EMT/NREMT Trauma Practice Test — Questions and Answers

Question 1: You arrive at a patient who has fallen off a ladder. Which of the following information is NOT important to the patient's care?

Surface the patient landed on
What part of the body hit first
Height of the ladder (Correct answer)
Distance the patient fell from

Correct answer: Height of the ladder

In assessing a fall, the *distance* the patient fell from is crucial for determining the potential for significant injury, as greater fall heights correlate with higher energy transfer and injury risk. The *surface* landed on and *what part of the body hit first* also directly impact injury patterns. The *height of the ladder itself* is less directly relevant to the patient's injuries than the actual fall distance.

Question 2: You've arrived at the scene of an MVA, where three patients have minor visible injuries. Two of them are refusing treatment, while the third is complaining neck and back pain. What should you do next?

Have your partner obtain refusals from the two patients who refused treatment, while you treat the last patient. (Correct answer)
Treat the third patient, nothing else is needed for the other two
Treat all three patients, they are visibly injured and need medical attention
Obtain signed refusals from the first two patients then proceed to the third

Correct answer: Have your partner obtain refusals from the two patients who refused treatment, while you treat the last patient.

In a multi-patient scenario, the priority is to address the most critical patient first, while simultaneously managing other necessary tasks. The patient with neck and back pain requires immediate assessment and stabilization due to potential spinal injuries. Delegating the task of obtaining refusals from the stable, refusing patients to a partner allows for efficient use of resources and ensures the critical patient receives timely care.

Question 3: Your patient is a 17-year-old guy who was discovered face down in a pool. He's being held face up on the water's surface currently. He is breathing and has a pulse, but he is unconscious. What is the most effective treatment for this patient?

Apply cervical and spinal immobilization while the patient is still in the pool (Correct answer)
Jump into the pool and begin CPR
Wait for a trained water rescue team
Remove the patient from the pool, immobilize, and transport.

Correct answer: Apply cervical and spinal immobilization while the patient is still in the pool

Any unconscious patient found in a pool, especially face down, should be treated as if they have a potential spinal injury due to the possibility of a diving accident or impact during the fall. Therefore, the most effective initial treatment is to apply cervical and spinal immobilization *while the patient is still in the water* to prevent further injury during extrication. CPR is not indicated if the patient has a pulse and is breathing.

Question 4: When there is penetrating trauma, the projectile contacts the tissues and forms a permanent cavity. What causes a temporary cavity to form?

Unspent gun powder
By the twisting of the projectile
By energy scrubbing off of the projectile (Correct answer)
The wadding entering the body

Correct answer: By energy scrubbing off of the projectile

In penetrating trauma, particularly from high-velocity projectiles, a temporary cavity is formed by the transfer of kinetic energy from the projectile to the surrounding tissues. As the projectile passes through, it pushes tissue radially away from its path, creating a temporary, pulsating cavity that is much larger than the projectile's diameter. This energy transfer, or "scrubbing off," causes significant tissue damage beyond the permanent wound tract.

Question 5: _______________ is the term that describes how a patient gets injured.

Injury pattern
Energy transfer
Mechanism of injury (Correct answer)
Mechanics of injury

Correct answer: Mechanism of injury

The term "mechanism of injury" (MOI) specifically refers to the forces and events that caused a patient's injury. Understanding the MOI helps EMS providers predict potential injuries based on the type and severity of the incident. This knowledge guides their assessment and treatment strategies.

Question 6: What is your first order of business when you arrive at a trauma scene?

C-Spine control
Scene safety (Correct answer)
Airway
Body substance Isolation

Correct answer: Scene safety

Scene safety is always the absolute first priority for EMS providers upon arrival at any emergency scene, especially trauma. Ensuring the scene is safe for both rescuers and the patient prevents further injury and allows for effective patient care. Without a safe scene, no other medical interventions can be performed safely.

Question 7: This is known as the large collection of blood under the skin.

Hematoma (Correct answer)
Bruise
Abrasion
Contusion

Correct answer: Hematoma

A hematoma is a localized collection of blood outside of blood vessels, typically clotted, that forms within tissues or an organ. While a bruise (contusion) is a type of hematoma, 'hematoma' is the more precise medical term for a large, palpable collection of blood under the skin. It indicates significant bleeding into the tissue space.

Question 8: The bleeding must be stopped in every traumatic incident where tissue damage has caused bleeding. What are the best ways to stop bleeding?

Direct pressure, pressure dressing, tourniquet
Direct pressure, elevation, tourniquet, digital pressure
Direct pressure, digital pressure, elevation, tourniquet (Correct answer)
Tourniquet, elevation, pressure dressing, direct pressure

Correct answer: Direct pressure, digital pressure, elevation, tourniquet

The most effective ways to stop external bleeding, in order of preference and effectiveness, are direct pressure, followed by elevation of the injured limb (if no fracture is suspected), and then the application of a tourniquet for severe, uncontrolled hemorrhage. Digital pressure can be used on specific pressure points but is often incorporated into direct pressure. This systematic approach ensures the most conservative yet effective methods are tried first.

Question 9: Your 16-year-old trauma patient appears to have a femur fracture in the mid-shaft. There is a laceration directly over the suspected fracture, which you observe. The bleeding is under control. What kind of fracture could this be?

Comminuted
Open (Correct answer)
Greenstick
Closed

Correct answer: Open

An open fracture, also known as a compound fracture, occurs when the bone breaks and pierces through the skin, creating an open wound. The presence of a laceration directly over the suspected fracture indicates that the bone has communicated with the outside environment. This type of fracture carries a higher risk of infection due to exposure.

Question 10: You intubate the patient on the way to the hospital. You hear wheezing in the upper lung areas during your assessment of tube placement. What's the most likely cause of wheezing?

Inhalation induced asthma attack
Inhalation injury to the lower airway (Correct answer)
Inhalation injury to the upper airway
Inhalation induced cardiac wheezing

Correct answer: Inhalation injury to the lower airway

Wheezing is a high-pitched whistling sound produced by narrowed airways, typically heard on exhalation. If wheezing is heard in the upper lung areas after intubation, it suggests an issue in the lower airway, such as bronchospasm or edema caused by an inhalation injury. The endotracheal tube bypasses the upper airway, so sounds originating from the lungs indicate a lower airway problem.

Question 11: What step should the paramedic do after immobilizing an extremity fracture in the lower right arm?

Assessing presence of distal motor, sensory, and perfusion. (Correct answer)
Placing the immobilized extremity below the level of the heart
Placing the hand in the position of function.
Ensuring the splint is applied tightly.

Correct answer: Assessing presence of distal motor, sensory, and perfusion.

After immobilizing any extremity fracture, it is crucial to reassess the patient's neurovascular status distal to the injury. This assessment, often remembered as 'PMS' (Pulse, Motor, Sensory) or 'CMS' (Circulation, Motor, Sensory), ensures that the splint is not too tight and that blood flow and nerve function are not compromised. This step is vital to prevent further injury or complications.

Question 12: You're working on a 24-year-old woman who has a gunshot wound on the right side of her back. There are no visible exit wounds. She is awake, but she is confused. Her skin is pale and diaphoretic, and her oral mucosa has cyanosis. Breathing sounds are clear and balanced on both sides. There is jugular vein distention. The blood pressure is 90/78 mmHg, the heart rate is 124 beats per minute, and the respiratory rate is labored at 28 beats per minute. The cardiac monitor shows sinus tachycardia. Which condition do you think this patient is most likely suffering from?

Lacerated aorta
Pericardial tamponade (Correct answer)
Hemothorax
Tension pneumothorax

Correct answer: Pericardial tamponade

The patient presents with classic signs of pericardial tamponade, which include hypotension (BP 90/78), jugular vein distention (JVD), and tachycardia (HR 124). These symptoms, known as Beck's Triad, combined with a penetrating chest injury, indicate that blood is accumulating in the pericardial sac and compressing the heart, impairing its ability to pump blood effectively.

Question 13: You're working on a 24-year-old woman who has a gunshot wound on the right side of her back. There are no visible exit wounds. She is awake, but she is confused. Her skin is pale and diaphoretic, and her oral mucosa has cyanosis. Breathing sounds are clear and balanced on both sides. There is jugular vein distention. The blood pressure is 90/78 mmHg, the heart rate is 124 beats per minute, and the respiratory rate is labored at 28 beats per minute. The cardiac monitor shows sinus tachycardia. Which of the following treatment regimens is best for this patient?

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.
High flow oxygen, spinal precautions, occlusive dressing over entrance wound, rapid transport. (Correct answer)

Correct answer: High flow oxygen, spinal precautions, occlusive dressing over entrance wound, rapid transport.

For a patient with a penetrating back wound and signs of shock/tamponade, immediate priorities include high-flow oxygen to support perfusion and spinal precautions due to the potential for spinal injury from the gunshot wound. Covering the entrance wound with an occlusive dressing prevents air from entering the chest cavity, and rapid transport to a trauma center is critical for definitive surgical care.

Question 14: Which of the following patients should be triaged to a non-trauma facility?

14-year-old male who fell 11 feet out of a tree, landing on his back
19-year-old male involved in a single car MVC at a rate of 25 miles per hour
67-year-old female who was electrocuted by a 220 volt electrical outlet
25-year-old female with a 1-inch laceration on her thigh (Correct answer)

Correct answer: 25-year-old female with a 1-inch laceration on her thigh

Trauma triage criteria are used to identify patients who require transport to a trauma center. A 1-inch laceration on the thigh, without other signs of significant injury or mechanism, is generally considered a minor injury that can be managed at a non-trauma facility. The other options involve significant mechanisms of injury or patient populations that warrant trauma center evaluation.

Question 15: You were dispatched to the home of a 37-year-old man who had lacerated his leg while working with a chainsaw in the backyard. The patient's wife, who is a nurse, applied pressure to the wound and had the patient in a Trendelenburg position prior to your arrival. Your examination of the patient reveals that he is responsive to painful stimuli, has a weak carotid pulse, and his blood pressure is undetermined. The patient on the ground is surrounded by a large amount of blood. The wound was arterial, according to the wife, and the accident happened about 10 to 15 minutes ago. What are your treatment priorities for this patient, in addition to oxygen therapy?

Apply an arterial tourniquet and call for ALS support.
Continue applying direct pressure to the wound and transport.
Continue applying direct pressure to the wound and call for ALS support. (Correct answer)
Apply an arterial tourniquet and call for ALS support.

Correct answer: Continue applying direct pressure to the wound and call for ALS support.

The patient is in profound shock from an arterial laceration, indicated by responsiveness to painful stimuli, a weak carotid pulse, and undetermined blood pressure with significant blood loss. The most immediate and effective treatment for severe external bleeding is continued direct pressure. Calling for ALS support is crucial for advanced interventions like IV fluids and potentially a tourniquet if direct pressure fails, but direct pressure remains the initial priority.

Question 16: Which of the following is the most common and noticeable finding in a crush injury?

Paresthesia
Paralysis
Pulselessness
Pain (Correct answer)

Correct answer: Pain

Pain is the most common and immediate symptom reported by patients with crush injuries due to the direct tissue damage, nerve compression, and inflammation. While paresthesia, paralysis, or pulselessness can occur, they are typically later or more severe manifestations. Pain is almost universally present from the outset of a crush injury.

EMT/NREMT Trauma Practice Test

You arrive at a patient who has fallen off a ladder.
Which of the following information is NOT important to the patient's care?