreased level of consciousness (GCS 9) and a fixed and dilated right pupil. Her vital signs are: BP 180/100 mmHg, HR 50 bpm, and an irregular respiratory rate of 8 breaths/minute. This presentation is most consistent with which of the following?

Accepted Answer

Cushing's triad

Answer

Cushing's triad is a late sign of increased intracranial pressure (ICP) and impending brain herniation. It consists of hypertension (specifically, a widening pulse pressure), bradycardia, and irregular respirations. Beck's triad (hypotension, JVD, muffled heart sounds) indicates cardiac tamponade.

Question 3

In the management of a trauma patient with suspected internal, uncontrolled hemorrhage and signs of shock, which of the following fluid resuscitation strategies is most appropriate prior to definitive surgical control?

Accepted Answer

Administer small fluid boluses with the goal of achieving a palpable radial pulse or a systolic blood pressure of 80-90 mmHg.

Answer

The concept of permissive hypotension, or hypotensive resuscitation, is the current standard for trauma patients with uncontrolled hemorrhage. The goal is to maintain just enough blood pressure to perfuse vital organs without raising the pressure so high that it disrupts existing clots ('popping the clot') and worsens the hemorrhage. Aggressive fluid resuscitation to normalize blood pressure can also lead to hemodilution and coagulopathy.

Question 4

A 30-year-old unrestrained driver was involved in a high-speed frontal collision. The patient is pale, diaphoretic, and complaining of severe lower abdominal and hip pain. Palpation of the pelvis reveals instability. Vital signs are BP 88/50 mmHg and HR 128 bpm. What is the most appropriate initial intervention?

Accepted Answer

Apply a commercially approved pelvic binder or an improvised sheet sling.

Answer

The signs and symptoms strongly suggest an unstable pelvic fracture, which can cause massive internal hemorrhage. Applying a pelvic binder is a critical intervention to stabilize the pelvis, reduce the pelvic volume, and help tamponade bleeding. Log rolling can worsen the injury and increase bleeding and should be avoided.

Question 5

A 70 kg adult patient has sustained full-thickness burns to his entire left arm and the anterior trunk. According to the Parkland formula, how much intravenous fluid should be administered in the first 8 hours from the time of the burn?

Accepted Answer

3,780 mL

Answer

First, calculate the Total Body Surface Area (TBSA) burned using the Rule of Nines: Entire left arm = 9%, Anterior trunk = 18%. Total TBSA = 27%. The Parkland formula is 4 mL x patient weight (kg) x %TBSA. Calculation: 4 mL x 70 kg x 27% = 7,560 mL total fluid in 24 hours. The first half of this total is given in the first 8 hours: 7,560 mL / 2 = 3,780 mL.

Paramedics Exam Practice Test

Paramedics Exam Practice Test

Free Paramedics Trauma Assessment and Management Questions and Answers