AEMT Final Exam Questions with correct Answers

Unrestrained and the car came to a halt and hit a tree, what injury pattern would we see? - ANSWER May be ejected from vehicle; increased risk of head/spinal injury and death Up & Over Pathway risks - ANSWER -Head inj ...

Unrestrained and the car came to a halt and hit a tree, what injury pattern would we see? - ANSWER May be ejected from vehicle; increased risk of head/spinal injury and death Up & Over Pathway risks - ANSWER -Head injury - Chest injury including rib fracture, flail chest, pneumo/ hemothorax, contusions, great vessel injury -Spine injury -Vena Cava , Aorta injuries -Abdominal injuries including solid organ, hollow organ diaphragm -Pelvis fracture Down and under pathway risks - ANSWER -Posterior knee and hip dislocations -Femur Fracture -lower extremity fracture -pelvic and acetabular fracture What is work - ANSWER Force acting over a distance; bends, pulls or compress tissues beyond their limit Ex: force needed to bend metal multiplied by the distance over which the metal is bent is the work that crushes front end of vehicle What is latent energy - ANSWER internal energy a system requires to undergo a phase transition, value specific to substance/s in question. Can vary with temperature and pressure What is kinetic energy - ANSWER KE= ½ mass X V2 Relationship between the mass (weight) of the object and velocity (speed)at which it is traveling; found in force of 2 moving vehicles that collide What is potential energy - ANSWER energy of falling objects, take into account mass, force of gravity and height; Energy of falling objects, gravity connects to kinetic energy ex. Worker falls, potential energy converted to kinetic energy, he hits ground, kinetic energy converted to work (work of bringing body to a stop which fractures bones and caused soft tissue damage By what mechanism are people injured when falling from a significant height? - ANSWER Worker falls, potential energy is converted to Kinetic energy. Worker hits ground, KE is converted into work, work of bringing body to a stop thereby fracturing bones and damaging tissues Three types of collisions in MVA; 1st - ANSWER Impact of vehicle against another object Most dramatic and provides info about collision severity; greater the damage, greater the energy Three types of collisions in MVA; 2nd - ANSWER passenger against the interior of vehicle KE produced by vehicles mass and velocity is converted to work to bring vehicle to stop KE produced by passenger's mass and velocity converted into work of stopping his body Three types of collisions in MVA; 3rd - ANSWER passengers internal organs against the solid structures of the body May not be as obvious as external injuries What injuries to a vehicle would we expect to see with high energy trauma? - ANSWER Head on/front impact, Side impact/lateral, Rear end Head on/front impact - ANSWER deformed front end/steering column, dashboard Clues: - bruised/lacerated head, bruised neck/chest, bruised abdomen/knee - Brain injury/cervical spine/tracheal, sternal or rib fracture/flail chest/pericardial tamp/ pneumo or hemothorax/aortic tear, femoral fracture/ruptured spleen liver bowel Side impact/lateral - ANSWER door smashed in/deformed side of vehicle/ b pillar performed/broke window Clues-bruise shoulder pelvis temple arms/lacerations Injuries- clavicular fracture humorous fracture hip/brain injuries Rear end - ANSWER deformity to rear Injuries- whiplash, bleeding bruising, or tearing inside skull What types of physical damage would we expect to see as a second result of a motor vehicle crash? - ANSWER Coup-contrecoup injury What is Coup-contrecoup injury - ANSWER Rapid deceleration when the brain comes to a quick stop by striking the inside of the skull results in compression injury ( bruising) to the anterior brain and stretching/tearing of the posterior brain. Can occur in frontal and lateral crash If somebody dies in the same vehicle as a patient why do we care? - ANSWER May be upset and not aware of own injuries--assess thoroughly If someone is unrestrained in MVA what will they most likely strike when the airbag deploys? - ANSWER Contact with airbag and/or door, dashboard or instrument panel at the knees, transferring energy from the knees through the femur to pelvis and hip joint; chest/abdomen - steering wheel Face- steering wheel/windshield If pediatric pt is only wearing a lap belt what type of injuries might we see? - ANSWER Unseen abdominal injury if placed too high Hip injury if placed too low What type of car crash is directly linked to increased aortic damage? - ANSWER Up and over injuries and Deformed steering column 3 Phases of impact (mechanisms of injury for car vs pedestrians) - ANSWER 1. vehicle/pedestrian 2. Pedestrian rotates on hood 3. Rolls off onto ground Injury pattern dependent on height of pedestrian and body part facing impact Ask about: speed, patient ejected, surface landed on, distance struck or pulled under vehicle Evaluate vehicle for structural damage from contact points 3 Phases of impact: children - ANSWER turn toward vehicle: head chest and go under vehicle 3 Phases of impact: adults - ANSWER turn away from vehicle causing lateral injury If a 12 year old jumps from 12 feet and lands on feet and has back pain, what mechanism is most responsible for back pain? - ANSWER Pediatric falls . 10 feet or 2-3 times their height are significant MOI and may cause multisystem injury Legs absorb most of the energy of the fall: less internal injury , but more serious injuries to lower extremities, pelvic and spinal injuries from energy legs did not absorb Take into account: Height of fall, type of surface struck, part of body hit first followed by path of energy displacement, area of body over which impact is distributed Gross generalizations about the elderly when it comes to trauma - ANSWER Consider syncope or other underlying medical condition Can sustain fractures from standing falls due to weakened bones from osteoporosis Generalities about low energy penetrating trauma - ANSWER Look at location of entrance wound and length of object used consider angle and direction of travel, may be accidental or purposeful capitation - ANSWER fixed amount of money per patient/unit of time paid in advance to the physician for delivery of healthcare services Cavitation - ANSWER additional damage caused by an object moving inside the body but not along a suspected pathway; results from rapid change in tissue and fluid pressure that occur with passage of projectile. Can result in organ damage distant to the bullet path` Cavitation: Temporary - ANSWER produced by stretching tissue surrounding point of impact Cavitation: Permanent - ANSWER Closer to bullet path where pressure fluctuations are greatest. Pathway remains Congruence - ANSWER joint surface formed from peret encasing of 2 interacting parts Conversion - ANSWER (Disorder) mental condition where a person has blindness, paralysis or other nervous system (neurogenic) symptoms that cannot be explained medically Primary Blast Injury - ANSWER from blast wave Injuries- flash burns, lungs, eardrums and other compressible organs Secondary Blast Injury - ANSWER struck from flying debris; blast wind longer than blast wave Injuries- blunt penetrating trauma Tertiary Blast Injury - ANSWER person hurled by explosion force (blast wind) against stationary/rigid objects Injuries- blunt and penetrating injuries Quaternary Blast Injury - ANSWER miscellaneous events that occur during explosion Injuries- burns, inhalation injuries (toxins), crush injuries from building collapse and entrapment What would we see from a pulmonary blast injury - ANSWER Pulmonary trauma What is Pulmonary trauma - ANSWER contusion, hemorrhage, tightness in chest, cough up blood(hemoptysis), tachypnea, subcutaneous emphysema. Results from short range exposure to detonation of explosives Open area - Injuries to side exposed to blast Confined areas - bilateral injury What is most critical for multisystem trauma patients. What kills? - ANSWER Person is subjected to multiple traumatic injuries involving more than 1 body system. 10 minute scene time is priority. Patients need teams of specialists to survive, therefore rapid treatment/transport is required. 60 minutes post injury, the body struggles to compensate for shock and traumatic injuries...Golden Hour If you have a patient with severe nausea and headache what injury would you suspect? - ANSWER Toxic exposure to CO When do we consider air ambulance transport? (National Transport) - ANSWER - Extended extrication - Distance > 20 -25 miles - Patient needs ALS and none is available - Traffic conditions - MCI - Stabilization at local hospital is required Glasgow coma scale: EYES - ANSWER 4 - Open spontaneously 3 - Open to verbal 2 - Open to pressure/pain 1 - None Glasgow coma scale: VERBAL - ANSWER 5 - Oriented speech 4 - Confused 3 - Words 2 - Sounds 1 - None Glasgow coma scale: MOTOR - ANSWER 6 - Obey commands 5 - Localizes pain 4 - Withdrawals pain 3 - Decorticate 2 - Decerebrate 1 - None Ranges for GCS - ANSWER Mild (13-15) Moderate (9-12) Severe(3-8) critical trauma patient criteria - ANSWER Includes GCS, respiratory rate, systolic BP Step 1: GCS 29 breaths/min (<20 in infant aged <1 year) Or need for ventilatory support Step 2: ALL penetrating injuries to head neck, torso and extremities proximal to elbow or knee - Chest wall instability or deformity, (flail chest) - 2 or more proximal long bone fractures - Crushed, degloved, mangled, or pulseless extremity - Amputation proximal to wrist or ankle - Pelvic fractures - Open or depressed skull fracture - Paralysis TRAUMA CENTER TRANSPORT During a profound state of hypoperfusion, what does our autonomic system do? - ANSWER Alpha receptor stimulation induces alpha and beta functions. Alpha receptors stimulate smooth muscle contraction in the blood vessels and bronchioles. Beta receptors relax smooth muscles in bronchioles and cause chronotropic and inotropic effects on the myocardial cells. - Redirects blood away from other organs to heart brain, lungs, kidneys, - Cardiovascular dynamic and is constantly adapting to changing conditions What is hemorrhaging and why do we care? - ANSWER A discharge of blood from the blood vessels: AKA bleeding. An adult has approximately 10 pints or 5 L of blood. A loss of 20% can be detrimental Capillary bleed - ANSWER dark red ooze Venous bleed - ANSWER dark blood and flows steadily Arterial bleed - ANSWER initially spurt, bright red, but decreases as BP decreases What is Jon's favorite weapon for blunt trauma? - ANSWER baseball bat How much blood can we lose in our legs from our legs from our femur fracture? - ANSWER 2 pints or 1L or more per femur factors that allow us to compensate for blood loss - ANSWER Release of chemical mediators by autonomic nervous system as it recognizes potential catastrophic events causes arterial blood pressure to remain normal or slightly elevated. Increased rate and depth of respirations to bring in more O2 and remove CO2. Helps maintain acid-base balance by creating respiratory alkalosis to offset metabolic acidosis. BP is maintained. Narrowing pulse pressure reflects tone of arterial system and is sensitive to changes in perfusion than systolic or diastolic blood pressure , may have positive orthostatic vital; signs (increased pulse, decreased systolic when supine to sitting) Gas exchange - ANSWER the process of obtaining oxygen from the environment and releasing carbon dioxide Blunt trauma, how to determine how severe internal bleeding is? - ANSWER Identify the signs and symptoms of internal bleeding and demonstrate its treatment. S&S - weakness, usually on one side of your body. - numbness, usually on one side of your body. - tingling, especially in hands and feet. - severe, sudden headache. - difficulty swallowing or chewing. - change in vision or hearing. - loss of balance, coordination, and eye focus. What factors affect how well we compensate for blood loss? - ANSWER Age, vessel elasticity, blood volume, medications, environment Pertinent physical exam findings for internal bleeding for geriatric pts? - ANSWER - Agitation, dizziness, syncope, hypotension and changes in mental status - Slower bleeding: emesis with coffee grounds appearance; pulse and systolic BP are normal - Brisk bleeding: Hematemesis, melena - NSAID and regular alcohol use may result in bleeding from irritation of the lining of the stomach or ulcers Environmental emergencies/Why does the skin become hot or flushed red in a hot environment? - ANSWER Dilation of peripheral blood vessels to help decrease heat Treatment priorities for closed soft tissue injuries - ANSWER Assess for more serious injuries: The greater the amount of force, the greater the risk of injury to deeper structures (organs, vessels) Assess ABC's and be alert for shock RICES (rest, ice, compression, and elevation) Treatment priorities for open soft tissue injuries - ANSWER - Control bleeding - If in chest, neck, upper abdomen, back: cover with occlusive dressing - Direct pressure, pressure dressings/splints, tourniquets Proper treatment for abdominal evisceration - ANSWER - DO NOT push down on evisceration - Cut away clothing around wound - Do not replace eviscerated organ - Cover with sterile gauze compresses moistened with sterile saline solution. Secure with dry sterile dressing and occlusive dressing - Treat for shock, keep warm, O2, transport to trauma center When is it appropriate to remove an impaled object - ANSWER - Interferes with CPR - Blocks airway or interferes with ventilation Rule of 9s Adult - ANSWER Head 9% Chest 18% Back 18% Arms 9% each arm Legs 18% each leg Genitalia1% Superficial - ANSWER (first degree) involves only the top layer of skin (epidermis). Skin turns red but does not blister, painful (sunburn) Partial - ANSWER (second degree) involve epidermis and some portion of the dermis. Does not destroy the entire thickness of the skin and subcutaneous tissue is not injured. Skin is moist, mottled and white to red, blisters are common Full thickness burn - ANSWER (third degree) Extends through all skin layers and may involve subcutaneous layers, muscle, bone, and internal organs. Burn area is dry and leathery and may appear white, dark brown or charred--eschar. Feels hard to touch. Clotted blood vessels or subcutaneous tissue may be visible under the burned skin. Severely burned area may have no feeling Minor burn - ANSWER Full thickness burn , 2% TBSA -Partial thickness burns covering : Less than 15% of TBSA if age 10-55 Less than 10% of TBSA if younger than 10 y or older than 50 y -Superficial burns covering less than 50% of TBSA Moderate burn - ANSWER Full thickness burns involving 2-10% TBSA (excluding hands, feet, Face, genitalia, and upper airway) -Partial thickness burns covering: 15-25% TBSA if 10 to 50 yo 10-20% TBSA if younger than 10y or older than 50 y -Superficial burns covering more than 50% TBSA - Low voltage electrical burns Major burns - ANSWER - Burns involving the hands, feet, face, major joints, or genitalia, or circumferential burns of other areas - Full thickness burns covering more than 10% TBSA - Partial thickness burns covering more than: 25% TBSA if 10-50 yo 20% TBSA if less than 10 or greater than 50 yo -Burns associated with respiratory injury (smoke inhalation or inhalation Injury -Burns complicated by fractures or trauma - high voltage electrical burns - Chemical burns - Burns on patients younger than 3 years or older than 55 years that would Be classified as moderate in young adults Pediatric rule of 9s: INFANT - ANSWER INFANT Head 18% Chest 18% Back 18% Legs 13.5 each leg Arms 9% each arm Genitalia1% Pediatric rule of 9s: CHILD - ANSWER CHILD Head 12% Chest 18% Back 18% Legs 16.5 each leg Arms 9% each arm Genitalia1% *For kids over 1yo, Head decreased 1%/ year up to 10 yo. Legs will increase 1%/ year....this is something that was included in the assessments from JBLearning Pediatric- palms to get total bsa - ANSWER - Aka rule of ones. - Uses size of the patients palm(including the fingers) to represent approximately 1% of the patients tbsa. - Most helpful when the burn covers less than 10% of tbsa or burn is irregularly shaped. Fluid administration in burns - ANSWER Parkland Formula- 2-4 mL X Patient weight (Kg)X % TBSA burned This is the amount of fluid to give over 24 hours. You should administer half in the first 8 hours and the rest in the remaining 16 hours Treatment priorities for nose bleed - ANSWER Lean patient forward and pinch nostrils together or apply pressure on upper gums with your glove Treatment priorities for a pt w a peanut lodged in ear - ANSWER Remove by doctor in ED. Do not touch it Diff btw arterial and venous bleeding? especially on neck - ANSWER Both can cause exsanguination and air embolism causing cardiac arrest. Occlusive dressing may become a constricting band due to swelling/expanding hematomas Arterial- Apply pressure above bleed in Carotid artery Venous- Apply pressure below bleed in Jugular vein Clinical findings associated with laryngeal injuries - ANSWER - Larynx is crushed against cervical spine, therefore possible C-spine injury - Respiratory distress, hoarseness, pain, difficulty swallowing (dysphagia), hemoptysis, cyanosis, pale, sputum in wound, subcutaneous emphysema, bruising, structural irregularity, hematoma - Mediastinitis- inflammation of mediastinum due to leakage of gastric contents into thoracic cavity--high mortality - Airway compromise Frontal Lobe - ANSWER anterior; Voluntary motor function, personality traits Parietal Lobe - ANSWER Posterior to frontal lobe; Somatic/voluntary sensory and motor functions, memory and emotions Temporal Lobe - ANSWER Infero lateral to parietal lobe; speech center, long term memory, hearing, Taste Occipital Lobe - ANSWER posteriorly; vision Cerebellum - ANSWER inferior and posterior to cerebrum; coordination Brainstem - ANSWER deep within cranium; midbrain, pons, medulla Reticular activation system: superior;maintains consciousness specific level of arousal