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Chapters 12-14
Intermediate Emergency Care And Transportation Of The Sick And Injured-Chapters 12-14
109
Medical
Professional
04/07/2013
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Term
A 40-year-old man has sustained a gunshot wound to the abdomen. He is hemodynamically stable at the scene. Which of the following facilities would be MOST appropriate transport destination?
 Definition
Level I trauma center
Term
A car is traveling at 55 mph when the unrestrained driver loses control and strikes a bridge pillar head-on. The driver will:
 Definition
continue to travel at 55 mph after the car impacts the pillar.
Term
Which of the following statements regarding kinetic energy (KE) is correct?
 Definition
Velocity of an object influences KE more than the object's weight.
Term
A force that acts on the body allows the EMT-I to predict the injury or injuries that occurred at the time of impact. This force is called:
 Definition
mechanism of injury.
Term
Which of the following statements is correct, regarding the second collision that occurs during a motor-vehicle crash?
 Definition
The resultant injuries are usually obvious and visible during the initial assessment.
Term
When assessing the interior of a crashed vehicle, which of the following findings would make you MOST suspicious that the patient sustained damage to his aorta or vena cava?
 Definition
Bent steering wheel underneath the airbag
Term
You are dispatched to the scene of a motor-vehicle crash, where a small passenger car
struck the back of a parked tractor-trailer. The driver of the car, a 39-year-old male, is
dead at the scene. The passenger, a 24-year-old female, is ambulatory and denies any pain or injury. You should:
 Definition
transport the passenger to an appropriate trauma center.
Term
While traveling at 70 mph, an unrestrained driver struck a utility pole. He is found lying across the front floorboard. On the basis of the mechanism of injury, you should expect to find injuries to the:
 Definition
pelvis, knees, or femurs.
Term
Whiplash-type injuries of the neck commonly occur during rear-end collisions, especially when the:
 Definition
headrest is not appropriately placed.
Term
A 21-year-old restrained male was struck on the driver's side of his car by another car
traveling approximately 45 mph. There is substantial intrusion into the passenger
compartment. Which of the following injuries are you LEAST likely to find during the rapid trauma assessment?
 Definition
Frontal and occipital brain trauma
Term
During a rollover crash, injuries sustained by an unrestrained passenger are difficult to predict because the:
 Definition
body may impact multiple parts of the vehicle's interior.
Term
When properly used, vehicle restraint systems:
 Definition
decrease the speed at which the occupant decelerates.
Term
The benefits of a properly worn shoulder restraint are lessened when the:
 Definition
seat is too close to the steering wheel.
Term
An infant or child is MOST protected from injury during a motor-vehicle crash when he or she is restrained in a safety seat that is:
 Definition
placed in the backseat as close to the center of the car as possible.
Term
Motorcycle collisions frequently cause serious injuries because:
 Definition
the rider is not protected by structures surrounding the bike.
Term
Which of the following would be LEAST pertinent when assessing the potential for serious injuries following a fall?
 Definition
Cause of the fall
Term
A fall is considered to be MOST significant when the patient:
 Definition
falls from a height greater than 15 feet.
Term
Head and spinal injuries after a patient falls and lands headfirst are MOST commonly seen in:
 Definition
children and divers.
Term
A 44-year-old male was stabbed with a knife in the abdomen during an altercation at a local bar. Although this is considered to be low-energy penetrating trauma, the patient has the GREATEST potential for serious internal injuries if the:
 Definition
assailant moved the knife in a twisting motion.
Term
In contrast to entrance wounds caused by a high-velocity gun, the exit wound is:
 Definition
pushed outward and is usually star-shaped.
Term
Following an explosion of a large fuel tanker, a 30-year-old male, who was near the tanker when it exploded, has a large piece of metal impaled in his chest. This injury MOST likely occurred:
 Definition
during the secondary phase of the explosion.
Term
In which of the following situations would the use of air transport be LEAST practical?
 Definition
A level I trauma center is approximately 15 minutes from the scene of a man with a gunshot wound to the head.
Term
Which of the following occurs during the second collision when a car traveling at a high rate of speed strikes a fixed object?
 Definition
The driver's body impacts with structures inside the vehicle.
Term
Which of the following mechanisms of injury and clinical assessment findings are MOST suggestive of a traumatic brain injury?
 Definition
Cracked windshield, slurred speech, combativeness, vomiting
Term
When properly applied, seat belts are successful in:
 Definition
preventing a second collision following a frontal impact.
Term
Rollover car crashes are particularly dangerous for unrestrained passengers because:
 Definition
multiple opportunities exist for second and third collisions.
Term
Perfusion is BEST defined as:
 Definition
circulation of blood within an organ or tissue.
Term
Blood leaves the capillary beds and is returned to the right side of the heart by the:
 Definition
venules and veins.
Term
Which of the following organs or systems can survive the longest without oxygen?
 Definition
Skeletal muscles
Term
During times of decreased perfusion, the autonomic nervous system:
 Definition
redirects blood to the most vital organs of the body.
Term
When managing a patient with severe bleeding, it is important to:
 Definition
take BSI precautions.
Term
If a patient is hemorrhaging, he or she is:
 Definition
bleeding.
Term
Which of the following injuries presents the greatest risk for severe internal bleeding?
 Definition
Pelvic fractures
Term
You should be MOST suspicious for serious bleeding when the:
 Definition
patient has a poor general appearance.
Term
Which of the following medications would interfere with the body's hemostatic effect?
 Definition
Anticoagulants
Term
During Stage 1 shock, the body compensates primarily by:
 Definition
constriction of the vascular bed.
Term
Following severe maxillofacial trauma, a 16-year-old male presents with oropharyngeal bleeding and inadequate respiratory effort. You should:
 Definition
suction the oropharynx.
Term
During your initial attempt to control severe external bleeding from an extremity, you should:
 Definition
apply direct pressure and elevate the extremity.
Term
A 19-year-old male sustained major head trauma following a motorcycle crash. During your assessment, you note the presence of blood draining from his left ear. What is the MOST important reason for not attempting to control the flow of this bleeding?
 Definition
An acute increase in intracranial pressure may occur.
Term
Which of the following occurs during shock (hypoperfusion)?
 Definition
The removal of metabolic waste products is decreased.
Term
Perfusion depends on adequate cardiac output, which is calculated as:
 Definition
heart rate times stroke volume.
Term
Long-term control of blood pressure is regulated by the:
 Definition
renal system.
Term
As perfusion decreases, the sympathetic nervous system is stimulated, resulting in:
 Definition
a release of epinephrine and norepinephrine.
Term
A patient in shock is experiencing tachycardia, among other signs. What physiologic response causes tachycardia during times of decreased perfusion?
 Definition
Beta1 receptor stimulation
Term
Anaerobic metabolism is a condition of the cell that results in:
 Definition
lactic acid production, decreased blood pH, and metabolic acidosis.
Term
A 20-year-old male has sustained blunt trauma to the face, chest, and abdomen after being attacked by a rival gang. Which of the following signs or symptoms would be MOST suggestive of decompensated shock?
 Definition
Narrowing pulse pressure
Term
Which of the following injuries or conditions would be LEAST likely to result in hypovolemic shock?
 Definition
Widespread vasodilation
Term
You are dispatched to a football game, where a spectator fell approximately 20' from the stands. As you approach the patient, you can see that he has obvious bilateral femur fractures. He is unconscious and appears to be breathing inadequately. Your initi
 Definition
open his airway and assess his breathing.
Term
When cleaning around her empty swimming pool, a 30-year-old female fell into the deep end of the pool. She presents with decreased sensation and movement in her lower extremities, a blood pressure of 80/50 mm Hg, and a heart rate of 50 beats/min. What is the MOST likely etiology of this patient's condition?
 Definition
Disruption of the nervous system and relative hypovolemia
Term
A 22-year-old male, who was the unrestrained driver of a car that struck a tree, has obvious bruising to his chest and abdomen. He is conscious but restless, has a blood pressure of 90/50 mm Hg, and a pulse rate of 110 beats/min, and is weak. There is no gross external bleeding. After applying 100% oxygen, performing a rapid trauma assessment, and immobilizing his spine, you should:
 Definition
immediately transport and administer crystalloid fluid boluses to maintain adequate perfusion.
Term
Which of the following injuries or conditions would contraindicate placing a patient in the shock position?
 Definition
Bilateral femur fractures
Term
A patient who presents with hypotension, jugular venous distention, and a rapid irregular pulse, should be suspected of experiencing:
 Definition
cardiogenic shock.
Term
Which of the following physiologic responses occurs during irreversible shock?
 Definition
Blood is shunted from the liver and kidneys to the brain and heart.
Term
Which of the following types of shock are caused by “relative hypovolemia”?
 Definition
Anaphylactic and neurogenic
Term
The goal of IV fluid replacement for the patient in hypovolemic shock is to:
 Definition
maintain adequate perfusion.
Term
In the majority of the population, a systolic BP of _______ is sufficient to adequately perfuse the brain and other vital organs.
 Definition
80 – 90 mm Hg
Term
After blood diffuses across the capillary membrane and perfuses the cells, it:
 Definition
returns waste products to the right side of the heart, starting with the venules.
Term
In the pulmonary circulatory system, deoxygenated blood leaves the heart and travels to the lungs via the:
 Definition
pulmonary artery.
Term
Which of the following conditions may afford the body longer periods of decreased perfusion before permanent damage occurs?
 Definition
Hypothermia with decreased metabolism
Term
When assessing a patient with blunt abdominal trauma, the severity of internal bleeding is BEST determined by:
 Definition
monitoring for signs of shock.
Term
A 22-year-old female was involved in a traumatic incident. She is exhibiting signs of shock, but there are no obvious external signs of trauma. You should suspect bleeding within the:
 Definition
abdominal cavity.
Term
Hemostasis is a natural response of the body in which:
 Definition
bleeding spontaneously clots through vasoconstriction and platelet aggregation.
Term
You are dispatched to a local nightclub for a patient who has been stabbed. After arriving at the scene and ensuring you and your partner's safety, you find the patient sitting on the ground. He is conscious, screaming in pain, and attempting to control bright red blood that is spurting from his groin area. After taking BSI precautions, you should:
 Definition
apply direct pressure to control the bleeding.
Term
Which of the following injuries or conditions would MOST likely overwhelm the body's hemostatic response and result in death?
 Definition
Ruptured aortic aneurysm
Term
A 21-year-old male has lost approximately 35% of his blood volume following a penetrating injury to the chest. Which of the following signs or symptoms would you NOT expect to see?
 Definition
Widened pulse pressure
Term
A patient is considered to be “orthostatic” if:
 Definition
the systolic pressure drops upon standing.
Term
What layer of the skin contains cells that are replaced with new cells that are formed in the germinal layer?
 Definition
Epidermis
Term
The layer of skin that lies below the germinal layer and contains nerves, sebaceous glands, and blood vessels is called the:
 Definition
dermis.
Term
The mouth, nose, and other body orifices are lined with ___________________, which secrete a watery substance and provide a protective barrier against harmful agents.
 Definition
mucous membranes
Term
Why does the skin become flushed or red when a person is exposed to a hot environment?
 Definition
Blood vessels dilate and heat radiates to the skin surface.
Term
A burn occurs when the soft tissue of the skin:
 Definition
receives more energy than it can absorb without injury.
Term
All of the following are characteristic of a closed soft tissue injury, EXCEPT:
 Definition
deformity of a short bone.
Term
A 28-year-old female was the unrestrained driver of a car that struck the rear end of another car while traveling at 35 mph. She is conscious and alert and complains of pain to the anterior chest. During your assessment, you note a large ecchymotic area over the superior aspect of the anterior chest. As your partner assumes manual stabilization of her head, you should:
 Definition
apply 100% oxygen via nonrebreathing mask.
Term
All patients with closed soft tissue injuries should be assessed for:
 Definition
serious hidden injuries.
Term
Priority treatment for a patient with an open soft tissue injury includes:
 Definition
hemorrhage management.
Term
Which of the following is the MOST significant acute complication associated with a laceration to the forearm?
 Definition
External bleeding
Term
You are dispatched to the scene of a shooting. Upon arrival, you are directed by law enforcement to the patient, a 44-year-old male, who is unconscious. He is lying in an impressive pool of blood and you can hear gurgling from his mouth when he breathes.
 Definition
suction the patient's oropharynx.
Term
When caring for an open wound that has small pieces of glass and other debris inside of it, you should:
 Definition
cover the wound with a sterile dressing.
Term
Appropriate management of a patient with an abdominal evisceration includes:
 Definition
covering the exposed organs with a moist, sterile dressing and securing it in place with a dry, sterile dressing.
Term
In which of the following circumstances would it be appropriate to remove an impaled object?
 Definition
Metal shard in the cheek and inadequate respiratory effort
Term
During an explosion, a metal worker sustained a large laceration to the left side of his neck by flying debris. He is conscious, but restless; the wound is moderately bleeding. Appropriate care for this patient's injury includes:
 Definition
preventing air from entering the wound and applying a pressure dressing.
Term
Death immediately following a burn is MOST commonly the result of:
 Definition
toxic chemical inhalation.
Term
An elderly male was removed from his burning house by firefighters. He has extensive full-thickness burns, is semiconscious, and has shallow stridorous respirations. After ensuring an open airway, you should:
 Definition
provide ventilatory assistance with a BVM and 100% oxygen.
Term
Common prehospital treatment for patients with severe burns includes all of the following, EXCEPT:
 Definition
tetanus prophylaxis.
Term
Which of the following factors has the MOST significant impact on determining the severity of a burn?
 Definition
Depth and extent of the burn
Term
Which of the following types of burns is characterized by intense pain and destruction of a portion of the dermis?
 Definition
Partial-thickness
Term
The “rule of palms” for estimating the extent of the body surface area (BS burned) is MOST useful with:
 Definition
irregularly-shaped burns.
Term
A 4-year-old male pulled a pot of boiling water from the stovetop. He has superficial and partial-thickness burns to his head, left anterior trunk, and left arm. On the basis of the “rule of nines,” what percentage of this child's body surface area (BSA) has been burned?
 Definition
36%
Term
A 55-year-old male sustained partial-thickness burns to his face and neck when he opened the hot radiator cap on his car. He is conscious and alert, but complains of dyspnea, and dysphagia. Your assessment reveals adventitious airway sounds and an oxygen saturation of 96% on room air. You should be MOST concerned about the:
 Definition
status of his airway.
Term
You arrive at the scene of a residential fire where the occupant, a 48-year-old male, has sustained partial- and full-thickness burns to his lower extremities and lower torso. Firefighters removed the patient's smoldering clothing and stopped the burning process prior to your arrival. The patient is conscious, but restless, and complains of intense pain to the burned areas. After taking the proper BSI precautions, you should:
 Definition
apply supplemental oxygen and monitor his airway.
Term
Patients with inhalation injuries rarely experience lower airway burns because:
 Definition
the upper airway absorbs the superheated air or steam, becomes edematous, and blocks the upper airway.
Term
When managing an adult patient with an inhalation injury, inspiratory stridor, and an altered mental status, you should:
 Definition
prepare for early definitive airway management.
Term
An industrial plant worker was splashed in the left eye with a strong acid chemical. The MOST appropriate initial care for this patient's injury is to:
 Definition
irrigate the eye laterally, away from the unaffected eye.
Term
High-voltage burn injuries occur MOST frequently in:
 Definition
utility workers.
Term
Upon arriving at the scene of a motor-vehicle crash involving a telephone pole, you note that the driver appears unconscious and is bleeding from the mouth. There is a power line across the hood and roof of the car. You should:
 Definition
ensure that the power line is not electrically active.
Term
You respond to a local golf course for a patient who was struck by lightning. After ensuring your own safety, you approach the patient, a 40-year-old male, who is lying in a supine position. Your first priority in the management of this patient is to:
 Definition
manually stabilize his head.
Term
When assessing a conscious patient who experienced an electrical injury, you note irregularity in his pulse. This is MOST indicative of:
 Definition
a cardiac dysrhythmia.
Term
You are assessing a 4-year-old male who was electrocuted when he stuck a pin into an electrical socket. He is conscious and alert and complains of pain to his left hand, where you find a small entrance wound. When treating this child, you should:
 Definition
anticipate extensive internal injuries.
Term
Following an electrical burn, estimating the extent of the BSA involved is:
 Definition
difficult because the degree and depth may be greater internally than externally.
Term
Common signs and symptoms of radiation sickness include:
 Definition
hair loss and skin burns.
Term
Which of the following factors have the MOST effect on a person's exposure to radiation?
 Definition
Exposure duration, distance, and shielding
Term
What occurs when ionizing radiation enters the body?
 Definition
It must naturally decay or be eliminated from the body.
Term
Your unit is the first to arrive at the scene of a radiation incident. From a safe distance, you can see several patients lying unconscious on the ground. You should:
 Definition
set up a staging area based on local protocols.
Term
When assessing a 50-year-old male with suspected internal bleeding, which of the following findings would be MOST pertinent?
 Definition
Dizziness or syncope upon standing
Term
A 49-year-old female attempted suicide by cutting her wrists. You have controlled the bleeding and your partner is taking her blood pressure. Upon noting signs of shock, you should:
 Definition
apply oxygen and transport immediately.
Term
All of the following can lead to shock (hypoperfusion), EXCEPT:
 Definition
increased venous return to the right atrium.
Term
A 50-year-old female with nausea, vomiting, and diarrhea complains of intense thirst and generalized weakness. Her blood pressure is 88/58 mm Hg and her pulse rate is 130 beats/min and thready. Which of the following treatment modalities would NOT be appropriate for her?
 Definition
Salt-containing solutions by mouth
Term
Which of the following assessment findings would be the LEAST reliable indicator of inadequate perfusion?
 Definition
BP of 104/60 mm Hg
Term
The MOST reliable indicator that suggests crystalloid IV fluids have improved perfusion is when the:
 Definition
radial pulses become stronger.
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