Deck 4: Trauma and Trauma Systems

Question 1

Which of the following is NOT an example of trauma?

A) An abrasion to the knee
B) Chest pain
C) Cerebral contusion
D) A stab wound to the abdomen

Answer 1

Chest pain

Question 2

Which of the following requires immediate transport to a trauma center?

A) A 40-year-old who fell 12 feet from a garage roof with a radius fracture
B) A 36-year-old woman in a motor vehicle crash who has a blood pressure of 100/60
C) A 22-year-old soccer player with lower leg pain
D) A 47-year-old involved in a motor vehicle crash that resulted in the death of his passenger

Answer 2

A 47-year-old involved in a motor vehicle crash that resulted in the death of his passenger

Question 3

Establishment of educational programs and improved auto technology are examples of which part of the public health model?

A) Surveillance
B) Risk identification
C) Intervention
D) Implementation

Answer 3

Intervention

Question 4

The leading cause of death in people under age 44 is:

A) heart attack.
B) trauma.
C) cancer.
D) cardiovascular disease.

Question 5

Which of the following acts resulted in the development of modern EMS systems?

A) Ryan White Act
B) Highway Safety Act of 1966
C) Good Samaritan Act
D) The Trauma Care Systems Planning and Development Act of 1990

Question 6

Which of the following physical findings indicates the need for immediate transport?

A) Vital signs: systolic blood pressure 80, respiratory rate 8
B) Glasgow Coma Scale score of 15
C) Second-degree burns involving 9 percent of total body surface area in an adult patient
D) Fractured right femur

Question 7

Trauma triage criteria application, field skill performance, response times, patient assessment, patient care and transport are all monitored through which of the following?

A) Quality improvement
B) Trauma registry
C) Centers for Disease Control and Prevention
D) Public healthcare model

Question 8

Which of the following patients is NOT a candidate for air medical transport?

A) Combative trauma patient
B) Seriously injured patient with cardiac tamponade
C) Patient with prolonged extrication time
D) Burn patient with over 50 percent second-degree burns

Question 9

Which of the following accounts for the highest number of trauma deaths in the United States of America?

A) Motor vehicle crashes
B) Falls
C) Assaults
D) Firearms injuries

Question 10

As a paramedic, your role in trauma care consists of all of the following, EXCEPT:

A) providing rapid transport to appropriate facilities.
B) promoting injury prevention.
C) providing care to seriously injured trauma patients.
D) providing surgical interventions to stop hemorrhage.

Question 11

A trauma center that has surgical care capability available at all times and can handle all but the most seriously injured specialty and multisystem trauma patients is a Level ________ trauma center.

A) III
B) I
C) IV
D) II

Question 12

Which of the following is the best definition of the Golden Period?

A) The ideal time it takes to assess a multi-system trauma patient
B) The ideal timeframe from time of injury until surgery
C) The ideal time from requesting a helicopter to it landing on scene
D) The ideal timeframe from call dispatch to arrival on scene

Question 13

In addition to handling all types of specialty trauma, which level of trauma center provides continuing medical and public education programs?

A) IV
B) III
C) I
D) II

Question 14

Which level of trauma facility has minimal surgical support but can stabilize before transferring to a higher-level trauma facility?

A) III
B) II
C) IV
D) I

Question 15

Upon arriving on a scene where the mechanism of injury indicates a potentially life-threatening injury, you should employ which of the following interventions to best help deliver the care that is needed?

A) Reevaluate the scene size-up.
B) Initiate transport immediately, delaying more extensive care until you are en route.
C) Ask a surgeon to respond to the scene.
D) Call immediately for air medical transport to reduce the "Golden Period."

Question 16

The purpose of determining the mechanism of injury and the index of suspicion for the trauma patient at the same time is to allow you to:

A) decide whether to transport the patient.
B) identify comorbid factors.
C) document a complete scene size-up.
D) anticipate your patient's injuries.

Question 17

Modern medicine treats trauma as a:

A) crisis.
B) disease.
C) life threat.
D) medical problem.

Question 18

Which of the following is the best, most cost-effective way for EMS personnel to help reduce trauma-related morbidity and mortality?

A) Participate in injury prevention programs.
B) Keep up to date on trauma management knowledge and skills.
C) Transport all trauma patients to a trauma center.
D) Provide complete patient care reports so that accurate data can be entered into the trauma registry.

Question 19

Which of the following trauma patients would be classified as "stable"?

A) Patient with facial burns and associated hoarseness and stridor
B) Patient who is unconscious, with no ventilations and no pulse
C) Patient with controlled bleeding from a laceration to the right forearm from a glass cut
D) Patient with closed, bilateral femur fractures but adequate ventilations

Question 20

Which of the following statements about trauma is FALSE?

A) Life-threatening injuries may exist with little external evidence.
B) Dramatic-appearing extremity injuries draw the paramedic's focus away from life-threatening injuries.
C) Life-threatening injury occurs in less than 10 percent of trauma patients.
D) Most patients with life-threatening trauma will have sustained external injury to the extremities (arms/legs).

Question 21

When assessing a patient with a crush injury, which of the following findings would indicate that toxins have entered the central circulation?

A) Hot, red skin
B) Increased urine output
C) Cardiac arrhythmia
D) Central hyperventilation syndrome

Question 22

Which of the following injuries is MOST likely in a rear-end collision?

A) Thoracic and abdominal injuries
B) Head and neck injuries
C) Pelvic fractures
D) Lumbar spine injuries

Question 23

Vehicle supplemental restraint systems (air bags) are meant to:

A) prevent unrestrained occupants from taking the down-and-under pathway in frontal impacts.
B) protect infants and children who ride in the front seat of the vehicle.
C) prevent injury from secondary impacts.
D) absorb the energy exchange of rapid deceleration.

Question 24

Which level of trauma facility strictly stabilizes trauma patients and prepares to transport, often by helicopter, to a more distant and higher-level trauma center?

A) I
B) II
C) IV
D) III

Question 25

Which of the following best differentiates medical and trauma patient assessment?

A) There is no concept for "medical load and go" patients.
B) Trauma triage guidelines are not critical with medical patients.
C) Scene safety is not an issue with the medical patient.
D) Assessing breath sounds is not crucial to trauma assessment.

Question 26

People in which of the following age groups are prone to significant trauma due to falls?

A) College-aged adults
B) Geriatric population
C) Pediatric population
D) Teenagers

Question 27

According to the Haddon Matrix, which of the following would be a pre-event host factor affecting the risk for injury in a vehicle collision?

A) Level of EMS providers responding to the scene
B) Presence of crash barriers near bridge abutments
C) Texting and/or talking on a cellphone while driving
D) Advanced automatic collision notification

Question 28

You assess a trauma patient who has an airway that cannot be maintained or secured. How should this patient be classified?

A) Critical
B) Unstable
C) Potentially unstable
D) Stable

Question 29

Which of the following injuries is NOT associated with the use of vehicle restraint systems?

A) Traumatic brain injury
B) Abrasions and contusions to the clavicle and chest area
C) Lumbar spine trauma
D) Abdominal injury

Question 30

Which of the following patients does NOT require specialty-center capabilities beyond that offered by a trauma center?

A) A 67-year-old with second- and third-degree burns over 50 percent of the body
B) A 25-year-old with amputation of three fingers
C) A 4-year-old with a closed-head injury
D) A 22-year-old with bilateral open femur fractures

Question 31

Which of the following mechanisms would yield the greatest index of suspicion for serious injury?

A) Helmeted bicyclist losing control and falling off his bike onto a grassy surface at 15 miles per hour
B) Adult falling 5 feet from a ladder and landing in the mud
C) Seventy-mile-per-hour motor vehicle crash with partial ejection
D) Pedestrian struck by a car travelling 5 miles/hour

Question 32

When a patient falls, which section of the spinal column is the most prone to compression injury?

A) Sacral
B) Cervical
C) Thoracic
D) Lumbar

Question 33

Which of the following is an acceptable way of reducing prehospital time to maximize the use of the "Golden Period" for trauma patients?

A) Skip spinal immobilization in the blunt trauma patient.
B) Start all IVs on the scene to allow for more rapid transport.
C) Load the patients and begin transport before doing a primary assessment.
D) Call for air medical transport, if indicated.

Question 34

Which of the following is NOT a complication of crush injury?

A) Renal failure
B) Difficult-to-control hemorrhage
C) Cardiac arrhythmias
D) Systemic alkalosis

Question 35

Applying Newton's second law of motion to a vehicle traveling 70 miles per hour, crashing into which of the following would transfer the most force to the patient?

A) Bridge abutment
B) Shrubbery
C) A body of water
D) Signpost

Question 36

Which level of trauma facility can provide neurosurgery, microsurgery, and care for multisystem trauma?

A) III
B) II
C) I
D) IV

Question 37

Which of the following is a "mental summation of suspected injuries based on the event analysis"?

A) Index of injury
B) Index of suspicion
C) Newton's First Law of Motion
D) Mechanism of injury

Question 38

The two factors that refer to the rate of change of speed are:

A) deceleration and velocity.
B) mass and weight.
C) acceleration and deceleration.
D) acceleration and inertia.

Question 39

Which of the following is the only way to determine which patient care procedures benefit trauma patients?

A) Surveillance
B) Risk identification
C) Implementation
D) Evaluation

Question 40

You are called to the scene of a vehicle crash in which a car was rear-ended while stopped at a stop sign. Which of the following laws of physics serves as the basis for analyzing the mechanism of injury and the associated index of suspicion for injuries?

A) The amount of energy transmitted to an object is inversely proportional to its rate of deceleration.
B) Energy can neither be created nor destroyed.
C) A body at rest will remain at rest unless acted on by an outside force.
D) A body in motion will remain in motion unless acted on by an outside force.

Question 41

For which of the following impacts should you maintain a higher index of suspicion because the degree of injury may be greater than the damage alone indicates?

A) Rear-end
B) Oblique
C) Lateral
D) Frontal

Question 42

Which of the following injuries is NOT commonly related to snowmobiling?

A) Ejections
B) Crush injuries
C) Drowning
D) Glancing blows against obstructions in the snow

Question 43

Which of the following contributes to a greater degree of injury than anticipated from vehicle damage alone in a lateral-impact motor vehicle collision?

A) Increased gravitational forces due to multiple changes in direction and velocity
B) Lack of a crumple zone
C) Taking the up-and-over pathway
D) The force of side-impact air bag deployment

Question 44

Which of the following is the most important priority when caring for a patient with a shallow-water diving injury?

A) Assessing the cervical spine for deformity
B) Maintaining cervical spine stabilization while opening the airway
C) Removing the patient from the water as soon as possible
D) Initiating rescue breathing once out of the water

Question 45

Your patient, a 23-year-old woman who is 6 months pregnant, was the unrestrained driver of a vehicle that rear-ended a parked car. The air bag deployed. Considering the likelihood of organ collision, for which of the following injuries should you maintain a high index of suspicion?

A) Cardiac contusion
B) Anterior flail segment
C) Abruptio placentae
D) Fractured sternum

Question 46

Which of the following is MOST likely to be fractured from a fall onto outstretched hands?

A) Carpals
B) Metacarpals
C) Clavicle
D) Ulna

Question 47

Which of the following is NOT a type of collision that must be considered when analyzing a motor vehicle collision?

A) The vehicle strikes an object.
B) The occupants' organs strike the interior of the body cavity.
C) The body of the occupant strikes the interior of the vehicle.
D) A hubcap flies off and strikes a tree.

Question 48

Which of the following best describes why the occupants of a vehicle moving at 50 miles per hour will be injured when the vehicle strikes a tree, but not when it brakes to a stop?

A) Braking allows the kinetic energy to be absorbed evenly into the frame of the vehicle, rather than concentrating it at the point of impact.
B) The energy gradually dissipates as heat due to the friction of braking, rather than transferring to the vehicle and its occupants.
C) The inertia of the tree increases the kinetic energy transmitted to the occupants by a factor of 10.
D) None of the above describes why.

Question 49

Which of the following is TRUE regarding a motorcycle collision?

A) Frontal impact can result in intraabdominal, pelvic, and femur injuries.
B) A rider who "lays down the bike" will generally receive more severe injuries than a rider who stays with the bike.
C) The structural steel of the vehicle absorbs most of the kinetic energy in a motorcycle collision.
D) The use of helmets has drastically reduced the incidence of cervical spine injuries.

Question 50

Which of the following best describes what happens to the kinetic energy of a vehicle traveling at 65 miles per hour when it collides into a concrete barrier wall?

A) The energy dissipates as sound waves.
B) The body of the vehicle and its occupants absorb the energy.
C) The wall's foundation absorbs the energy.
D) The energy converts to heat through friction.

Question 51

Which of the following injuries is associated with the pressure wave produced by a blast?

A) Pneumothorax
B) Lacerated liver
C) Fractures
D) Ruptured spleen

Question 52

Axial loading is MOST likely to occur in which type of impact?

A) Frontal with an up-and-over pathway
B) Frontal with a down-and-under pathway
C) Rear with the headrest too low
D) Lateral on the side of the vehicle opposite the occupant

Question 53

Which of the following affects the severity of injury sustained in a motor vehicle collision?

A) Gross vehicle weight
B) Rate of acceleration or deceleration
C) Vehicle speed
D) All of the above

Question 54

Which of the following is TRUE of the differences between adult and pediatric pedestrians when struck by a vehicle?

A) Adults tend to be thrown under the vehicle.
B) Children tend to be thrown onto the hood of the vehicle.
C) Children tend to be thrown under the vehicle.
D) Adults tend to have injuries higher on the body.

Question 55

Which of the following best defines the term energy?

A) The ability to deform solid objects
B) The rate of motion related to time
C) The capacity to do work
D) The amount of heat generated through friction

Question 56

Upon arriving at the scene of a single-vehicle collision in which the vehicle struck a utility pole, you note that the windshield is "starred," and that the driver is not restrained. Which of the following injuries is MOST likely?

A) Whiplash injury of the neck muscles
B) Compression injury of the cervical spine
C) Distraction injury of the cervical spine
D) Ligamentous neck injury due to rotation beyond the range of motion

Question 57

Which pathway of patient travel results in higher mortality with a frontal impact collision?

A) Vertical
B) Straight
C) Up-and-over
D) Down-and-under

Question 58

Which of the following factors is NOT a consideration in the severity of injury related to falls?

A) Landing surface
B) Wind resistance
C) The initial point of impact
D) Distance of the fall

Question 59

Which of the following "paper bag syndrome" injuries may occur due to sudden compression of the thorax or abdomen?

A) Pulmonary and myocardial contusions
B) Pneumothorax and diaphragmatic rupture
C) Cardiac tamponade and aortic dissection
D) Pneumothorax and myocardial contusion

Question 60

Which two of the following factors proportionately affect the kinetic energy of a bullet fired from a gun?

A) Friction and distance
B) Mass and friction
C) Velocity and mass
D) Friction and velocity

Question 61

Which of the following scenarios would likely lead to the development of compartment syndrome?

A) A crush injury to the lower leg
B) A loose-fitting cast that covers the thigh and leg
C) An excessive release of intracellular potassium
D) A tennis shoe that doesn't fit correctly

Question 62

Infants and very small children (up to two years of age) should have their child safety seat positioned where in a car?

A) The front seating area, facing backward
B) The rear seating area, facing backward
C) The front seating area, facing frontward
D) The rear seating area, facing frontward

Question 63

Which of the following mechanisms in a motor vehicle collision would MOST likely result in a tear of the liver at the ligamentum teres?

A) Gradual deceleration
B) Sudden acceleration
C) Sudden deceleration
D) Gradual acceleration

Question 64

The branch of physics dealing with objects in motion and energy exchanges that occur as these objects collide is called what?

A) Kinematics
B) Kinetics
C) Inertia
D) Force

Question 65

Frontal impacts in which the patient takes a "down-and-under" pathway typically result in which of the following injury patterns?

A) Traumatic brain injury
B) Hip and femur fractures
C) Rupture of the diaphragm
D) Rupture of hollow organs

Question 66

When inspecting the interior of a vehicle involved in a frontal collision, you note that the dash panel beneath the steering wheel is broken. Which of the following injuries might this indicate?

A) Fracture of the acetabulum
B) Femur fracture
C) Knee injury
D) All of the above

Question 67

Which of the following is TRUE of the injuries sustained by the elderly due to falls?

A) The injuries sustained by the elderly are less likely to result in hospitalization.
B) Only more significant falls cause fractures.
C) Less-significant falls may cause fractures.
D) The elderly sustain injuries similar to other age groups in comparable falls.

Question 68

Which of the following statements is NOT true of occupant ejection in motor vehicle collisions?

A) Ejection accounts for 27 percent of motor vehicle fatalities.
B) The number of occupant impacts increases with ejection.
C) Ejection has not been reported with lateral-impact collisions.
D) Ejection is most often associated with frontal-impact collisions.

Question 69

Which of the following is NOT one of the major types of recreational vehicles involved in crashes?

A) Snowmobiles
B) Jet skis
C) All-terrain vehicles
D) Go-karts

Question 70

Which of the following statements about the impact of motorcycle helmet usage is TRUE?

A) Helmet use moderately increases the incidence of cervical spine injury.
B) Helmet use moderately decreases the incidence of cervical spine injury.
C) Helmet use substantially decreases the incidence of cervical spine injury.
D) Helmet use neither increases nor decreases the incidence of cervical spine injury.

Question 71

Which type of motor vehicle collision is most common in rural areas?

A) Frontal
B) Lateral
C) Rollover
D) Rear-end

Question 72

Which of the following statements about lateral impact collisions is TRUE?

A) The substantial lateral crumple zone prevents most injuries.
B) Damage to the vehicle is a reliable indication of the seriousness of injuries.
C) The degree of injury may be greater than the damage alone would indicate.
D) Fatalities are rare because the upper extremities absorb the energy.

Question 73

Which of the following injuries is associated with the tertiary phase of a blast?

A) Crush injuries
B) Barotrauma
C) Burns
D) Projectile injuries

Question 74

Which of the following may result from aggressive ventilation of the blast patient?

A) Emboli
B) Pericardial tamponade
C) Hemorrhage
D) Acidosis

Question 75

When the driver's chest strikes the steering wheel during a motor vehicle collision, what produces the next injury?

A) The air bag deploys a second time.
B) The steering column shears off, causing penetrating trauma.
C) Unsecured objects in the vehicle become projectiles.
D) The heart continues its forward motion until it strikes the chest wall.

Question 76

You have responded to a soccer field on which two 13-year-olds have collided during a game. Which of the following findings in either patient requires ambulance transport for further evaluation in the emergency department?

A) Weakness in the upper extremities
B) Complaint of "getting the wind knocked out of me"
C) Contusion to the thigh
D) Minor epistaxis

Question 77

A vehicle is struck in its right front as it passes through an intersection, resulting in an oblique impact. Which of the passengers is subjected to the greatest acceleration forces?

A) The right-rear passenger
B) The left-rear passenger
C) The front-seat passenger
D) The driver

Question 78

Which of the following mechanisms may result in a conventional explosion?

A) Fumes
B) Dust
C) Natural gas
D) All of the above

Question 79

Which of the following mechanisms is most consistent with fractured vertebrae from a rapid lateral twisting motion?

A) Direct trauma, such as from a blow to the head
B) Low-velocity penetrating trauma from an ice pick
C) High-velocity penetrating trauma from a gunshot wound
D) Lateral-impact motor vehicle collision

Question 80

Which of the following is TRUE of supplemental restraint systems?

A) They may deploy during rescue operations, injuring the patient and/or EMS personnel.
B) When worn incorrectly, they may cause spinal injury or decapitation.
C) They guard against thoracic impact with the steering wheel.
D) They are primarily useful in preventing injury to infants and children riding in the front seat.