Paramedics Exam Trauma Management 4 — Questions and Answers
Question 1: A patient presents with Beck's triad after a stab wound to the chest. Which condition does this indicate?
- Tension pneumothorax
- Massive hemothorax
- Traumatic cardiac tamponade (Correct answer)
- Aortic transection
Correct answer: Traumatic cardiac tamponade
Beck's triad (hypotension, JVD, muffled heart sounds) is the classic presentation of traumatic cardiac tamponade requiring rapid transport for pericardiocentesis or thoracotomy.
Question 2: When immobilizing a pediatric patient on a long backboard, what modification is necessary for children under 8 years old?
- Pad under the thorax to maintain neutral alignment (Correct answer)
- Use a pediatric cervical collar two sizes smaller
- Hyperextend the neck to open the airway
- No modification is needed if the board fits
Correct answer: Pad under the thorax to maintain neutral alignment
Children under 8 have proportionally larger heads, so padding under the thorax raises the body to maintain a neutral cervical spine position and prevent inadvertent flexion.
Question 3: A construction worker fell 30 feet onto his back. He has no sensation or movement below T4 and his BP is 80/50 with HR 52. What type of shock is this?
- Hypovolemic shock
- Obstructive shock
- Neurogenic shock (Correct answer)
- Septic shock
Correct answer: Neurogenic shock
Neurogenic shock results from cervical or high thoracic spinal cord injury causing loss of sympathetic tone, presenting with hypotension and paradoxical bradycardia.
Question 4: Which burn depth classification involves destruction of the epidermis, dermis, and underlying subcutaneous tissue?
- Superficial (first-degree)
- Partial thickness superficial
- Partial thickness deep
- Full thickness (third-degree) (Correct answer)
Correct answer: Full thickness (third-degree)
Full-thickness burns destroy all skin layers including subcutaneous tissue, appearing leathery and white/charred, with no pain sensation due to nerve destruction.
Question 5: Using the Parkland formula, what is the 24-hour fluid requirement for an 80 kg patient with 40% TBSA burns?
- 6,400 mL
- 9,600 mL
- 12,800 mL (Correct answer)
- 16,000 mL
Correct answer: 12,800 mL
Parkland formula: 4 mL × weight (kg) × %TBSA = 4 × 80 × 40 = 12,800 mL over 24 hours, with half given in the first 8 hours.
Question 6: A trauma patient has an open skull fracture with brain matter visible. What is the most appropriate prehospital management?
- Apply direct pressure to control bleeding
- Cover loosely with a moist sterile dressing (Correct answer)
- Irrigate the wound with saline
- Attempt to replace displaced bone fragments
Correct answer: Cover loosely with a moist sterile dressing
Open skull fractures with visible brain matter should be covered loosely with a moist sterile dressing—never apply pressure, irrigate, or manipulate brain tissue.
Question 7: In a patient with suspected thoracic aortic injury after a high-speed deceleration MVC, which prehospital sign is most suggestive?
- Midscapular back pain with pulse differential between arms (Correct answer)
- Anterior chest wall bruising with rib tenderness
- Bilateral wheezing and hemoptysis
- Subcutaneous emphysema at the clavicle
Correct answer: Midscapular back pain with pulse differential between arms
Midscapular pain combined with blood pressure or pulse differences between upper extremities suggests traumatic aortic injury requiring rapid surgical intervention.
Paramedics Exam Trauma Management 4
A patient presents with Beck's triad after a stab wound to the chest.
Which condition does this indicate?