Paramedics Exam Trauma Assessment and Management 5 â Questions and Answers
Question 1: A patient has a sucking chest wound. After applying a vented chest seal, the patient's condition deteriorates with increasing respiratory distress and hypotension. The next step is:
- Apply a second unvented occlusive dressing over the first
- Remove or burp the chest seal and reassess for tension pneumothorax (Correct answer)
- Administer a 500 mL fluid bolus
- Perform needle decompression at the 2nd intercostal space bilaterally immediately
Correct answer: Remove or burp the chest seal and reassess for tension pneumothorax
Deterioration after chest seal application suggests conversion to tension pneumothorax; temporarily lifting (burping) the seal releases trapped air and is the first response.
Question 2: Which pediatric anatomical difference is MOST important to consider when managing a child's airway after blunt head trauma?
- Children have smaller tonsils that rarely obstruct the airway
- The occiput is proportionally larger, causing passive neck flexion when supine (Correct answer)
- The trachea is longer and more rigid than in adults
- Children's airways are less susceptible to swelling
Correct answer: The occiput is proportionally larger, causing passive neck flexion when supine
A child's large occiput causes the head to flex forward when supine, potentially obstructing the airway; a padding roll under the shoulders maintains a neutral position.
Question 3: In a patient with suspected spinal injury who is combative and cannot be immobilized safely, the best approach is:
- Physically restrain the patient and force full immobilization
- Use chemical restraint and then immobilize once sedated (Correct answer)
- Abandon all spinal precautions and focus on other injuries
- Immobilize the head only with a cervical collar and transport
Correct answer: Use chemical restraint and then immobilize once sedated
Chemical restraint followed by appropriate spinal motion restriction is safer than forceful immobilization, which can cause additional injury to both patient and providers.
Question 4: Which wound characteristic from a gunshot wound BEST indicates a high-velocity (rifle) injury versus a low-velocity (handgun) injury?
- Single entry wound only
- Large irregular exit wound with significant surrounding tissue destruction (Correct answer)
- Entry wound larger than the exit wound
- Absence of an exit wound
Correct answer: Large irregular exit wound with significant surrounding tissue destruction
High-velocity rounds transfer far more kinetic energy, creating a temporary cavity and causing large, irregular exit wounds with extensive tissue damage.
Question 5: A construction worker fell onto an impaled rebar through his thigh. Prehospital management of the impaled object should be:
- Remove it quickly to facilitate tourniquet placement
- Stabilize it in place and control bleeding around it (Correct answer)
- Cut it flush with the skin and bandage over the stump
- Remove it only if it interferes with airway management
Correct answer: Stabilize it in place and control bleeding around it
Impaled objects should never be removed in the field; they are stabilized in place because removal can cause massive uncontrolled hemorrhage.
Question 6: The revised trauma score (RTS) is calculated using which three parameters?
- Heart rate, respiratory rate, and pupillary response
- Glasgow Coma Scale, systolic blood pressure, and respiratory rate (Correct answer)
- GCS, oxygen saturation, and mechanism of injury
- Systolic BP, heart rate, and GCS
Correct answer: Glasgow Coma Scale, systolic blood pressure, and respiratory rate
The RTS combines GCS, systolic blood pressure, and respiratory rate, each coded and weighted to produce a score that correlates with survival probability.
Question 7: A patient with a crush injury to the lower extremities is trapped for 4 hours and has just been extricated. The PRIMARY concern during initial assessment is:
- Fracture stabilization of bilateral lower extremities
- Reperfusion-related hyperkalemia causing cardiac dysrhythmia (Correct answer)
- Hypothermia from prolonged outdoor exposure
- Infection risk from contaminated wounds
Correct answer: Reperfusion-related hyperkalemia causing cardiac dysrhythmia
Crush syndrome releases potassium and myoglobin from damaged muscle; upon reperfusion, sudden hyperkalemia can cause life-threatening cardiac dysrhythmias.
Paramedics Exam Trauma Assessment and Management 5
A patient has a sucking chest wound.
After applying a vented chest seal, the patient's condition deteriorates with increasing respiratory distress and hypotension.
The next step is: