Your WHAT hurts?
Which of the following assessments would allow you to BEST differentiate a pneumothorax from a hemothorax?
Chest percussion:
pneumo/hyperresonant
hemo/dull
You are dispatched to a man collapsed in a freshly dug ditch. The fire department assures you it is safe to enter. They advise you the victim hit an energized power line and collapsed. What would you do FIRST?
Manually immobilize the head.
At the scene where your victim is found to have an ax buried into the chest, your partner notes that the patient has gone into cardiac arrest. The ax is securely fixed into the sternum. You both decide for treatment to continue, you must:
Remove the ax from the sternum and begin CPR
You have a patient who was struck on the left side of the abdomen. The patient is complaining of abdominal pain and left shoulder pain and is showing signs of hypoperfusion. Which organ has most likely been injured?
Spleen
Which of the six "P's" would you MOST commonly expect to see with a patent having a mid-shaft long bone fracture?
Pain
You have responded to the scene of a motor vehicle collision where a 27-year-old driver has been pinned by the steering wheel. The patient is unresponsive, respirations 30 and shallow, petechiae from shoulders up. What other signs would you MOST likely expect to observe with this patient?
Bloodshot eyes
Tachycardia
JVD
You have a patient who was the passenger of a motor vehicle involved in a front-end collision. The patient was wearing the lap restraint too high and has a red mark at the level of the umbilicus. The patient has JVD, diminished lung sounds on the left, hyporesonance to percussion on the left, hypotension, and a hollow-appearing abdomen. Which should be your immediate intervention?
Assist ventilations
(ruptured diaphragm)
Your victim at an explosion has a tender, firm and distended abdomen and is showing signs of shock. Which interventions would be of the greatest benefit to the patient?
Rapidly transport to a trauma center.
(Spinal precautions, fluids and oxygen are appropriate, but do not do anything definitive to treat this patient).
During assessment of a trauma patient, you observe a stab wound just left of the sternum in the fourth intercostal space. The wound is not bubbling, lung sounds are clear and equal, neck veins are distended, and the trachea is midline. What is the problem?
Pericardial tamponade
How much blood can be lost from closed bilateral femur fractures and lower leg fractures?
3 liters
(each femur can lose 1 liter and each lower leg can lose 500ml)
You are called to a football field to treat a patient with a flexed knee and a lateral displacement of the patella after being tackled. Which is MOST likely occurring in this situation?
Patellar dislocation
Which of the following BEST explains why a thorough scene survey and evaluation of mechanism of injury is so important in cases of abdominal trauma?
Abdominal injuries are often slow to produce obvious signs.
You are attending to a patient suffering from a blunt trauma to the chest, which resulted in respiratory distress, cyanosis, hemoptysis, and massive subcutaneous emphysema. You have intubated this patient and initiated positive pressure ventilations. Compliance is minimal and lung sounds are dimished bilaterally. What should you do next?
Perform bilateral pleural decompressions
A patient has been stabbed on the right anterior portion of the chest along the anterior midclavicular line at the 8th intercostal space. What organ is likely damaged?
Liver
Which of the following should be your MOST immediate intervention for a patient with a tension pneumothorax?
Perform a pleural decompression
A 25-year-old male has a puncture would to the back close to the armpit. The patient advises you the injury was caused by a flying piece of metal that broke off a metal press. Blood loss appears minimal, but the patient is complaining of dyspnea. Which treatment is MOST appropriate?
Applying an airtight dressing to the injury site. (Occlusive)
After securing a dressing over a stab wound to the stomach, you believe the patient's organs could squeeze out of the injury site. What is the BEST way to prevent this from happening?
Recommend the patient flex his knees slightly.
Which of the following is the BEST way to stop the paradoxical movement of a flail segment on an unresponsive patient?
Ventilate the patient
You have a 30-year-old patient who was the driver of a vehicle that was hit in the driver's side door. The patient is unresponsive, trachea is midline, neck veins are flat, lung sounds are absent of the left side, and percussion reveals hyporesonance. The patient has a rapid carotid pulse and absent radial pulses and is not demonstrating any paradoxical breathing, though appears to have some broken ribs on the left side. The abdomen is flat and non-tender. What is the problem?
Massive hemothorax
You are caring for a pregnant patient who is near term She was properly restrained during a motor vehicle crash and has no apparent injuries. Now she is secured on an ambulance stretcher to provide spinal motion restriction and vital signs are normal. At the hospital she is lightheaded. Vitals reflect tachycardia, hypotension, pale, cool, clammy skin. What is causing this change in condition?
Supine hypotensive syndrome
You are assessing a patient you suspect has a pneumothorax. Which of the following sounds would you expect to obtain upon percussion of the left chest?
Hyperresonance
Your patient has received a stab wound to the anterior upper abdomen, resulting in a laceration of the inferior vena cava. The patient has shallow respirations of 24, a blood pressure of 80/60, pulse 50. What is the appropriate scene management if your transport time to a trauma facility is 10 minutes?
Assist ventilations now.
IVs should be started en route
You are called to assess and treat a patient who has suffered a deep, penetrating wound to the central chest and is complaining of difficult and painful swallowing, pleuritic chest pain, and pain radiating to the mid back. What treatment is contraindicated for this patient?
Combitube - due to damage to the esophagus
Your assessment of a victim at the scene of a motor vehicle collision reveals difficulty breathing with redness across the upper chest. The patient has extensive jugular venous distension with clear lung sounds. Pulse is thready at 128, BP is 80/66. What condition is most likely occurring with this patient?
Cardiac tamponade
(because of the clear and equal lung sounds)
During your rapid secondary assessment of a trauma patient, you discover a sucking chest wound to the right lateral chest. What should you do NEXT?
Seal the wound with a gloved hand and continue the assessment