Paramedics Exam Trauma Assessment and Management 3 — Questions and Answers
Question 1: A patient with a stab wound to the right chest has absent breath sounds on the right, JVD, and hypotension. The FIRST intervention should be:
- Large-bore IV access and fluid resuscitation
- Immediate needle decompression of the right chest (Correct answer)
- Intubation and positive pressure ventilation
- Application of an occlusive dressing
Correct answer: Immediate needle decompression of the right chest
This triad (absent breath sounds, JVD, hypotension) with a penetrating mechanism indicates tension pneumothorax requiring immediate needle decompression.
Question 2: What is the recommended target systolic BP for permissive hypotension in an adult trauma patient with suspected internal hemorrhage and NO traumatic brain injury?
- 60–70 mmHg
- 80–90 mmHg (Correct answer)
- 100–110 mmHg
- 120 mmHg or higher
Correct answer: 80–90 mmHg
Permissive hypotension targets a systolic BP of 80–90 mmHg to maintain perfusion while minimizing clot disruption in hemorrhaging patients without TBI.
Question 3: During a mass casualty incident, a patient is found apneic after repositioning the airway. Under START triage, this patient is tagged:
- Red (immediate)
- Yellow (delayed)
- Green (minor)
- Black (expectant/deceased) (Correct answer)
Correct answer: Black (expectant/deceased)
Under START triage, a patient who remains apneic after airway repositioning is tagged black (expectant/deceased) because resources must go to salvageable patients.
Question 4: A patient with a gunshot wound to the neck is speaking in a hoarse voice with subcutaneous emphysema palpable at the neck. The airway should be managed by:
- Waiting and monitoring for deterioration
- Early definitive airway before swelling closes it (Correct answer)
- High-flow oxygen by non-rebreather mask only
- Nasopharyngeal airway insertion
Correct answer: Early definitive airway before swelling closes it
Expanding hematoma and edema from zone II neck trauma can rapidly close the airway; early definitive airway management prevents a surgical emergency.
Question 5: The Cincinnati Prehospital Stroke Scale is NOT part of trauma assessment; however, which trauma tool assesses CNS status in the primary survey?
- AVPU scale (Correct answer)
- Hunt-Hess scale
- CPSS
- Revised Trauma Score
Correct answer: AVPU scale
The AVPU scale (Alert, Voice, Pain, Unresponsive) provides a rapid CNS assessment during the primary survey's neurological component.
Question 6: Which sign is MOST indicative of a basilar skull fracture during the secondary assessment?
- Raccoon eyes (periorbital ecchymosis) (Correct answer)
- Midface instability on palpation
- Epistaxis from the nares
- Tracheal deviation
Correct answer: Raccoon eyes (periorbital ecchymosis)
Raccoon eyes (bilateral periorbital ecchymosis) and Battle's sign (mastoid ecchymosis) are classic delayed signs of basilar skull fracture.
Question 7: A trauma patient in hemorrhagic shock has received 2 units of packed red blood cells. In a damage control resuscitation approach, the next component to administer is:
- Normal saline bolus
- Fresh frozen plasma at a 1:1 ratio (Correct answer)
- Hypertonic saline
- Albumin 5%
Correct answer: Fresh frozen plasma at a 1:1 ratio
Damage control resuscitation uses blood products in a 1:1:1 ratio (RBCs:FFP:platelets) to replace all components of lost whole blood and prevent coagulopathy.
Paramedics Exam Trauma Assessment and Management 3
A patient with a stab wound to the right chest has absent breath sounds on the right, JVD, and hypotension.
The FIRST intervention should be: