Deck 11: Special Considerations in Trauma

Question 1

Which of the following best describes the appropriate timing of the rapid trauma assessment?

A) After the focused history and assessment of the stable trauma patient
B) After establishing airway, ventilation, and hemorrhage control in a critical trauma patient
C) Upon making initial contact with the unresponsive trauma patient
D) When considering accepting a refusal of treatment and transport from a stable trauma patient

Answer 1

After establishing airway, ventilation, and hemorrhage control in a critical trauma patient

Question 2

Assuming that none of the following patients has any neurologic deficits, which patient requires cervical spinal immobilization?

A) A 19-year-old man who has a gunshot wound to the right thigh
B) A 3-year-old girl who fell on the sidewalk while running and who has a bite injury to her tongue
C) A 10-year-old male skateboarder who fell while skating down a hill and received abrasions to his hands, elbows, chest, and knees
D) A 70-year-old woman involved in a moderate-speed, lateral-impact motor vehicle collision, who is complaining of left arm pain

Answer 2

A 70-year-old woman involved in a moderate-speed, lateral-impact motor vehicle collision, who is complaining of left arm pain

Question 3

The uncritical use of which of the following when caring for the trauma patient has been questioned by research?

A) PASG
B) Rapid isotonic fluid infusion
C) Capillary refill as an indicator of tissue perfusion
D) All of the above

Answer 3

All of the above

Question 4

All the following are complications of hypothermia in the trauma patient EXCEPT:

A) inhibited clotting cascade.
B) release of anticoagulant agents.
C) reduction in blood loss.
D) increased energy use.

Question 5

The elderly patient in shock may be less likely to exhibit which of the following expected manifestations of shock?

A) Cardiac arrhythmias
B) Hypothermia
C) Altered mental status
D) Tachycardia

Question 6

Which of the following offers a valuable model for EMS to consider when trying to reduce injury-related morbidity and mortality?

A) The Pan American Health Organization
B) American Society for Testing Materials (ASTM)
C) The fire service
D) Drug Abuse Resistance Education (DARE)

Question 7

Your patient is the 24-year-old male victim of a drive-by shooting. He is sitting on the ground on your arrival, with his legs stretched in front of him. You note that his sweatpants are bloody below the right knee. He is alert, though complaining of right leg pain, and has adequate ventilation, as well as a radial pulse of 88. To decide if this patient should be transported quickly to a trauma center, you should consider if he meets which of the following?

A) A Glasgow Coma Scale score of at least 15
B) CDC Guidelines for Field Triage of Injured Patients
C) A revised trauma score of at least 20
D) All of the above

Question 8

Which of the following statements about the pediatric pedestrian who is struck by a vehicle is NOT true?

A) A child commonly turns toward the oncoming vehicle at the moment of impact.
B) Smaller children are likely to suffer fractures of the tibia and fibula as a result of impact with the vehicle's bumper.
C) A smaller child is more likely to be thrown to the ground following initial impact, versus being thrown onto the hood.
D) Anatomically, the injuries caused by the initial impact of the vehicle will be higher on the body than in an adult.

Question 9

A thorough inspection of the trauma patient can be best performed if which of the following guidelines is used?

A) Assess for tenderness, the ability to move, and distal sensation and circulation.
B) Assess for abnormalities in skin color, deformity of any part of the body, and any disruption of the skin.
C) Assess for deformity, swelling, and angulation of any part of the body.
D) Assess for pulse, paresthesia, pallor, and pain.

Question 10

Your patient is a 55-year-old man with a gunshot wound to the abdomen. Which of the following does NOT have a bearing on the mechanism of injury analysis?

A) The distance of the shooter from the victim at the time of injury
B) The type of ammunition used
C) Whether the shooter is right- or left-handed
D) The type of firearm used

Question 11

Which of the following probably contributes to injury-related morbidity and mortality in the young male population (those aged 11 to 35 years)?

A) The tendency to put small objects in the mouth
B) Disregard for safety practices
C) Poor physiological compensatory mechanisms
D) None of the above

Question 12

Which of the following best describes the significance of finding an abrasion during the prehospital assessment of the pediatric trauma patient?

A) Abrasions are superficial wounds and not of particular concern in the prehospital setting.
B) There is a risk of infection.
C) There is proportionally greater fluid loss when compared with an adult.
D) It is a possible indication of more significant trauma beneath the abrasion.

Question 13

Your patient is the 23-year-old female victim of an attempted abduction at knifepoint. The assailant was interrupted and drew his knife across the victim's throat as he fled the scene. A first responder on the scene immediately applied direct pressure to the neck wound. Your assessment reveals a very agitated young woman with ongoing blood loss despite direct pressure to the wound. There appears to be both bright-red bleeding and slower but steady dark-red bleeding. It appears that the trachea has not been penetrated but that there is a hematoma around the laceration. Which of the following is the most appropriate sequence of intervention for this patient?

A) Apply a pressure dressing to the wound, accompanied by pressure-point compression.
B) Use rapid sequence intubation of the patient to protect the trachea from the expanding hematoma while maintaining direct pressure on the wound.
C) Apply an occlusive dressing to the wound, and continue direct pressure.
D) Apply direct pressure, and request an order from medical control to decompress the hematoma.

Question 14

Which of the following groups has the highest trauma morbidity and mortality rates?

A) Males aged 11 to 35 years
B) Males aged 45 to 70
C) Both genders aged 60 to 75 years
D) Children aged 1 to 12 years

Question 15

A critical trauma patient should be reassessed every ________ minute(s) en route to the trauma center.

A) 5
B) 10
C) 15
D) 1

Question 16

Which of the following has the greatest potential for reducing injury-related morbidity and mortality?

A) Injury prevention activities
B) Increased funding for rural EMS system development
C) Increasing the scope of practice of paramedics to include such lifesaving procedures as pericardiocentesis and trephination of the skull to reduce intracranial pressure
D) Using physicians and physician's assistants as prehospital care providers

Question 17

Paramedics should do everything possible to ensure that they are on the scene of a traumatic emergency for no more than ________ minutes.

A) 15
B) 20
C) 10
D) 25

Question 18

Your patient is the 24-year-old female driver of a vehicle in a motor vehicle collision. She rear-ended a vehicle stopped at a traffic light at about 25 miles per hour. She was restrained, and the front airbags deployed. She is 32 weeks pregnant. She is anxious because she has not felt the baby move since the impact, and she is complaining of constant pain on the left side of her abdomen. Palpation of the abdomen reveals unusual firmness over the left side of the abdomen. The patient has a pulse of 116, a blood pressure of 92/60, and respirations of 28. Her skin is cool but dry, and she has no other complaints. For which of the following should you have the highest index of suspicion?

A) Placenta previa
B) Placenta accreta
C) Abruptio placentae
D) Stress-induced onset of labor

Question 19

Your patient is the 40-year-old male driver of a vehicle that was struck in the driver's-side door by another vehicle at an intersection. The estimated speed of the vehicle that struck the patient's car is 30 miles per hour. The patient was restrained, but his vehicle lacks side-impact airbags. On your arrival, he is awake and complaining of head pain. He has a 4 cm laceration to the left posterior parietal area of the head. There was moderate bleeding before your arrival, but the bleeding is now minor. Witnesses state that there was no loss of consciousness, but immediately following the collision, the patient seemed confused and did not immediately understand that witnesses wanted him to unlock his door and use his cell phone to call for help. The patient's skin is warm and dry, his respirations are 16, and the radial pulse is strong at 88 per minute. Which of the following most accurately describes how to best remove the patient from the vehicle?

A) Place a cervical collar, maintain manual stabilization of the cervical spine, place a vest-type extrication device, and remove the patient onto a long backboard.
B) Place a cervical collar, assist the patient in standing up, and then use a "standing take-down" to place him on a long backboard.
C) Place a cervical collar, place a long backboard on the stretcher, and position it next to the driver's door. Instruct the patient to slide onto the board as you maintain manual stabilization of the cervical spine.
D) Place a cervical collar, maintain manual stabilization of the cervical spine, and have the patient take several rest breaks, then move onto a long backboard.

Question 20

Which of the following best describes definitive care for the pregnant trauma patient with ongoing, significant hemorrhage?

A) Invasive hemodynamic monitoring and serial hematocrits
B) Administration of hypertonic crystalloid or colloid solution
C) Immediate surgery
D) Administration of blood or blood products

Question 21

Which of the following should the paramedic assess when performing palpation during examination of a trauma patient?

A) Discoloration, such as erythema or ecchymosis
B) General muscle tone
C) Hyporesonance or hyperresonance of the thorax and abdomen
D) The depth of open wounds

Question 22

Which of the following is NOT part of the key elements for the patient care report?

A) Results of assessment
B) Interventions
C) Results of interventions
D) Scene survey

Question 23

Bariatric patients are at greater risk for all of the following, EXCEPT:

A) Arrhythmias
B) Cardiac failure
C) Systemic hypertension
D) Bradycardia

Question 24

During which part of your assessment would you note the need for additional resources?

A) Scene size-up
B) Primary assessment
C) Secondary assessment
D) None of the above

Question 25

When administering fluid to a multisystem trauma patient with no signs of head injury but with signs of hypoperfusion, the paramedic should administer fluid only to maintain a systolic blood pressure equal to ________ mmHg.

A) 70
B) 80
C) 60
D) 100

Question 26

Which of the following is NOT an element of the scene size-up on a trauma response?

A) Assessing for scene hazards
B) Determining the number of patients
C) Setting up an IV
D) Evaluating the mechanism of injury

Question 27

All of the following are components of the revised trauma score, EXCEPT:

A) Glasgow Coma Scale
B) Systolic blood pressure
C) Pulse rate
D) Respiratory rate

Question 28

Which of the following best explains the importance of determining the trauma patient's level of consciousness and orientation in the primary assessment?

A) It determines whether the patient requires further assessment.
B) It provides immediate information about the severity of the patient's injury.
C) It immediately rules in or out the need for spinal immobilization.
D) It serves as a baseline for determining improvement or deterioration in the patient's condition.

Question 29

________ refers to a reduction in blood pressure caused by cardiac, vascular, neurogenic, or volume problems to a level that is lower than normal for the patient.

A) Hypotension
B) Hypovolemia
C) Hypoperfusion
D) Hypothermia

Question 30

The blood pressure of the pregnant woman falls by 5 to 15 mmHg during which trimester?

A) First
B) Second
C) Third
D) Fourth

Question 31

Which of the following patients' mechanisms of injury meets trauma triage criteria for transport to a trauma center?

A) A 17-year-old man with a gunshot wound to the arm
B) A 31-year-old man involved in a medium-velocity motor vehicle collision
C) A 10-year-old male soccer player with a laceration over his right eye after colliding with another player's head
D) A 9-year-old girl who fell 15 feet from the grandstand bleachers at a baseball game

Question 32

Which of the following is a reason for use of air medical transport in the out-of-hospital setting?

A) The patient has a low potential to require high-level life support available from an air medical helicopter, which is not available by ground transport.
B) The patient has a significant potential to require a time-critical intervention, and an air medical helicopter will deliver the patient to an appropriate facility faster than ground transport.
C) The patient is located in an area that would make ground transport viable or slightly delayed.
D) Local EMS resources are acceptable.

Question 33

In which type of vehicle impact are patients afforded the most protection?

A) Frontal impacts
B) Side impacts
C) Lateral impacts
D) None of the above

Question 34

Bariatric trauma patients have a mortality of up to ________ times greater than normal weight patients.

A) two
B) six
C) three
D) four

Question 35

Your patient is a 19-year-old man who was thrown from a horse while riding in a rodeo. After throwing the patient off, the horse stepped on the patient's abdomen. When you reach the patient, you note that his face, neck, and shoulders are pale, cool, and diaphoretic but that the patient's skin is otherwise warm and dry. The patient has some movement and sensation in his forearms and hands but otherwise no movement or sensation below the shoulders. He is anxious and has a respiratory rate of 24, a heart rate of 68, and a blood pressure of 106/66. Which of the following should be the primary concern when determining this patient's transport priority?

A) The potential for neurologic shock, requiring immediate surgery
B) The potential for intraabdominal hemorrhage that may be masked by loss of nervous function
C) The potential for traumatic brain injury
D) The potential for respiratory failure secondary to paralysis of the diaphragm

Question 36

Your patient is a four-year-old child. He has received an accidental gunshot wound to the groin and has lost a significant amount of blood. He responds to painful stimuli and has a heart rate of 150 with no radial pulse. Respirations are 32 and shallow. What is the total amount of intravenous fluid you should administer to this patient, assuming that his condition does NOT improve with intervention?

A) 10 mL/kg
B) 20 mL/kg
C) 30 mL/kg
D) 40 mL/kg