Paramedic Quiz Chapters 23,24

The patient's complaint of tingling in her fingers and the coolness of her hand suggest a potential issue with blood flow and nerve function. Therefore, the correct course of action is to readjust the bandage if needed and reassess distal neurovascular function. This will help ensure that there is no further compromise to the blood supply or nerve function in the injured arm.

Fractures of the lower rib cage should make you most suspicious for injuries to the liver or spleen. The liver and spleen are located in the upper abdomen and are protected by the rib cage. Fractures in the lower rib cage suggest a significant force or impact to the area, which can result in damage to these organs. The location of the fractures and the proximity to the liver and spleen make them the most likely organs to be affected. Injuries to the urinary bladder, ascending aorta, kidneys, or pancreas are less likely in this scenario.

Traumatic injuries to the aorta are most commonly the result of shearing forces. Shearing forces occur when there is a sudden deceleration or acceleration of the body, causing the aorta to move in different directions. This can lead to tearing or rupture of the aorta, which is a life-threatening condition. Rear-end collisions, penetrating trauma, and motorcycle crashes can also cause aortic injuries, but shearing forces are the most common cause.

The correct answer is that the intraabdominal cavity can accommodate large amounts of blood. This means that even if there is bleeding within the abdominal cavity, there may not be obvious signs or symptoms of trauma. The abdominal cavity has a lot of space to accommodate the blood, so it may not cause immediate symptoms such as pain or swelling. This can make it difficult to detect intraabdominal bleeding without further investigation or imaging techniques.

The periumbilical area refers to the area around the umbilicus or belly button. It includes the skin and tissues that surround the belly button. This area is commonly used in medical examinations to assess for any abnormalities or signs of disease.

After intubating an unconscious, apneic patient with a suspected spinal injury, it is important to ventilate at a rate of 10-12 breaths per minute and monitor the end-tidal CO2. This is because maintaining proper ventilation is crucial for oxygenation and preventing hypercapnia. Monitoring the end-tidal CO2 helps ensure that the patient is adequately ventilated and that the ET tube is properly placed. This allows for prompt recognition of any changes in ventilation status and allows for appropriate adjustments to be made if necessary.

The correct answer is "diaphragm to the pelvis". The abdominal cavity is the space within the abdomen that contains various organs such as the stomach, liver, intestines, and reproductive organs. It is bounded by the diaphragm, which is a muscle that separates the abdomen from the chest cavity, and the pelvis, which is the bony structure at the lower part of the abdomen. This answer accurately describes the anatomical boundaries of the abdominal cavity.

Recognizing the need for rapid transport is the correct answer because in cases of abdominal trauma, time is of the essence. Rapid transport ensures that the patient reaches a medical facility quickly, where they can receive the necessary surgical interventions or specialized care. Delaying transport can lead to an increase in mortality and morbidity as the patient's condition may worsen without timely medical attention. Therefore, recognizing the urgency for rapid transport is crucial for EMS providers to have the most positive impact on the outcome of patients with abdominal trauma.

The space between the second and third ribs is called the second intercostal space. The intercostal spaces are the spaces between adjacent ribs, and they are numbered according to the rib above them. In this case, the space between the second and third ribs is referred to as the second intercostal space.

When air accumulates in the pleural space, it can cause a condition known as pneumothorax. This leads to decreased pulmonary function because the air in the pleural space prevents the lung from fully expanding and filling with air. As a result, the affected lung is unable to effectively exchange oxygen and carbon dioxide, leading to decreased pulmonary function.

The eighth, ninth, and tenth ribs are indirectly attached to the sternum by the costal cartilage. Costal cartilage is a flexible connective tissue that connects the ribs to the sternum, allowing for movement and flexibility in the ribcage. This attachment helps to protect the organs in the thoracic cavity and provides support for the chest wall. The manubrium, angle of louis, and suprasternal notch are not directly involved in the attachment of the ribs to the sternum.

The cardiac output is calculated by multiplying the heart rate by the stroke volume. In this case, the heart rate is 80 beats per minute and the stroke volume is 60 mL. Therefore, the cardiac output would be 80 beats/min * 60 mL = 4,800 mL/min, which is equivalent to 4.8 L/min.

The liver is a solid organ that lies in the right upper abdominal quadrant and detoxifies the blood. This statement is the most correct because the liver is indeed a solid organ and is located in the right upper abdominal quadrant. It is responsible for various functions, including detoxifying the blood by removing toxins and metabolizing drugs. The liver also plays a role in producing bile, but it is not the largest hollow organ in the abdomen. Additionally, the liver is well-vascularized and can be injured during blunt abdominal trauma.

The correct answer is to manually stabilize the patient's head in a neutral position, suction his oropharynx, and assist ventilations with a BVM device and 100% O2. This is the appropriate initial management for a patient with extensive maxillofacial injuries and compromised respiratory effort. Stabilizing the head prevents further injury to the spine, suctioning the oropharynx clears any obstruction, and assisting ventilations with a BVM device and 100% O2 ensures adequate oxygenation. This approach addresses the immediate concerns of airway management and respiratory support in this critically injured patient.

The correct answer is to suction the blood from his mouth and assist ventilations with a BVM. This is the most appropriate action to take in a patient with inadequate breathing and oropharyngeal bleeding. Suctioning the blood will help clear the airway and improve ventilation, while assisting ventilations with a BVM will ensure that the patient is receiving adequate oxygenation. Intubation may be necessary later on, but the immediate priority is to address the airway obstruction and provide ventilation support.

The skier's complaints of neck stiffness and numbness and tingling in all extremities suggest a potential spinal injury. Immobilizing his spine will help prevent further damage and potential paralysis. Moving him to a warmer environment is important to prevent hypothermia, which can worsen his condition. Therefore, immobilizing his spine and quickly moving him to a warmer environment is the most appropriate action to take in this situation.

In this scenario, the man is pinned under a large metal beam, indicating a potentially life-threatening situation. As the first unit on the scene, it is crucial to prioritize the safety and well-being of the patient. Requesting a special rescue team immediately is the most appropriate action to ensure that the patient receives the necessary specialized equipment, expertise, and manpower to safely free him from the debris. This will minimize the risk of further injury and provide the best chance for a successful rescue.

The size of the patient does not contribute to the extent of injury from a gunshot wound to the abdomen. The factors that do contribute to the extent of injury include the profile of the bullet, trajectory of the bullet, and the distance the bullet traveled. However, the size of the patient does not directly affect the injury caused by a gunshot wound to the abdomen.

Gross hematuria (visible blood in the urine) and suprapubic pain (pain above the pubic bone) after a pelvic injury suggest injury to the bladder. The bladder is located in the lower abdomen and is susceptible to injury during trauma to the pelvic region. The presence of blood in the urine indicates damage to the bladder's blood vessels, while suprapubic pain is a common symptom of bladder trauma. Injury to the ureters, urethra, or kidneys may also occur in pelvic injuries, but the combination of gross hematuria and suprapubic pain is most indicative of bladder injury.

After completing spinal immobilization, it is most important to reassess pulse, motor, and sensory functions in all extremities. This is because spinal injuries can cause nerve damage and compromise the patient's ability to move or feel sensations in their extremities. By reassessing these functions, the healthcare provider can determine if there are any changes or worsening of the patient's condition, which may require immediate intervention. Starting an IV of normal saline, applying a cardiac monitor and obtaining vital signs, and performing a detailed physical exam are also important steps in the management of a patient with a possible spinal injury, but reassessing pulse, motor, and sensory functions takes priority to evaluate the patient's neurologic status.

The diaphragm forms a barrier between the thoracic and abdominal cavities. This means that it separates the chest cavity (thoracic cavity) from the abdominal cavity. This separation is important for various reasons. It helps to protect the organs in the thoracic cavity, such as the heart and lungs, from the organs in the abdominal cavity, such as the liver and intestines. It also helps to maintain the pressure differences between these two cavities, allowing for proper functioning of the respiratory and digestive systems.

Based on the information provided, the patient is conscious, alert, and breathing adequately. This suggests that the patient did not experience a significant trauma or injury. The most appropriate next step would be to obtain vital signs to assess the patient's overall condition, and to assess her blood glucose level as a potential cause for her fainting episode. This will help determine if there are any underlying medical issues that need to be addressed. Spinal immobilization and rapid trauma assessment are not necessary in this case as there are no indications of trauma.

An open pneumothorax occurs when there is an opening in the chest wall that allows air to enter the pleural space, the space between the lungs and the chest wall. During inspiration, the diaphragm contracts and the chest cavity expands, creating a negative pressure that draws air into the pleural space through the open wound. This can lead to a collapsed lung and ventilatory inadequacy.

The correct answer is to carefully remove the patient's contact lenses, flush both eyes for at least 20 minutes, and transport with continuous eye irrigation. This is the proper care for a patient with a chemical burn to both eyes. Removing the contact lenses is important to prevent further injury, and flushing the eyes for at least 20 minutes helps to remove the chemical and reduce the risk of damage. Transporting with continuous eye irrigation ensures that the eyes continue to be flushed during transportation.

The correct answer is to cover the laceration with an occlusive dressing and control the bleeding. In this scenario, the patient sustained a large laceration to the lateral aspect of his neck. This type of injury can be life-threatening due to the risk of severe bleeding and potential damage to vital structures in the neck. By covering the laceration with an occlusive dressing, it helps to create a seal and prevent further bleeding. Controlling the bleeding is crucial to prevent excessive blood loss and maintain the patient's hemodynamic stability.

In this scenario, the correct answer is to start 2 large bore IVs of normal saline, apply a cardiac monitor, and contact medical control before removing the rock from her legs. This is because the patient is conscious and alert, indicating that she has a patent airway and is able to breathe adequately. However, she is experiencing a potential neurovascular compromise due to being pinned under the rock for several hours. By starting IVs of normal saline, it helps to maintain her fluid balance and prevent hypovolemia. Applying a cardiac monitor allows for continuous monitoring of her heart rhythm. Contacting medical control ensures that the appropriate medical guidance is obtained before attempting to remove the rock, which could potentially cause further harm if not done correctly.

The pressure within the right ventricle is one fourth of the pressure within the left ventricle. This is because the right ventricle pumps blood to the lungs to be oxygenated, while the left ventricle pumps oxygenated blood to the rest of the body. The left ventricle has a thicker muscular wall and needs to generate more pressure to pump blood to the entire body, whereas the right ventricle only needs to pump blood to the lungs which are closer in proximity. Therefore, the pressure within the right ventricle is lower compared to the left ventricle.

The correct answer is to apply a dry, sterile dressing and transport her to the hospital. This is because the wound is showing signs of infection, such as redness, inflammation, and purulent drainage. Applying a dry, sterile dressing will help protect the wound from further contamination, and transporting her to the hospital will allow for proper evaluation and treatment of the infection.

During a motor vehicle crash, the rapid deceleration causes the unrestrained person to be propelled forward. This forward motion leads to the person's abdomen colliding with the steering wheel, resulting in a significant force being exerted on the abdominal organs. As a result of this force, the abdominal organs shear or detach from their points of attachment, causing them to rupture upon impact.

Periumbilical ecchymosis, commonly known as Cullen's sign, is a condition observed in the prehospital setting after blunt force trauma to the abdomen. This sign may take hours or even days to develop following abdominal trauma. It is often seen alongside flank bruising and is highly indicative of injury to the liver or spleen. It should not be confused with Grey Turner's sign, which manifests almost immediately after blunt abdominal trauma.

In this scenario, the driver is conscious and complaining of lower back pain, while the backseat passenger, a young child, is bleeding from the head and appears to be unconscious. The priority should be to quickly access and provide care to the unconscious child, as they may have a more serious injury and require immediate medical attention. Therefore, the correct answer is to rapidly extricate the driver so that quick access can be gained to the child in the backseat.

A massive hemothorax is defined as the accumulation of more than 1,500 mL of blood within the pleural space. This condition is characterized by pulmonary injury with secondary myocardial injury, but it is not specifically defined by this feature. Additionally, a massive hemothorax does not necessarily lead to cardiac arrest, although severe intrapleural bleeding can be life-threatening. Therefore, the most accurate and specific criterion for diagnosing a massive hemothorax is the presence of more than 1,500 mL of blood in the pleural space.

When blood is released into the peritoneal cavity, it can cause the abdomen to become grossly distended. This is often a result of blunt force trauma to the pancreas. Additionally, even with as little as 500 mL of internal blood loss, blood pressure can fall. In such cases, nonspecific signs such as tachycardia (rapid heart rate) and hypotension (low blood pressure) may occur. These signs are not specific to any particular condition or injury, but can be indicators of internal bleeding in the peritoneal cavity.

Dysrhythmias following a myocardial contusion are usually secondary to damage to myocardial tissue at the cellular level. This is because a myocardial contusion refers to a bruise or injury to the heart muscle, which can disrupt the normal functioning of the heart cells. This damage at the cellular level can lead to abnormal electrical signals and rhythm disturbances, resulting in dysrhythmias.

The correct answer is to auscultate his breath sounds before administering IV fluids. This is important because the patient has suffered burns to his arms and chest, which can lead to airway compromise and respiratory distress. By auscultating his breath sounds, the healthcare provider can assess for any signs of airway obstruction or lung injury that may require immediate intervention. Administering IV fluids without assessing the patient's respiratory status could potentially worsen his condition and lead to further complications.

Hollow organ injury can lead to peritonitis, which is inflammation of the peritoneum (the lining of the abdominal cavity). When a hollow organ, such as the stomach or intestines, ruptures, it can cause the contents of the organ to spill into the abdominal cavity. This can introduce bacteria and toxins into the peritoneum, leading to infection and inflammation. Peritonitis can be a serious complication and can cause symptoms such as abdominal pain, fever, and tenderness. Prompt medical intervention is necessary to treat peritonitis and prevent further complications.

The pancreas is located in the retroperitoneum, which is a deep position in the abdomen. Due to its deep location, it is protected by other organs and structures. Therefore, it usually requires a high amount of force or trauma to cause damage to the pancreas. In contrast, the liver, spleen, and stomach are located in more superficial positions and are more susceptible to injury from lower energy forces.

After experiencing blunt trauma to the face, the patient is presenting with epistaxis (nosebleed), double vision, and an inability to look upward. These symptoms are indicative of an orbital blowout fracture, which occurs when there is a fracture of the bones surrounding the eye socket. This fracture can cause entrapment or damage to the muscles and nerves responsible for eye movement, leading to double vision and limited upward gaze. Additionally, the epistaxis may be a result of the trauma causing damage to blood vessels in the nasal cavity.

According to the Parkland formula, the amount of normal saline that should be administered to a burn patient in the first 24 hours is calculated by multiplying the patient's weight in kilograms by the percentage of body surface area burned, and then multiplying that by 4. The result is the total amount of fluid to be administered over the first 24 hours, with half of it given in the first 8 hours. Since the question asks for the amount to be given in 30 minutes, we need to divide the total amount by 16 (since 8 hours is equal to 480 minutes, and 480 divided by 30 is 16). Given that the patient weighs 110 lbs, which is approximately 50 kg, and has burns covering 55% of her body, the calculation would be: 50 kg x 55% x 4 / 16 = 340 mL. Therefore, the correct answer is 340 mL.

The most appropriate treatment for this patient involves continuing CPR, protecting her spine while ventilating, reassessing her cardiac rhythm after 2 minutes of CPR, and defibrillating if necessary. This is because the patient is pulseless and apneic, indicating cardiac arrest. CPR should be continued to provide circulation and oxygenation to the vital organs. Protecting the spine while ventilating is important to prevent any potential spinal injury. After 2 minutes of CPR, reassessing the cardiac rhythm is necessary to determine if a shockable rhythm, such as ventricular fibrillation or pulseless ventricular tachycardia, is present, which would require defibrillation.

The correct answer is that the visceral pericardial layer adheres to the heart and forms the epicardium. The epicardium is the outermost layer of the heart and is also known as the visceral pericardium. It is a thin, protective layer that covers the surface of the heart and is directly attached to the heart muscle. This layer helps to protect the heart and also plays a role in lubricating the heart to reduce friction during its contractions.

The coronary sinus is not a sight of potential injury when the aorta is subjected to shearing forces during rapid deceleration. The coronary sinus is a vein located in the heart that collects blood from the coronary veins and returns it to the right atrium. It is not directly connected to the aorta and therefore is not at risk of injury from shearing forces during rapid deceleration.

The patient's symptoms, such as restlessness, tachypnea, hypotension, weak pulse, and increased heart rate, indicate that he is experiencing burn shock. Burn shock occurs when there is a significant loss of fluids and electrolytes due to the burn injury. Administering high flow oxygen will help improve oxygenation, keeping the patient warm will prevent hypothermia, starting an IV of normal saline will replenish fluid volume, and administering fluid boluses will maintain adequate perfusion. This approach will help stabilize the patient's condition and prevent further complications.

The correct answer is pancreas. Intraperitoneal organs are organs that are located within the peritoneal cavity, which is the space between the abdominal organs and the abdominal wall. The pancreas is located behind the stomach and is retroperitoneal, meaning it is situated outside the peritoneal cavity. Therefore, it is not considered an intraperitoneal organ.

The diaphragm is a dome-shaped muscle that separates the thoracic cavity from the abdominal cavity. It inserts into the anterior thoracic cage, specifically attaching to the inner surface of the lower ribs and the xiphoid process of the sternum. The insertion point of the diaphragm is below the fifth rib, which means it does not extend all the way to the ninth or tenth rib. Therefore, the statement that the diaphragm inserts into the anterior thoracic cage below the fifth rib is the most correct statement among the given options.

The correct answer is to intubate the patient's trachea after preoxygenating her for 2-3 minutes with a BVM, transporting immediately, starting at least one large bore IV en route, applying a cardiac monitor, and performing frequent neurologic assessments. This is the most appropriate treatment because the patient is unconscious with signs of a severe head injury, including a fall from a height, blood draining from her nose, and bilaterally dilated pupils. Intubating her trachea will help maintain her airway and ensure adequate oxygenation. Transporting immediately and starting IV access will allow for further treatment and monitoring, while applying a cardiac monitor and performing neurologic assessments will help detect any changes in her condition.

The Rule of Nines is commonly used to estimate the percentage of total body surface area (TBSA) burned in adults. According to this rule, the head and neck account for 9% of TBSA, each upper limb accounts for 9% (18% total), the anterior trunk accounts for 18%, and the posterior trunk accounts for 18%. In this case, the patient has full thickness burns to his head and anterior trunk, which accounts for 27% (9% + 18%) of TBSA. Additionally, he has mixed partial and full thickness burns to both anterior upper extremities, which accounts for another 9% (2 x 4.5%). Therefore, the total percentage of TBSA burned is 36%.

The correct answer is pylorus. The pylorus is the part of the stomach that connects to the duodenum, which is the first part of the small intestine. It acts as a valve, regulating the flow of partially digested food from the stomach into the small intestine. This allows for proper digestion and absorption of nutrients. The gallbladder is not directly involved in the passage of contents from the stomach, and the cardiac sphincter is the valve that controls the flow of food from the esophagus into the stomach.

The self-splinting effect observed in patients with chest wall trauma refers to the natural reflex of the body to immobilize the injured area by limiting movement. While this can help in reducing pain and protecting the injured area, it can also have negative consequences. One of these consequences is the potential development of atelectasis, which is the collapse of a portion of the lung due to reduced ventilation. This can lead to hypoxemia, which is a decrease in the oxygen levels in the blood, and can further predispose the patient to developing pneumonia, an infection in the lungs. Therefore, the self-splinting effect may cause atelectasis, hypoxemia, or pneumonia.

Isolated rib fractures may result in inadequate ventilation because the patient often purposely limits chest wall movement. When a rib is fractured, the patient may instinctively try to minimize movement in order to avoid exacerbating the pain. This can lead to reduced chest wall expansion and inadequate ventilation. The other options, such as paradoxical chest wall movement, hyperventilation due to pain, or preferential use of the intercostal muscles reducing tidal volume, do not provide a plausible explanation for inadequate ventilation in isolated rib fractures.