Deck 33: Eye, Face, and Neck Trauma

Question 1

What instructions would you provide to the Emergency Medical Responders when treating a patient who was punched in the eye and has blood visible in the anterior chamber?

A) "It is important to keep pressure down in the eye so we will transport him in a sitting position."
B) "Let's apply a cold pack to the eye and immobilize him for transport."
C) "Let's put a shield over the eye and bandage it in place to apply some pressure to the eye."
D) "We will need to cover both eyes with patches before we transport him."

Answer 1

D

Question 2

A man grinding metal took his safety goggles off and was struck in the face with a shower of tiny metal fragments. He is complaining of pain and visual disturbance in his right eye. When assessing the eye, you note that the globe is red with several pieces of metal embedded in the tissue. Proper care of this patient would include:

A) applying a cold pack over the affected eye.
B) attempting removal of the metal with a sterile swab.
C) covering both eyes with a bandage.
D) flushing the eye with a sterile saline solution.

Answer 2

C

Question 3

While working to build a house, a construction worker was hit in the head by a 2" × 4" plank that slid from the roof and fell to the ground below. The patient has a sizable laceration to the left side of his face and is spitting blood. He also lost several teeth, two of which he is holding. Your initial action when caring for this patient would be to:

A) suction the airway.
B) establish manual in-line spinal stabilization.
C) obtain and preserve the teeth.
D) apply occlusive dressing to the laceration.

Answer 3

B

Question 4

A patient complaining of eye pain informs you that he was diagnosed with a corneal abrasion three days ago. He called 911 today because the discomfort has not yet resolved and he desires medical attention. Based on this information, which of the following is true?

A) The sclera must be infected.
B) The lens of the eye has been abraded.
C) The clear structure that covers the pupil has been damaged.
D) Fluid is leaking from the posterior chamber.

Question 5

A patient complains of pain and discomfort to the left eye after being hit in the face with a cloud of dust while working at a manufacturing complex. As you specifically assess the eye, you note some redness to the globe but do not see any obvious foreign object. The most appropriate care you can provide to this patient would be:

A) covering both eyes with a bandage.
B) carefully wiping the eye with a soft piece of sterile gauze.
C) gently massaging the eye to promote tearing.
D) applying gauze and direct pressure over the eye.

Question 6

An elderly woman is suffering from a closed head injury after falling down five steps. She is responsive to painful stimuli and is breathing shallowly. When evaluating her airway, you note that she has both upper and lower dentures. Her upper dentures are secure, but her lower dentures are loose. Prior to providing positive pressure ventilation, you would:

A) re-secure the lower dentures.
B) remove both the upper and lower dentures.
C) remove the lower dentures.
D) leave the dentures as you found them.

Question 7

A young male golfer has been struck in the right eye with a golf club. The upper and lower lids are swollen shut and ecchymotic. There are also blood clots between the two eyelids. Which of the following indicates that the EMT is providing proper care to this patient?

A) He gently opens the lids to assess for injury to the eye.
B) He places a numbing medication in the eye.
C) He irrigates blood from the eye with sterile saline solution.
D) He wipes blood from the face but not the eye.

Question 8

During an altercation, an intoxicated male was cut with a sharp knife. Assessment reveals a laceration, oozing dark red blood, across the right eyelid down to the right cheek. It also appears that the patient's eye was cut with the knife, reinforced by the complaint of eye pain and collection of blood in the sclera. The EMT would:

A) clean the incision with sterile water and peroxide.
B) apply direct pressure to the eyelid to control bleeding.
C) apply cold packs to the eyelid to decrease swelling.
D) cover the eye with a sterile dressing soaked in saline.

Question 9

A 21-year-old-female has been struck in the left eye by a softball. Which finding is most concerning for an eye injury?

A) Edema to the upper eyelid
B) Unusual sensitivity to light
C) Bruising and swelling to the orbit
D) Vision disturbance that resolves by blinking

Question 10

You suspect that a patient has a fracture of the left orbit. What statement made by the patient would reinforce this suspicion?

A) "The light is hurting my eyes."
B) "I am seeing two of everything."
C) "Everything looks yellow."
D) "My eye feels like it is burning."

Question 11

You have arrived on the scene of an industrial plant where a female worker had a chemical splashed into her eye. She is complaining of severe pain in the eye and is flushing it with tap water over a sink. Which of the following questions is it most important that the EMT ask first?

A) "What is your past medical history?"
B) "Are you wearing contact lenses?"
C) "Do you take any medications?"
D) "Have you ever had an eye injury before?"

Question 12

When assessing a male patient who was punched in the face by another man, you detect blood in the white part of his eye. As such, you would recognize injury to what optical structure?

A) Sclera
B) Cornea
C) Lens
D) Retina

Question 13

A baseball player was struck in the side of the face by a baseball. Assessment findings include swelling and numbness to the left side of the face and left eyelid, as well as crepitus in the same area. Assessment of the eye reveals no obvious injury. The patient denies any problem with his eyesight, but is having difficulty visually tracking your finger upward. Which of the following would be appropriate care for this injury?

A) Cold packs to the face and eyelid
B) Gentle pressure over the face and eye
C) Gentle cleansing of the eye with sterile water
D) Warm packs to the area of swelling

Question 14

A young boy was running with a pencil and tripped. The pencil impaled the boy's left eye and remains lodged in place. He is in his mother's arms and both are crying hysterically. Appropriate care for the eye would include:

A) stabilizing the impaled object and providing immediate transport.
B) carefully removing the pencil from the eye to prevent the loss of vision, then providing immediate transport.
C) applying ice to the affected eye to decrease pressure, swelling, and subsequent damage.
D) applying gentle pressure to the pencil and eye to prevent movement followed by immediate transport.

Question 15

While running in a parking lot, a young boy tripped and fell. He hit his face and mouth on a curb, knocking one of his top front teeth from its socket. Bleeding has been controlled and the tooth found. What instructions would you give your partner when caring for the tooth?

A) "Wrap the tooth in dry gauze and put it in a plastic bag placed in cool water."
B) "Scrub the tooth first to get the dirt off of it and then we will put it back in the socket."
C) "Make sure to only touch it by its root when scrubbing the dirt off it."
D) "Rinse the tooth first then put it in a cup of saline for transport."

Question 16

A young girl complains of eye pain after having sand thrown in her face by another girl at the park. When assessing her eyes, you note large particles of sand in the right eye. The sand appears to be on the conjunctiva, which also seems to be scratched and irritated. Your initial action would be:

A) stop the tearing by applying gentle pressure to the eye.
B) attempt to remove the larger pieces of sand using a cotton swab.
C) flush the eye with clean water from a nearby sink.
D) gently wipe the inner eye with sterile pieces of gauze.

Question 17

A patient has been splashed in the face with battery acid. He is complaining of being unable to see anything and severe burning to his face. You observe him holding both eyes tightly shut with significant burns on his cheeks and eyelids. In this situation, the EMT would assess the eyes:

A) prior to assessing the airway.
B) after assessing the patient's radial pulse.
C) after determining the patient's level of consciousness.
D) following manual in-line spinal immobilization.

Question 18

You have been called to a high school science lab where a male student was splashed in the eye with an alkaline solution. He is complaining of burning to the eye as well as pain. After performing the primary assessment and finding no life-threatening conditions, you would:

A) obtain a set of vital signs and determine if the patient is taking medications or has any past medical problems.
B) determine the exact compound the patient was splashed with and the appropriate chemical antidote.
C) hold the patient's eye open and begin flushing with large amounts of tap water and continue throughout transport.
D) cover both eyes with eye shields and move to the ambulance for immediate transport.

Question 19

A patient had an unknown chemical splashed into her left eye. You have been irrigating the eye on scene and are now getting ready to transfer her to the stretcher. Knowing that you will need to continue irrigation throughout transport, how will you position this patient on the stretcher?

A) Left lateral recumbent
B) Right-side-lying position
C) Prone with head turned to the patient's left side
D) Semi-Fowler's position

Question 20

Which of the following statements made by an EMT indicates an understanding of facial anatomy and injuries?

A) "The face has little blood supply but will readily swell when injured."
B) "Airway compromise is not a concern unless the neck is also injured."
C) "Injury to the eye(s) takes precedence over any and all other injuries."
D) "The only movable bone making up the face is the mandible."

Question 21

A 21-year-old male has a stab wound to the left side of his neck. Emergency Medical Responders are holding manual in-line spinal stabilization. As you approach the patient, you note blood on his shirt and pale-looking skin color. As team leader, what direction would you give first?

A) "Let's look for other injuries on his chest."
B) "Can someone start the patient on high-concentration oxygen?"
C) "I need someone to place a gloved hand over the stab wound."
D) "Before we do anything else, we need to place a cervical collar on his neck."

Question 22

A 36-year-old male patient was involved in an altercation with a knife and has suffered a 2-inch laceration to the right side of the neck. Bleeding was controlled prior to your arrival by Emergency Medical Responders. Your paramedic partner has asked you to apply an occlusive dressing to the wound. You recognize that the primary benefit of the action is to:

A) prevent the cervical collar from touching the wound.
B) control the bleeding from large blood vessels.
C) prevent air entry into the circulatory system.
D) promote clot formation in order to stop bleeding.

Question 23

For a patient suffering from conjunctivitis, the EMT would expect to observe a/an:

A) inflamed and irritated cornea.
B) infected lens.
C) reddened membrane over the sclera.
D) nonresponsive pupil.

Question 24

A 15-year-old female was struck in the mouth with a baseball bat. She has lost her front teeth and is spitting blood. The EMT's priority concern when caring for this patient would be:

A) blood loss.
B) jaw fracture.
C) seizure activity.
D) airway compromise.

Question 25

A worker in a factory complex has a sliver of metal lodged in the colored portion of his eye. The EMT would recognize the foreign body as lying in the:

A) cornea.
B) iris.
C) lens.
D) sclera.

Question 26

A young boy riding an ATV did not see a chain stretched between two poles and hit it with his neck while traveling forward. Subsequently, he was thrown backward from the bike with significant force. He was not wearing a helmet. Emergency Medical Responders are with the patient and are holding manual in-line spinal immobilization as well as administering oxygen. When you are assessing this patient, which of the following signs would indicate the injury that must be addressed and managed first?

A) Difficulty speaking
B) Laceration to the forehead
C) Open fracture to the left arm
D) Partially avulsed ear

Question 27

A construction worker has been shot with a nail gun, resulting in a long nail going through his cheek and firmly embedding into the lower gum and jaw. There is considerable blood in his mouth and he is in excruciating pain. Given this scenario, which of the following would be your first priority?

A) Removing the nail
B) Suctioning the airway
C) Applying oxygen
D) Placing a cervical collar

Question 28

A 3-year-old has stuck a crayon in his nose. Assessment reveals the crayon to be deeply embedded in the right nostril with some irritation and swelling noted. His vital signs are: pulse 124, respiration 20, and SpO₂ 100%. Which of the following would be most appropriate when caring for this child?

A) Non-emergent transport to the hospital
B) High-concentration oxygen
C) Attempt removal of the crayon with forceps
D) Place a warm pack to the bridge of the nose

Question 29

The function of the ocular lens is to:

A) focus light onto the retina.
B) allow light into the eye.
C) protect the sclera.
D) manufacture vitreous humor.

Question 30

Which of the following is a general guideline to use when determining whether or not to remove a patient's contact lenses?

A) Remove only soft contact lenses and not hard.
B) Remove only if the eye has been traumatically injured.
C) Remove only if the eye is traumatically injured and the patient is conscious.
D) Remove if the eye has been injured by a chemical burn.

Question 31

A conscious and alert 32-year-old was assaulted and struck in the jaw with a baseball bat. He complains of tremendous jaw pain and exhibits an unstable mandible. His airway is patent, breathing adequate, and radial pulse normal. In caring for this patient and his injury, you would:

A) insert an oral airway to stabilize the jaw.
B) suction the airway to provide airway patency.
C) start positive pressure ventilation.
D) immobilize to a long spine board.

Question 32

A construction worker complains of pain to both eyes after an extended period spent welding on a gas well. The light is bothering him and he rates the pain as a 10/10. He states that this occurred once before and was caused by the light of his welding tool. The primary assessment reveals no deficits and his vital signs are: pulse 80, respirations 14, blood pressure 132/68, and SpO₂ 98%. Although very painful, his vision is not compromised. Which of the following instructions indicate proper care of this patient?

A) "Why don't we flush the eyes with the sterile saline on the ambulance?"
B) "We will need to flush the eyes with bicarbonate to stop the burning."
C) "Applying direct pressure very gently to both eyes may provide pain relief."
D) "I do not think that we will need to provide supplemental oxygen."

Question 33

A young male patient has been involved in a motor vehicle accident. As an unrestrained driver, his head went through the driver's side window; in the process a portion of his ear was severed. Blood is now coming from the remaining portion of his left ear. In overseeing the care of this patient, which of the following would require corrective action?

A) A loose dressing placed over the left ear
B) Rolled gauze in the ear canal
C) The severed ear wrapped in saline-soaked gauze
D) Transport immobilized in a supine position

Question 34

A 23-year-old male struck his face on the steering wheel after he struck another car from behind. His nose is deformed and actively bleeding. In his care, which of the following would be a priority?

A) Making one attempt to realign the nose
B) Packing the nares with sterile gauze
C) Suctioning the airway to keep it free of blood
D) Pinching the nose to control hemorrhage

Question 35

A patient with hyphema would exhibit:

A) deformity of the sclera.
B) edema of the globe.
C) disfigurement of the eye.
D) blood in the eye chamber.

Question 36

A patient with a maxillary fracture would have sustained injury to her:

A) orbits.
B) lower jaw.
C) nose and orbits.
D) upper jaw.

Question 37

A 22-year-old male attempted to hang himself in a garage using chains suspended from the roof trusses. He was quickly found by family members and taken down to the ground. Currently he is complaining of neck pain as well as mild difficulty breathing. Assessment shows his airway to be patent, breathing adequate, and skin warm and dry. His neck is red, but free of any subcutaneous air or swelling. Which of the following will you do first when caring for this patient?

A) Place ice packs to his neck.
B) Insert a nasal airway.
C) Immediate transport.
D) Apply a cervical collar.

Question 38

You have been called for an elderly female found by family members on the floor of her bathroom. She is unresponsive and has a bruise to the right side of her face. Her respirations are snoring and shallow. Her skin is cool and dry, and she is incontinent of urine. Her daughter tells you that the patient has a past medical history of stroke, COPD, and seizures. Which of the following would be most appropriate when managing this patient's airway?

A) Suction
B) Jaw-thrust maneuver
C) High-concentration oxygen
D) Head-tilt, chin-lift

Question 39

A female patient struck her face on the steering wheel in a head-on motor vehicle collision and has deformity and crepitus to the bridge of her nose. Further assessment reveals bleeding deep within the nasal passages. The patient has been fully immobilized to a long board. To best address the hemorrhage in the nasopharynx, the EMT would:

A) suction blood from the airway as needed.
B) transport fully immobilized with her feet elevated.
C) apply ice packs to the bridge of the nose to control hemorrhage.
D) carefully pack the nasal passages with rolls of sterile gauze.

Question 40

911 was dialed by a frantic mother for her 3-year-old daughter who stuck a small, dried bean into her ear. Assessment shows the bean to be lodged firmly in the ear canal. When treating this patient, the EMT would:

A) make one attempt to remove the bean with tweezers.
B) gently flush the ear canal with sterile water until the bean is dislodged.
C) reassure the mother and transport the patient.
D) have the patient follow up with her family physician.

Question 41

A 19-year-old female was assaulted by her intoxicated boyfriend. After punching her in the chest, he slashed her face with a knife. Assessment reveals her to be stable with a large laceration from beneath her right eye to her right ear. She is very upset and crying and repeatedly asks you if this injury will leave a permanent scar on her face. Your best response would be:

A) "You will be fine. You are lucky he didn't cut an artery."
B) "I am not worried about your looks; I am worried about preventing infection."
C) "When we get to the hospital, we can discuss this with the doctor."
D) "You will be fine. The stitches used today do not scar like they used to."