1
After being assaulted by her boyfriend, an 18-year-old female who is 33 weeks pregnant is round unresponsive in the bedroom. She has been beaten in the head and abdomen as evidenced by multiple hematomas and lacerations to these areas. Which finding should concern you the most and be addressed first?
Bright red vaginal bleeding
Abdominal contusions
Room air SpO2 of 93%
Rapid heart rate
C
With the patient possessing a room air saturation of 93% the baby is likely not receiving enough oxygen.
What instructions would you provide to the Emergency Medical Responders when treating a patient who was punched in the eye and now has blood in the anterior chamber?
We will need to cover both eyes with patches before we transport him.""
Let's apply a cold pack to the eye and immobilize him for transport.""
Let's put a shield over the eye and bandage it in place to apply some pressure to the eye.""
It is important to keep pressure down in the eye so we will transport him in a sitting position." "
A
We will need to cover both eyes with patches before we transport him.' Covering both eyes is important to ensure the unaffected eye does not cause the injured eye to move causing additional injury.
Who should a full-body scan be performed on?
Stable patients who are able to tell you exactly what happened.
All patients with traumatic injuries who will require EMS transport.
Responsive medical patients and patients without a significant MOI.
Patients with a significant MOI and unresponsive medical patients.
D
Full-body scans should be completed on patients with a significant MOI and unresponsive medical patients. It is important to do a full-body scan to find any injuries that are not obvious as well as find signs or symptoms of a medical patient.
After performing the primary assessment on a patient with a gunshot wound on his left hand, your partner quickly focuses his attention on the left hand and begins a specific assessment of the injury. What type of exam is your partner performing?
Rapid
Extremity
Specific
Focused
D
After a 30 feet fall,, a construction worker is semiconscious with rapid, shallow respirations. Further assessment reveals deformity to the thoracic region of the spine. His blood pressure is 70/50 mmHg, his pulse is 66 beats/min and weak, and his skin is warm and dry. In addition to spinal immobilization and rapid transport, what should your treatment include?
oxygen via non-rebreathing mask, blankets for warmth, and elevation of his head.
assisted ventilation, thermal management, and elevation of the lower extremities.
oxygen via non-rebreathing mask, thermal management, and elevation of the legs.
assisted ventilation, preventing hyperthermia, and elevating his lower extremities.
B
Assisted ventilation as the patient's breathing is not adequate. Thermal management and elevation of the lower extremities to mange shock symptoms.
A young boy was running with a pencil and tripped. The pencil impaled the boy's left eye and remains lodged in place. He is in his mother's arms and both are crying hysterically. To treat the eye appropriately you would include:
stabilizing the impaled object and providing immediate transport.
applying gentle pressure to the pencil and eye to prevent movement followed by immediate transport.
carefully removing the pencil from the eye to prevent the loss of vision, then providing immediate transport.
applying ice to the affected eye to decrease pressure, swelling, and subsequent damage.
A
Stabilizing the impaled object and providing immediate transport is the most appropriate treatment plan.
Of the following, what assessment finding would best indicate that a patient has suffered a full thickness burn to his leg?
Moist skin with blisters
Charred skin with intense pain
Red skin that is painful
Dry skin with little pain
D
A full thickness burn is characterized by dry skin and little pain due to pain receptors being damaged.
The assessment of a patient involved in a motor vehicle collision reveals a deformity to the left side of the head underneath the hair. On further inspection you note that the skin overlying the deformity is till intact. Based on these assessment findings, which is your greatest concern?
Possible brain injury
Potential for infection of the brain
Fracture of the skull
Soft tissue trauma to the scalp
A
With a deformity present to the left side of the head there is a possibly of a closed brain injury.
You should detect which one of the following injuries or conditions when performing the secondary assessment of a critical patient?
Inadequate respiratory effort.
Weak carotid pulse and clammy skin.
Bruising and tenderness to the abdomen.
Decreased level of consciousness.
C
Bruising and tenderness to the abdomen are indicators of internal bleeding which prioritizes the patient as an emergent transport. All of the other responses you should have noticed during the primary assessment.
You have covered an open chest wound with your gloved hand and the patient's breathing has improved. In order to free your hand to provide further care, you would have to:
cover the wound with an occlusive dressing.
remove your hand to see if the wound has closed.
apply a bulky dressing over the wound.
cover the wound with a sterile dressing.
A
An occlusive dressing secured on three sides covering the wound will help to seal the wound but allow air to escape from the chest cavity.
In order to classify a burn as either superficial, partial thickness, or full thickness, you would need to determine the:
percentage of body burned.
agent causing the burn.
depth of the burn.
time of heat exposure.
C
The depth of a burn classifies the burn as superficial, partial thickness, or full thickness.
Which of the following information should you gain first when assessing a patient that has been stabbed?
Angle at which the knife entered the patient.
Make and model of the knife.
Size and type of the knife.
Owner of the knife.
C
The size and type of the knife will determine the mechanism of injury and provide information on how deep the stab wound may be and the severity of the wound.
A 29-year-old male complains of a severe headache and nausea that has gradually worsened over the past 12 hours. He is conscious, alert, and oriented and tells you that his physician diagnosed him with migraine headaches. He further tells you that has taken numerous different medication, but none of them seem to help. His blood pressure is 132/74 mm Hg, his pulse is 110 beats/min and strong, and his respirations are 20 breaths/min and adequate. In addition to high-flow oxygen your treatment would include:
assisting him with his migraine medication and transporting without lights and siren.
placing him in a supine position and transporting with lights and siren to a stroke center.
applying warm compresses to the back of his neck and transporting with light and siren.
dimming the lights in the back of the ambulance and transporting without lights and siren.
D
The patient's condition can worsen with bright lights and use of lights and sirens during transport. Dimming the lights in the back of the ambulance and transporting without lights and siren will provide a more positive outcome than an emergent transport.
An open fracture would MOST accurately be defined as a fracture in which:
bone ends protrude through the skin.
a large laceration overlies the fracture.
a bullet shatters the underlying bone.
the overlying skin is no longer intact.
D
An open fracture would MOST accurately be defined as a fracture in which the overlying skin is no longer intact.
A patient is being extricated from a car using a vest-type short immobilization device. After the patient has been extricated, you would:
remove the vest-type short immobilization device and secure the patient to a long backboard.
immobilize the patient with the vest-type short immobilization device to a long backboard.
secure the patient and vest device in a supine position on the stretcher with the legs flexed.
place the patient in a semi-Fowler's position on the stretcher for transport to the hospital.
B
The patient can remain in the vest-type short immobilization device and secure the patient to a long backboard.
You have been called to a high school science lab where a male student was splashed in the eye with an alkaline solution. He is complaining of burning to the eye as well as pain. After performing the primary assessment and finding no life-threatening conditions, you next step would be:
obtain a set of vital signs and determine if the patient is taking medications or has any past medical problems.
hold the patient's eye open and begin flushing with large amounts of tap water and continue throughout transport.
determine the exact compound the patient was splashed with and the appropriate chemical antidote.
cover both eyes with shields and move to the ambulance for immediate transport.
B
Holding the patient's eye open and flushing the eye with large amounts of tap water is the initial treatment. The flushing should continue throughout transport being sure to not allow the runoff to enter the unaffected eye.
Of the following patients, which would justify the need to directly transport to a trauma center based on special patient considerations?
An unlicensed teenage driver who has a pulse rate of 120 after a MVC and a 4 minute EMS response
An elderly patient on anticoagulants who slipped out of her wheelchair and is complaining of pelvis pain
An end-stage renal disease (ERSD) patient who tripped and fell and is complaining of shoulder pain on the same side as his shunt
A pregnant female in the third trimester who is spotting (showing small amounts of vaginal bleeding) following a low mechanism of injury MVC
D
The pregnant female is at a higher risk for complications due to being in the third trimester even in a low mechanism of injury situation.
A patient that has fallen 30 feet had previously been responding to your questions suddenly stops responding during your detailed physical exam. What should be done next?
Call medical control for orders.
Continue the detailed physical assessment.
Start CPR.
Repeat the primary assessment.
D
The patient was experienced a significant change in mental status. Reassess the primary assessment to evaluate the patine's airway, breathing, and circulation.
Of the following, which is the most significant mechanism of injury for a driver in a vehicle accident?
Death of a passenger in the same vehicle
Rear-end collision
Encroachment greater than 12 inches of the driver's compartment
Spidering of the windshield
A
The most significant mechanism of injury is a death in the same vehicle. This means the forces encountered during the incident were so intense a person was unable to survive.
When splinting an injury of the wrist, the hand must be placed:
into a fist.
in a straight position.
in an extended position.
in a functional position.
D
When splinting an injury of the wrist, the hand must be placed in a functional position. This is normally with the fingers slightly curled to a position of comfort.
A patient was stabbed in the right anterior chest and is in obvious respiratory distress. As you perform the secondary assessment, what signs and/or symptoms would concern you that she is suffering from a tension pneumothorax?
Respiratory distress, absent breath sounds on the left, flat neck veins, tachycardia
Absent breath sounds on the right, distended neck veins, tracheal deviation to the left
Absent breath sounds on the left, hypotension, SpO2 at 98%, bradycardia
Absent breath sounds on the right, tracheal deviation to the right, cyanosis
B
Absent breath sounds on the right, distended neck veins, tracheal deviation to the left are all strong indicators of a tension pneumothorax.
A patient has been pulled from a house fire. Assessment reveals him to be lethargic with stridorous respirations and a rapid but strong radial pulse. Firefighters are dousing his body with water to cool him. Your next immediate action would be:
Provide positive pressure ventilation with a bag-valve mask.
Determine if critical areas of the body have been burned.
Begin removing the patient's clothes to determine the type of burn.
Administer oxygen through a non-rebreather face mask and obtain a full set of vitals.
A
Airway and breathing are always priority for burn victims. Providing positive pressure ventilation will help to ensure adequate oxygenation and ventilation.
A 77-year-old woman slipped and fell on a throw rug and landed on her left hip. She denies striking her head or losing consciousness. Assessment of her left leg reveals that it is shortened and externally rotated. Distal pulses, sensory, and motor functions are intact. Your next step would be to:
manually stabilize her left leg, apply a traction splint, and then source her to a long backboard or scoop.
carefully slide a long backboard underneath her, keep her in a supine position, and apply a splint to her leg.
place her onto a scoop stretcher, pad around her left hip with pillows, and secure her to the scoop with straps.
bind both of her legs together with triangular bandages and carefully secure her onto the ambulance stretcher.
C
By utilizing a scoop stretcher the patient does not need to be rolled. Place padding around her left hip with pillows, and secure her to the scoop with straps.
A patient who cannot remember the events that preceded their head injury is experiencing:
retrograde amnesia.
anterograde amnesia.
perigrade amnesia.
post-traumatic amnesia.
A
Retrograde amnesia (RA) is a loss of memory-access to events that occurred, or information that was learned, before an injury or the onset of a disease.
As well as severe bleeding, the MOST life-threatening complication associated with an open neck injury is:
an air embolism.
a spinal fracture.
an ischemic stroke.
nerve fiber damage.
A
An air embolism is blockage of blood supply caused by air bubbles in a blood vessel or the heart.
How will you conduct the rapid secondary assessment on an unresponsive 31-year-old male severely injured in a car accident that is being ventilated by your partner using a bag-valve mask?
Focus on the chest and abdomen.
Perform a head-to-toe exam.
Focus on the head and torso.
Palpate the body but do not auscultate.
B
With the patient being unresponsive it is imperative to perform a thorough head-to-toe exam to discover any injuries.
Of the following, which would MOST likely occur as the direct result of the second collision in a motor vehicle crash?
collapsed dashboard
deformed steering wheel
caved-in passenger door
intrathoracic hemorrhage
B
The second collision in a motor vehicle crash is when the body strikes an object inside the vehicle. In this case the body strikes the steering wheel.
Of the following statements about removing a helmet in the prehospital setting, which one is true?
Any patient wearing a helmet should have it removed so the airway and breathing can be properly assessed.
It is acceptable to leave the helmet on a patient if the patient has no airway or breathing problems.
Since helmets should never be removed, you must be creative in providing care around the obstacle of a helmet.
Helmets should only be removed if they are too tight or spinal immobilization will be required.
B
The helmet can and should remain in place as long as it is not impeding any airway or breathing of the patient.
On assessment of the midsection of a 32-year-old male who was struck by a car, you find an abdominal evisceration with several loops of his large intestine exposed. The abdomen appears to have a clean-cut laceration and the bleeding is controlled. Of the following, which is the BEST approach toward managing the exposed intestines?
Moisten a sterile dressing with saline solution and cover the abdominal contents
Cover the abdomen with an occlusive dressing of aluminum foil.
Gently replace the intestines after moistening with sterile solution.
Leave the abdominal contents in the place in which they were found and transport immediately.
A
An abdominal evisceration should be covered by a moist sterile dressing covering the exposed intestines.
A construction worker has been shot with a nail gun, resulting in a long nail going through his cheek and firmly embedding into the lower gum and jaw. There is considerable blood in his mouth and he is in excruciating pain. Given this scenario, which would be your first priority?
Applying oxygen
Removing the nail
Suctioning the airway
Placing a cervical collar
C
Suctioning the airway is the first priority as without a patent airway the patient's condition will worsen quickly.