EMT Practice: Systems, Safety and Care Part 9

Which of the following would be the first sign of hypovolemic shock?

- Anxiety

- Nausea and vomiting

- Pale skin color

- Decreasing blood pressure

You determine that your patient is experiencing internal bleeding. What should you do first?

- Apply cold packs.

- Administer oxygen.

- Immobilize the injury.

- Apply pressure dressings.

Which condition is likely when signs of hypotension; tachycardia; and cool, clammy skin are found?

- Internal bleeding

- Intracranial bleeding

- CNS depression

- Shock

What should you do first to control external bleeding in an extremity?

- Apply a pressure dressing.

- Apply a tourniquet.

- Elevate the extremity.

- Apply direct pressure.

You are assessing a patient who is bleeding from the ear, which gives you a high index of suspicion that he has a skull fracture. How should you address this?

- Pack a pressure dressing in the ear canal.

- Loosely cover the site.

- Do not do anything. Trying to stop the blood flow will force the blood back into the head.

- Apply direct pressure.

Which of the following statements regarding hemophilia is correct?

- Approximately 25% of the population has hemophilia.

- Hemophilia is defined as a total lack of platelets.

- Hemophiliacs take aspirin to enhance blood clotting.

- Patients with hemophilia may bleed spontaneously.

Significant vital sign changes will occur if the typical adult acutely loses more than ______ of his or her total blood volume.

- 15%

- 5%

- 20%

- 10%

A 43-year-old man is experiencing a severe nosebleed. His blood pressure is 190/110 mm Hg and his heart rate is 90 beats/min and bounding. Preferred treatment for this patient includes:

- having the patient pinch his own nostrils and then lie supine.

- packing both nostrils with gauze pads until the bleeding stops.

- pinching the patient's nostrils and having him lean forward.

- placing a rolled 4² × 4² dressing between his lower lip and gum.

Following blunt trauma to the abdomen, a 21-year-old female complains of diffuse abdominal pain and pain to the left shoulder. Your assessment reveals that her abdomen is distended and tender to palpation. On the basis of these findings, you should be MOST suspicious of injury to the:

- gallbladder.

- liver.

- pancreas.

- spleen.

Internal bleeding into a fractured extremity is MOST often controlled by:

- applying a tourniquet.

- keeping the patient warm.

- applying chemical ice pack.

- splinting the extremity.

Which portion of the blood carries oxygen to and wastes away from body tissues?

- Platelets

- Red blood cells

- White blood cells

- Plasma

Which organ or organ system has the greatest tolerance for lack of perfusion (shock)?

- Kidneys

- Brain

- Gastrointestinal system

- Skeletal muscle

Circulation of blood within an organ or tissue in adequate amounts to meet the cells' oxygen, nutritional, and waste-removal needs is termed _______.

- hypoperfusion

- coagulation

- perfusion

- hemorrhage

If applying a dressing to control the bleeding of a patient's arm, the EMT should ________.

- apply direct pressure first

- use large or small gauze pads or dressings depending upon the size of the wound

- cover the entire wound, above and below, with the dressing

- All of these answers are correct.

Which section of the heart receives deoxygenated blood?

- Atria

- Right

- Left

- Ventricles

A 67-year-old male presents with weakness, dizziness, and melena that began approximately 2 days ago. He denies a history of trauma. His blood pressure is 90/50 mm Hg and his pulse is 120 beats/min and thready. You should be MOST suspicious that this patient is experiencing:

- intrathoracic hemorrhaging.

- an aortic aneurysm.

- acute appendicitis.

- gastrointestinal bleeding.

The severity of bleeding should be based on all of the following findings, EXCEPT:

- clinical signs and symptoms.

- poor general appearance.

- systolic blood pressure.

- the mechanism of injury.

Hypovolemic shock occurs when:

- the clotting ability of the blood is enhanced.

- at least 10% of the patient's blood volume is lost.

- the patient's systolic blood pressure is less than 100 mm Hg.

- the body cannot compensate for rapid blood loss.

A young male was shot in the abdomen by an unknown type of gun. He is semiconscious, has shallow breathing, and is bleeding externally from the wound. As you control the external bleeding, your partner should:

- obtain baseline vital signs.

- assist the patient's ventilations.

- perform a secondary assessment.

- apply a nonrebreathing mask.

Whether you are using a commercial device or a stick and triangular bandage as a tourniquet, it is important to remember that:

- the tourniquet should be applied directly over a joint if possible because this provides better bleeding control.

- you should try to control the bleeding by applying pressure to a proximal arterial pressure point first.

- bulky dressings should be securely applied over the tourniquet to further assist in controlling the bleeding.

- the tourniquet should only be removed at the hospital because bleeding may return if the tourniquet is released.

Which of the following findings would be the MOST significant when assessing a patient with possible internal bleeding?

- The patient has not eaten in 24 hours.

- The patient has a history of hypertension.

- The patient had a stroke 5 years prior.

- The patient takes rivaroxaban (Xeralto).

Which of the following splinting devices would be MOST appropriate to use for a patient who has an open fracture of the forearm with external bleeding?

- Sling and swathe

- Air splint

- Cardboard splint

- Vacuum splint

If direct pressure fails to immediately stop severe bleeding from an extremity, you should apply:

- digital pressure to a proximal artery.

- a tourniquet proximal to the injury.

- additional sterile dressings.

- a splint and elevate the extremity.

What mechanism(s) does the body use to control bleeding?

- Clotting

- Coagulation

- Vasoconstriction

- All of these answers are correct.

In older patients, the first indicator of nontraumatic internal bleeding may be:

- diaphoresis and pale skin.

- a low blood pressure.

- weakness or dizziness.

- a heart rate over 120 beats/min.

Which of the following is the final stage of wound healing?

- Formation of new capillaries

- Inflammation

- Cessation of blood loss

- Collagen production

You are assessing a 28-year-old with a rigid cast extending the length of his left leg. The patient is complaining of pain on passive movement and he is showing signs of impaired circulation. What do you suspect?

- Ecchymosis

- Crush syndrome

- Avulsion

You are assessing a patient who has been in a high-impact T-bone collision. She is bleeding from the abdomen and you can see part of her large intestine outside her body. What is this injury called?

- Impalement

- Evisceration

- Avulsion

- Ecchymosis

You are treating an 8-year-old who fell while riding his bike on a gravel road. The wound on his arm is seeping blood, is about 7 inches long, and there is a lot of dirt and gravel in it. How should you treat this injury?

- Apply occlusive dressing.

- Flush the area with sterile saline.

- Manually brush/pick the foreign material out.

- Apply sterile dressing.

The severity of a thermal injury directly correlates with temperature, concentration, and what other factor?

- Duration of exposure

- Current

- Chemical reaction

- Source of thermal injury

You are responding to a fight at a restaurant and find a man, conscious and alert. His face is mottled with blisters and abrasions, and he has blood on his shirt. He tells you he was trying to stop the fight when he was hit in the face with scalding hot coffee and fell backwards over a chair. According to the rule of nines, what percentage of the patient's skin surface is burned?

- 4.5%

- 18%

- 9%

- 12%

What is your first responsibility when treating a burn patient?

- Administering high-flow oxygen

- Stopping the burning

- Preventing loss of body heat

- Identifying life-threatening injuries

Which of the following is true about electrical burns?

- They always have an entrance wound but only occasionally have an exit wound.

- Seriousness of electrical burns depends on the type of current, amperage, and conductivity.

- They are always more severe than the external signs indicate.

- The patient can go into cardiac arrest at any time within 24 hours of contact with electricity.

Which type of soft-tissue injury is LEAST likely to result in infection?

- Contusions on the left lateral chest

- Abrasions to the face

- Burns to the face

- Abdominal laceration

When using the rule of nines, which of the following do you need to include in your calculations?

- Superficial, full-, and partial-thickness burns

- Only full-thickness burns

- Full- and partial-thickness burns

- Superficial and full-thickness burns

A 21-year-old male was working in an auto repair shop and sustained radiator burns to the anterior aspect of both arms and to his anterior chest. According to the rule of nines, this patient has burns that cover _____ of his BSA.

- 18%

- 36%

- 45%

- 27%

A 33-year-old male sustained an abdominal evisceration to the left lower quadrant of his abdomen after he was cut with a large knife. After appropriately managing his ABCs and assessing him for other life-threatening injuries, how you should care for his wound?

- Irrigate it with sterile water and cover it with a dry dressing.

- Cover the exposed bowel and keep his legs in a straight position.

- Carefully replace the exposed bowel into the abdomen and transport.

- Cover it with moist, sterile gauze and secure with an occlusive dressing.

A 39-year-old male was struck in the head by a baseball during a game. He is confused and has slurred speech. He has a large hematoma in the center of his forehead and cannot remember the events preceding the injury. After manually stabilizing his head and assessing his airway, you should:

- palpate his radial pulses.

- administer high-flow oxygen.

- apply ice to the hematoma.

- perform a neurologic exam.

A 56-year-old male has an incomplete avulsion to his right forearm. After controlling any bleeding from the wound, you should:

- carefully probe the wound to determine if the bleeding is venous or arterial.

- thoroughly irrigate the wound with sterile water and cover it with a sterile dressing.

- replace the avulsed flap to its original position and cover it with a sterile dressing.

- carefully remove the avulsed flap and wrap it in a moist, sterile trauma dressing.

A burn that is characterized by redness and pain is classified as a:

- partial-thickness burn.

- second-degree burn.

- superficial burn.

- full-thickness burn.

A closed soft-tissue injury characterized by swelling and ecchymosis is called a(n):

- crush injury.

- abrasion.

- contusion.

- hematoma.

An 8-year-old male was bitten by a stray dog. He has a large laceration to the back of his left hand, which your partner covered with a sterile dressing and bandage. In addition to transporting the child to the hospital, you should:

- administer oxygen via a nonrebreathing mask.

- advise the child that he will need rabies shots.

- ask the child's father to try to locate the dog.

- report the incident to the appropriate authorities.

As you approach a young male who was involved in an industrial accident, you note that his eyes are closed and that he is not moving. You can see several large contusions to his arms, a laceration to his forehead with minimal bleeding, and a closed deformity to his right leg. You should:

- open his airway and assess his breathing status.

- perform an immediate head-to-toe assessment.

- assess his pulse for rate, regularity, and quality.

- apply high-flow oxygen and assess his injuries.

Burns to pediatric patients are generally considered more serious than burns to adults because:

- pediatric patients are more prone to hyperthermia.

- pediatric patients have a proportionately larger volume of blood.

- pediatric patients have more surface area relative to total body mass.

- most burns in children are the result of child abuse.

During your assessment of a patient who was shot in the abdomen, you notice a large entrance wound with multiple small puncture wounds surrounding it. This wound pattern is MOST consistent with a:

- shotgun.

- .22-caliber pistol.

- handgun.

- .357 magnum.

In addition to severe bleeding, the MOST life-threatening complication associated with an open neck injury is:

- an air embolism.

- nerve fiber damage.

- a spinal fracture.

- an ischemic stroke.

In which of the following patients should you remove an impaled object?

- A conscious and alert patient with a fishhook impaled in the eye

- A pulseless and apneic patient with a knife impaled in the back

- A semiconscious patient with an ice pick impaled in the chest

- An apneic patient with a shard of glass impaled in the abdomen

The sebaceous glands produce sebum, a material that:

- discharges sweat onto the skin's surface.

- waterproofs the skin and keeps it supple.

- pulls the hair erect when you are cold.

- facilitates shedding of the epidermis.

When caring for a patient whose arm is covered with a dry chemical, you should:

- quickly irrigate the arm with large amounts of water.

- deactivate the chemical with a 5% vinegar solution.

- brush away the chemical before flushing with water.

- use forceful streams of water to remove the chemical.

Which of the following areas of the body has the thinnest skin?

- Back

- Soles of the feet

- Ears

- Scalp

Which of the following is a severe burn in a 65-year-old patient?

- Partial-thickness burn to 20% of the BSA

- Superficial burn to 30% of the BSA

- Full-thickness burn to 1% of the BSA

- Second-degree burn covering 10% of the BSA

Which of the following open soft-tissue injuries is limited to the superficial layer of the skin and results in the least amount of blood loss?

- Laceration

- Incision

- Abrasion

- Avulsion

Which of the following processes occurs during the inflammation phase of the healing process?

- The blood vessels in and around the injury site constrict, which forces bacteria and other microorganisms away, thus preventing significant infection.

- White blood cells are forced away from the injury site, thus allowing an increase in the flow of red blood cells, resulting in increased blood flow.

- The immune system releases histamines, which cause vasodilation and increased capillary permeability, resulting in local redness and swelling.

- The veins and arteries at the injury site constrict and platelets aggregate, which stops bleeding and causes a temporary increase in the size of the wound.

Which of the following statements regarding crush syndrome is correct?

- Provided that a patient with a crush injury is freed from entrapment within 6 hours, the amount of tissue damaged is generally minimal.

- With crush syndrome, massive blood vessel damage occurs following severe soft-tissue injuries, such as amputation of an extremity.

- Compromised arterial blood flow leads to crush syndrome and can occur when an area of the body is trapped for longer than 4 hours.

- Tissue damage that occurs in crush syndrome is severe, but kidney injury is unlikely because toxins are quickly eliminated from the body.

You have applied a dressing and roller-gauze bandage to a laceration on the arm of a young female. During transport, she begins to complain of numbness and tingling in her hand. You should:

- assess distal circulation and readjust the bandage as needed.

- remove the gauze bandage and replace it with an elastic one.

- carefully manipulate her arm until the symptoms subside.

- remove the bandage and dressing and apply another one.

What is a hematoma?

- A rupture of the eye

- A characteristic crackling sensation felt on palpation of the skin, caused by the presence of air in soft tissue

- A collection of blood within the tissues

- A flap of skin that is separated from the underlying muscle and fascia

Which of the following fractures is associated with bruising around the ears and blood coming from the nose?

- Maxilla fracture

- Basilar skull fracture

- Orbit fracture

- Mandibular fracture

What is hyphema?

- Nosebleed

- Bleeding into the anterior chamber of the eye

- Pain or difficulty swallowing

- When air sucked into the heart

You are assessing a patient who was hit in the face by a baseball bat. There are multiple contusions on his face, and he reports double vision. His left eye does not track with his right eye. What should you suspect?

- Corneal burn

- Blow-out fracture

- Foreign object entrapment

- Retinal detachment

Which of the following is or are found in the middle ear?

- Tympanic membrane

- Pinna

- Anvil, hammer, and stirrup

- Eustachian tube

In which instance would you consider removing an impaled object?

- When the object is impaled in the ear and creates basilar trauma

- When the object is impaled in the neck into or near the carotid artery

- When the object is impaled in the eye and threatens vision

- When the object is impaled in the cheek and compromises the airway

What is an air embolism?

- A clinical situation in which a vein is punctured and air is sucked into the heart

- A swelling or enlargement of the wall of a blood vessel that results from weakening of the vessel wall

- A lack of oxygen that deprives tissues of necessary nutrients, resulting from partial or complete blockage of blood flow

- A crackling sensation felt when palpating the neck resulting from air in the soft tissues

Unequal pupils most likely indicate what type of injury?

- Skull

- Brain

- Spine

- Chest

You are treating a patient with significant bruising to her face and a broken nose. She is conscious, but her LOC is significantly altered and her breathing is labored. What should you do to manage this patient's airway?

- Insert a nasopharyngeal airway.

- Insert an oropharyngeal airway.

- Apply high-flow oxygen via a nonrebreathing mask.

- Give oxygen via a nasal cannula at 4 L/min.

Which area of the body are you palpating if you feel subcutaneous emphysema?

- Abdomen

- Spine

- Chest

- Neck

The upper jawbones are called the:

- maxillae

- mandible

- zygoma

- mastoid

A 6-year-old female was riding her bicycle and struck a clothesline with her throat. She is breathing, but with obvious difficulty. Your assessment reveals a crackling sensation in the soft tissues of her neck and facial cyanosis. In addition to the appropriate airway management, the intervention that will MOST likely improve her chance of survival is:

- careful monitoring her vital signs.

- quickly immobilizing her spinal column.

- rapidly transporting her to the hospital.

- requesting a paramedic ambulance.

When performing a full body scan, you should assess for ________.

- DCAP-BTLS

- OPQRST

- AVPU

- SAMPLE

You are assessing a 59-year-old male and note that his pupils are unequal. He is conscious and alert. When obtaining his medical history, it is MOST pertinent to ask him if he:

- is allergic to any medications.

- regularly sees a family physician.

- has a history of eye surgeries.

- noticed the change during a meal.

A 4-year-old female has a peanut lodged in the external auditory canal of her right ear. You should:

- use tweezers to try to remove the object.

- thoroughly flush her ear with sterile saline.

- remove the peanut with a cotton-tipped swab.

- transport her to the emergency department.

Which of the following statements regarding anterior nosebleeds is correct?

- They are usually severe and require aggressive treatment to control.

- They usually originate from the septum area and bleed slowly.

- They are usually caused by a fracture of the basilar skull.

- They cause blood to drain into the posterior pharynx.

When caring for a patient with an open facial injury, the EMT's immediate priority should be to:

- consider the mechanism of injury.

- manually stabilize the patient's head.

- wear gloves and facial protection.

- closely assess the patient's airway.

When transporting a patient with a facial injury, it is MOST important to be as descriptive as possible with the hospital regarding the patient's injuries because:

- it saves time on repeat assessments at the hospital.

- they may need to call a specialist to see the patient.

- they must make arrangements for an ICU bed.

- most patients with facial trauma will need surgery.

Which of the following statements regarding the vitreous humor is correct?

- It is a clear, watery fluid that is located in front of the lens and can be replaced if it is lost.

- It is a clear fluid that is produced by the lacrimal glands and cannot be replaced if it is lost.

- It is a clear, watery fluid surrounding the eye and can be replaced if it is lost.

- It is a clear, jellylike fluid near the back of the eye that cannot be replaced if it is lost.

A 52-year-old unrestrained female struck the steering wheel with her face when her truck collided with another vehicle. She has obvious swelling to her face and several dislodged teeth. A visual exam of her mouth reveals minimal bleeding. She is conscious and alert with a blood pressure of 130/80 mm Hg, a pulse of 110 beats/min, and respirations of 22 breaths/min with adequate tidal volume. You should:

- assist ventilations with a BVM device, immobilize her spine, suction her oropharynx for 30 seconds, and transport.

- fully immobilize her spine, attempt to locate the dislodged teeth, suction as needed, and transport.

- fully immobilize her spine, irrigate her empty tooth sockets, attempt to locate the dislodged teeth, and transport.

- apply oxygen via a nonrebreathing mask, suction her airway as needed, disregard the dislodged teeth, and transport.

Significant trauma to the face should increase the EMT's index of suspicion for a(n):

- spinal column injury.

- displaced mandible.

- airway obstruction.

- basilar skull fracture.

Following blunt trauma to the face, a 21-year-old male complains of a severe headache and decreased ability to move his eyes. This patient's clinical presentation is MOST consistent with:

- a blowout fracture.

- a lacerated globe.

- optic vessel compression.

- a ruptured eyeball.

A factory worker was splashed in the eyes with a strong acid chemical. He complains of intense pain and blurred vision. Your ambulance does not carry bottles of sterile saline or water. You should:

- flush both eyes with an alcohol-based solution and transport.

- mix baking soda with water and irrigate his eyes with the solution.

- irrigate both eyes continuously for 20 minutes with plain water.

- neutralize the acid chemical in his eye with an alkaline chemical.

The MOST significant complication associated with facial injuries is:

- damage to the eyes.

- mandibular immobility.

- airway compromise.

- cervical spine injury.

The Adam's apple is:

- below the thyroid cartilage and forms the upper part of the trachea.

- the small indentation in between the thyroid and cricoid cartilages.

- the upper part of the larynx that is formed by the thyroid cartilage.

- the lower part of the larynx that is formed by the cricoid cartilage.

When a light is shone into the pupil:

- it should become smaller in size.

- it should become larger in size.

- the opposite pupil should dilate.

- both pupils should dilate together.

The superficial temporal artery can be palpated:

- at the angle of the jaw.

- just anterior to the tragus.

- slightly above the ear.

- over the mastoid process.

If your patient swallows blood following facial trauma, there is an increased risk of ________.

- vomiting

- hypotension

- altered LOC

- GI trauma

Bleeding from soft-tissue injuries to the face is MOST effectively controlled with:

- ice packs and elevation of the patient's head.

- pressure dressings and chemical ice packs.

- digital pressure to an adjacent pulse point.

- direct pressure using dry, sterile dressings.

A 30-year-old female presents with redness, inflammation, and pain to her left eye. During your assessment, you note that she is having difficulty keeping her eyes open. You should suspect that she is experiencing:

- acute retinitis.

- a corneal abrasion.

- conjunctivitis.

- a detached retina.

Which of the following acts as a shock absorber for the CNS?

- Pia mater

- Cerebrospinal fluid

- Fascia

- Dura meter

Accounting for approximately 80% of all skull fractures, which of the following often present with no physical signs?

- Basilar skull fractures

- Depressed skull fracture

- Linear skull fractures

- Open skull fractures

Place a clean dressing over the bloody one.

You are treating a patient who might have a skull fracture. What should you do if a dressing you have applied to a head wound becomes soaked?

- Replace the dressing with a fresh one.

- Remove the dressing and apply an occlusive dressing.

- Place a clean dressing over the bloody one.

Cushing triad in a patient is a sign of which of the following?

- Concussion

- Spinal cord damage

- Intracranial pressure

- Blood clot in the brain

While performing a secondary assessment of a patient who was hit with a tire iron on the side of the head, you find a depressed area above the patient's left ear. This indicates that the patient could have which of the following?

- A subarachnoid hemorrhage

- An intracerebral hematoma

- A subdural hematoma

- An epidural hematoma

When securing a patient to a backboard, what area of the body should you secure last?

- Head

- Upper legs

- Pelvis

- Upper torso

The time between an initial period of unconsciousness and a subsequent loss of consciousness is referred to as what?

- Lucid interval

- Danger zone

- Recognition period

- Coherent stage

You are reassessing a patient and you find that her left pupil is dilated and fixed. What does this indicate?

- Increased intracranial pressure

- Decreased blood pressure

- Drug abuse

- Increased blood pressure

Battle sign is an indication of which of the following?

- Concussion

- Contusion

- Skull fracture

- Secondary injury

You are treating a patient who went face-first through a windshield. She has extensive head injuries and is displaying hypertension, bradycardia, and Cheyne-Stokes respirations. Which of the following should you suspect?

- C6

- Cushing triad

- Cerebral edema

- Concussion

An indicator of an expanding intracranial hematoma or rapidly progressing brain swelling is:

- an acute increase in the patient's pulse rate.

- acute unilateral paralysis following the injury.

- a rapid deterioration of neurologic signs.

- a progressively lowering blood pressure.

The five sections of the spinal column, in descending order, are the:

- coccygeal, sacral, lumbar, thoracic, and cervical.

- cervical, coccygeal, thoracic, sacral, and lumbar.

- thoracic, cervical, lumbar, coccygeal, and sacral.

- cervical, thoracic, lumbar, sacral, and coccygeal.

A patient with a head injury presents with abnormal flexion of his extremities. What numeric value should you assign to him for motor response?

- 2

- 5

- 4

- 3

The ideal procedure for moving an injured patient from the ground to a backboard is:

- the use of a scoop stretcher.

- the direct patient carry.

- the four-person log roll.

- the clothes drag.

Which of the following breathing patterns is MOST indicative of increased intracranial pressure?

- Increased rate with a normal inspiratory time and a prolonged expiratory time

- Irregular rate, pattern, and volume of breathing with intermittent periods of apnea

- Increased rate and depth with the distinct odor of acetone on the patient's breath

- Slow, shallow, occasional gasps that progress to prolonged periods of apnea