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Chapters 15-18
Review of chapters 15-18
97
Medical
Professional
02/06/2013
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Term
Any injury at the nipple line should be considered a thoracic and abdominal injury because:
 Definition
the diaphragm may elevate as high as the nipple line upon exhalation.
Term
The mediastinum encompasses all of the structures within the thoracic cavity, EXCEPT for the:
 Definition
lungs.
Term
A 34-year-old male is in late shock secondary to blunt chest trauma. His respirations of 6 breaths/min and shallow will initially result in:
 Definition
carbon dioxide retention and acidosis.
Term
Visceral injuries in the chest that occur from shearing forces, compression, or rupture, are MOST commonly seen with:
 Definition
blunt chest trauma.
Term
When percussing the chest of a patient who experienced blunt chest trauma, you note hyperresonance on the left side. This suggests:
 Definition
air in the pleural space.
Term
The presence of a scaphoid abdomen and bowel sounds in the lower hemithorax are MOST suggestive of a:
 Definition
ruptured diaphragm.
Term
A 40-year-old male was struck in the lower chest with a baseball bat. He is conscious and alert and complains of pain to the area of impact. His blood pressure is 136/56 mm Hg, pulse is 90 and regular, and respirations are 24 breaths/min with adequate depth. When further assessing and treating this patient, you should:
 Definition
reconsider the mechanism of injury.
Term
During your rapid trauma assessment of a semiconscious 44-year-old female with blunt thoracic trauma, you detect an area on the left anterior chest that bulges during exhalation. Your partner is providing ventilatory assistance with a BVM and 100% oxygen. You should:
 Definition
stabilize the chest wall deformity and continue your assessment.
Term
You are performing a rapid trauma assessment on a 30-year-old male who was involved in a motor-vehicle crash. The patient is conscious, but restless. He complains of difficulty breathing and chest pain. Your assessment reveals diminished breath sounds in the left hemithorax, normal jugular veins, and a midline trachea. His blood pressure is 124/64 mm Hg, heart rate is 120 and regular, and respirations are 26 breaths/min and shallow. Which of the following injuries should you suspect?
 Definition
Simple pneumothorax
Term
During your rapid trauma assessment of a patient with a gunshot wound to the chest, you located an open wound to the right anterior chest and sealed it with the appropriate dressing. A few minutes later, the patient's respirations are increasingly labored and his heart rate has significantly increased. You should:
 Definition
relieve pleural tension by lifting a corner of the dressing
Term
A 40-year-old male experienced blunt trauma to the chest. His initial blood pressure is 96/60 mm Hg. Which of the following repeat blood pressures would indicate a narrowing pulse pressure?
 Definition
90/64 mm Hg
Term
Which of the following is a LATE sign of a tension pneumothorax?
 Definition
Contralateral tracheal shift
Term
A 22-year-old male with blunt thoracic trauma presents with severely labored respirations. His level of consciousness is decreased and his heart rate is 140 beats/min and thready. Further assessment reveals absent breath sounds on the entire left side of his chest and jugular venous distention. After appropriately managing his airway and immobilizing his spine, you should:
 Definition
transport immediately, start a large-bore IV en route, and request a paramedic rendezvous.
Term
Of the following chest injuries, which would NOT present with jugular venous distention?
 Definition
Massive hemothorax
Term
A trauma patient who presents with shock, jugular venous distention, and bilaterally equal breath sounds has MOST likely experienced a:
 Definition
pericardial tamponade.
Term
The MOST important treatment that the EMT-I can provide to a patient with a thoracic injury is:
 Definition
aggressive airway support.
Term
The primary muscle(s) of respiration is/are the:
 Definition
diaphragm and intercostal muscles.
Term
Common signs and symptoms of a chest injury include all of the following, EXCEPT:
 Definition
hyperpnea.
Term
The presence of gastric juices and bacteria in the abdominal cavity causes an intense inflammatory reaction called:
 Definition
peritonitis.
Term
Which of the following organs lie in the right upper quadrant of the abdomen?
 Definition
Liver and gallbladder
Term
A 25-year-old male has experienced blunt abdominal trauma and is developing shock. Which of the following assessment parameters would you expect to deteriorate LAST?
 Definition
Blood pressure
Term
During your assessment of a 48-year-old female with localized blunt abdominal trauma, you should:
 Definition
be prepared for the patient to vomit.
Term
Diffuse (global) swelling of the abdomen is MOST suggestive of:
 Definition
intraabdominal bleeding.
Term
Which of the following is the MOST reliable means of determining the potential for abdominal injuries following a motor-vehicle crash?
 Definition
Lifting a deployed airbag and assessing the steering wheel.
Term
In addition to providing 100% oxygen and controlling external bleeding, the MOST appropriate management for a patient with a knife impaled in the abdomen includes:
 Definition
stabilizing the knife in place and infusing crystalloids to maintain organ perfusion.
Term
The kidneys lie within the:
 Definition
retroperitoneal space.
Term
Priority management for a patient with a partially amputated penis and stable vital signs includes:
 Definition
controlling any active hemorrhage.
Term
Blunt or penetrating trauma can be especially lethal in pregnant patients because the:
 Definition
gravid uterus is highly vascular.
Term
A 29-year-old female had a glass bottle inserted into her vagina during a sexual assault. She is conscious and alert and has stable vital signs, but she is in severe pain. How should you manage this patient?
 Definition
Stabilize the bottle with bulky dressings, monitor her vital signs, provide emotional support, and transport promptly.
Term
Which of the following abdominal organs would cause the MOST profuse bleeding when severely injured?
 Definition
Liver
Term
After applying supplemental oxygen and placing a patient with blunt abdominal trauma in the appropriate position, you should next:
 Definition
obtain a set of baseline vital signs.
Term
In an attempt to minimize the pain associated with abdominal trauma, the patient will typically:
 Definition
draw his or her knees into the abdomen and tense the abdominal muscles
Term
A 29-year-old male has sustained a large laceration across the lower abdomen and has a loop of bowel protruding through the wound. To minimize the amount of body heat that radiates from the open wound, you should:
 Definition
cover the wound with moist sterile dressings.
Term
Which of the following statements regarding trauma to the kidneys is correct?
 Definition
Kidney injury is usually associated with injury to other abdominal organs.
Term
Following blunt trauma to the right flank area, a 20-year-old male presents with hematuria. Assessment of the area reveals pain to palpation, but no visible signs of trauma. His blood pressure is 120/76 mm Hg, pulse is 120 and respirations are 24 breaths/min and unlabored. In addition to 100% supplemental oxygen and spinal immobilization, the MOST appropriate treatment for this patient includes:
 Definition
two large-bore IVs set at a keep vein open (KVO) rate and prompt transport
Term
Signs of a ruptured urinary bladder include all of the following, EXCEPT:
 Definition
hematemesis.
Term
While transporting a pregnant trauma patient who is immobilized on a backboard, you note a sudden decrease in her blood pressure and a decrease in her mental status. You should:
 Definition
tilt the backboard to the left.
Term
When caring for a patient who was sexually assaulted, male or female, you should:
 Definition
treat any injuries and provide privacy and reassurance
Term
If a person places his or her hand on a hot stove:
 Definition
the sensory nerve will bypass the brain and send a message directly to the motor nerve.
Term
What portion of the nervous system controls the functions of many of the body's vital organs, over which the brain has no voluntary control?
 Definition
Autonomic
Term
A 38-year-old male committed suicide by hanging himself. This mechanism of injury MOST likely resulted in:
 Definition
distraction of the upper cervical spine.
Term
A young female was involved in a motor-vehicle crash and complains of neck pain. When assessing her, you should NOT:
 Definition
determine cervical range of motion.
Term
When stabilizing a patient's cervical spine, you should:
 Definition
align the patient's nose with the navel.
Term
A young male has experienced a possible neck injury. When you attempt to place his head in a neutral in-line position, he complains of a severe spasm in his neck. You should:
 Definition
immobilize him in the position in which you found him.
Term
A 37-year-old male was struck on the driver side of his vehicle by another car traveling at 45 mph. Your initial assessment reveals that the patient is semiconscious and in respiratory distress. When extricating this patient from his car, you should:
 Definition
apply a C-collar and rapidly remove him on a long backboard.
Term
Of the following clinical findings, which one would you MOST likely encounter during the early phase following a fracture of the midface or basilar skull?
 Definition
Altered mental status
Term
A 19-year-old male was struck by a baseball in the occipital region of the skull. Witnesses report that the patient was briefly unconscious following the incident. He is now conscious and alert, but cannot remember the events immediately following the injury. He is breathing without difficulty and his vital signs are stable. This patient's clinical presentation is MOST consistent with a/an:
 Definition
cerebral concussion.
Term
A 40-year-old female is semiconscious following blunt head trauma. Your assessment reveals that her respirations are slow and shallow, her pulse is slow, and her blood pressure is elevated. Her pupils are bilaterally dilated and sluggishly reactive. Appropriate management for this patient includes:
 Definition
assisted ventilation at a rate of 10 breaths/min.
Term
Of the following, which is the LEAST common sign or symptom of a head injury?
 Definition
A cardiac rhythm disturbance
Term
An appropriately-sized cervical collar should:
 Definition
rest on the shoulder and provide support under the mandible.
Term
Which of the following situations dictates removal of a football or motorcycle helmet?
 Definition
Respirations of 24 breaths/min and reduced tidal volume
Term
During a motor-vehicle crash, a 3-year-old female, who was properly restrained in her car seat, is crying and asking for her mommy. There is no obvious injury to the child and she is breathing without difficulty. You should:
 Definition
immobilize her in the car seat and apply padding as needed.
Term
When immobilizing a patient onto a long backboard, it is important to:
 Definition
secure the torso prior to securing the head.
Term
Manual C-spine stabilization should continue until:
 Definition
the patient is fully secured to a long backboard.
Term
A 48-year-old male fell approximately 20' from his roof. As you approach him, you note that his eyes are closed and that he is not moving. His respirations are gurgling and you see blood draining from his mouth. You should
 Definition
don gloves and facial protection.
Term
A person would MOST likely experience a compression injury of the lumbar spine when he or she:
 Definition
falls and lands on his or her feet.
Term
While assessing a patient with blunt head trauma, you note an unstable segment of the skull and a large laceration to the scalp. You should control active bleeding, administer 100% oxygen, and:
 Definition
be alert for increased intracranial pressure.
Term
Mastoid bruising is also referred to as:
 Definition
Battle's sign.
Term
You are transporting a 40-year-old male who experienced blunt trauma to the side of his head. At the scene, he was conscious and alert; however, you note that his mental status has deteriorated and his respirations have become irregular and shallow. You should:
 Definition
assist ventilations with a BVM and 100% oxygen.
Term
The MOST significant complication associated with a severe closed head injury is:
 Definition
increased intracranial pressure.
Term
Following a minor head injury, which of the following occurs more commonly in children than adults?
 Definition
Vomiting
Term
You are transporting a 37-year-old male with a head injury to a local trauma center. When performing your ongoing assessment, which of the following clinical findings would be the earliest and MOST reliable indicator of increasing intracranial pressure?
 Definition
A decreasing level of consciousness
Term
A 57-year-old male with a traumatic brain injury and no cardiac history suddenly becomes pulseless and apneic. You look at the cardiac monitor and see ventricular fibrillation. You should:
 Definition
perform immediate defibrillation.
Term
A football player sustained a possible spinal injury when he was tackled. He is conscious and alert, complains of pain to the mid-cervical spine region, and has stable vital signs. You should:
 Definition
immobilize him with his helmet on unless it is not tight-fitting.
Term
Which of the following types of muscle has characteristic striations and usually crosses at least one joint?
 Definition
Skeletal
Term
___________ muscle performs much of the automatic work of the body and is found within the walls of most tubular structures in the body.
 Definition
Smooth
Term
Articular cartilage functions by:
 Definition
covering the bone ends of moving joints and allowing them to glide easily.
Term
In addition to providing the framework for the human body, bones also:
 Definition
produce blood cells in the marrow.
Term
An injury that may result in complete separation of a joint due to stretching or tearing of the supporting ligaments is called a:
 Definition
sprain.
Term
A 34-year-old male sustained a twisting injury to his left lower leg when he stepped into a hole. Your assessment reveals ecchymosis and pain to the area, but no deformity or crepitus. You should suspect a:
 Definition
nondisplaced fracture.
Term
A fracture that occurs in the growth section of a child's bone and which may prematurely stop growth of the bone is called a/an __________________ fracture.
 Definition
epiphyseal fracture
Term
When palpating an injured extremity, a patient complains of point tenderness. On the basis of this clinical finding, you:
 Definition
are unable to determine the type of fracture.
Term
Following blunt force trauma to the elbow, a 40-year-old female complains of severe pain and the feeling that her elbow is “locked”. Your assessment reveals marked deformity and swelling. This patient has MOST likely experienced a/an:
 Definition
dislocation.
Term
A 29-year-old male fell approximately 5 feet from a ladder and landed on his right shoulder. He is conscious and alert, denies loss of consciousness, and complains of severe pain to the shoulder. The MOST appropriate management sequence for this patient includes:
 Definition
focused physical exam, splinting the injury, vital signs, and transport.
Term
Compartment syndrome is caused by:
 Definition
increased pressure in the fascial compartment.
Term
Which of the following would be the LEAST reliable assessment parameter when determining adequate circulatory and neurologic functions in a patient with a possible extremity fracture?
 Definition
Ability to move the extremity
Term
You arrive at the scene of a motor-vehicle crash in which a 30-year-old male was ejected from his truck. As you approach the patient, who is not moving, you can see that he has gross deformity to both of his femurs and an angulated left humerus. You should:
 Definition
stabilize his head and open his airway.
Term
When assessing a patient with multiple systems trauma, which of the following musculoskeletal injuries would pose the GREATEST threat to the patient's life?
 Definition
Multiple closed fractures
Term
When assessing a patient with a grossly deformed humerus, you note that the radial pulse is absent and the extremity is becoming cyanotic. You should:
 Definition
use constant, gentle manual traction to align the humerus.
Term
General principles of splinting an injured extremity include:
 Definition
frequently assessing gross neurovascular functions.
Term
You and your partner are applying a Hare traction splint to a patient with a deformed midshaft femur. As you expose the injured femur and assess neurovascular functions, your partner should:
 Definition
manually support and stabilize the injured leg.
Term
The MOST effective method of immobilizing a fractured clavicle is with a:
 Definition
sling and swathe.
Term
A 50-year-old male fell approximately 20 feet and landed on his side. He is conscious and alert and denies loss of consciousness. During your assessment, you note pain and crepitus when palpating the iliac crests. In addition to the potential for spinal injury, you should be MOST concerned about:
 Definition
internal hemorrhaging.
Term
Tough, ropelike structures that are extensions of the fascia covering all skeletal muscles are known as:
 Definition
tendons.
Term
The MOST accurate definition of a fracture is a:
 Definition
break in the continuity of a bone.
Term
Joints are bathed and lubricated by:
 Definition
synovial fluid.
Term
A 70-year-old female slipped on a throw rug, but grabbed an adjacent table before she fell to the ground. When assessing her, you should recall that:
 Definition
even minor mechanisms of injury can result in fractures in the elderly.
Term
A 34-year-old male twisted his lower leg and ankle while skiing. He complains of severe pain and swelling to the area. When assessing for deformity, you should:
 Definition
compare the injured extremity to the uninjured extremity.
Term
A 59-year-old male patient impacted the dashboard with his knees when his car struck a tree at 50 mph. During your initial assessment, you note bleeding from an obvious open femur fracture. After controlling the bleeding, applying oxygen, and extricating him from the car, you should:
 Definition
perform a rapid assessment, immobilize his spine, and transport.
Term
Which of the following injuries would pose the LEAST threat to the patient?
 Definition
Major sprains at a major joint
Term
A 29-year-old male was involved in a rollover motor-vehicle crash. The patient was removed from his vehicle prior to your arrival. During your general impression, you note that he is conscious, yelling in pain, and has an actively bleeding open fracture of his left lower leg. As your partner assumes manual stabilization of the patient's head and communicates with him, you should:
 Definition
apply direct pressure to his leg.
Term
In which of the following situations would it NOT be appropriate to splint a patient's fractures before moving him or her?
 Definition
Confused patient with tachycardia and shallow breathing
Term
A 55-year-old male fell from the roof of his house and sustained a closed, displaced femur fracture. He is restless, diaphoretic, and tachycardic. After appropriately managing his ABCs and performing a rapid trauma assessment, you should:
 Definition
immobilize him on a long backboard, transport, and start a large-bore IV en route.
Term
Goals of in-line traction in the prehospital setting include all of the following, EXCEPT:
 Definition
reduction of the fracture.
Term
A 21-year-old male presents with a severely angulated forearm and extreme pain. Distal sensory, motor, and circulatory functions are intact. You should:
 Definition
splint the forearm in the position of deformity.
Term
On which of the following injuries would it be MOST appropriate to apply a traction splint?
 Definition
Swelling and ecchymosis to the midshaft femur
Term
In the process of applying a splint on a 21-year-old female with an apparent dislocated patella, the patella spontaneously returns to its normal position. You should:
 Definition
immobilize her knee with a long board splint.
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