Adult Advanced Flashcards

A 36-year-old male sustains blunt force thoracic trauma and fits the criteria for a load-and-go patient. Which of the following should be performed on the scene?

Answer: Assess for other potentially life-threatening conditions

Explanation: The purpose of the initial assessment is to prioritize the patient and to identify all immediately life-threatening conditions. The information gathered is used to make decisions about critical interventions and time of transport.

The use of external laryngeal manipulation:

Answer: Improves glottic visualization

Explanation: Manipulating the thyroid cartilage can help bring the vocal cords into view during endotracheal intubation. This is called external laryngeal manipulation (ELM). The movement is usually pressing the thyroid cartilage backward against the esophagus and then upward and slightly to the patient’s right side.

A pericardiocentesis is performed to:

Answer: To remove fluid from the lining around the heart

Explanation: The pericardial sac is an inelastic membrane that surrounds the heart. If blood collects rapidly between the heart and pericardium from a cardiac injury, the ventricles of the heart will be compressed, making the heart less able to refill, and cardiac output falls.

A 56-year-old male sustains a gunshot wound to the abdomen. Vital signs are BP 74/32, P 136 present only at the carotid, and R 24 and shallow. The target of fluid resuscitation is:

Answer: Return of peripheral pulses

Explanation: This is an example of internal, uncontrolled hemorrhage. Administer sufficient normal saline to maintain peripheral perfusion, following local or EMS agency medical direction policies. Maintaining peripheral perfusion is generally defined as giving enough fluid—usually in boluses—to return a peripheral pulse, such as a radial pulse.

A 34-year-old man has a gunshot wound to the right groin area. Arterial bleeding, which cannot be controlled with direct pressure or a tourniquet, is coming from the wound. The patient appears confused, diaphoretic and has weak peripheral pulses. What is the appropriate fluid resuscitation regimen for this patient?

Answer: Intravenous fluid; gives enough fluid to maintain peripheral pulses

Explanation: Give only enough normal saline to maintain a blood pressure high enough for adequate peripheral perfusion. Maintaining peripheral perfusion may be defined as producing a peripheral pulse (such as a radial pulse)

The gold standard to confirm that the endotracheal tube is placed in the trachea is:

Answer: Waveform capnography

Explanation: Although the most reliable method of ensuring proper placement is actually visualizing the tube passing through the glottic opening, even this is not 100% certain. In fact, it is only reliable for the moment you see it. The gold standard for confirming and monitoring ETT placement is waveform capnography.

Which of the following injuries would change a trauma patient's transport classification from "stable" to "load and go"?

Answer: Pelvic fracture

Explanation: Conditions that can rapidly lead to shock include penetrating wounds to the torso, abnormal chest exam, tender distended abdomen, pelvic instability, and bilateral femur fractures.

Which of the following findings would not make a patient difficult to ventilate with a bag-valve mask?

Answer: Multiple nose piercings

Explanation: Predictors of difficult mask ventilation can be remembered using the “BOOTS” mnemonic: B – Beards O – Obesity O – Older patients T – Toothlessness S – Snores or stridor

What is the most frequent cause for an intubated trauma patient to develop poor lung compliance while being ventilated?

Answer: Tension pneumothorax

Explanation: The development of decreased lung compliance (difficulty in squeezing the bag-mask device) in the intubated patient should always alert you to the possibility of a tension pneumothorax.

Hemostatic agents applied directly to the source of bleeding must be used in conjunction with:

Answer: Direct pressure to the wound

Explanation: Pack the hemostatic agent in the wound and hold firm pressure. The hemostatic agent is an “adjunct” to assist in controlling hemorrhage, not a hemorrhage control by itself.

Routine use of hyperventilation in the traumatic brain injury (TBI) patient will:

Answer: cause vasoconstriction and increased cerebral ischemia.

Explanation: Hyperventilation has only a slight effect on brain swelling, but causes a significant decrease in cerebral perfusion from that same vasoconstriction, resulting in cerebral hypoxia. Thus, both hyperventilation and hypoventilation can cause cerebral ischemia and increased mortality in the TBI patient.