Deck 36: Multisystem Trauma and Trauma in Special Patient Populations

Question 1

You are presenting information on emergency care to a class of pregnant women. A participant asks you what the most frequent cause of injury is to a woman during pregnancy. Which one of the following is the correct response?

A) Motor vehicle collisions
B) Falls
C) Domestic violence
D) Sexual assault

Answer 1

A

Question 2

A 32-week pregnant female who was involved in a motor vehicle collision is currently immobilized to the long spine board. Which one of her following statements should concern the EMT most?

A) "I think that I just had a contraction."
B) "I forgot to tell you that I am having twins."
C) "My back is really hurting from being on this board."
D) "I have not taken prenatal vitamins for one week."

Answer 2

A

Question 3

When assessing and treating a traumatically injured female in her third trimester of pregnancy, the EMT must remember that:

A) immobilization to a long spine board increases her risk for vomiting.
B) the maternal heart rate naturally decreases as the due date approaches.
C) care for the baby will come from caring for the mother.
D) an increase in blood volume makes her naturally resistant to shock.

Answer 3

C

Question 4

A female patient who is 35 weeks pregnant tripped and fell down 12 stairs. She is complaining of back pain as well as nausea. She is fully immobilized and being nonemergently transported to the hospital for evaluation. While en route, she exclaims that she is having contractions and thinks that her water may have broken. Which one of the following should you do immediately?

A) Provide rapid transport and continue monitoring.
B) Examine her genitalia for crowning or bleeding.
C) Tilt the long spine board to the left side.
D) Release her from the long board and prepare for delivery.

Question 5

The EMT shows he is correctly using the pediatric assessment triangle on a 3-year-old male trauma patient when he:

A) quickly determines the circulation based on skin color.
B) uses it in place of the primary assessment.
C) carefully examines the chest for signs of retractions.
D) makes a conscious effort to look for bruises to the patient's body.

Question 6

You are transporting an elderly female who fell in a nursing home and displays outward rotation of her left leg. She has a lengthy medical history, including dementia. Currently, she is very quiet and receiving oxygen through a nasal cannula at 6 liters per minute. She also is immobilized to a long spine board. During your reassessment, you note her to be alert but confused, with slightly accelerated respirations and a strong radial pulse. You also note that her SpO₂ has dropped from 97% on scene to 91%. You should:

A) perform a head-tilt, chin-lift maneuver.
B) request ALS assistance.
C) apply a nonrebreather.
D) start positive pressure ventilation.

Question 7

A 62-year-old female with severe kyphosis has fallen and hit the back of her head, which is oozing blood from a small laceration. Family members state that she suddenly complained of a "very bad headache" before collapsing to the kitchen floor. She has snoring respirations and cyanosis in the extremities. Of the following interventions, which one should you do first?

A) Apply a cervical collar.
B) Use a jaw-thrust maneuver.
C) Start positive pressure ventilation.
D) Cover the laceration.

Question 8

The EMT knows that the majority of all deaths in children who are 1 to 14 years of age could be prevented by:

A) better parental supervision.
B) wearing helmets while riding bikes.
C) safer driving of vehicles.
D) prevention of child abuse.

Question 9

A female patient who is 36 weeks pregnant tripped in a parking lot, hitting her head and wrist, as well as her abdomen. She is alert and oriented and complains of a headache and abdominal and wrist pain. She denies shortness of breath and has an SpO₂ of 96% on room air. Assessment reveals a large abrasion and hematoma to her forehead and abdomen and deformity to her left wrist. Which one of the following interventions will best treat the injuries the baby may have suffered?

A) Immobilization to a long spine board
B) Covering the abdominal abrasion to prevent infection
C) Applying an ice pack to the wrist to decrease pain
D) Administering high-concentration oxygen through a nonrebreather

Question 10

You are by the side of an 88-year-old male who fell. He has a hematoma to his forehead as well as deformity to his left forearm. His daughter informs you that he has severe dementia and she cares for him at home. As you assess him, he continually screams out, "Mary, help me. I need help!" At this time, what question is most appropriate to ask the daughter?

A) "Was Mary his wife?"
B) "Is this how he normally is?"
C) "Do you know what he means by this?"
D) "My mother suffers from dementia; it is a terrible disease"

Question 11

A 78-year-old male pedestrian was struck by a car at a convenience store. The patient is conscious but confused and is suffering from multisystem trauma. Which of the following represents the best sequence of care for this patient?

A) Primary assessment, oxygen, secondary assessment, immobilization, and all other care en route to the hospital
B) Primary assessment, immobilization, and all other care en route to the hospital
C) Primary assessment, oxygen, secondary assessment, and all other care en route to the hospital
D) Primary assessment, oxygen, secondary assessment, cervical collar, and all other care en route to the hospital

Question 12

The EMT is correctly assessing a 2-year-old male who is unresponsive after being assaulted by the mother's live-in boyfriend when he:

A) checks the patient's brachial pulse.
B) recognizes a respiratory rate of 30 per minute as abnormal.
C) takes the time to get a blood pressure.
D) checks capillary refill time to help determine perfusion.

Question 13

An 83-year-old female has fallen down the basement stairs. Once at her side, she tells you that her left hip hurts and rates it 10/10. Since the patient is downstairs, you recognize the need for assistance in extricating from the residence. As you start the primary assessment, you note a dog at the top of the stairs growling. At this time, what is your primary concern?

A) Airway
B) Pain
C) Need for additional help
D) Dog

Question 14

After being assaulted by her boyfriend, an 18-year-old female who is 33 weeks pregnant is found unresponsive in her bedroom. She appears to have been beaten in the head and abdomen as evidenced by multiple hematomas and lacerations to these areas. Which assessment finding should concern the EMT most and be addressed first?

A) Rapid heart rate
B) Bright red vaginal bleeding
C) Abdominal contusions
D) Room air SpO₂ at 93%

Question 15

An unrestrained female patient, who was involved in a minor motor vehicle collision, refuses EMS care or transport. She is seven months pregnant and is alert and oriented. When asked, she denies any complaint. Your best action would be to:

A) have her follow up with her obstetrician.
B) contact medical direction for instructions.
C) make contact with her obstetrician.
D) have the police witness her signing the refusal.

Question 16

When treating a pediatric trauma patient, which one of the following is it important for the EMT to remember?

A) The elevated metabolism of a child causes them to retain heat, thus a blanket should not be applied when in shock.
B) Since the body of a child is smaller than an adult's body, there is less chance of multisystem trauma.
C) The flexibility of the chest wall in a child can allow for internal injury without obvious external signs.
D) Because children tend to be healthier than adults, they are able to compensate longer when in shock.

Question 17

An elderly female has fallen and is very confused, and you are having a problem getting her past medical history. Which one of the following is your next best action?

A) Transport the patient without delay.
B) Contact the patient's doctor for the history.
C) Transport her to a hospital that has cared for her before.
D) Ask the patient's daughter for the history.

Question 18

You suspect the lethargic 6-month-old baby beside you is the victim of child abuse. When performing the primary assessment, which one of the following should you use to quickly establish his perfusion?

A) Heart rate
B) Temperature of the skin
C) Presence of a radial pulse
D) Blood pressure

Question 19

A car swerved to miss a deer in the road and hit a utility pole at a low rate of speed. Damage to the car is minimal, but the 82-year-old male passenger was not wearing a seat belt and hit his head on the dashboard. He presents as confused and diaphoretic. His daughter, the driver, states that he has a history of dementia, high blood pressure, and diabetes, as well as coronary artery disease. She adds that he did take his insulin about 2 hours ago. Which one of the following questions to the daughter would be most important at this time?

A) "How far along is the dementia?"
B) "He seems sweaty. Was he feeling okay this morning?"
C) "Did he eat anything today?"
D) "Does he take medication for the high blood pressure?"

Question 20

An unresponsive 10-year-old male was struck by a car while riding his bike. He has blood on his face and presents with snoring respirations. Respirations are approximately 10 per minute, with cyanosis noted to his extremities. Manual in-line spinal stabilization is being held by Emergency Medical Responders. Which one of the following should you do next?

A) Perform a jaw-thrust maneuver.
B) Start positive pressure ventilation.
C) Suction the airway.
D) Quickly assess for life-threatening injuries.

Question 21

An 81-year-old woman with severe kyphosis and osteoporosis has fallen and is complaining of neck pain as well as nausea. Given the patient's past medical history, which one of the following is most appropriate?

A) Transfer her to the stretcher and transport in a position of comfort.
B) Place her in a supine position on the long board and pad all voids.
C) Apply a cervical collar only and transport her supine on the stretcher.
D) Position her on her left side and immobilize her to the long board.

Question 22

The EMT would recognize which patient as suffering from multisystem trauma?

A) A pregnant female with a single gunshot wound to the head
B) A 43-year-old male with extremity trauma and shock from an MVC
C) A 66-year-old female with a deformed arm after having a syncopal episode
D) A 23-year-old female with a fractured clavicle sustained in a soccer game

Question 23

An 89-year-old female with dementia who is being cared for by her daughter has fallen and exhibits deformity to her left upper arm. As you attempt to splint her arm, she continually screams and pulls away from you. After several attempts, your best course of action should be to:

A) contact advanced life support for assistance.
B) have the daughter help apply the splint.
C) transport without a splint and document that splinting was attempted.
D) gently restrain the patient and apply the splint.

Question 24

A 37-year-old woman, who is four months pregnant, is complaining of abdominal and pelvic pain after being assaulted in her home by a live-in boyfriend. During the assault, he struck her in the head, chest, and abdomen with his fists and a chair as she lay on the floor. There are no obvious threats to the airway, breathing, or circulation, and her vital signs are: pulse 124, respiration 22, blood pressure 114/68, and SpO₂ 97% on room air. Regarding your care of this patient, which of the following is needed?

A) Immobilization to the long board with it tilted left for transport
B) Immediate transport with care such as immobilization provided en route
C) Calming reassurance and transport quietly in a position of comfort
D) Application of a nonrebreather with high-concentration oxygen

Question 25

You are assessing an 86-year-old male who has fallen down a flight of stairs after getting out of bed to use the bathroom. He is complaining of severe head, neck, and back pain. Which one of the following questions is most appropriate to ask this patient?

A) "Were you holding onto the railing?"
B) "Were you confused when you fell?"
C) "What caused you to fall?"
D) "Do you seem to fall a lot?"

Question 26

A 31-year-old unrestrained pregnant female has been involved in an MVC and is complaining of chest and abdominal pain after striking the steering wheel. She is conscious, alert, and oriented with no deficits noted to the airway, breathing, or circulation. When asking her questions regarding her status, what questions should you ask first?

A) "Have there been any problems with previous pregnancies?"
B) "Are you receiving prenatal care from an obstetrician?"
C) "Do you feel as though you are having contractions?"
D) "Is there a reason as to why you were not wearing a seat belt?"

Question 27

Tragically, you have just arrived by the side of a 23-year-old female who is 37 weeks pregnant and apneic and pulseless after being shot in the abdomen. Regarding care of this woman, which of the following statements would you provide to other rescuers on scene?

A) "Sadly, there is nothing that can be done, I will call medical direction and inform the doctor."
B) "I am going to call for ALS backup; it is her and her baby's only chance for survival."
C) "I need someone to listen for fetal heart tones to see if the baby is still alive."
D) "Waiting for ALS backup is not beneficial; we need to provide CPR and get her to the hospital now!"

Question 28

You have been called to a nursing home for a confused 91-year-old male patient who became dizzy and fell, striking his head on the floor. Which one of the following statements made by the nurse should be of most concern to you?

A) "I just checked his blood sugar and it is 154 mg/dL."
B) "He did not have any of his medications today."
C) "He has a heart valve problem and takes Coumadin for it."
D) "He is normally confused and his family just made him a DNR."

Question 29

You observe a traumatically injured 3-year-old female immobilized to a long spine board with no padding behind the neck, shoulders, or back. Which one of the following is the issue of most concern with this oversight?

A) Airway compromise
B) Extension of the cervical spine
C) Bruising to the back
D) Pain and discomfort

Question 30

Which EMS crew has satisfied the platinum ten minutes?

A) Assessed, immobilized, and initiated transport within 10 minutes of arriving on scene
B) Arrived on scene and by the patient's side within 10 minutes of being dispatched
C) Stabilized the patient and called for ALS within 10 minutes of arriving on scene
D) Completed the assessment and treated any life threats within 10 minutes of the incident occurring

Question 31

You are called to a nursing home for a male patient with chest pain. On arrival you find the patient in a wheelchair with a noticeable hematoma to his forehead and a skin tear to his left wrist. Staff states that the patient had an episode of chest pain just before falling to the ground. When asked, the patient states that he still has chest discomfort. Which one of the following should you do immediately?

A) Take manual in-line spinal stabilization.
B) Apply oxygen and look for other injuries the patient may have suffered.
C) Assume a cardiac event and apply oxygen.
D) Perform the primary assessment and apply oxygen.

Question 32

Assessment of a 79-year-old female with a long history of medical complaints reveals tenderness and deformity to her left hip. Staff at the personal care home state that she slipped in some water and fell onto her buttocks. Currently, she is alert and oriented and stating the pain is 10/10. Regarding care of her leg, which one of the following is most appropriate?

A) Apply traction with a traction splint until the pain subsides.
B) Straighten the leg and splint it in that position.
C) Determine the presence of a pedal pulse, and then apply the traction splint.
D) Maintain the leg in the position found and transfer to a long spine board.

Question 33

What statement accurately describes multisystem trauma?

A) Multisystem trauma is the leading cause of death for those over the age of 65 years.
B) The multisystem trauma patient is less likely to develop shock if otherwise healthy.
C) Multisystem trauma has a noted higher incidence of morbidity and mortality.
D) The definitive care for multisystem trauma is cardiopulmonary resuscitation.

Question 34

You are by the side of an 11-month-old female with a decreased level of consciousness. Caregivers will not provide an accurate history of how the child came to this condition, only that she was hard to wake up this morning, about 30 minutes ago. When assessing the child, what finding would be most immediately concerning?

A) Bruise to the head
B) Lack of crying as you assess her
C) Bradycardic heart rate
D) Healing bruises on the lower legs

Question 35

Which statement is true regarding care of the multisystem trauma patient?

A) Any threat to life should be managed as it is identified.
B) All care should be provided en route to the hospital.
C) Immobilization can be foregone if the patient is near death.
D) Advanced life support by paramedics is the definitive care for multisystem trauma. patients

Question 36

When treating a pregnant female involved in a traumatic event, the EMT must remember:

A) the amniotic fluid protects the baby from injury to the mother's abdomen.
B) an elevated heart rate seen in shock may not be observed due to increased blood volume.
C) the diaphragm tends to be lower, making internal chest and lung injury more likely.
D) gastric mobility increases, posing an increased risk of vomiting and aspiration.

Question 37

A 27-year-old male has been involved in a motor vehicle collision and is entrapped in his car. He is unresponsive with agonal gurgling respirations and blood coming from his nose. His respirations show poor effort and are inadequate. The radial pulse is rapid and weak and skin cool and diaphoretic. An Emergency Medical Responder is holding manual in-line spinal stabilization. What action would you perform first?

A) Mechanical extrication from the vehicle
B) Application of a cervical collar
C) Control a nasal hemorrhage
D) Suction the airway with a hard-tip catheter

Question 38

How would you tell a pregnant woman to restrain herself when traveling in a car?

A) Wear all seat belts normally, as you would if not pregnant.
B) Use the shoulder restraint but not the lap belt to prevent abdominal injury.
C) Avoid the belt system as long as your car has front and side air bags in place.
D) The lap belt by itself should be adequate, as long as the car is equipped with air bags.

Question 39

To prevent the majority of traumatic injuries in the geriatric population, what prevention program should you develop?

A) Safe driving
B) Elder abuse
C) Smoke alarm maintenance
D) Fall prevention

Question 40

The mother of a 4-year-old boy states that he fell off the top bunk bed and hit his head. After falling, he appeared to seize for approximately 30 seconds. Presently he has nonpurposeful movement to painful stimuli, with a patent airway and slow respirations. His radial pulse is intact, and his skin is warm and dry. You note urinary incontinence. After taking manual in-line spinal stabilization, which one of the following should you do immediately?

A) Insert an oropharyngeal airway and provide high-concentration oxygen.
B) Perform a jaw-thrust maneuver and start positive pressure ventilation.
C) Apply oxygen, fully immobilize the patient, and then initiate rapid transport.
D) Perform a head-tilt, chin-lift and administer high-concentration oxygen.

Question 41

The EMT is correctly assessing the perfusion status of a 10-month-old when she:

A) obtains a blood pressure.
B) feels for a brachial pulse.
C) looks for cyanosis in the extremities.
D) observes the characteristics of the fontanelles.

Question 42

The young pediatric patient is more prone to head injury because:

A) the skull is still cartilaginous and remains weak in structure.
B) the chest muscles are weak and cannot support the head.
C) the head is proportionately heavier and the neck muscles weaker.
D) the brain is smaller and floats within the larger skull.

Question 43

When treating an injured geriatric patient, it is very important to:

A) always use high-concentration oxygen.
B) work to achieve an oxygen saturation of at least 94%.
C) place the patient in a sitting position to promote adequate breathing.
D) avoid use of a nonrebreather and high-concentration oxygen unless apneic.

Question 44

Family has called you for a 78-year-old female, with a history of dementia, because she appears more confused than normal. The primary assessment reveals no life-threatening conditions and her vital signs are: pulse 88, respirations 22, blood pressure 134/66, and SpO₂ 95% on room air. Aside from the dementia, she had a history of hypertension, COPD, and breast cancer, which resulted in the removal of her right breast 11 years ago. Lately, she had an upper respiratory infection and is telling family that she has a headache. Your first question to family should be:

A) "It sounds like the dementia is getting worse, do you agree?"
B) "Do you know if she fell recently and hit her head?"
C) "Is there any possibility of diabetes and a low blood sugar level?"
D) "Does she take any medications for the high blood pressure?"

Question 45

You are caring for a crying 30-month-old male who fell 16 feet from a second-story window, landing on a patch of soft dirt and leaves. He is alert and oriented and complaining of left shoulder and arm pain. What instruction would you give to the team of EMS providers caring for this individual?

A) "When we get him on the long board, place padding under his head."
B) "I will need a blood pressure every 5 minutes to see if he is in shock."
C) "It is important to keep him cool in the event he is in shock."
D) "Whatever we do, let's make sure his SpO₂ is greater than 94%."

Question 46

An 85-year-old male with a history of an irregular heartbeat, diabetes, renal failure, and stroke fell getting out of bed, striking his head on the nightstand. He is alert and oriented and denies complaint. Vital signs are all within normal limits. There is a minor abrasion on his forehead, but he denies any associated pain or headache. Which of the following should be your priority?

A) Asking him if he ate breakfast and checking his blood sugar
B) Inquiring whether he is up to date on his tetanus immunization
C) Determining if he takes blood thinners for the irregular heartbeat
D) Asking family members if he has developed dementia yet

Question 47

An 84-year-old female has fallen down six steps, landing on carpet. She complains of abdominal and pelvic pain. Her airway is open, breathing adequate, and radial pulse intact. Skin is cool and dry with a noted tear to the left elbow with minor bleeding. EMRs report the following vital signs: pulse 84, respirations 20, blood pressure 126/68, and SpO₂ 97% on room air. Her family states she is acting normally. The hips are easily moved and do not appear broken. The patient does not want to go to the hospital and is asking to refuse. Your next action would be to:

A) ask to see what medications she is taking.
B) clean and wrap the skin tear to prevent infection.
C) ask family members for their input.
D) contact medical direction for authorization to refuse.