Paramedics Exam Trauma Assessment and Management 4 — Questions and Answers
Question 1: A motorcyclist struck a guardrail at high speed and has an open femur fracture with visible bone. Hemorrhage is controlled. The next priority is:
- Reduce and splint the fracture in the field
- Traction splint application to reduce blood loss and pain (Correct answer)
- Immediate surgical referral only; no prehospital splinting
- Wrap with a pressure bandage and avoid splinting
Correct answer: Traction splint application to reduce blood loss and pain
A traction splint reduces femur fracture displacement, decreasing internal blood loss (up to 1–2 liters) and pain before transport.
Question 2: Which of the following is a contraindication for applying a traction splint?
- Femur fracture with intact distal pulse
- Suspected hip or knee joint injury (Correct answer)
- Isolated mid-shaft femur fracture
- Femur fracture in an adult over 60
Correct answer: Suspected hip or knee joint injury
Traction splints are contraindicated when there is an associated hip, knee, or ankle injury because traction would distract those joints and cause further injury.
Question 3: You are assessing a 45-year-old who fell 20 feet from scaffolding and has point tenderness over T10. Proper spinal motion restriction includes:
- Cervical collar alone is sufficient for a thoracic injury
- Full spinal motion restriction with long backboard or vacuum mattress (Correct answer)
- Sitting spinal immobilization only since the patient is alert
- No spinal restriction if the patient can move all extremities
Correct answer: Full spinal motion restriction with long backboard or vacuum mattress
A fall from height with thoracic point tenderness is a high-risk mechanism requiring full spinal motion restriction regardless of neurological status.
Question 4: Kehr's sign (left shoulder pain in a supine trauma patient) suggests injury to which structure?
- Left lung and pleura
- Spleen with diaphragmatic irritation (Correct answer)
- Left kidney
- Cardiac tamponade
Correct answer: Spleen with diaphragmatic irritation
Kehr's sign is referred left shoulder pain caused by blood irritating the diaphragm, classically associated with splenic laceration.
Question 5: A patient with traumatic cardiac arrest from penetrating thoracic trauma has CPR in progress. The prehospital intervention with the highest potential benefit is:
- Standard ACLS medication protocol
- Bilateral needle decompression and rapid transport to a trauma center (Correct answer)
- Transcutaneous pacing
- High-dose epinephrine every 3 minutes
Correct answer: Bilateral needle decompression and rapid transport to a trauma center
Penetrating traumatic cardiac arrest often results from tension pneumothorax or tamponade; bilateral decompression and rapid transport for thoracotomy offer the best chance of survival.
Question 6: Beck's triad (hypotension, muffled heart sounds, JVD) in a penetrating chest trauma patient indicates:
- Massive hemothorax
- Tension pneumothorax
- Cardiac tamponade (Correct answer)
- Aortic injury
Correct answer: Cardiac tamponade
Beck's triad classically describes cardiac tamponade, where pericardial blood compresses the heart, reducing output while increasing venous pressure.
Question 7: For a patient with a traumatic brain injury and a GCS of 8, target end-tidal CO2 during BVM ventilation should be maintained at:
- 25–30 mmHg (aggressive hyperventilation)
- 35–45 mmHg (normal range) (Correct answer)
- 50–55 mmHg (slight hypercapnia)
- 60+ mmHg (permissive hypercapnia)
Correct answer: 35–45 mmHg (normal range)
Normocapnia (EtCO2 35–45 mmHg) is the target for TBI patients; hyperventilation causes cerebral vasoconstriction and worsens ischemia except as a temporary herniation rescue measure.
Paramedics Exam Trauma Assessment and Management 4
A motorcyclist struck a guardrail at high speed and has an open femur fracture with visible bone.
Hemorrhage is controlled.
The next priority is: