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EMT FISDAP TRAUMA EXAM LATEST EXAM
2024 | ALL QUESTIONS AND CORRECT
ANSWERS WITH EXPLANATIONS |
ALREADY GRADED A+ | VERIFIED
ANSWERS
A man was stabbed to the left side of the chest. His skin is cool and clammy, his blood pressure is 90/60 mm Hg, his respirations are 22 breaths/min, and his pulse is 120 beats/min and weak. His breath sounds are equal bilaterally and his jugular veins are distended. What should you do? A) Cover the wound and position him on his left side. B) Ventilate the patient, apply an AED, and transport. C) Cover the wound, administer oxygen, and transport. D) Suspect a pneumothorax and contact medical control. ------CORRECT ANSWER---------------C) Cover the wound, administer oxygen, and transport. The mechanism of injury and clinical presentation indicate a pericardia! tamponade. Pericardia! tamponade occurs when blood fills the pericardia! sac and restricts the heart from relaxing. If the heart cannot relax, it cannot fill with blood. If the right side of the heart cannot fill with blood, there is nothing for it to send to the left side of the heart; as a result, the patient's cardiac output drops and shock develops. Signs of pericardia! tamponade include muffled or distant heart tones (difficult to assess in the field); a rapid, weak pulse; hypotension; jugular venous distention; and a narrowing pulse pressure (difference between the systolic and diastolic blood pressures). A pneumothorax is unlikely in this patient; his breath sounds are equal bilaterally. Pericardia! tamponade
is a life-threatening emergency that requires prompt treatment. For this patient, you should cover the wound on his chest, administer oxygen, and transport without delay. Shock patients should be transported supine, not on their side. The AED is not indicated for this patient because he is not in cardiac arrest. A trauma patient opens his eyes slightly and moans when the EMT applies a painful stimulus. When the EMT palpates the patient's arm, he pulls it away. His Glasgow Coma Scale (GCS) score is: A) B) 8 C) 9 D) 10 ------CORRECT ANSWER---------------B) 8 If a patient opens his or her eyes in response to pain, a score of 2 is assigned for eye opening. If the patient moans or makes unintelligible sounds, a score of 2 is assigned for verbal response. If the patient withdraws from pain, a score of 4 is assigned for motor response. In total, this patient's GCS is 8, which indicates severe neurologic impairment. Which of the following assessment findings is the MOST concerning in a patient with significant burns? A) Severe blisters to both hands B) Closed deformity of the wrist C) Dry cough and a hoarse voice D) Clothes adhered to burned skin ------CORRECT ANSWER---------------C) Dry cough and a hoarse voice Any condition or injury that involves airway, breathing, or circulation warrants the EMT's most immediate attention. A dry cough and hoarse voice are signs of
Assessment of a trauma patient reveals paradoxical movement to the left side of his chest. The patient is conscious, but restless, and is experiencing severe pain. His breathing is rapid and shallow and his pulse is rapid and weak. The EMT should: A) ventilate the patient with a bag-mask device. B) position the patient on the injured side and transport. C) administer high-flow oxygen via nonrebreathing mask. D) stabilize the unstable chest wall with bulky dressings. ------CORRECT ANSWER---------------A) ventilate the patient with a bag-mask device. The patient in this scenario has a flail chest and inadequate ventilation (ie, rapid, shallow [reduced tidal volume] breathing). A flail chest occurs when several ribs are fractured in more than one place; the result is a free-floating section of ribs (flail segment) that collapses during inhalation and bulges out during exhalation (paradoxical chest movement). As the flail segment collapses, the lung is compressed and ventilation is impaired. Treatment should include positive pressure ventilation and prompt transport. In the past, treatment included splinting of the flail segment with bulky dressings; however, restricting chest wall movement is no longer recommended and positive pressure ventilation is now preferred. A young man fell and landed on his outstretched hand, resulting in pain and deformity to the left midshaft forearm. Distal circulation should be assessed at which of the following pulse locations? A) Radial B) Brachia! C) Pedal D) Popliteal ------CORRECT ANSWER---------------A) Radial The radius and ulna are the bones of the forearm. The radial pulse can be palpated on the lateral aspect (thumb side) of the wrist and is the most distal pulse
site relative to the injury. The brachia! pulse is located on the medial aspect of the arm. The popliteal pulse is located behind the knee. The pedal (dorsalis pedis) pulse is located on top of the foot. Which of the following patients would be MOST in need of a rapid head-to- toe assessment? A) responsive 22-year-old man with a small-caliber gunshot wound to the abdomen B) A responsive 25-year-old woman who fell 9 feet from a roof and landed on her side C) A 43-year-old woman with a unilaterally swollen, painful deformity of the midshaft femur D) A 60-year-old man who fell from a standing position and has small abrasions on his cheek ------CORRECT ANSWER---------------A) responsive 22 - year-old man with a small-caliber gunshot wound to the abdomen A rapid head-to-toe assessment is indicated for any patient with abnormal findings in the primary assessment or when the mechanism of injury warrants it. Significant mechanisms of injury include falls in the adult of greater than 15 feet (or three times the patient's height); penetrating injuries to the head, neck, chest, or abdomen; and multiple long bone fractures, among others. A patient with a closed head injury opens his eyes in response to pain, is mumbling words that you cannot understand, and pushes your hand away when you apply a painful stimulus. His Glasgow Coma Scale (GCS) score is: A) 6 B) 7 C) 8 D) 9 ------CORRECT ANSWER---------------D) 9
neurogenic shock (ie, warm, dry skin; normal [or slow] heart rate) are not present. Firefighters have rescued a man from his burning house. He is conscious and alert, but is experiencing significant respiratory distress. He has a brassy cough and singed nasal hairs. The MOST immediate threat to this patient's life is: A) hypothermia. B) severe burns. C) severe infection. D) airway swelling. ------CORRECT ANSWER---------------D) airway swelling. Because of the patient's signs and symptoms, your most immediate concern should be the potential for swelling and closure of the upper airway; be prepared to assist the patient's ventilations. Signs of upper airway burns include respiratory distress, singed facial and/or nasal hairs, a brassy cough, difficulty breathing, and coughing up sooty sputum. Infection, the burns themselves, and hypothermia should concern you; however, airway problems pose the most immediate life threat. A 70-year-old woman fell and struck her head two days ago, but did not seek medical attention. Today, she is confused, is vomiting, and has slurred speech. The EMT should suspect a/an: A) epidural hematoma. B) subdural hematoma. C) intracerebral hematoma. D) acute ischemic stroke. ------CORRECT ANSWER---------------B) subdural hematoma. This case is classic for a subdural hematoma. A subdural hematoma occurs when bleeding occurs between the dura mater (the outer meningeal layer) and the
surface of the brain; it is typically caused by venous bleeding. As such, subdural hematomas often do not present with symptoms until several hours, or even days, have past since a head injury. By contrast, epidural hematoma, bleeding between the skull and dura mater, is usually caused by arterial bleeding; patients with this type of injury usually present with symptoms immediately following the injury. lntracerebral hemorrhage, bleeding within the brain itself, would also be expected to produce immediate symptoms. While acute ischemic stroke could also explain this patient's symptoms, the fact that she recently experienced a head injury makes the diagnosis of a subdural hematoma more likely. A 33-year-old factory worker was crushed between two pieces of machinery. You find him lying supine on the ground reporting severe pain to his pelvis. He is restless, diaphoretic, and tachycardic. What should you do? A) Prepare for immediate transport. B) Perform a detailed secondary exam. C) Carefully log roll him to check his back. D) Palpate his pelvis to assess for crepitus. ------CORRECT ANSWER------- --------A) Prepare for immediate transport. Based on the mechanism of injury and the presence of signs of shock (eg, restlessness, tachycardia, diaphoresis), you should suspect that the patient has a fractured pelvis and is bleeding internally. Therefore, after completing your primary assessment and initiating shock treatment (eg, high-flow oxygen, applying blankets), you should perform a rapid head-to-toe assessment to assess for other injuries and then prepare for immediate transport. Spinal precautions should be considered. Do not log roll the patient; doing so compresses the pelvis and may cause further injury. You should also avoid palpating his pelvis; this will only cause further pain and may cause additional injury. Palpation of the pelvis is performed to assess its stability, not to elicit crepitus.
During your assessment of a patient with a gunshot wound to the chest, you note that his skin is pale. This finding is the result of: A) a critically low blood pressure. B) a significantly elevated heart rate. C) decreased blood flow to the skin. D) peripheral dilation of the vasculature. ------CORRECT ANSWER----------- ----C) decreased blood flow to the skin. When the body attempts to compensate for shock, peripheral vasoconstriction shunts blood away from the skin to the more vital organs in the body such as the brain, heart, lungs, and kidneys. When there is minimal or no peripheral blood flow, the skin assumes a pale appearance. By contrast, when peripheral circulation increases (ie, vasodilation), the skin assumes a red (flushed) appearance. Pallor does not necessarily indicate hypotension. Tachycardia is a compensatory response of the nervous system in an attempt to increase cardiac output and maintain adequate perfusion. You are called to a local nightclub for an injured patient. Law enforcement personnel have secured the scene. Upon arrival, you see a young man who is lying on the ground screaming in pain; bright red blood is spurting from an apparent stab wound to his groin area. You should: A) control the bleeding. B) apply 100% oxygen. C) ensure an open airway. D) prevent hypothermia. ------CORRECT ANSWER---------------A) control the bleeding. This patient's airway is obviously patent; he is screaming in pain. Blood spurting from the groin area indicates arterial bleeding from the femoral artery. If this bleeding is not controlled immediately, the patient will die. Oxygen and other shock treatment (ie, keeping him warm) should be initiated after this lifethreatening bleeding is controlled. If you take the time to set up and administer oxygen prior to managing the bleeding, the patient will die. Base your
treatment priorities on what will kill the patient first. Following penetrating trauma to the abdomen, a 50-year-old woman has a large laceration with a loop of protruding bowel. How should you manage this injury? A) Carefully replace the bowel and apply an occlusive dressing. B) Apply a tight pressure dressing to control any external bleeding. C) Apply a dry, sterile dressing covered by an occlusive dressing. D) Apply a moist, sterile dressing covered by a dry, sterile dressing. ------ CORRECT ANSWER---------------D) Apply a moist, sterile dressing covered by a dry, sterile dressing. Management of an open abdominal wound with an eviscerated bowel includes controlling any external bleeding, covering the exposed bowel with a moist, sterile dressing, and covering that with a dry, sterile dressing. Applying a dry dressing directly to the exposed bowel will cause the bowel to dry. You must never replace the exposed bowel into the abdominal cavity or apply pressure to the wound; doing so significantly increases the patient's risk for infection as well as further trauma. Which of the following is an example of a primary blast injury? A) Depressed skull fracture B) Spinal injury with paralysis C) Stick impaled in the abdomen D) Ruptured tympanic membrane ------CORRECT ANSWER---------------D) Ruptured tympanic membrane Primary blast injuries are a direct result of the pressure wave that occurs during an explosion. Hollow organs are the most susceptible to the primary blast wave, and ruptured tympanic membranes (eardrums) are a common injury. Secondary blast injuries occur when shrapnel and other debris are propelled away
Closed head injuries can cause a variety of signs and symptoms. In addition to pupillary abnormalities (ie, unequal pupils, sluggishly reactive pupils), a classic finding that indicates a significant increase in intracranial pressure is Cushing's triad. This trio of findings includes hypertension; bradycardia; and abnormal breathing, which can vary from slow and irregular to rapid and deep. In contrast to an incision, a laceration: A) is a jagged cut. B) is a superficial injury. C) bleeds more severely. D) usually involves an artery. ------CORRECT ANSWER---------------A) is a jagged cut. A laceration is a jagged cut caused by a sharp object or a blunt force that tears the tissue, whereas an incision is a sharp, smooth cut. The depth of the injury can vary; it can extend through the skin and subcutaneous tissue or into the underlying muscles and adjacent nerves and blood vessels. Lacerations and incisions can involve arteries, veins, or both, potentially resulting in severe bleeding. Which of the following clinical findings is consistent with decompensated shock? A) Diaphoresis and pallor B) Falling blood pressure C) Restlessness and anxiety D) Tachycardia and tachypnea ------CORRECT ANSWER---------------B) Falling blood pressure During shock, the compensatory mechanisms of the body attempt to maintain the blood pressure. This is accomplished by increasing the heart rate, shunting
blood from the skin to more vital organs, and increasing the respiratory rate to increase the oxygen content of the blood. Once these compensatory mechanisms fail, the blood pressure will fall (hypotension). Hypotension signifies a state of decompensated shock. You must not rely on the patient's blood pressure as an indicator of overall perfusion. Restlessness, anxiety, tachycardia, tachypnea, and cool, clammy skin (diaphoresis) are earlier signs of shock and do not necessarily indicate a decompensated state. Which of the following injury mechanisms involves axial loading? A) skater slips and falls, landing on her outstretched arm. B) A construction worker falls off a roof and lands feet first. C) A woman's knees impact the dash during a frontal collision. D) A man's neck is forced laterally during a side impact collision. ------ CORRECT ANSWER---------------B) A construction worker falls off a roof and lands feet first. Axial loading injuries occur when a sudden, excessive compression force drives the long axis of the body toward the head, or the head toward the feet. Common injuries that involve axial loading are heavy objects falling on a patient's head, diving head first into shallow water, and falls in which the patient lands feet first. All of these mechanisms cause compression of the spine, potentially resulting in serious injury. None of the other injury mechanisms described are consistent with axial loading. A man was stabbed in the cheek with a dinner fork, and the fork is still impaled in his cheek. He is conscious and alert, breathing adequately, and has blood in his oropharynx. You should: A) apply high-flow oxygen via a nonrebreathing mask, carefully remove the fork, and control any external bleeding. B) suction his oropharynx, control any external bleeding, stabilize the fork in place, and protect it with bulky dressings.
aspiration. Therefore, your first action should be to ensure that the patient is sitting up and leaning forward. This will prevent blood from draining down the back of the throat. Next, apply direct pressure by pinching the fleshy part of the nostrils together; you or the patient may do this. Placing a chemical ice pack over the nose may further help control the bleeding by constricting the nasal vasculature. After controlling the nosebleed, continue your assessment, which includes assessing for facial deformities and visual disturbances. The presence of subcutaneous emphysema following blunt trauma to the anterior neck should make you MOST suspicious for a: A) pneumothorax. B) fractured larynx. C) ruptured esophagus. D) carotid artery injury. ------CORRECT ANSWER---------------B) fractured larynx. Crushing or blunt trauma to the anterior neck can injure the trachea or larynx. Once the cartilages of the upper airway and larynx are fractured, they do not spring back to their normal position. Such a fracture can lead to loss of voice, airway obstruction, and leakage of air into the soft tissues of the neck. Air leakage into the soft tissues is called subcutaneous emphysema. Subcutaneous emphysema may also be observed in patients with a tension pneumothorax, although it is typically located in the chest. Esophageal rupture would likely present with difficulty swallowing (dysphagia) and vomiting blood (hematemesis). You should suspect injury to a carotid artery or jugular vein if you observe a rapidly expanding hematoma to the neck following blunt trauma. A 22-year-old man had a strong acid chemical splashed into both of his eyes. He is conscious and alert, is experiencing intense pain, and states that he is wearing contact lenses. Treatment should include:
A) leaving the contact lenses in and beginning irrigation of both eyes. B) removing the contact lenses and beginning irrigation of both eyes. C) leaving the contact lenses in and covering both eyes with sterile gauze. D) removing the contact lenses and covering both eyes with sterile gauze. - -----CORRECT ANSWER---------------B) removing the contact lenses and beginning irrigation of both eyes. As a general rule, contact lenses should be left in place. Chemical eye burns are an exception to this rule. If left in place, the chemical could get behind the contact lens and continue to cause injury. Therefore, you should remove the contact lenses and immediately irrigate the eyes with sterile saline or water. If needed, continue to irrigate the eyes throughout transport. Following blunt force trauma to the anterior chest, a man presents with difficulty breathing, distended jugular veins, absent breath soundsover the left side of the chest, and hypotension. Which of the following BEST describes the pathophysiology of this patient's injury? A) Increased pressure in the pleural space is compressing the great vessels B) Blood is filling the pleural space and is collapsing the lung on the left side C) Blood is filling the pericardia! sac and is restricting cardiac relaxation D) The aorta has been injured and blood is rapidly filling the thoracic cavity ------CORRECT ANSWER---------------A) Increased pressure in the pleural space is compressing the great vessels The patient is experiencing a tension pneumothorax. This type of injury occurs when air fills the pleural space and progressively collapses the lung. In the process, the vena cavae are compressed and blood return to the heart is reduced; clinically, this manifests as jugular vein distention because blood is backing up into the systemic venous system. If blood return to the heart is reduced, the amount of blood that leaves the heart will also be reduced; as a result, cardiac
B) covering the bums with dry, sterile dressings. C) avoiding the use of bum ointments or antiseptics. D) flushing the bums with cool water for 10 minutes. ------CORRECT ANSWER---------------D) flushing the bums with cool water for 10 minutes. Unless the patient is on fire, do not apply water to a full-thickness (third- degree) burn, especially if the patient is already prone to hypothermia and infection (ie, older adults, small children). Cover the burns with dry, sterile dressings or a sterile burn sheet. The use of burn creams, ointments, or antiseptics should be avoided; these increase the risk of infection and will only need to be removed at the hospital. Apply high-flow oxygen, treat any associated injuries, and rapidly transport the patient. If the patient is breathing inadequately (eg, fast or slow rate, shallow breathing [reduced tidal volume]), assist ventilations with a bag-mask device. After covering a large open chest wound with an occlusive dressing, it becomes necessary to ventilate the patient with a bag-mask device. What should you do? A) Remove the occlusive dressing. B) Ventilate with greater volume. C) Ventilate at 24 breaths/min. D) Request a paramedic intercept. ------CORRECT ANSWER---------------A) Remove the occlusive dressing. If it becomes necessary to ventilate a patient after covering an open chest wound, you should remove the occlusive dressing. With the wound closed, positive pressure ventilation will quickly increase intrathoracic pressure, resulting in a tension pneumothorax. Ventilating the patient with greater volume and/or a faster rate would only cause a more rapid increase in pleural tension and should be avoided. Excessive ventilation can also reduce venous return to the heart,
causing a decrease in perfusion. Consider requesting a paramedic intercept, as long as it does not cause a delay in transporting the patient to a trauma center. Which of the following factors would reduce the blood's natural ability to clot, thus worsening internal or external bleeding? A) Tachycardia B) Hypothermia C) Hypotension D) Vasoconstriction ------CORRECT ANSWER---------------B) Hypothermia Hypothermia can cause an abnormality in blood clotting (coagulopathy), which can impair clotting factors and cause prolonged bleeding. This is why patients with hemorrhagic shock should be kept warm. Tachycardia, hypotension, and vasoconstriction do not impair the blood's ability to clot. Internal or external bleeding would be especially severe in a patient: A) with hemophilia. B) who takes aspirin. C) with heart disease. D) who is hypotensive. ------CORRECT ANSWER---------------A) with hemophilia. Hemophilia is a condition in which the patient lacks one or more of the blood's clotting factors. There are several forms of hemophilia, most of which are hereditary and some of which are severe. Sometimes bleeding occurs spontaneously in patients with hemophilia. Because the patient's blood does not clot, all injuries, no matter how minor they appear, are potentially serious. Aspirin does not destroy the blood's clotting factors; it decreases the ability of platelets to stick together. Although this may cause prolonged bleeding time, the patient with hemophilia, who lacks key clotting factors, will bleed for a much longer
