emt- TRAUMA scenarios

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A 19-year-old male is unresponsive, apneic, and pulseless after being struck in the center of the chest with a softball. Based on the mechanism of injury, what MOST likely occurred?

ventricular fibrillation when the impact occurred during a critical portion of the cardiac cycle

The thoracic cavity is separated from the abdominal cavity by the:

diaphragm

Elevation of the rib cage during inhalation occurs when

the intercostal muscles contract

A flail chest occurs when:

a segment of the chest wall is detached from the thoracic cage

You arrive at the scene of a major motor vehicle crash. The patient, a 50-year-old female, was removed from her vehicle prior to your arrival. Bystanders who removed her state that she was not wearing a seatbelt. The patient is unconscious, tachycardic, and diaphoretic. Your assessment reveals bilaterally clear and equal breath sounds, a midline trachea, and collapsed jugular veins. You should be MOST suspicious that this patient has experienced a:

laceration of the aorta

During your assessment of a patient with blunt chest trauma, you note paradoxical movement of the left chest wall. As your partner is administering oxygen to the patient, you should:

stabilize the chest wall with a bulky dressing

A spinal cord injury at the level of C7 would MOST likely result in:

paralysis of intercostal muscles

While jogging, a 19-year-old male experienced an acute onset of shortness of breath and pleuritic chest pain. He is conscious and alert with stable vital signs. Your assessment reveals that he has diminished breath sounds over the left side of the chest. You should:

administer oxygen and transport to the hospital

Immediate death from blunt chest trauma following a motor vehicle crash is MOST often the result of:

traumatic aortic rupture

Following a stab wound to the left anterior chest, a 25-year-old male presents with a decreased level of consciousness and signs of shock. Which of the following additional assessment findings should increase your index of suspicion for a cardiac tamponade?

engorged jugular veins

You have sealed the open chest wound of a 40-year-old male who was stabbed in the anterior chest. Your reassessment reveals that he is experiencing increasing respiratory distress and tachycardia, and is developing cyanosis. You should:

partially remove the dressing

If a patient with a chest injury is only able to inhale small amounts of air per breath, he or she:

must increase his or her respiratory rate to maintain adequate minute volume

In order to avoid exacerbating a patient's injury, it is especially important to use extreme caution when providing positive-pressure ventilation to patients with a:

pneumothorax

Common signs and symptoms of a chest injury include all of the following, EXCEPT:

hematemesis

A rapid, irregular pulse following blunt trauma to the chest is MOST suggestive of a:

myocardial contusion

When a person is lying supine at the end of exhalation, the diaphragm:

may rise as high as the nipple line

Patients with rib fractures will commonly

breathe rapidly and shallowly

Pneumothorax is defined as:

an accumulation of air in the pleural space

The phrenic nerves control the diaphragm and exit the spinal cord at:

C3, C4, and C5.

Signs and symptoms of a tension pneumothorax include all of the following, EXCEPT:

collapsed jugular veins

Hemoptysis is defined as:

coughing up blood

Very young children tend to breathe predominantly with their diaphragm because

their intercostal muscles are not fully developed

A 28-year-old male was struck in the chest with a baseball bat during an altercation. He is conscious and alert and complains of severe chest pain. Your assessment reveals a large area of ecchymosis over the sternum and a rapid, irregular pulse. In addition to applying 100% oxygen, you should:

prepare for immediate transport

A 37-year-old male was pinned between a flatbed truck and a loading dock. On exam, you find bruising to the chest, distended neck veins, bilaterally diminished breath sounds, and bilateral scleral hemorrhaging. You should

aggressively manage his airway

Subcutaneous emphysema is an indication that:

air is escaping into the chest wall from a damaged lung

When assessing a patient with a hemothorax, you will MOST likely find:

signs and symptoms of shock

An open pneumothorax occurs when:

air enters the pleural space from outside the body

If a person's tidal volume decreases, but his or her respiratory rate remains unchanged:

minute volume will decrease

A spontaneous pneumothorax would MOST likely occur as the result of:

exertion of a person with a congenital lung defect.

Following blunt trauma to the chest, an 18-year-old female presents with respiratory distress, reduced tidal volume, and cyanosis. Her blood pressure is 80/50 mm Hg and her pulse is 130 beats/min and thready. You should:

provide some form of positive-pressure ventilation

Accumulation of blood in the abdominal cavity will MOST likely cause

distention

It can be difficult to assess the severity of injuries to the genitourinary system following sexual assault because:

patients may be hesitant to allow you to examine them

You respond to a residence for a 40-year-old female who was assaulted by her husband; the scene has been secured by law enforcement. Upon your arrival, you find the patient lying supine on the floor in the kitchen. She is semiconscious with severely labored breathing. Further assessment reveals a large bruise to the left anterior chest, jugular venous distention, and unilaterally absent breath sounds. As your partner is supporting her ventilations, you should:

immediately request ALS support

You are transporting a stable patient with a possible pneumothorax. The patient is receiving 100% oxygen and has an oxygen saturation of 95%. During your reassessment, you find that the patient is now confused, hypotensive, and profusely diaphoretic. What is MOST likely causing this patient's deterioration?

Compression of the aorta and vena cava

Pleural fluid is contained between the

Visceral and parietal pleurae

Irritation or damage to the pleural surfaces that causes sharp chest pain during inhalation is called

pleurisy

A patient who presents with profound cyanosis following a chest injury

requires prompt oxygenation and ventilation

When a hollow organ is punctured during a penetrating injury to the abdomen

peritonitis may not develop for several hours

The presence of tachycardia following a significant abdominal injury:

should be assumed to be a sign of shock.

All of the following are signs of a significant abdominal injury, EXCEPT:

localized pain

A 30-year-old male has a large laceration to his right lower abdominal quadrant with a loop of bowel protruding through the wound. When treating this patient, the EMT-B should recall that the:

protruding bowel should be kept warm and moist.

Because the depth of an open abdominal wound is often difficult to determine

prompt transport to the hospital is essential.

You are dispatched to a residence for a young female who was kicked in the abdomen by her boyfriend. While en route to the scene, you should ask the dispatcher if:

law enforcement is at the scene.

The ________ nerves control the diaphragm

phrenic

Definitive care for a tension pneumothorax involves:

inserting a needle through the rib cage into the pleural space.

A 66-year-old male presents with dark red rectal bleeding and abdominal pain. He is conscious and alert; however, his skin is cool and clammy and his heart rate is elevated. Further assessment reveals that his blood pressure is 112/60 mm Hg. Which of the following questions would be MOST pertinent to ask him?

Have you experienced recent abdominal trauma?

A 33-year-old male was stabbed in the left anterior chest. He is conscious, but is experiencing signs of shock. Further assessment reveals that his jugular veins are distended and his breath sounds are bilaterally equal and clear. This patient is MOST likely experiencing

a pericardial tamponade.

A football player was struck by another player in the right flank area just below the posterior rib cage. He complains of severe pain and point tenderness to the area. Your assessment reveals that there is a small amount of blood in his underwear. You should be MOST suspicious for:

blunt injury to the kidney

The mesentary is

membranous folds that attach the intestines to the walls of the body

Your presence is requested by law enforcement to assess a 33-year-old female who was sexually assaulted. The patient is conscious and obviously upset. As you are talking to her, you note an impressive amount of blood on her clothes in the groin area. Her BP is 98/58 mm Hg, pulse is 130 beats/min, and respirations are 24 breaths/min. You should:

control any external bleeding, administer oxygen, and transport at once.

A sign of kidney damage following blunt trauma is:

hematuria

Peritonitis, an intense inflammatory reaction of the abdominal cavity, usually occurs when:

hollow abdominal organs are damaged and spill their contents

Contraction or tensing of the abdominal muscles in an effort to ease pain is called:

gaurding

While assessing a 21-year-old female who struck a tree head-on with her small passenger car, you note that her airbag deployed. You should

lift the airbag and look for deformity of the steering wheel

Airbags, in conjunction with properly worn seatbelts, are of MOST benefit when a person is involved in a:

head on crash

Early bruising following abdominal trauma is often indicated by

red areas of the skin

A 40-year-old male presents with severe abdominal pain following blunt trauma. He is diaphoretic, thirsty, and has a weak and rapid pulse. Appropriate treatment for this patient includes all of the following, EXCEPT

giving him small sips of water

When worn properly, a seatbelt should lie:

below the anterior superior iliac spines of the pelvis and against the hip joints.

A 54-year-old male experienced an avulsion to his penis when his foreskin got caught in the zipper of his pants. He was able to unzip his pants and remove the foreskin prior to your arrival. Your assessment reveals that he is in severe pain and that the avulsion is bleeding moderately. The MOST appropriate treatment for this patient includes:

applying direct pressure with a dry, sterile dressing.

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