EMT Trauma Practice Test 2 — Questions and Answers
Question 1: En route to the hospital, you intubate the patient. During your assessment of tube placement, you hear wheezing in the upper lung fields. What is most likely causing this wheezing?
- Inhalation injury to the upper airway
- Inhalation induced cardiac wheezing
- Inhalation induced asthma attack
- Inhalation injury to the lower airway (Correct answer)
Correct answer: Inhalation injury to the lower airway
Wheezing is a high-pitched whistling sound, typically heard on exhalation, caused by narrowing or obstruction of the lower airways (bronchioles). In a patient who has been intubated after a traumatic event, new-onset wheezing in the upper lung fields suggests an issue within the smaller, lower airways, such as bronchospasm or edema resulting from an inhalation injury (e.g., smoke, chemicals).
Question 2: Following the immobilization of an extremity fracture to the lower right arm, the paramedic should perform what step last?
- Ensuring the splint is applied tightly.
- Placing the hand in the position of function.
- Assessing presence of distal motor, sensory, and perfusion. (Correct answer)
- Placing the immobilized extremity below the level of the heart
Correct answer: Assessing presence of distal motor, sensory, and perfusion.
After immobilizing any extremity fracture, it is crucial to reassess the neurovascular status distal to the injury as the final step. This involves checking for motor function, sensation, and perfusion (pulses, capillary refill, skin color/temperature) to ensure the splint is not too tight and is not compromising circulation or nerve function. This assessment must be performed both before and after splinting to identify any changes and confirm proper application.
Question 3: Please answer the following question. You are treating a 24-year-old female with a gunshot wound to the right side of the back. No exit wound is visible. She is awake but confused. Her skin is pale and diaphoretic with cyanosis noted to the oral mucosa. Breath sounds are clear and equal bilaterally. Jugular vein distention is present. Blood pressure is 90/78 mmHg, heart rate is 124 beats per minute, and respiratory rate is 28 per minute and labored. Sinus tachycardia is seen on the cardiac monitor. What condition do you think is most likely present with this patient?
- Lacerated aorta
- Hemothorax
- Tension pneumothorax
- Pericardial tamponade (Correct answer)
Correct answer: Pericardial tamponade
The patient's presentation of a gunshot wound to the back, confusion, pale/diaphoretic skin, cyanosis, hypotension, tachycardia, and critically, jugular vein distention (JVD) with clear and equal breath sounds, strongly indicates pericardial tamponade. JVD with hypotension and muffled heart sounds (though not explicitly stated, clear lungs rule out tension pneumothorax) in a trauma patient is a classic presentation of this life-threatening condition, where blood compresses the heart.
Question 4: Please answer the following question. You are treating a 24-year-old female with a gunshot wound to the right side of the back. No exit wound is visible. She is awake but confused. Her skin is pale and diaphoretic with cyanosis noted to the oral mucosa. Breath sounds are clear and equal bilaterally. Jugular vein distention is present. Blood pressure is 90/78 mmHg, heart rate is 124 beats per minute, and respiratory rate is 28 per minute and labored. Sinus tachycardia is seen on the cardiac monitor. Which of the following treatment regimens would be the most appropriate for this patient?
- High flow oxygen, spinal precautions, occlusive dressing over entrance wound, rapid transport. (Correct answer)
- High flow oxygen by nonrebreather, spinal precautions, allow patient to remain in a position of comfort.
- High flow oxygen by nonrebreather, cover entrance wound with an occlusive dressing.
- High flow oxygen, pleural decompression to right side of chest, rapid transport.
Correct answer: High flow oxygen, spinal precautions, occlusive dressing over entrance wound, rapid transport.
For a patient with suspected pericardial tamponade from a gunshot wound, immediate priorities include providing high-flow oxygen to support oxygenation and initiating spinal precautions due to the mechanism of injury. An occlusive dressing should be applied to the entrance wound to prevent air from entering the chest cavity if it's a penetrating chest injury. Rapid transport to a trauma center is critical for definitive surgical intervention, as pericardial tamponade is a life-threatening condition.
Question 5: Please answer the following question. You are treating a 12-year-old male patient who was hit in the nose with a baseball. His nose is deviated to the left with moderate epistaxis. He is complaining of severe pain to his nose. He is alert and oriented with no loss of consciousness. Which of the following treatment sequences would best manage this patient?
- Pack nares with gauze to control bleeding.
- Have patient lie supine while holding pressure to nares. (Correct answer)
- Align nose in the neutral position while holding pressure to nares.
- Have patient sit upright and lean forward while holding pressure to nares.
Correct answer: Have patient lie supine while holding pressure to nares.
While leaning forward and pinching the nostrils is the standard initial treatment for epistaxis, in a trauma patient with a suspected nasal fracture and severe pain, having the patient lie supine might be considered for overall patient stability. This position can facilitate a more thorough assessment for other head/neck injuries and manage potential syncope from pain or blood loss, even if it's not the ideal position solely for nosebleed control.
Question 6: Please answer the following question. You are called for an elderly female that fell down and hurt her knee. When you find the patient, she tells you she tripped and fell, and landed on her left knee. She denies any loss of consciousness or trauma to her head. The patient is only complaining of pain to the distal portion of her femur. During your assessment, you notice deformity and swelling to the femur, proximal to the knee. The patient has good distal pulses, motor function, and sensation. What would be the most appropriate treatment for this patient?
- Secure to a backboard and pad appropriately (Correct answer)
- Application of padded board splints
- Traction splinting
- Inflation of the PASG on both legs
Correct answer: Secure to a backboard and pad appropriately
The patient has a suspected proximal femur fracture (distal portion of femur, proximal to the knee) with deformity and swelling. Traction splints are generally contraindicated for fractures close to the knee or hip. In this scenario, securing the patient to a backboard with appropriate padding provides full body immobilization and stabilizes the suspected fracture without applying traction, which could worsen the injury or cause complications.
Question 7: Which of the following patients would be most appropriate for triage to a non-trauma center?
- 67-year-old female who was electrocuted by a 220 volt electrical outlet
- 19-year-old male involved in a single car MVC at a rate of 25 miles per hour
- 25-year-old female with a 1-inch laceration on her thigh (Correct answer)
- 14-year-old male who fell 11 feet out of a tree, landing on his back
Correct answer: 25-year-old female with a 1-inch laceration on her thigh
Trauma centers are specialized facilities equipped to handle severe, life-threatening injuries. A 1-inch laceration on the thigh, while requiring medical attention, is generally considered a minor injury that does not meet the criteria for trauma center activation or transport. The other options describe patients with high-mechanism injuries (electrocution, high-speed MVC, significant fall height) that warrant evaluation at a trauma center due to the potential for serious, unseen internal injuries or complex trauma.
Question 8: Please answer the following question. You have responded to a local residence of a 37-year-old male who had lacerated his leg while using a chainsaw in the back of his house. Prior to your arrival, the patient's wife, who is a nurse, applied pressure to the wound and has the patient in a Trendelenburg position. Your assessment of the patient reveals him to be responsive to painful stimuli with a weak carotid pulse and the blood pressure unobtainable. There is a massive amount of blood surrounding the patient on the ground. The wife tells you that the wound is arterial and the injury occurred about 10 to 15 minutes ago. In addition to oxygen therapy, what are your treatment priorities for this patient?
- Continue applying direct pressure to the wound and call for ALS support. (Correct answer)
- Apply an arterial tourniquet and call for ALS support.
- Apply an arterial tourniquet and call for ALS support.
- Continue applying direct pressure to the wound and transport.
Correct answer: Continue applying direct pressure to the wound and call for ALS support.
The patient is in profound shock due to massive blood loss, indicated by responsiveness to painful stimuli, a weak carotid pulse, and unobtainable blood pressure. The immediate priority is to control the massive bleeding. Continuing and reinforcing direct pressure on the wound is the most effective initial method for controlling external hemorrhage. Simultaneously, calling for ALS support is crucial for advanced interventions like fluid resuscitation and rapid transport to definitive care.
Question 9: Which of the following findings in a crush injury is typically the earliest and most prominent?
- Pain (Correct answer)
- Pulselessness
- Paresthesia
- Paralysis
Correct answer: Pain
In a crush injury, the immediate and most prominent symptom is typically severe pain due to the direct trauma to tissues, nerves, and bones. While other signs like pulselessness, paresthesia (numbness/tingling), and paralysis can develop later as indicators of nerve damage or compartment syndrome, intense pain is almost universally the earliest and most intense sensation experienced by the patient at the time of injury.
Question 10: Please answer the following question. Your 26-year-old female patient has been pulled out of a house fire. Her chest and arms have been burned. The area is charred and the patient states she has little pain in the burned area. What is the most likely classification of this patient's burns?
- Full thickness (Correct answer)
- Superficial partial thickness burns
- Deep partial thickness burns
- Superficial
Correct answer: Full thickness
Full thickness burns (third-degree burns) involve all layers of the skin and often extend into underlying tissue, resulting in a charred appearance. A key characteristic is the destruction of nerve endings in the burned area, which leads to little to no pain sensation within the deepest burn itself, even though surrounding partial-thickness burns may be very painful.
Question 11: Please answer the following question. You have responded for a 43-year-old male who was involved in an altercation. The patient was reportedly beaten about the face and head with a baseball bat. The patient is unresponsive. Evaluation of the patient's face reveals instability from the orbits to the mandible. Based on this information, how would you definitively manage this patient's airway?
- Immediately assist ventilations with a Bag-Valve-Mask.
- Orally intubate the patient and assist ventilations with a Bag-Valve-Mask. (Correct answer)
- Insert an oral airway and assist ventilations with a Bag-Valve-Mask.
- Insert a nasal airway and assist ventilations with a Bag-Valve-Mask.
Correct answer: Orally intubate the patient and assist ventilations with a Bag-Valve-Mask.
The patient has severe facial and head trauma (unresponsive, instability from orbits to mandible) and is unresponsive, indicating a compromised airway and the need for definitive airway management. Oral intubation is the preferred method for securing the airway in such a patient, as it provides a secure, patent airway and allows for assisted ventilations. Nasal intubation is generally contraindicated with suspected facial fractures due to the risk of intracranial placement.
Question 12: When managing an open fracture, you should do which of the following?
- Cover the exposed bone ends with a moist sterile dressing. (Correct answer)
- Provide mild manual traction to restore distal circulation.
- Leave the wound exposed if there is no massive bleeding from the area.
- Apply a pressure dressing to prevent blood loss.
Correct answer: Cover the exposed bone ends with a moist sterile dressing.
When managing an open fracture, the primary goal after controlling any severe bleeding is to protect the exposed bone ends from contamination and further injury. Covering the wound with a moist sterile dressing helps prevent infection by creating a barrier and keeps the exposed tissues viable. This step is crucial before immobilization and transport.
Question 13: What is the most common spinal injury associated with improper lifting techniques?
- Thoracic
- Cervical
- Lumbar (Correct answer)
- Sacral
Correct answer: Lumbar
Improper lifting techniques, particularly lifting heavy objects with a rounded back instead of using the legs, place significant strain on the lower back. This often leads to injuries in the lumbar spine, such as muscle strains, ligament sprains, or herniated discs, making it the most common spinal injury associated with poor lifting mechanics.
Question 14: You respond to the scene of a residential natural gas explosion to find a 36-year-old male patient complaining of a diminished ability to hear, moderate dyspnea, and acute abdominal pain. These symptoms are likely due to what mechanism?
- Primary blast injury (Correct answer)
- Secondary blast injury
- Tertiary blast injury
- Toxic inhalation of natural gas
Correct answer: Primary blast injury
Primary blast injuries are caused by the direct effects of the blast wave itself, which can damage gas-filled organs. Symptoms like diminished hearing (due to ruptured eardrums), moderate dyspnea (from lung contusions or barotrauma), and acute abdominal pain (indicating potential bowel rupture) are classic signs of primary blast injury, as the pressure wave directly impacts these susceptible organs.
Question 15: While assessing the carotid and radial pulse in your unresponsive patient, you determine that the carotid pulse is weak and rapid, and the peripheral pulses are absent. What other clinical assessment finding would you expect to be present?
- An irregular rhythm of the pulse
- A decrease in the respiratory rate
- Cool and pale skin (Correct answer)
- An increase in arterial pressure
Correct answer: Cool and pale skin
A weak and rapid carotid pulse with absent peripheral pulses indicates significant hypoperfusion, often due to shock. In this state, the body shunts blood away from the periphery to vital organs through vasoconstriction in the skin. This physiological response manifests clinically as cool, pale, and often clammy skin, as blood flow to the skin is significantly reduced.
EMT Trauma Practice Test 2
En route to the hospital, you intubate the patient.
During your assessment of tube placement, you hear wheezing in the upper lung fields.
What is most likely causing this wheezing?