Emergency Management of Trauma Patients: Hemorrhage, Resuscitation, and Injury Assessment, Exams of Nursing

Download Emergency Management of Trauma Patients: Hemorrhage, Resuscitation, and Injury Assessment and more Exams Nursing in PDF only on Docsity! 2024 ATLS Exam PHTLS Post and Pre-Test New Latest Version with 200+ Questions from Actual Past Exam and Correct Answers Which one of the following findings in an adult is most likely to require immediate management during the primary survey? Select one: a. distended abdomen b. Glasgow Coma Scale score of 11 c. temperature of 36.5°C (97.8°F) d. deformity of the right thigh e. respiratory rate of 40 breaths per minute ---------- Correct Answer ---------- e. respiratory rate of 40 breaths per minute A 20-year-old woman that is 32 weeks gestation , is stabbed in the upper right chest. In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate first step is to: Select one: a. perform tracheal intubation b. insert an oropharyngeal airway c. perform needle or finger decompression of the right chest d. manually displace the gravid uterus to the left side of the abdomen e. initiate 2, large-caliber peripheral IV lines and crystalloid infusion ---------- Correct Answer ---------- c. perform needle or finger decompression of the right chest Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? Select one: a. The fetus is in jeopardy only with major maternal abdominal trauma. b. Leakage of amniotic fluid is an indication for hospital admission. c. Indications for peritoneal lavage are different from those in the nonpregnant patient. d. With penetrating trauma, injury to the mother's abdominal hollow viscus is more common in late than in early pregnancy. e. The secondary survey follows a different pattern from that of the nonpregnant patient. -- -------- Correct Answer ---------- b. Leakage of amniotic fluid is an indication for hospital admission. The first maneuver to improve oxygenation after chest injury is to: Select one: a. intubate the patient b. assess arterial blood gases c. administer supplemental oxygen d. ascertain the need for a chest tube e. obtain a chest x-ray ---------- Correct Answer ---------- c. administer supplemental oxygen A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: Select one: a: 2 b: 4 c: 6 d: 9 e: 12 ---------- Correct Answer ---------- d: 9 An important, immediate step in the management of an open pneumothorax is: Select one: a. endotracheal intubation b. operation to close the wound c. placing a chest tube through the chest wound d. placement of an occlusive dressing over the wound secured on three sides b. attempt nasotracheal intubation c. ventilate him with a bag-mask device until c-spine injury can be excluded d. restrict cervical motion and attempt orotracheal intubation using 2 people e. ventilate the patient with a bag-mask device until his beard can be shaved for ---------- Correct Answer ---------- d. restrict cervical motion and attempt orotracheal intubation using 2 people A patient is brought to the emergency department after a motor vehicle crash. He is conscious and there is no obvious external trauma. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm. Which one of the following statements is TRUE? Select one: a. Vasoactive medications have no role in this patient's management. b. The hypotension should be managed with volume resuscitation alone. c. Flexion and extension views of the c-spine should be performed early. d. Abdominal visceral injuries can be excluded as a cause of hypotension. e. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. -------- -- Correct Answer ---------- e. Flaccidity of the lower extremities and loss of deep tendon reflexes are expected Which one of the following is the most effective method for initially treating frostbite? Select one: a. moist heat b. early amputation c. padding and elevation d. vasodilators and heparin e. topical application of silver sulfadiazine ---------- Correct Answer ---------- a. moist heat A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival to the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, a pulse cannot be palpated below the right femoral artery and the muscles of the lower extremity are firm and hard. During the management of this patient, which of the following is most likely to improve the chances for limb salvage? Select one: a. applying skeletal traction b. administering anticoagulant drugs c. administering thrombolytic therapy d. surgical consultation for right lower extremity fasciotomy e. transferring the patient to the trauma center 120 km away ---------- Correct Answer ------- --- d. surgical consultation for right lower extremity fasciotomy A patient arrives in the emergency department after being beaten about the head and face with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw is to: Select one: a. request a CT scan b. insert a gastric tube c. suction the oropharynx d. obtain a lateral cervical spine x-ray e. ventilate the patient with a bag-mask ---------- Correct Answer ---------- c. suction the oropharynx A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital; no surgical capabilities are available. In the emergency department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just before the patient is placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute. The next step should be to: Select one: a. clamp the chest tube b. cancel the patient's transfer c. perform an emergency department thoracotomy d. repeat the primary survey and proceed with transfer e. delay the transfer until the referring doctor can contact a thoracic surgeon ---------- Correct Answer ---------- d. repeat the primary survey and proceed with transfer A 22-year-old man is hypotensive and tachycardic after a shotgun wound to the left shoulder. His blood pressure is initially 80/40 mm Hg. After initial fluid resuscitation his blood pressure increases to 122/84 mm Hg. His heart rate is now 100 beats per minute and his respiratory rate is 28 breaths per minute. A tube thoracostomy is performed for decreased left chest breath sounds with the return of a small amount of blood and no air leak. After chest tube insertion, the most appropriate next step is: Select one: a. reexamine the chest b. perform an aortogram c. obtain a CT scan of the chest d. obtain arterial blood gas analyses e. perform transesophageal echocardiography ---------- Correct Answer ---------- A) Reexamine the chest A construction worker falls two stories from a building and sustains bilateral calcaneal fractures. In the emergency department, he is alert, vital signs are normal, and he is complaining of severe pain in both heels and his lower back. Lower extremity pulses are strong and there is no other deformity. The suspected diagnosis is most likely to be confirmed by: Select one: a. angiography b. compartment pressures c. retrograde urethrogram d. Doppler ultrasound studies e. complete spine x-ray series ---------- Correct Answer ---------- e) Complete spine x-ray series hypotension d. increased vascular resistance e. evidence of inadequate organ perfusion ---------- Correct Answer ---------- e. evidence of inadequate organ perfusion A 7-year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate management of the wound should consist of: Select one: a. application of a tourniquet b. direct pressure on the wound c. packing the wound with gauze d. direct pressure on the femoral artery at the groin e. debridement of devitalized tissue ---------- Correct Answer ---------- b. direct pressure on the wound For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: Select one: a. respiratory acidosis b. metabolic acidosis c. cerebral vasoconstriction with diminished perfusion d. neurogenic pulmonary edema e. shift of the oxyhemoglobin dissociation curve ---------- Correct Answer ---------- c. cerebral vasoconstriction with diminished perfusion After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: Select one: a. obtain contrast angiography b. transfer to a higher level trauma center c. perform an exploratory laparotomy d. infuse additional crystalloid fluids e. Obtain transesophageal echocardiography ---------- Correct Answer ---------- c. perform an exploratory laparotomy A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you should first: Select one: a. intubate the patient b. perform diagnostic peritoneal lavage or FAST c. insert a left chest tube d. call the receiving hospital and speak to the surgeon on call e. discuss the advisability of transfer with the patient's family ---------- Correct Answer ------- --- d. call the receiving hospital and speak to the surgeon on call Hemorrhage of 20% of the patient's blood volume is associated usually with: Select one: a. oliguria b. confusion c. hypotension d. tachycardia e. blood transfusion requirement ---------- Correct Answer ---------- d. tachycardia Which one of the following statements concerning intraosseous infusion is TRUE? Select one: a. Only crystalloid solutions may be safely infused through the needle. b. Aspiration of bone marrow confirms appropriate positioning of the needle. c. Intraosseous infusion is the preferred route for volume resuscitation in small children. d. Intraosseous infusion may be utilized indefinitely. e. Swelling in the soft tissues around the intraosseous site is not a reason to discontinue infusion. ---------- Correct Answer ---------- b. Aspiration of bone marrow confirms appropriate positioning of the needle. A young female sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6, blood pressure is 140/90 mm Hg, and her heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to: Select one: a. avoid hypotension b. administer an osmotic diuretic c. aggressively treat systemic hypertension d. reduce metabolic requirements of the brain e. distinguish between intracranial hematoma and cerebral edema ---------- Correct Answer ---------- a. avoid hypotension A 33-year-old female is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her from the car. Upon arrival in the emergency department, her heart rate is 120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS score is 15. Examination reveals bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the following, the most likely diagnosis is: Select one: a. hemorrhagic shock b. cardiac tamponade Which situation requires Rh immunoglobulin administration to an injured female? Select one: a. negative pregnancy test, Rh negative, and has torso trauma b. positive pregnancy test, Rh positive, and has torso trauma c. positive pregnancy test, Rh negative, and has torso trauma d. positive pregnancy test, Rh positive, and has an isolated wrist fracture e. positive pregnancy test, Rh negative, and has an isolated wrist fracture ---------- Correct Answer ---------- c. positive pregnancy test, Rh negative, and has torso trauma A 22-year-old female athlete is stabbed in her left chest at the third interspace in the anterior axillary line. On admission to the ED and 15 minutes after the incident, she is awake and alert. Her heart rate is 100 beats per minute, blood pressure is 80/60 mm Hg, and respiratory rate is 20 breaths per minute. A chest x-ray reveals a large left hemothorax. A left chest tube is placed with an immediate return of 1600 mL of blood. The next management step for this patient is to: Select one: a. perform a thoracoscopy b. perform an arch aortogram c. insert a second left chest tube d. prepare for an exploratory thoracotomy e. perform a chest CT ---------- Correct Answer ---------- d. prepare for an exploratory thoracotomy A 6-year-old boy walking across the street is struck by the front bumper of a sports utility vehicle traveling at 32 kph (20 mph). Which one of the following statements is TRUE about this patient? Select one: a. A flail chest is probable. b. A symptomatic blunt cardiac injury is expected. c. A pulmonary contusion may be present in the absence of rib fractures. d. Transection of the thoracic aorta is more likely than in an adult patient. e. Rib fractures are commonly found in children with this mechanism of injury. ---------- Correct Answer ---------- c. A pulmonary contusion may be present in the absence of rib fractures The displacement of tissue away from the path of a projectile, both temporarily and permanently, is known as: A. Conization B. Cavitation C. Crepitation D. Contusion --------- Correct Answer ---------- B. Cavitation The single most important factor in determining the potential for injury due to energy exchange is: A. Mass of the bodies involved B. Velocity of the bodies involved C. Density of the tissues involved D. Surface area of the impact involved --------- Correct Answer ---------- B. Velocity of the bodies involved In the management of shock, isotonic crystalloid solutions, such as Ringer's, are preferred because: A. The protein molecules in crystalloid solutions act as volume expanders B. These fluids draw interstitial fluid into the vascular space to enhance volume C. These solutions will stay in the vascular space longer than water solutions, such as D5W D. Their pH enhance oxygen delivery to the tissues --------- Correct Answer ---------- C. These solutions will stay in the vascular space longer than water solutions, such as D5W With respect to the distance of a fall, which of the following is a guideline for determining a critical fall? A. 3 times the height of the patient B. 2 times the height of the patient C. 5 times the height of the patient D. 1 ½ times the height of the patient --------- Correct Answer ---------- A. 3 times the height of the patient The phase of an explosion, or blast, in which hollow organs are squeezed and may rupture is called the __________ phase. A. Tertiary phase B. Quaternary phase C. Secondary phase D. Primary phase --------- Correct Answer ---------- D. Primary phase During the primary survey and management of a trauma patient, the E in ABCDE stands for _________? A. Edema B. Eyes & ears C. Expose/Environment D. Electrical therapy --------- Correct Answer ---------- C. Expose/Environment The time in which surgical intervention can make a difference in patient outcome is the __________? A. Golden period B. Golden time C. Golden era D. Golden minutes --------- Correct Answer ---------- A. Golden period (hour) In the absence of extenuating circumstances, the maximum amount of time it should take to identify and manage immediate threats to life, prepare the patient for transport and begin transport is _________? A. 5 minutes B. 10 minutes C. 15 minutes D. 30 minutes --------- Correct Answer ---------- B. 10 minutes In which of the following situations is the use of a short spinal immobilization device indicated? A. 28 year old male, unrestrained driver in a frontal impact crash. Awake, asks repeatedly what happened, complains of a headache, has a hematoma on his forehead. BP 122/84, HR 92, VR 20. B. 40 year old female who was pushed down a flight of stairs and is lying prone on the landing between two flights of stairs, complaining of back pain. BP 118/78, HR 100, VR 20. C. 17 year old female, restrained driver in a frontal impact crash. Awake, pale and diaphoretic, complains of upper right quadrant abdominal pain. BP 100/70, HR 108, VR 20. D. None of the above --------- Correct Answer ---------- D. None of the above Your patient is a 32 year old man, restrained driver of a vehicle that has been involved in a frontal impact with a concrete bridge abutment. The patient is awake, but has difficulty answering questions due to shortness of breath. His ventilatory rate is 30 per deceleration with the lap belt placed across the abdomen, most likely represents which of the following injuries? A. Abdominal aortic aneurysm B. Ruptured diaphragm C. Ruptured esophagus D. "Paper bag" syndrome of the lungs --------- Correct Answer ---------- B. Ruptured diaphragm Which of the following is NOT a component of the Fick Principle? A. Adequate number of platelets in the blood B. Oxygenation of red blood cells C. Transportation of red blood cells to the tissues of the body D. Off-loading oxygen from the red blood cells to the tissues --------- Correct Answer ----- ----- A. Adequate number of platelets in the blood One of the earliest signs of hypovolemic shock is: A. Hypotension B. Bradycardia C. Anxiety D. Reduced urine output --------- Correct Answer ---------- C. Anxiety Which of the following characterizes the washout phase of shock? A. Systemic acidosis B. Localized tissue acidosis C. Edema D. Reduced capillary blood flow --------- Correct Answer ---------- A. Systemic acidosis A trauma patient who has fallen 20 feet from an apartment balcony is alert with warm, dry, pink skin, with normal capillary refilling time to the lower extremities, and is hypotensive. The upper extremities are cool, pale and diaphoretic. Which of the following injuries should be suspected? A. Aortic dissection B. Liver laceration C. Fractured pelvis D. Spinal cord injury --------- Correct Answer ---------- D. Spinal cord injury Which of the following is a limitation of prehospital fluid resuscitation of the patient in hemorrhagic shock? A. Inability of fluids to carry oxygen B. Pulmonary edema C. Increased hemorrhage D. All of the above --------- Correct Answer ---------- D. All of the above Which of the following statements regarding signs of intraabdominal injury is NOT true? A. Fresh blood in the abdominal cavity does not cause signs of peritonitis B. A significant amount of blood loss occurs before abdominal distention can be noticed C. Substantial intraabdominal hemorrhage always causes tenderness and abdominal rigidity D. Signs and symptoms of shock greater than can be explained by other injuries is a reliable indicator of intraabdominal injury --------- Correct Answer ---------- C. Substantial intraabdominal hemorrhage always causes tenderness and abdominal rigidity Which of the following assessment techniques is least useful in the prehospital assessment of the patient with suspected intraabdominal trauma? A. Palpation B. Auscultation C. Inspection D. Scene assessment --------- Correct Answer ---------- B. Auscultation Pregnant trauma patients should be placed on the left side because: A. This prevents seizures due to eclampsia B. This prevents abruption of the placenta C. This prevents compression of the vena cava D. This is the best way to auscultate fetal heart tones --------- Correct Answer ---------- C. This prevents compression of the vena cava Survival of the fetus in a trauma situation is most dependent upon which of the following factors? A. Gestational age of the fetus B. Prenatal care C. Immediate cesarean section D. Good resuscitation of the mother --------- Correct Answer ---------- D. Good resuscitation of the mother A patient struck in the back of the head with a baseball bat may sustain a cerebral contusion to which area of the brain? A. Frontal and occipital B. Occipital C. Parietal D. Frontal --------- Correct Answer ---------- B. Occipital (probably too low velocity for Coup & Contre Coup) In the context of the caring for an adult patient with traumatic brain injury who is deteriorating and exhibiting signs of herniation, hyperventilation means ventilating with a BVM and 100% oxygen at a rate of: A. 12 to 16 per minute B. 32 to 40 per minute C. 8 to 12 per minute D. 20 per minute --------- Correct Answer ---------- D. 20-hyperventilate to temp decrease ICP In the United State, which of the following mechanisms most frequently causes spinal cord injury in adults? A. Shallow water diving B. Vehicle crashes C. Falls D. Pedestrian struck by a vehicle --------- Correct Answer ---------- B. Vehicle crashes Which of the following presentation indicate spinal cord injury? A. Complete loss of sensory and motor function below the site of injury B. Weakness and parethesia in the upper extremities, but normal function in the lower extremities C. Complete loss of function on one side of the body and loss of pain and temperature sensation on the opposite side D. All of the above --------- Correct Answer ---------- D. All of the above Of the following, which is the earliest indication of compartment syndrome? A. Paralysis of the affected muscles B. Loss of pulses C. Loss of feeling in the web space between the thumb and index finger or between the first and second toes D. Tense swelling of the involved area --------- Correct Answer ---------- D. Tense swelling of the involved area A traction splint may be used for which of the following injuries? A. Knee dislocation B. Pelvic fractures C. Femur fractures D. All of the above --------- Correct Answer ---------- C. Femur fractures Which of the following descriptions meets the criteria for transport to a facility with a burn unit? Which of the following patients is not indicated for spinal immobilization? A. Intoxicated patient in a MVC B. Patient who fell 8 feet and lost consciousness C. Patient complaining of pain on palpation of the neck D. Patient with a knife wound to the chest and a GCS of 15 --------- Correct Answer ------ ---- D. Patient with a knife wound to the chest and a GCS of 15 The premise of PHTLS is that: A. EMTs must treat all trauma patient based on protocols B. EMTs are capable of sound patient care judgment, given an adequate knowledge base C. EMTs must work only under on-line medical direction when caring for trauma patients D. EMTs are capable of working independently of medical direction --------- Correct Answer ---------- B. EMTs are capable of sound patient care judgment, given an adequate knowledge base Which of the following warrants classification of a patient as a critical trauma patient? A. An extremity fracture B. Preexisting major medical problem C. Bleeding from the nose D. Deployment of air bags in a motor vehicle crash --------- Correct Answer ---------- B. Preexisting major medical problem Which of the following is the foundation of effective trauma care? A. Protocols permitting invasive airway procedures B. The ability to administer large amounts of crystalloid fluids C. The ability to quickly locate and manage life-threatening and potentially life- threatening injuries D. Effective spinal immobilization skills --------- Correct Answer ---------- C. The ability to quickly locate and manage life-threatening and potentially life-threatening injuries You arrive at the scene of a motor vehicle collision in which a vehicle struck a tree. Which is the best indicator of potential injury? A. Circumference of the vehicle B. Diameter of the tree C. Mass of the vehicle D. Speed of the vehicle --------- Correct Answer ---------- D. Speed of the vehicle The potential for death or serious injury is greatest in which of the following motor vehicle collisions? A) Down and under B) Ejection from vehicle C) Lateral compression D) Up and over --------- Correct Answer ---------- B) Ejection from vehicle Bilateral femur fractures are most often associated with which type of motorcycle crash? A) Angular impact B) Bike-road impact C) Head-on impact D) Rear impact --------- Correct Answer ---------- C) Head-on impact Which is the preferred fluid for resuscitation of hemorrhagic shock in the prehospital setting? A) 5% dextrose in water B) 7.5% hypertonic saline C) Hetastarch D) Lactated Ringer's --------- Correct Answer ---------- D) Lactated Ringer's Which is the most common cause of upper airway obstruction in the trauma patient? A) Blood B) Teeth C) Tongue D) Vomitus --------- Correct Answer ---------- C) Tongue Which is the preferred adjunct device for verifying placement of an endotracheal tube in a patient with a perfusing rhythm? A) End-tidal CO2 monitoring (capnography) B) Esophageal detector device C) Pulse oximeter D) Stethoscope --------- Correct Answer ---------- A) End-tidal CO2 monitoring (capnography) Which is the most important reason to maintain an open airway in the trauma patient? A) Prevents aspiration and pneumonia B) Prevents hypoxemia and hypercarbia C) Prevents snoring respirations D) Prevents the tongue from blocking the pharynx --------- Correct Answer ---------- B) Prevents hypoxemia and hypercarbia Essential airway skills include manual clearing of the airway, manual maneuvers, suctioning and which of the following? A) Dual lumen airway B) Endotracheal intubation C) Laryngeal mask airway D) Oropharyngeal airway --------- Correct Answer ---------- D) Oropharyngeal airway Your patient is a middle aged male who crashed his motorcycle. He is unresponsive. After opening the airway using a modified jaw thrust, you note the patient has respirations at a rate of 6. Auscultation reveals breath sounds are absent on the left side. Which of the following is the most appropriate next intervention? A) Apply a non-rebreather mask B) Begin ventilation with a BVM C) Insert an endotracheal tube D) Perform a needle decompression --------- Correct Answer ---------- B) Begin ventilation with a BVM Which best describes shock? A) Decreased Glasgow Coma Scale (GCS) B) Flushed, dry, hot skin combined with bradycardia C) Generalized inadequate tissue perfusion D) Low blood pressure combined with tachycardia --------- Correct Answer ---------- C) Generalized inadequate tissue perfusion Your patient has a deep laceration to his antecubital fossa with significant bleeding. What is the most appropriate initial action? A) Apply a tourniquet B) Apply direct pressure C) Initiate rapid transport D) Restore blood volume --------- Correct Answer ---------- B) Apply direct pressure Hypotension of unknown etiology in a trauma patient should be assumed to result from which of the following? A) Blood loss B) Cardiac tamponade C) Spinal injury D) Tension pneumothorax --------- Correct Answer ---------- A) Blood loss Which assessment is most beneficial in differentiating hemorrhagic shock from neurogenic shock in the prehospital setting? C) Elevate the leg and apply pressure to the femoral artery D) Maintain direct pressure and transport immediately --------- Correct Answer ---------- B) Apply a tourniquet and tighten it until bleeding stops An 18-year-old female was struck by a car and has sustained an apparent left femur fracture. Communication with her is hampered because she only speaks a foreign language. Which finding, by itself, does not mandate immobilization of the cervical spine? A) Fracture of the femur B) Inability to communicate C) Mechanism of injury D) Tenderness over the cervical spine --------- Correct Answer ---------- C) Mechanism of injury During the primary survey of a trauma patient, you note that the patient is agitated and confused, and has multiple injuries from an altercation. Which of the following choices is the most appropriate first treatment priority? A) Blood glucose determination B) Correction of possible hypoxia C) Full immobilization to a backboard D) Obtain intravenous access --------- Correct Answer ---------- B) Correction of possible hypoxia When something crashes in secondary survey, you... --------- Correct Answer ---------- GO BACK TO PRIAMRY SURVEY If the question says you do not have capabilities, you will most likely --------- Correct Answer ---------- PREPARE FOR AND DO NOT DELAY TRANSPORT How much blood can femur lose --------- Correct Answer ---------- 2L What is always going to be the shock type to pick --------- Correct Answer ---------- Hemorrhagic What are the classes of hemorrhagic shock --------- Correct Answer ---------- 0-15% is class 1 15-30 is class 2 30-40% is class 3 >40% is class 4 What is the EARLIEST predictor of shock at what class --------- Correct Answer ---------- Narrowed pulse pressure in class 2 What will be base deficit for class 2 shock? --------- Correct Answer ---------- -2 to -6 meQ What will be the deficit for class 4? --------- Correct Answer ---------- -10 or less When will urine output start to decrease in shock? --------- Correct Answer ---------- Class 3 and 4 When does BP start to fall in shock --------- Correct Answer ---------- Class 3 What is GCS? --------- Correct Answer ---------- E-4 V-5 M-6 Eye spont 4 To command 3 To pain 2 None 1 Verbal spont is 5 Verbal confused is 4 Inappropriate 3 Garbling is 2 None is 1 Motor spont is 6 Localize pain is 5 Withdrawal pain is 4 Decorticating (flexion) is 3 Decebrate (extension) is 2 None is 1 Two main reasons to think about why GCS goes down? --------- Correct Answer ---------- TBI Hemorrhagic shock Why do you want to put in chest tube before needle decompression? --------- Correct Answer ---------- SIMPLE PTX can turn into TENSION PTX When is DPL useful over fast? --------- Correct Answer ---------- No ultrasound available. What is LEMON for airway patency --------- Correct Answer ---------- Look Evaluate Malay-ATI Obstruction Neck mobility What is DEFINITIVE airway? --------- Correct Answer ---------- Tube in trachea BELOW vocal cords WHEN is surgical airway indicated? --------- Correct Answer ---------- When you CANNOT do any other form of airway (2 attempts typically) What is contraindicated with suspicion of basilar skull frx? --------- Correct Answer -------- -- OPA, put in gastric tube for suction because it can go through up into cranium thru cribiform plate Peds kid with bicycle trauma is most likely goin to be? --------- Correct Answer ---------- PANCREATIC injury Organ tear is more common with? --------- Correct Answer ---------- Penetrating injury What type of pelvic fracture is binder indicated in --------- Correct Answer ---------- Open book If there is BLOOD at the meatus, then what do you need to do? --------- Correct Answer ---------- RUG first, because if you do a cyst gram you will be spilling into the abd cavity If patient is unstable, free air/blood on CT, peritoneal signs yield what? --------- Correct Answer ---------- EMERGENT laparotomy What lab value is good for assessing hydration in burn patient? --------- Correct Answer - --------- URINE OUTPUT How do you determine difference between PTX and tamponade? --------- Correct Answer ---------- BREATH SOUNDS Blowing air leak on chest tube is sign of? --------- Correct Answer ---------- TRACHEOBRONCHIAL RUPTURE Bowel sounds on chest auscultation are reflective of --------- Correct Answer ---------- Diaphragm injury Apical capping and widened mediastinum are reflective of what? --------- Correct Answer ---------- Aortic trauma Circumferential burn? --------- Correct Answer ---------- Escharotomy What is main goal of priamry brain injury? --------- Correct Answer ---------- Preventing secondary brain injury 2 big causes of secondary brain injury? --------- Correct Answer ---------- HYPOVOLEMIA and HYPOXEMIA A 7-year-old boy is brought to the emergency department by his parents several minutes after he fell through a window. He is bleeding profusely from a 6-cm wound of his medial right thigh. Immediate management of the wound should consist of: --------- Correct Answer ---------- direct pressure on the wound For the patient with severe traumatic brain injury, profound hypocarbia should be avoided to prevent: --------- Correct Answer ---------- cerebral vasoconstriction with diminished perfusion After being involved in a motor vehicle crash, a 25-year-old man is brought to a hospital that has surgery capabilities available.. Computed tomography of the chest and abdomen shows an aortic injury and splenic laceration with free abdominal fluid. His blood pressure falls to 70 mm Hg after CT. The next step is: --------- Correct Answer ----- ----- perform an exploratory laparotomy Which one of the following statements regarding abdominal trauma in the pregnant patient is TRUE? --------- Correct Answer ---------- Leakage of amniotic fluid is an indication for hospital admission. The first maneuver to improve oxygenation after chest injury is: --------- Correct Answer - --------- administer supplemental oxygen A 25-year-old man, injured in a motor vehicular crash, is admitted to the emergency department. His pupils react sluggishly and his eyes open to pressure. He does not follow commands, but he does moan periodically. His right arm is deformed and does not respond to pressure; however, his left hand reaches purposefully toward the stimulus. Both legs are stiffly extended. His GCS score is: --------- Correct Answer -------- -- 9 A 20-year-old woman who is at 32 weeks gestation, is stabbed in the upper right chest. In the emergency department, her blood pressure is 80/60 mm Hg. She is gasping for breath, extremely anxious, and yelling for help. Breath sounds are diminished in the right chest. The most appropriate first step is to: --------- Correct Answer ---------- perform needle or finger decompression of the right chest Which one of the following findings in an adult is most likely to require immediate management during the primary survey? --------- Correct Answer ---------- respiratory rate of 40 breaths per minute The most important, immediate step in the management of an open pneumothorax is: -- ------- Correct Answer ---------- placement of an occlusive dressing over the wound The following are contraindications for tetanus toxoid administration: --------- Correct Answer ---------- history of neurological reaction or severe hypersensitivity to the product A 56-year-old man is thrown violently against the steering wheel of his truck during a motor vehicle crash. On arrival in the emergency department he is diaphoretic and complaining of chest pain. His blood pressure is 60/40 mm Hg and his respiratory rate is 40 breaths per minute. Which of the following best differentiates cardiac tamponade from tension pneumothorax as the cause of his hypotension? --------- Correct Answer --- ------- breath sounds Bronchial intubation of the right or left mainstem bronchus can easily occur during infant endotracheal intubation because: --------- Correct Answer ---------- The trachea is relatively short. A 23-year-old man sustains 4 stab wounds to the upper right chest during an altercation and is brought by ambulance to a hospital that has full surgical capabilities. His wounds are all above the nipple. He is endotracheally intubated, closed tube thoracostomy is performed, fluid resuscitation is initiated through 2 large-caliber IVs. FAST exam does not reveal intraabdominal injuries. His blood pressure now is 60/0 mm Hg, heart rate is 160 beats per minute, and respiratory rate is 14 breaths per minute (ventilated with 100% O2). 1500 mL of blood has drained from the right chest. The most appropriate next step in managing this patient is to: --------- Correct Answer ---------- urgently transfer the patient to the operating room A 39-year-old man is admitted to the emergency department after an automobile collision. He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6. His full beard makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is to: --------- Correct Answer ---------- restrict cervical motion and attempt orotracheal intubation using 2 people A patient is brought to the emergency department after a motor vehicle crash. He is conscious and there is no obvious external trauma. He arrives at the hospital completely immobilized on a long spine board. His blood pressure is 60/40 mm Hg and his heart rate is 70 beats per minute. His skin is warm. Which one of the following statements is TRUE? --------- Correct Answer ---------- Flaccidity of the lower extremities and loss of deep tendon reflexes are expected. Which one of the following is the most effective method for initially treating frostbite? ---- ----- Correct Answer ---------- moist heat A 32-year-old man's right leg is trapped beneath his overturned car for nearly 2 hours before he is extricated. On arrival in the emergency department, his right lower extremity is cool, mottled, insensate, and motionless. Despite normal vital signs, pulses cannot be palpated below the right femoral artery and the muscles of the lower extremity are firm and hard. During the management of this patient, which of the following is most likely to improve the chances for limb salvage? --------- Correct Answer ---------- surgical consultation for right lower extremity fasciotomy A patient arrives in the emergency department after being beaten about the head and face with a wooden club. He is comatose and has a palpable depressed skull fracture. His face is swollen and ecchymotic. He has gurgling respirations and vomitus on his face and clothing. The most appropriate step after providing supplemental oxygen and elevating his jaw is to: --------- Correct Answer ---------- suction the oropharynx A 22-year-old man sustains a gunshot wound to the left chest and is transported to a small community hospital no surgical capabilities are available. In the emergency department, a chest tube is inserted and 700 mL of blood is evacuated. The trauma center accepts the patient in transfer. Just before the patient is placed in the ambulance for transfer, his blood pressure decreases to 80/68 mm Hg and his heart rate increases to 136 beats per minute. The next step should be to: --------- Correct Answer ---------- repeat the primary survey and proceed with transfer A 64-year-old man involved in a high-speed car crash, is resuscitated initially in a small hospital without surgical capabilities. He has a closed head injury with a GCS score of 13. He has a widened mediastinum on chest x-ray with fractures of left ribs 2 through 4, but no pneumothorax. After initiating fluid resuscitation, his blood pressure is 110/74 mm Hg, heart rate is 100 beats per minute, and respiratory rate is 18 breaths per minute. He has gross hematuria and a pelvic fracture. You decide to transfer this patient to a facility capable of providing a higher level of care. The facility is 128 km (80 miles) away. Before transfer, you should first: --------- Correct Answer ---------- call the receiving hospital and speak to the surgeon on call Hemorrhage of 20% of the patient's blood volume is associated usually with: --------- Correct Answer ---------- tachycardia Which one of the following statements concerning intraosseous infusion is TRUE? ------- -- Correct Answer ---------- Aspiration of bone marrow confirms appropriate positioning of the needle. A young woman sustains a severe head injury as the result of a motor vehicle crash. In the emergency department, her GCS is 6. Her blood pressure is 140/90 mm Hg and her heart rate is 80 beats per minute. She is intubated and mechanically ventilated. Her pupils are 3 mm in size and equally reactive to light. There is no other apparent injury. The most important principle to follow in the early management of her head injury is to: - -------- Correct Answer ---------- avoid hypotension A 33-year-old woman is involved in a head-on motor vehicle crash. It took 30 minutes to extricate her from the car. Upon arrival in the emergency department, her heart rate is 120 beats per minute, BP is 90/70 mm Hg, respiratory rate is 16 breaths per minute, and her GCS score is 15. Examination reveals bilaterally equal breath sounds, anterior chest wall ecchymosis, and distended neck veins. Her abdomen is flat, soft, and not tender. Her pelvis is stable. Palpable distal pulses are found in all 4 extremities. Of the following, the most likely diagnosis is: --------- Correct Answer ---------- cardiac tamponade None is 1 Two main reasons to think about why GCS goes down? --------- Correct Answer ---------- TBI Hemorrhagic shock Why do you want to put in chest tube before needle decompression? --------- Correct Answer ---------- SIMPLE PTX can turn into TENSION PTX When is DPL useful over fast? --------- Correct Answer ---------- No ultrasound available. What is LEMON for airway patency --------- Correct Answer ---------- Look Evaluate Malay-ATI Obstruction Neck mobility What is DEFINITIVE airway? --------- Correct Answer ---------- Tube in trachea BELOW vocal cords WHEN is surgical airway indicated? --------- Correct Answer ---------- When you CANNOT do any other form of airway (2 attempts typically) What is contraindicated with suspicion of basilar skull frx? --------- Correct Answer -------- -- OPA, put in gastric tube for suction because it can go through up into cranium thru cribiform plate Peds kid with bicycle trauma is most likely goin to be? --------- Correct Answer ---------- PANCREATIC injury Organ tear is more common with? --------- Correct Answer ---------- Penetrating injury What type of pelvic fracture is binder indicated in --------- Correct Answer ---------- Open book If there is BLOOD at the meatus, then what do you need to do? --------- Correct Answer ---------- RUG first, because if you do a cyst gram you will be spilling into the abd cavity If patient is unstable, free air/blood on CT, peritoneal signs yield what? --------- Correct Answer ---------- EMERGENT laparotomy What lab value is good for assessing hydration in burn patient? --------- Correct Answer - --------- URINE OUTPUT How do you determine difference between PTX and tamponade? --------- Correct Answer ---------- BREATH SOUNDS Blowing air leak on chest tube is sign of? --------- Correct Answer ---------- TRACHEOBRONCHIAL RUPTURE Bowel sounds on chest auscultation are reflective of --------- Correct Answer ---------- Diaphragm injury Apical capping and widened mediastinum are reflective of what? --------- Correct Answer ---------- Aortic trauma Circumferential burn? --------- Correct Answer ---------- Escharotomy What is main goal of priamry brain injury? --------- Correct Answer ---------- Preventing secondary brain injury 2 big causes of secondary brain injury? --------- Correct Answer ---------- HYPOVOLEMIA and HYPOXEMIA Girl falls on her head, loses consciousness, and is now unstable. What kind of hematoma is this? --------- Correct Answer ---------- EPIDURAL, *lucid interval* is common between time of injury and presentation What is more common, subdural or epidural --------- Correct Answer ---------- Subdural What is considered mid TBI? --------- Correct Answer ---------- 13-15 T/o secondary management of mild TBI? --------- Correct Answer ---------- CT repeat if first is abnormal OR GCS persists at under 15. Serial exams Initial management of TBI? --------- Correct Answer ---------- elevate head NS (3%) Indications of transport to higher Level of care with TBI? --------- Correct Answer ---------- Worsening GCS, GCS <8. Lesions on CT Above what level can you get neurogenic shock --------- Correct Answer ---------- T6 Description of neurogenic shock patient? --------- Correct Answer ---------- What is bulbovesicular reflex indicative of? --------- Correct Answer ---------- NOT qualify as sacral sparing. If there is ANY motor or sensory function below level of injury, constitutes as incomplete injury and should be documented appropriately T/F: Stridor is LATE finding of airway damage in burn pt? --------- Correct Answer --------- - TRUE Initial management of burn? --------- Correct Answer ---------- DRY dressing. NOT moist! Transfer indications for burn? --------- Correct Answer ---------- Partial thickness >40% BSA What is dark urine reflective of in burn pt? --------- Correct Answer ---------- RHABDO What do you constantly need to replenish burn pt? --------- Correct Answer ---------- Cellular losses 2/2 inflammation What is GOAL urine output in burn? --------- Correct Answer ---------- 3-50mL per hour, BEST assessment of hydration What do you need to monitor for with rewarming in hypothermia --------- Correct Answer ---------- ARRYTHMIA MCC of cardiac arrest in kids? --------- Correct Answer ---------- HYPOXIA If you fail an IV in a kid what is next step? --------- Correct Answer ---------- IO What is crystalloid infusion unit for kids --------- Correct Answer ---------- 20/kg Two MCC of geriatric injuries? --------- Correct Answer ---------- FALL, MVC