Paramedics Exam Trauma Assessment and Management 2 — Questions and Answers
Question 1: A patient with a suspected pelvic fracture is hypotensive despite 2L of IV fluid. What is the most appropriate next intervention?
- Apply a pelvic binder and prepare for rapid transport (Correct answer)
- Administer an additional 2L of normal saline
- Place the patient in Trendelenburg position
- Insert a urinary catheter to monitor output
Correct answer: Apply a pelvic binder and prepare for rapid transport
A pelvic binder stabilizes the fracture and reduces internal hemorrhage volume, which is the priority in an unstable pelvic fracture with hemorrhagic shock.
Question 2: During a secondary assessment, you find paradoxical chest wall movement on the left side with decreased breath sounds. This presentation is most consistent with:
- Open pneumothorax
- Flail chest with pulmonary contusion (Correct answer)
- Tension pneumothorax
- Hemothorax
Correct answer: Flail chest with pulmonary contusion
Paradoxical movement (segment moves inward on inspiration) with decreased breath sounds indicates flail chest, typically accompanied by underlying pulmonary contusion.
Question 3: Which of the following BEST describes the purpose of the rapid trauma assessment in a high-mechanism patient?
- To identify and treat all injuries before transport
- To detect life threats not found in the primary survey and prioritize transport (Correct answer)
- To obtain a complete SAMPLE history
- To perform detailed neurological testing
Correct answer: To detect life threats not found in the primary survey and prioritize transport
The rapid trauma assessment quickly identifies additional life threats after the primary survey while avoiding scene time delays that increase mortality.
Question 4: A 28-year-old restrained driver has a GCS of 14, BP of 98/60, and seat belt sign across the abdomen. The priority concern is:
- Lumbar spine fracture
- Hollow organ and mesenteric injury (Correct answer)
- Traumatic brain injury
- Rib fractures with pneumothorax
Correct answer: Hollow organ and mesenteric injury
A seat belt sign with hypotension strongly suggests hollow organ (bowel, bladder) or mesenteric injury from compressive forces, which can cause significant internal hemorrhage.
Question 5: When applying a tourniquet for severe extremity hemorrhage, the correct placement is:
- Directly over the wound
- 2–3 inches proximal to the wound (Correct answer)
- Over a joint for maximum compression
- Distal to the wound on the forearm or lower leg
Correct answer: 2–3 inches proximal to the wound
A tourniquet placed 2–3 inches proximal to the wound effectively occludes arterial blood flow while avoiding joint placement where compression is ineffective.
Question 6: A patient ejected from a vehicle is unresponsive with decerebrate posturing. The MOST immediate airway intervention is:
- Nasopharyngeal airway with BVM ventilation
- Rapid sequence intubation with inline spinal stabilization (Correct answer)
- Oropharyngeal airway alone
- Surgical cricothyrotomy
Correct answer: Rapid sequence intubation with inline spinal stabilization
RSI with manual inline stabilization is the standard definitive airway for an unresponsive trauma patient with a suspected spinal injury.
Question 7: Which mechanism of injury MOST commonly causes aortic transection?
- Penetrating abdominal trauma
- High-speed deceleration crash with anterior chest impact (Correct answer)
- Fall from less than 10 feet
- Direct lateral blow to the thorax
Correct answer: High-speed deceleration crash with anterior chest impact
Aortic transection typically occurs at the ligamentum arteriosum due to shear forces in high-speed deceleration crashes, most often anterior chest impacts.
Paramedics Exam Trauma Assessment and Management 2
A patient with a suspected pelvic fracture is hypotensive despite 2L of IV fluid.
What is the most appropriate next intervention?