EMT Practice: Systems, Safety and Care Part 10

What part of the nervous system controls the body's voluntary activities?

- Autonomic

- Sensory

- Central

- Somatic

You should be MOST suspicious that a patient has experienced a significant head injury if his or her pulse is:

- irregular.

- weak.

- slow.

- rapid.

When immobilizing a trauma patient's spine, the EMT manually stabilizing the head should not let go until:

- the patient has been secured to the ambulance stretcher.

- an appropriately sized cervical collar has been applied.

- the patient has been completely secured to the backboard.

- the head has been stabilized with lateral immobilization.

Which of the following statements regarding secondary brain injury is correct?

- Signs are often present immediately after an impact to the head.

- It results from direct brain trauma following an impact to the head.

- Hypoxia and hypotension are the two most common causes of secondary brain injury.

- Because cerebral edema develops quickly, it is considered to be a primary brain injury.

The central nervous system (CNS) is composed of the:

- cerebrum and meninges.

- cerebellum and brain.

- meninges and spinal cord.

- brain and spinal cord.

In contrast to a cerebral concussion, a cerebral contusion:

- results from a laceration to the brain tissue.

- does not cause pressure within the skull.

- involves physical injury to the brain tissue.

- usually does not cause a loss of consciousness.

A tight-fitting motorcycle helmet should be left in place unless:

- the patient complains of severe neck or back pain.

- the patient must be placed onto a long backboard.

- the helmet is equipped with a full face shield or visor.

- it interferes with your assessment of the airway.

Hyperextension injuries of the spine are MOST commonly the result of:

- diving.

- falls.

- compression.

- hangings.

When assessing a patient with a head injury, you note the presence of thin, bloody fluid draining from his right ear. This indicates:

- rupture of the tympanic membrane following diffuse impact to the head.

- fractures to the internal structures of the ear following direct trauma.

- a linear skull fracture and a significant increase in intracranial pressure.

- significant pressure and bleeding in between the skull and dura mater.

A man jumped from the roof of his house and landed on his feet. He complains of pain to his heels, knees, and lower back. This mechanism of injury is an example of:

- axial loading.

- hyperflexion.

- distraction.

- hyperextension.

Common signs and symptoms of a serious head injury include all of the following, EXCEPT:

- decerebrate posturing.

- a rapid, thready pulse.

- CSF leakage from the ears.

- widening pulse pressure.

The Glasgow Coma Scale (GCS) is used to assess:

- eye opening, verbal response, and motor response.

- mental status, eye opening, and respiratory rate.

- sensory response, pupil reaction, and heart rate.

- verbal response, eye opening, and mental status.

Once a cervical collar has been applied to a patient with a possible spinal injury, it should not be removed unless:

- lateral immobilization has been applied.

- it causes a problem managing the airway.

- sensory and motor functions remain intact.

- the patient adamantly denies neck pain.

When activated, the sympathetic nervous system produces all of the following effects, EXCEPT:

- shunting of blood to vital organs.

- pupillary constriction.

- dilation of the bronchiole smooth muscle.

- increase in heart rate.

What is ventilation?

- The process of removing carbon dioxide and waste products from the body

- The exchange of gases across the alveoli of the lungs

- The process of delivering oxygen to the cells

- The body's ability to move air in and out of the chest and lung tissue

When a patient sustains a spinal cord injury above the C3 region, which of the following is likely to happen?

- Loss of the ability to breathe due to loss of ability of phrenic nerves to function

- Cardiogenic shock

- Severe pain radiating from C3 down to L1

- Belly breathing due to the loss of power to move the intercoastal muscles

You are assessing a patient who sustained a blunt force chest injury during a motorcycle accident. There are no obvious signs of external bleeding, but the patient is hypovolemic and there are decreased breath sounds on the left side. Which of the following should you suspect?

- Hemopneumothorax

- Traumatic asphyxia

- Hemothorax

- Pneumothorax

Which of the following are you likely to see in flail chest?

- Paradoxical motion

- Ventricular fibrillation

- Myocardial contustion

- Belly breathing

What are the two most common injuries caused by penetrating chest trauma?

- Commotio cordis and hemopneumothorax

- Pulmonary and myocardial contusion

- Open pneumothorax and cardiac tamponade

- Flail chest and simple pneumothorax

What is the best position in which to place a patient when you want to assess for jugular vein distention?

- Modified fowler

- Prone

- Sitting at a 45-degree angle

- Supine

You are assessing a patient and notice he has a collapsed jugular vein. What does this indicate?

- Tension pneumothorax

- Hemothorax

- Commotio cordis

- Cardiac tamponade

You are treating a patient who fell hard on her right side when she fell off a bike. Exposure of the patient's chest reveals a large bruise on the lateral aspect of the right side of the chest. When you palpate the area, the patient yells out in extreme pain and states that she cannot take a deep breath. What condition should you suspect?

- Rib fractures

- Open pneumothorax

- Spontaneous pneumothorax

- Cardiac tamponade

Which of the following blood vessels can be lacerated by a fractured rib?

- Jugular vein

- Iliac veins

- Aorta

- Brachial artery

In which condition is it recommended you use positive-pressure ventilation?

- Pneumothorax

- Tension pneumothorax

- Traumatic asphyxia

- Flail chest

Closed chest injuries are typically caused by _______.

- high-velocity weapons

- penetrating trauma

- blunt trauma

- flying debris

A man called EMS 12 hours after injuring his chest. Your assessment reveals a flail segment to the right side of the chest. The patient is experiencing respiratory distress and his oxygen saturation is 78%. His breath sounds are equal bilaterally and his jugular veins are normal. You should suspect:

- traumatic asphyxia.

- tension pneumothorax.

- pulmonary contusion.

- massive hemothorax.

Patients with chest injuries will often present with _______.

- Cheyne-Stokes respirations

- tachypnea

- Kussmaul respirations

- agonal respirations

You arrive at the scene of a major motor vehicle crash. The patient, a 50-year-old female, was removed from her vehicle prior to your arrival. Bystanders who removed her state that she was not wearing a seatbelt. The patient is unresponsive, tachycardic, and diaphoretic. Your assessment reveals bilaterally clear and equal breath sounds, a midline trachea, and collapsed jugular veins. You should be MOST suspicious that this patient has experienced a:

- massive hemothorax.

- pericardial tamponade.

- laceration of the aorta.

- tension pneumothorax.

Immediately life-threatening chest injuries must be found and managed during the _______.

- scene size-up

- secondary assessment

- primary assessment

- patient history

Which of the following is most likely to cause immediate death?

- Myocardial contusion

- Aortic rupture

- Pulmonary contusion

- Aortic dissection

When a person is lying supine at the end of exhalation, the diaphragm:

- contracts and flattens inferiorly.

- may rise as high as the nipple line.

- is less prone to penetrating trauma.

- descends below the level of the navel.

An open pneumothorax occurs when:

- a fractured rib perforates the tissue of the lung.

- air enters the pleural space from outside the body.

- extreme pleural pressure causes the lung to rupture.

- air enters the pleural space from a perforated lung.

Following a stab wound to the left anterior chest, a 25-year-old male presents with a decreased level of consciousness and signs of shock. Which of the following additional assessment findings should increase your index of suspicion for a cardiac tamponade?

- Engorged jugular veins

- A rapid, irregular pulse

- Diminished breath sounds

- Widening pulse pressure

If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she:

- will maintain adequate minute volume if his or her respiratory rate stays the same.

- often breathes at a slower rate because of lung damage caused by the injury.

- must increase his or her respiratory rate to maintain adequate minute volume.

- will eliminate more carbon dioxide than if he or she were breathing deeply.

In order to avoid exacerbating a patient's injury, it is especially important to use extreme caution when providing positive-pressure ventilation to patients with a:

- pneumothorax.

- cardiac tamponade.

- myocardial contusion.

- flail chest.

A simple pneumothorax:

- is commonly caused by blunt chest trauma.

- heals on its own without any treatment.

- often has a nontraumatic cause.

- is caused by penetrating chest trauma.

A 28-year-old male was struck in the chest with a baseball bat during an altercation. He is conscious and alert and complains of severe chest pain. Your assessment reveals a large area of ecchymosis over the sternum and a rapid, irregular pulse. In addition to providing supplemental oxygen, you should:

- apply bulky dressings to the sternum.

- prepare for immediate transport.

- apply an AED and assess his BP.

- determine if he has cardiac problems.

Children are often "belly breathers" because _______.

- they are routinely hypoxic

- they are consciously controlling ventilations

- their intercostal muscles are not developed

- their diaphragm is not functional

While jogging, a 19-year-old male experienced an acute onset of shortness of breath and pleuritic chest pain. He is conscious and alert with stable vital signs. Your assessment reveals that he has diminished breath sounds over the left side of the chest. You should:

- circumferentially tape a dressing around his chest.

- recognize that he needs a needle decompression.

- immediately perform a rapid head-to-toe exam.

- administer oxygen and transport to the hospital.

You have sealed the open chest wound of a 40-year-old male who was stabbed in the anterior chest. Your reassessment reveals that he is experiencing increasing respiratory distress and tachycardia, and is developing cyanosis. You should:

- begin ventilatory assistance.

- partially remove the dressing.

- call for a paramedic ambulance.

- begin rapid transport at once.

A spinal cord injury at the level of C7 would MOST likely result in:

- paralysis of all the respiratory muscles.

- paralysis of the intercostal muscles.

- paralysis of the diaphragm.

- immediate cardiac arrest.

A flail chest occurs when:

- a segment of fractured ribs bulges during the inhalation phase.

- a segment of the chest wall is detached from the thoracic cage.

- more than three ribs are fractured on the same side of the chest.

- multiple ribs are fractured on both sides of the thoracic cage.

You respond to a residence for a 40-year-old female who was assaulted by her husband; the scene has been secured by law enforcement. Upon your arrival, you find the patient lying supine on the floor in the kitchen. She is semiconscious with severely labored breathing. Further assessment reveals a large bruise to the left anterior chest, jugular venous distention, and unilaterally absent breath sounds. As your partner is supporting her ventilations, you should:

- obtain a set of baseline vital signs.

- perform a focused secondary exam.

- immediately request ALS support.

- insert an oropharyngeal airway.

The thoracic cavity is separated from the abdominal cavity by the:

- intercostal margin.

- diaphragm.

- anterior rib cage.

- costovertebral angle.

Bruising over the right upper quadrant could indicate injury to which of the following?

- Liver

- Appendix

- Kidney

- Colon

You should have an index of suspicion that a patient with pain referred to the right shoulder has an injury to which organ?

- Intestine

- Bladder

- Liver

- Kidney

Which of the following are considered solid organs?

- Pancreas and spleen

- Liver and intestines

- Kidneys and bladder

- Spleen and stomach

Which of the following signs would indicate that an injury to the kidney has occurred?

- Hemoptysis

- Hematemesis

- Hematuria

- Hematoma

You are assessing a patient who reports pain that is tearing and describes it as going from the abdomen posteriorly. What should you suspect?

- Gallbladder inflammation

- Kidney damage

- Dissecting abdominal aneurysm

- Ruptured appendix

What is the major cause of death following injury to a hollow organ in the abdomen?

- Sepsis

- Evisceration

- Rigidity

- Internal hemorrhage

What is the purpose of wrapping a sexual assault victim in a burn sheet?

- To keep the patient calm (swaddling)

- To protect the patient's privacy

- To maintain body temperature as a result of shock

- To preserve potential evidence

Which of the following is an indication of a spleen injury?

- Radiating pain from left upper quadrant down through the flank

- Hematuria

- Referred left shoulder pain

- Referred right shoulder pain

Which of the following statements is true?

- There are four levels of velocity.

- Low-velocity injuries produce extensive temporary would channels.

- The velocity of an object is not a critical determination in your assessment.

- The higher the velocity of a projectile, the larger the cavity it produces.

Where is abdominal injury most likely to occur in young children?

- Appendix

- Liver

- Gallbladder

- Fractured ribs

All of the following are hollow abdominal organs, EXCEPT the:

- ureters.

- bladder.

- spleen.

- stomach.

Which of the following organs would MOST likely bleed profusely when injured?

- Intestine

- Stomach

- Liver

- Bladder

You are transporting a patient with blunt abdominal trauma. The patient is unstable and is experiencing obvious signs and symptoms of shock. Your estimated time of arrival at the hospital is less than 10 minutes. After treating the patient appropriately, you should:

- perform a comprehensive secondary assessment.

- begin documenting the call on the patient care form.

- closely monitor him and reassess him frequently.

- forgo the hospital radio report because of his condition.

Difficulty breathing and a sunken appearance of the anterior abdominal wall is MOST indicative of a ruptured:

- aorta.

- diaphragm.

- stomach.

- spleen.

You are transporting a 42-year-old male who experienced blunt abdominal trauma. He is receiving oxygen at 12 L/min via a nonrebreathing mask and full spinal precautions have been applied. During your reassessment, you note his level of consciousness has decreased and his respirations have become shallow. You should:

- suction his oropharynx to ensure it is clear of secretions and then increase the oxygen flow rate to 15 L/min.

- reassess his vital signs and then notify the receiving hospital of the change in his clinical status.

- perform a comprehensive secondary assessment to determine why his clinical status has changed.

- insert an airway adjunct if he will tolerate it and begin assisting his ventilations with a BVM.

Which of the following statements regarding abdominal eviscerations is correct?

- The protruding organs should be kept warm and moist.

- Most eviscerations occur to the left upper quadrant.

- The organs should be replaced carefully to avoid heat loss.

- Adherent material is preferred when covering an evisceration.

In pediatric patients, the liver and spleen are _______.

- more protected by the thorax compared to adults

- larger in proportion to the abdomen

- less likely to bleed when injured

- smaller in proportion to the abdomen

Compression injury is most likely due to which of the following?

- Hollow-organ rupture

- Improperly placed lab belt

- Ejection of unrestrained driver

- Stabbing

Because the depth of an open abdominal wound is often difficult to determine:

- the abdomen must be vigorously palpated.

- prompt transport to the hospital is essential.

- vital signs should be monitored frequently.

- the EMT must perform a thorough exam.

A 54-year-old male experienced an avulsion to his penis when his foreskin got caught in the zipper of his pants. He was able to unzip his pants and remove the foreskin prior to your arrival. Your assessment reveals that he is in severe pain and that the avulsion is bleeding moderately. The MOST appropriate treatment for this patient includes:

- applying direct pressure with a dry, sterile dressing.

- administering 100% oxygen via a nonrebreathing mask.

- requesting a paramedic to administer pain medication.

- covering the avulsion with moist, sterile dressings.

Your documentation on a sexual assault victim should _______.

- be objective and factual

- describe the status of the suspect(s)

- include your opinion of the nature of the incident

- be subjective and summarize the crime

Placing a pregnant patient in a supine position during the third trimester of pregnancy:

- is recommended if the patient has severe abdominal discomfort.

- results in spontaneous urinary incontinence if the bladder is full.

- may decrease the amount of blood that returns to the heart.

- often causes hypotension secondary to cardiac compression.

Which of the following is true regarding injury to the kidneys?

- Kidney injuries are rarely caused by blunt trauma.

- Injury to the kidneys usually indicates injury to other organs.

- The kidneys are not well protected.

- Only minimal force is needed to damage the kidneys.

Abdominal pain, vomiting, and fever are most likely due to _______.

- evisceration

- infection

- hypovolemia

- hemorrhage

You should suspect a kidney injury anytime the patient presents with _______.

- dyspnea

- abdominal distention

- a hematoma in the flank region

- nausea

Injuries to the external male genitalia _______.

- frequently lead to hypovolemic shock

- are often life-threatening

- are rarely life-threatening

- usually result in permanent damage

When a patient stiffens the muscles of the abdomen, it is known as _______.

- distention.

- instability.

- guarding.

- crepitus.

When a hollow organ is punctured during a penetrating injury to the abdomen:

- it commonly protrudes through the injury site.

- it will bleed profusely and rapidly cause shock.

- peritonitis may not develop for several hours.

- the abdomen will become instantly distended.

When should you visually inspect the external genitalia on your patient?

- Only when there is a complaint of severe pain or other injury

- Only when ordered by medical direction

- Always during the secondary assessment

- Anytime the patient agrees to treatment and transport

Your presence is requested by law enforcement to assess a 33-year-old female who was sexually assaulted. The patient is conscious and obviously upset. As you are talking to her, you note an impressive amount of blood on her clothes in the groin area. Her blood pressure is 98/58 mm Hg, her pulse is 130 beats/min, and her respirations are 24 breaths/min. You should:

- arrange for a rape crisis center representative to speak with the patient.

- allow her to change her clothes and take a shower before you transport.

- control any external bleeding, administer oxygen, and transport at once.

- visualize the vaginal area and pack the vagina with sterile dressings.

When assessing distal circulation in a patient's lower extremities, which pulse should you palpate?

- Popliteal

- Iliac

- Dosalis pedis

- Femoral

Which MOI causes a fracture or dislocation at a distant point?

- Indirect force

- High-impact injury

- Direct blow

- Twisting force

What is the most reliable indicator of an underlying fracture?

- Deformity

- Crepitus

- Guarding

- Point tenderness

A disruption of a joint in which the bone ends are no longer in contact is known as what?

- Strain

- Fracture

- Dislocation

- Sprain

In the musculoskeletal injury grading system, under which category would you place a laceration of a major nerve or blood vessel?

- Moderate

- Serious

- Critical

- Severe

Which of the following would you use to stabilize an AC separation?

- Sling and swathe

- Traction splint

- Zippered air splint

- Rigid splint

You are attending to a patient with a nondisplaced elbow fracture. She has a strong pulse and good capillary refill. How should you address this type of injury?

- Apply ice to reduce swelling.

- Apply a sling and swathe to reduce pain.

- Splint from the shoulder joint to the wrist joint to stabilize the entire arm.

- Apply a Sager traction splint to stabilize the joint.

What is the primary goal of in-line traction?

- Reduce swelling

- Minimize pain

- Avoid further neurovascular compromise

- Prevent permanent disability

Which sign/symptom would give you a high index of suspicion that a patient may have compartment syndrome?

- Referred pain

- Limb deformity

- Hypersensation

- Disproportionate pain

Which of the following is a drawback of an air splint?

- Temperature changes affect air pressure in the splint.

- It restricts distal blood flow.

- It is complicated to use and requires multiple EMTs.

- It does not provide uniform contact, so bone movement is possible.

During your assessment of a 29-year-old female with significant deformity to her left elbow, you are unable to palpate a radial pulse. Your transport time to the hospital is approximately 40 minutes. You should:

- splint the elbow in the position of deformity and transport immediately.

- carefully straighten the injured arm and secure it with padded board splints.

- apply gentle manual traction in line with the limb and reassess for a pulse.

- make two or three attempts to restore distal circulation by manipulating the elbow.

Which of the following musculoskeletal injuries would pose the greatest threat to a patient's life?

- Bilateral femur fractures

- Nondisplaced long bone fractures

- Pelvic fracture with hypotension

- An amputated extremity

A "hip" fracture is actually a fracture of the:

- proximal femur.

- femoral shaft.

- pubic symphysis.

- pelvic girdle.

The musculoskeletal system refers to the:

- connective tissue that supports the skeleton.

- bones and voluntary muscles of the body.

- nervous system's control over the muscles.

- involuntary muscles of the nervous system.

With regard to musculoskeletal injuries, the zone of injury is defined as the:

- part of the body that sustained secondary injury.

- area of soft-tissue damage surrounding the injury.

- exact part of the bone or joint that was disrupted.

- area of obvious deformity over the site of impact.

A supracondylar or intercondylar fracture is also known as a fracture of the:

- olecranon process.

- radial head.

- distal humerus.

- proximal radius.

In general, musculoskeletal injuries should be splinted before moving the patient unless:

- deformity and swelling are present.

- the patient is in severe pain.

- the patient is clinically unstable.

- transport time is less than 15 minutes.

Which of the following statements regarding compartment syndrome is correct?

- In most cases, compartment syndrome develops within a few minutes after an injury.

- Most cases of compartment syndrome occur following a severe fracture of the pelvis.

- Compartment syndrome typically develops within 6 to 12 hours after an injury.

- Compartment syndrome occurs because of increased pressure within the bone cavity.

Skeletal muscle is attached to the bone by tough, ropelike, fibrous structures called:

- cartilage.

- fascia.

- tendons.

- ligaments.

The MOST significant hazard associated with splinting is:

- reduction in circulation distal to the injury site.

- aggravation of the injury or worsened pain.

- delaying transport of a critically injured patient.

- compression of nerves, tissues, and vasculature.

When caring for a patient with a possible fracture of the scapula, the EMT should:

- carefully assess the patient for breathing problems.

- assume that minimal force was applied to the back.

- apply rigid board splints across the chest and back.

- recognize that scapular fractures are life threatening.

An open fracture is MOST accurately defined as a fracture in which:

- a bullet shatters the underlying bone.

- a large laceration overlies the fracture.

- bone ends protrude through the skin.

- the overlying skin is no longer intact.

A 17-year-old female dislocated her patella while playing soccer. Her knee is flexed and she complains of severe pain. You should:

- keep her knee flexed and secure it with padded board splints.

- flex her knee slightly more and assess for distal circulation.

- make one attempt to return the patella to its normal position.

- gently straighten her knee and apply a padded board splint.

In which of the following situations should the EMT splint an injured limb in the position of deformity?

- When distal circulation and neurological functions are absent

- If transport time to the hospital is greater than 20 to 30 minutes

- If a traction splint will be used to immobilize the injured extremity

- If resistance is encountered or the patient experiences severe pain

A 22-year-old female was ejected from her car after striking a tree head-on. As you approach her, you note obvious closed deformities to both of her femurs. She is not moving and does not appear to be conscious. You should:

- apply manual stabilization to both of her femurs.

- administer oxygen and perform a rapid assessment.

- stabilize her head and perform a primary assessment.

- assess for a carotid pulse and assist her ventilations.

A 54-year-old male accidentally shot himself in the leg while cleaning his gun. Your assessment reveals a small entrance wound to the medial aspect of his right leg. The exit wound is on the opposite side of the leg and is actively bleeding. The patient complains of numbness and tingling in his right foot. You should:

- control the bleeding and cover the wound with a sterile dressing.

- assess distal pulses as well as sensory and motor functions.

- gently manipulate the injured leg until the numbness dissipates.

- manually stabilize the leg above and below the site of injury.

During your primary assessment of a 19-year-old unconscious male who experienced severe head trauma, you note that his respirations are rapid, irregular, and shallow. He has bloody secretions draining from his mouth and nose. You should:

- assist his ventilations with a BVM.

- suction his oropharynx for up to 15 seconds.

- immobilize his spine and transport immediately.

- pack his nostrils to stop the drainage of blood.