Paramedics Exam Trauma Management 5 — Questions and Answers
Question 1: A patient with blunt abdominal trauma has Kehr's sign (left shoulder pain). Which organ injury does this suggest?
- Liver laceration
- Splenic rupture (Correct answer)
- Pancreatic injury
- Left kidney contusion
Correct answer: Splenic rupture
Kehr's sign is referred pain to the left shoulder caused by diaphragmatic irritation from blood pooling under the left hemidiaphragm due to splenic rupture.
Question 2: Which parameter determines whether a trauma patient meets physiological criteria for trauma center activation?
- Mechanism involving a rollover MVC
- SBP < 90 mmHg or GCS < 14 (Correct answer)
- Age > 55 with any injury
- Involvement of a pedestrian
Correct answer: SBP < 90 mmHg or GCS < 14
Physiological trauma triage criteria include SBP <90 mmHg or GCS <14, indicating hemodynamic or neurological compromise requiring highest-level trauma care.
Question 3: What is the preferred first-line vasopressor for neurogenic shock refractory to fluid resuscitation?
- Epinephrine
- Dopamine
- Norepinephrine (Correct answer)
- Vasopressin
Correct answer: Norepinephrine
Norepinephrine is preferred in neurogenic shock for its combined alpha-1 (vasoconstriction) and beta-1 (chronotropy) effects, addressing both hypotension and bradycardia.
Question 4: A patient sustains a traumatic amputation of the right hand. After tourniquet application, how should the amputated part be managed?
- Place directly on ice in a sealed bag
- Wrap in a dry sterile dressing and keep at room temperature
- Wrap in a moist sterile dressing, place in a bag, then in ice water (Correct answer)
- Submerge the part in normal saline
Correct answer: Wrap in a moist sterile dressing, place in a bag, then in ice water
The amputated part should be wrapped in a moist sterile dressing, placed in a sealed bag, then kept cool in ice water to slow metabolism without freezing tissue.
Question 5: Which finding on a trauma patient's pelvis exam warrants immediate cessation of further manipulation?
- Tenderness on palpation of the iliac crests
- Instability or crepitus on compression (Correct answer)
- Asymmetry of the iliac crests visually
- Leg length discrepancy without instability
Correct answer: Instability or crepitus on compression
Instability or crepitus on pelvic compression indicates an unstable pelvic fracture; further manipulation risks disrupting a tamponading hematoma and worsening hemorrhage.
Question 6: A construction worker has rebar impaled through his right thigh. The object extends 12 inches outside the body. What is the correct management?
- Remove the object and apply a pressure dressing
- Shorten the object and secure it in place
- Stabilize the object in place without removal (Correct answer)
- Apply a tourniquet above the object and remove it
Correct answer: Stabilize the object in place without removal
Impaled objects should never be removed in the field; they may be tamponading major vessels, and removal can cause catastrophic hemorrhage.
Question 7: During a rapid trauma assessment, which finding indicates intraabdominal hemorrhage requiring immediate surgical intervention?
- Mild periumbilical tenderness on deep palpation
- Guarding, rigidity, and progressive abdominal distension (Correct answer)
- Nausea and abdominal cramping with normal BP
- Bruising only to the anterior abdominal wall
Correct answer: Guarding, rigidity, and progressive abdominal distension
Guarding, rigidity, and abdominal distension indicate significant intraperitoneal hemorrhage with peritoneal irritation, requiring emergent surgical hemorrhage control.
Paramedics Exam Trauma Management 5
A patient with blunt abdominal trauma has Kehr's sign (left shoulder pain).
Which organ injury does this suggest?