Paramedics Exam Trauma Management 3 — Questions and Answers
Question 1: A motorcyclist ejected at high speed has bruising across the flank and a rigid abdomen. Which organ injury is most suspected?
- Bladder rupture
- Splenic laceration (Correct answer)
- Diaphragmatic rupture
- Small bowel obstruction
Correct answer: Splenic laceration
Flank bruising (Grey Turner's sign), combined with peritoneal signs, strongly suggests splenic laceration, the most commonly injured solid organ in blunt abdominal trauma.
Question 2: After needle decompression of a tension pneumothorax, the patient's condition does not improve. What is the next step?
- Repeat needle decompression at the same site
- Perform needle decompression on the opposite side
- Perform a finger thoracostomy (Correct answer)
- Increase IV fluid rate
Correct answer: Perform a finger thoracostomy
If needle decompression fails to relieve tension pneumothorax, a finger thoracostomy provides a definitive prehospital decompression by creating an open chest wall opening.
Question 3: Which mechanism is associated with a Chance fracture of the lumbar spine?
- Axial loading from a fall
- Lap belt restraint in a high-speed MVC (Correct answer)
- Hyperextension from a rear-end collision
- Direct blow to the spinous process
Correct answer: Lap belt restraint in a high-speed MVC
A Chance fracture is a flexion-distraction injury associated with lap belt use during high-speed collisions, causing the vertebra to split horizontally.
Question 4: In the context of traumatic cardiac arrest, which reversible cause should be addressed first?
- Hypovolemia
- Hypothermia
- Tension pneumothorax (Correct answer)
- Hyperkalemia
Correct answer: Tension pneumothorax
Tension pneumothorax is the most rapidly correctable cause of traumatic cardiac arrest and should be immediately decompressed bilaterally during resuscitation.
Question 5: A patient struck by a vehicle has anterior neck ecchymosis, hoarseness, and subcutaneous emphysema. What is the priority intervention?
- Nasopharyngeal airway insertion
- Bag-valve-mask ventilation only
- Early definitive airway via RSI (Correct answer)
- High-flow oxygen via non-rebreather mask
Correct answer: Early definitive airway via RSI
Laryngeal fracture can rapidly progress to complete airway obstruction; early RSI or surgical airway is indicated before edema eliminates the airway.
Question 6: Which finding best differentiates a hemothorax from a tension pneumothorax in a trauma patient?
- Tracheal deviation toward the affected side
- Dull percussion on the affected side (Correct answer)
- Jugular vein distension
- Absent breath sounds
Correct answer: Dull percussion on the affected side
Dull percussion on the affected side indicates fluid (hemothorax), while tension pneumothorax produces hyperresonance due to air accumulation.
Question 7: What is the target end-tidal CO2 range for a ventilated traumatic brain injury patient without signs of herniation?
- 25–30 mmHg
- 30–35 mmHg
- 35–45 mmHg (Correct answer)
- 45–55 mmHg
Correct answer: 35–45 mmHg
Normocapnia (ETCO2 35–45 mmHg) is the target for TBI patients to avoid secondary injury from hypocapnia-induced vasoconstriction or hypercapnia-induced vasodilation.
Paramedics Exam Trauma Management 3
A motorcyclist ejected at high speed has bruising across the flank and a rigid abdomen.
Which organ injury is most suspected?