Aemt Bleeding, Chest & Abdominal Trauma (Mwn)

Front 1

How long can each organ go without adequate -perfusion:
-heart
-kidneys
-skeletal muscles
-GI tract

Back 1

-Heart requires constant perfusion or it will not function properly.
-Brain and spinal cord: 4 to 6 minutes.
-Kidneys: 45 minutes.
-Skeletal muscles: 2 hours.
-GI Tract: several hours.

Front 2

______________ nervous system monitors the body’s needs and adjusts blood flow.

Back 2

Autonomic

Front 3

Perfusion is:

Back 3

the circulation of blood within an organ or tissue to meet the cells’ needs for oxygen, nutrients, and waste removal.

Front 4

Shock is

Back 4

the system fails to provide sufficient circulation for every body part to perform its function.

Front 5

Nontraumatic causes of bleeding include

Back 5

Bleeding ulcers
Bleeding from colon
Ruptured ectopic pregnancy
Aneurysms

Front 6

Frequent signs of internal bleeding

Back 6

Abdominal tenderness
Guarding
Rigidity
Pain
Distention

Vomiting of blood
Bloody diarrhea or urine
Pain (most common)
Swelling in the area of bleeding
Distention
Bruising
Hematoma
Bleeding from any body opening
Hematemesis
Hemoptysis
Melena
Hematochezia
Referred Pain

Front 7

Hypovolemic shock (hypoperfusion) Later signs include:

Back 7

Tachycardia
Weakness, fainting, or dizziness at rest
Thirst
Nausea and vomiting
Cold, moist (clammy) skin
Shallow, rapid breathing
Altered LOC

Front 8

Body will not tolerate blood loss greater than____ of blood volume.

Back 8

20%

Front 9

If adult loses more than ________L of blood, vital signs significantly change.

Back 9

1 L

Front 10

How well people compensate for blood loss is related to

Back 10

how rapidly they bleed.

Front 11

body's response to bleeding may fail do to;

Back 11

Medications
Severe injury
Hemophilia

Front 12

Primary Assessment - Circulation in bleeding emergencies should include:

Back 12

Assess pulse rate and quality.
Determine skin condition, color, and temperature.
Check capillary refill time.
Control external bleeding.
Treat for shock.

Front 13

Signs and symptoms of hypovolemic shock:

Back 13

Rapid, weak pulse
Mental status changes
Cool, pale, clammy skin
Low blood pressure (late sign)

Front 14

SAMPLE History in bleeding emergencies should include:

Back 14

-Gather information on chief complaint (OPQRST).
-Any dizziness or syncope?
-Signs/symptoms of hypovolemic shock?
-Current blood-thinning medications or history of clotting insufficiency?
-Any pain, tenderness, bruising, guarding, deformity, distention, discoloration, or swelling?

Front 15

Hypoperfusion: a systolic blood pressure of less than ______mm Hg with a weak, rapid pulse.

Back 15

100

Front 16

Tourniquet precautions

Back 16

-Do not apply directly over joint.
-Tighten securely.
-Never use wire, rope, a belt, or any other narrow material.

Front 17

benefits of Rigid splints, considerations

Back 17

-Can help stabilize fractures
-Reduce pain
-Prevent further damage to soft-tissue injuries
-Once the splint is applied, monitor circulation in the distal extremity.

Front 18

Traction splints considerations

Back 18

-Designed to stabilize femur fractures
-When an AEMT pulls traction to the ankle, countertraction is applied to the ischium and groin.
-Once the splint is applied, monitor circulation in the distal extremity.

Front 19

Pneumatic antishock garment (PASG) is for

Back 19

-Stabilizing fractures of the pelvis and bilateral femurs
-Controlling significant internal bleeding associated with fractures of the pelvis and bilateral femurs
-Controlling massive soft-tissue bleeding of lower extremities when direct pressure is not effective

Front 20

Pneumatic Antishock Garment contraindicated

Back 20

Pulmonary edema

Relative contraindications include:
Pregnancy
Penetrating abdominal injuries or evisceration
Penetrating chest injuries
Groin injuries
Major head injuries
A transport time of less than 30 minutes

Front 21

Control Epistaxis by

Back 21

pinching the nostrils together

Front 22

If skull fracture suspected Tx =

Back 22

-Loosely cover the bleeding site with a sterile gauze pad.
-Apply light compression with a dressing.

Front 23

Internal Hemorrhaging Tx

Back 23

Provide rapid transport to the ED.
Control internal bleeding in the field by splinting the extremity.

Management of internal hemorrhaging:
Treat shock.
Minimize movement of injured or bleeding part or region.
Transport rapidly.

Front 24

Signs of internal bleeding include

Back 24

deformity,
tenderness,
bruised chest,
swelling,
distended abdomen,
guarding,
pain,
hematemesis,
melena,
hemoptysis, and
broken ribs

Front 25

The methods to control bleeding include

Back 25

direct, even pressure and elevation; pressure dressings and/or splints; and tourniquets.

If direct pressure fails to stop hemorrhaging, apply a tourniquet if protocol allows.

Front 26

Which of the following is NOT a component of the cardiovascular system?
Heart
Lungs
Venules
Plasma

Back 26

Lungs

Front 27

Perfusion is MOST accurately defined as:
-the removal of adequate amounts of carbon dioxide during exhalation.
-the intake of adequate amounts of oxygen during the inhalation phase.
-circulation of blood within an organ with sufficient amounts of oxygen.
-the production of carbon dioxide, which accumulates at the cellular level.

Back 27

circulation of blood within an organ with sufficient amounts of oxygen.

Front 28

A man involved in a motorcycle crash has multiple abrasions and lacerations. Which of the following injuries has the HIGHEST treatment priority?
-Widespread abrasions to the back with pinkish ooze
-3" laceration to the forehead with dark red, flowing blood
-Laceration to the forearm with obvious debris in the wound
-1" laceration to the thigh with spurting, bright red blood

Back 28

1" laceration to the thigh with spurting, bright red blood

Front 29

Which of the following sets of vital signs is LEAST indicative of internal bleeding?
-BP, 140/90 mm Hg; pulse rate, 58 beats/min; respirations, 8 breaths/min
-BP, 100/50 mm Hg; pulse rate, 120 beats/min; respirations, 24 breaths/min
-BP, 98/60 mm Hg; pulse rate, 110 beats/min; respirations, 28 breaths/min
-BP, 102/48 mm Hg; pulse rate, 100 beats/min; respirations, 22 breaths/min

Back 29

BP, 140/90 mm Hg; pulse rate, 58 beats/min; respirations, 8 breaths/min

Internal hemorrhage typically reveals vital signs that are consistent with shock: hypotension, tachycardia, and tachypnea. Hypertension, bradycardia, and bradypnea (choice “A”) is consistent with a closed head injury, not internal bleeding.

Front 30

The quickest and MOST effective way to control external bleeding from an extremity is:
-a pressure bandage.
-direct pressure and elevation.
-a splint.
-a tourniquet.

Back 30

direct pressure and elevation

Front 31

When applying a tourniquet to an amputated arm, the AEMT should:
-use the narrowest bandage possible.
-avoid applying the tourniquet over a joint.
-cover the tourniquet with a sterile bandage.
-use rope to ensure that the tourniquet is tight.

Back 31

avoid applying the tourniquet over a joint

You should use the widest bandage possible and make sure it is secured tightly. Never use wire, rope, a belt, or any other narrow material, as it could cut the skin. The tourniquet should never be covered with a bandage. Leave it open and in full view.

Front 32

A 70-year-old man is experiencing a severe nosebleed. When you arrive, you find him leaning over a basin, which contains an impressive amount of blood. He has a history of coronary artery disease, diabetes, and migraine headaches. His BP is 180/100 and his heart rate is 100 beats/min. Which of the following is the MOST likely contributing factor to his nosebleed?
-His blood pressure
-His history of diabetes
-The fact that he is elderly
-His heart rate of 100 beats/min

Back 32

His blood pressure

Several conditions can cause a nosebleed (epistaxis), including skull fractures, facial injuries, sinusitis (inflamed sinuses), high blood pressure, coagulation disorders (ie, hemophilia), and digital trauma (ie, nose picking). A BP of 180/100 indicates a significant amount of pressure on the arteries, which is no doubt the main contributing factor to this patient’s nosebleed.

Front 33

The treatment of active internal bleeding includes:
-20 mL/kg of normal saline or lactated Ringer’s solution.
-a 250-mL bolus of normal saline or lactated Ringer’s solution.
-positioning the patient in the sitting position.
-providing slow and considerate transport.

Back 33

20 mL/kg of normal saline or lactated Ringer’s solution.

Patients with active internal bleeding require IV fluid be given at 20 mL/kg, using either normal saline or lactated Ringer’s (provided the lungs are clear) while en route to the emergency room.

Front 34

Describe the characteristics of arterial, venous and capillary bleeding.

Back 34

Capillary vessels - Blood is dark red and oozes steadily but slowly.

Open artery - Bright red and spurts in time with the pulse.

Open vein - Darker and flows steadily

Front 35

Characteristics of Stage 1 blood loss?

Back 35

up to15% blood loss
compensated by constriction of vascular bed
BP maintained
tachycardia
skin pallor
normal pulse pressure, RR and renal output

Front 36

Characteristics of Stage 2 blood loss?

Back 36

15% to 25% blood loss
cardiac output not maintained by arteriolar constriction.
reflex tachcardia
BP maintained
increased diastolic pressure
increased RR
catecholamines increase peripheral resistance
narrow pulse pressures
diaphoresis from sympathetic stimulation
normal renal output.

Front 37

Characteristics of Stage 3 blood loss?

Back 37

25% to 35% blood loss

Classic signs of hypovolemic shock:
Marked tachycardia (increased heart rate) >120 bpm
Marked tachypnea (increased rate of respiration) >30 bpm
decreased BP
decreased renal output
altered LOC
diaphoresis with cool pale skin.

Front 38

Characteristics of Stage 4 blood loss?

Back 38

loss > 35%

extreme tachcardia
pronounced tachpenea
significantly decreased systolic BP
confusion and lethargy
skin is diaphoretic, cool and extremely pale

Front 39

What is the most commonly effective method for controlling external hemorrhage?

Back 39

direct pressure

Front 40

Discuss how to make a tourniquet if a commercially manufactured one is not available.

Back 40

fold triangular bandage until it is 4" wide and 6-8 layers thick

wrap around extremity twice

tie knot in bandage - place stick on top and tie over top of stick

twist to tighten

secure stick in place

write TK and time on adhesive tape on Pt forehead

(Also can use a BP cuff as a tourniquet)

Front 41

A 1 year old has a total blood volume of how many mL?

significant symptoms occur with loss of ___ ml

Back 41

800

100-200

Front 42

adult blood volume

Back 42

70 ml/kg or about 6 liters

Front 43

an isolated femur fracture can result in a blood loss of

Back 43

1 l or more

Front 44

hemostasis

Back 44

Hemostasis: platelets aggregate at site, plugging hole and sealing the vessel.

Front 45

1. The LEAST desirable method of bleeding control in the prehospital setting is:
A) clamping a bleeding artery with hemostats.
B) applying a tourniquet proximal to the injury.
C) maintaining manual pressure over the injury.
D) applying a pressure dressing and bandage.

Back 45

A) clamping a bleeding artery with hemostats.

Front 46

2. Any injury at the nipple line should be considered a thoracic and abdominal injury because:
A) the liver, spleen, and stomach are completely protected by the ribs.
B) the diaphragm may elevate as high as the nipple line upon exhalation.
C) penetrating injuries to the upper chest often result in liver lacerations.
D) the diaphragm ascends into the chest cavity during the inspiration phase.

Back 46

B) the diaphragm may elevate as high as the nipple line upon exhalation.

Front 47

3. A patient has severe bleeding from a large laceration to the anterior forearm. Direct pressure and a pressure dressing are not immediately effective in controlling the bleeding. You should:
A) elevate the arm and apply ice to the injury.
B) apply additional dressings and elevate the arm.
C) apply a tourniquet above the level of the bleeding.
D) locate and apply digital pressure to the brachial artery.

Back 47

C) apply a tourniquet above the level of the bleeding.

Front 48

4. A trauma patient who presents with shock, jugular venous distention, and bilaterally equal breath sounds has MOST likely experienced a:
A) simple pneumothorax.
B) pericardial tamponade.
C) pulmonary contusion.
D) massive hemothorax.

Back 48

B) pericardial tamponade.

Front 49

5. In contrast to paradoxical chest motion, asymmetrical chest movement occurs when:
A) both sides of the chest move shallowly during normal breathing.
B) one side of the chest fails to move normally during inspiration.
C) both sides of the chest wall move in unison during deep inspiration.
D) one segment of the chest wall moves opposite the remainder of the chest.

Back 49

B) one side of the chest fails to move normally during inspiration.

Front 50

6. You are caring for a 59-year-old male involved in a motor-vehicle crash. During your assessment, you note that his pelvis is unstable, he is pale and diaphoretic, and his blood pressure is 80/50 mm Hg. Use of the pneumatic antishock garment (PASG) would be absolutely contraindicated if further assessment of this patient revealed:
A) bilateral femur fractures
B) coarse crackles in the lungs
C) a rigid, distended abdomen.
D) collapsed jugular veins.

Back 50

B) coarse crackles in the lungs

Front 51

7. Kehr sign is defined as:
A) the presence of flank bruising secondary to intraabdominal bleeding.
B) referred pain to the shoulder following injury to the liver or spleen.
C) bruising around the umbilicus secondary to intraabdominal bleeding.
D) pain that radiates from the flank to the groin following a kidney injury.

Back 51

B) referred pain to the shoulder following injury to the liver or spleen.

Front 52

JVD suggests

Back 52

cardiac Tamponade

tension pneumothorax

volume overload

right side heart failure

Front 53

8. A 29-year-old male has sustained a large laceration across the lower abdomen and has a loop of bowel protruding through the wound. To minimize the amount of body heat that radiates from the open wound, you should:
A) irrigate the wound with warm sterile water.
B) cover the wound with moist sterile dressings.
C) apply a pressure dressing to the open wound.
D) cover the wound with a dry sterile dressing.

Back 53

B) cover the wound with moist sterile dressings.

Front 54

9. During your rapid assessment of a semiconscious 44-year-old female with blunt thoracic trauma, you detect an area on the left anterior chest that bulges during exhalation. Your partner is assisting her ventilations with a bag-mask device and 100% oxygen. You should:
A) advise your partner to increase the rate and depth of ventilations.
B) stabilize the chest wall deformity and continue your assessment.
C) call for a paramedic crew to perform a needle chest decompression.
D) place a sandbag over the deformed area and auscultate breath sounds.

Back 54

stabilize the chest wall deformity and continue your assessment.

Front 55

10. During Stage 1 hemorrhage, the body compensates primarily by:
A) increasing systolic blood pressure.
B) constriction of the vascular bed.
C) increasing the respiratory rate.
D) narrowing the pulse pressure.

Back 55

B) constriction of the vascular bed.

Front 56

11. Significant vital signs changes, including increased heart and respiratory rates and a decreasing blood pressure, would likely occur if an 80-kg adult patient acutely loses as little as _____ L of blood.
A) 0.5
B) 1
C) 2
D) 2.5

Back 56

B) 1

Front 57

12. Just before striking a tree with her car, a 17-year-old female suddenly gasps and holds her breath. What type of injury will she MOST likely experience?
A) Disruption of the great vessels
B) Compression of the myocardium
C) Rupture of the lung parenchyma
D) Multiple pulmonary contusions

Back 57

C) Rupture of the lung parenchyma

Front 58

13. Hemostasis is a natural response of the body in which:
A) platelets lose their ability to aggregate due to severe internal bleeding.
B) blood is diverted away from the skin to areas where it is needed the most.
C) bleeding spontaneously clots through vasoconstriction and platelet aggregation.
D) all body systems work together to maintain stability of the internal environment.

Back 58

bleeding spontaneously clots through vasoconstriction and platelet aggregation

Front 59

14. During your rapid assessment of a patient with a gunshot wound to the chest, you located an open wound to the right anterior chest and sealed it with the appropriate dressing. A few minutes later, the patient's respirations are increasingly labored and his heart rate has significantly increased. You should:
A) request a paramedic to perform a needle decompression.
B) relieve pleural tension by lifting a corner of the dressing.
C) transport the patient to a trauma center for definitive care.
D) ensure that all sides of the dressing are adhered to the chest.

Back 59

C) relieve pleural tension by lifting a corner of the dressing.

Front 60

15. A 22-year-old male with blunt thoracic trauma presents with severely labored respirations. His level of consciousness is decreased and his heart rate is 140 beats/min and thready. Further assessment reveals absent breath sounds on the entire left side of his chest and jugular venous distention. After appropriately managing his airway and immobilizing his spine, you should:
A) perform a secondary assessment, transport immediately, and establish vascular access en route.
B) insert a multilumen airway device, start a large-bore IV, and transport to a trauma center.
C) transport immediately, start a large-bore IV en route, and request a paramedic rendezvous.
D) start a large-bore IV, administer a 20 mL/kg normal saline bolus, reassess his vital signs, and transport.

Back 60

B) insert a multilumen airway device, start a large-bore IV, and transport to a trauma center.

Front 61

16. Perfusion is MOST accurately defined as:
A) removal of carbon dioxide from the body.
B) circulation of blood within an organ or tissue.
C) adequate supplies of glucose within the brain.
D) oxygen and carbon dioxide exchange in the lungs.

Back 61

B) circulation of blood within an organ or tissue.

Front 62

17. A 1-year-old female sustained blunt abdominal trauma following a motor-vehicle crash in which she was not properly restrained. Significant signs and symptoms will MOST likely occur after as little as _____ of blood loss.
A) 50 mL
B) 100 mL
C) 250 mL
D) 300 mL

Back 62

B) 100 mL

Front 63

18. A 33-year-old male was shot in the abdomen during an altercation at a bar. He is semiconscious, his heart rate is 160 beats/min and thready, and his respirations are 38 breaths/min and shallow. On the basis of this patient's clinical presentation, you should suspect that he is experiencing stage ____ hemorrhage.
A) 1
B) 2
C) 3
D) 4

Back 63

C) 3

Front 64

19. Fracture of the first and second ribs following severe blunt trauma would MOST likely result in a:
A) massive hemothorax.
B) myocardial contusion.
C) tracheobronchial injury.
D) pericardial tamponade.

Back 64

C) tracheobronchial injury.

Front 65

atelectasis

Back 65

alveolar collapse

Front 66

20. A 19-year-old male sustained major head trauma following a motorcycle crash. During your assessment, you note the presence of blood draining from his left ear. What is the MOST important reason for not attempting to control the flow of this bleeding?
A) An increase in intracranial pressure may occur.
B) The patient may develop a life-threatening infection.
C) Its origin is from a location that you cannot access.
D) It would likely skew the physician's assessment.

Back 66

A) An increase in intracranial pressure may occur.

Front 67

21. Commotio cordis is a condition in which:
A) immediate cardiac arrest occurs when the chest is impacted during the heart's repolarization period.
B) shearing forces tear the aorta from its point of attachment, resulting in profound intrathoracic hemorrhage.
C) a patient takes a deep breath just before blunt trauma to the chest, resulting in rupture of one or both lungs.
D) increased intrathoracic pressure causes the intercostal muscles to bulge from in between the ribs.

Back 67

A) immediate cardiac arrest occurs when the chest is impacted during the heart's repolarization period.

Front 68

22. In addition to controlling bleeding and immobilizing the spine as needed, appropriate care for a patient with a penetrating abdominal wound and signs of shock includes:
A) ensuring adequate ventilation, maintaining adequate perfusion with IV fluids, and transporting to the most appropriate facility.
B) assisting ventilations, infusing normal saline to increase the systolic blood pressure, and transporting to the closest hospital.
C) administering high-flow oxygen, limiting IV fluids to a maximum of 500 mL, and transporting to a regional trauma center.
D) starting two large-bore IV lines, running the IVs wide open, and promptly transporting to the closest, most appropriate facility.

Back 68

B) assisting ventilations, infusing normal saline to increase the systolic blood pressure, and transporting to the closest hospital

Front 69

23. Which of the following seatbelt positions will MOST likely result in severe intraabdominal injuries when a vehicle suddenly decelerates?
A) Shoulder harness and lap belt placed superior to the iliac crest
B) Use of the lap belt only with the shoulder harness behind the back
C) Shoulder harness used and lap belt across the anterior iliac crest
D) Shoulder harness not used and lap belt across the anterior iliac crest

Back 69

D) Shoulder harness not used and lap belt across the anterior iliac crest

Front 70

24. Patients with a tension pneumothorax experience a decreased cardiac output and shock secondary to:
A) myocardial compression and decreased preload.
B) massive blood accumulation in the pleural space.
C) decreased intrathoracic pressure and increased preload.
D) significant intrapulmonary shunting and severe hypoxia.

Back 70

A) myocardial compression and decreased preload.

Front 71

25. The presence of a scaphoid abdomen and bowel sounds in the lower hemithorax are MOST suggestive of a:
A) pneumothorax.
B) perforated lung.
C) perforated bowel.
D) ruptured diaphragm.

Back 71

D) ruptured diaphragm.

Front 72

Cullen sign

Back 72

periumbilical bruising

Front 73

grey turner sign

Back 73

bruising in r upper, left upper or flank suggest injury to liver, spleenor kidney

Front 74

26. Blunt abdominal trauma may result in tearing of the mesentery, which is/are:
A) multiple bands of thick muscle that protect the abdominal organs.
B) the main supporting structure of the descending abdominal aorta.
C) a vascular network that provides exclusive blood supply to the liver.
D) membranous folds that attach the intestines to the abdominal wall.

Back 74

D) membranous folds that attach the intestines to the abdominal wall.

Front 75

27. Which of the following injuries presents the greatest risk for severe internal bleeding?
A) Rib fractures
B) Pelvic fractures
C) Tibial fractures
D) Bilateral femur fractures

Back 75

A) Rib fractures

Front 76

hematochezia

Back 76

passage of bloody stools (typically from hemrroids)

Front 77

28. Increasing the blood pressure with IV crystalloids in a patient with intraabdominal bleeding would MOST likely:
A) result in clinical improvement.
B) exacerbate the internal bleeding.
C) facilitate the hemostatic process.
D) improve perfusion to vital organs

Back 77

B) exacerbate the internal bleeding.

Front 78

29. A construction worker is pinned in between a truck and a loading dock. He is conscious and in respiratory distress. Further assessment reveals upper torso and facial cyanosis and bilateral conjunctival hemorrhages. When treating this patient, you must:
A) suspect that he will experience metabolic alkalosis.
B) be prepared for severe hypotension once he is freed.
C) administer 3 liters of normal saline before he is freed.
D) avoid fluid boluses as this may cause pulmonary edema.

Back 78

B) be prepared for severe hypotension once he is freed.

Front 79

30. Which of the following medications would interfere with the body's hemostatic effect?
A) Antianginals
B) Antidepressants
C) Anticoagulants
D) Antihypertensives

Back 79

C) Anticoagulants

Front 80

31. When caring for a patient with significant thoracic trauma and signs of shock, it is MOST important to:
A) establish two large-bore IV lines.
B) transport promptly to a trauma center.
C) perform a detailed secondary assessment.
D) administer high-flow oxygen at all times.

Back 80

B) transport promptly to a trauma center.

Front 81

32. Which of the following is a LATE sign of a tension pneumothorax?
A) Contralateral tracheal shift
B) Bulging intercostal muscles
C) Narrowing pulse pressure
D) Profound shortness of breath

Back 81

A) Contralateral tracheal shift

Front 82

33. Shortly after arriving home from the airport, a 19-year-old male experienced an acute onset of sharp chest pain and difficulty breathing. He denies a history of trauma. Your assessment reveals that he is in moderate distress and is tachycardic. Breath sounds are diminished over the apex of the right lung. You should suspect a/an:
A) localized hemothorax.
B) spontaneous pneumothorax.
C) acute onset of pneumonia.
D) developing tension pneumothorax.

Back 82

B) spontaneous pneumothorax.

Front 83

34. Which of the following medications or medical devices may inhibit the body's tachycardic response during shock?
A) Aspirin
B) Anticoagulant
C) Beta-blocker
D) Implanted defibrillator

Back 83

C) Beta-blocker

Front 84

35. Which of the following organs or systems can survive the longest without oxygen?
A) Gastrointestinal system
B) Skeletal muscles
C) The myocardium
D) Central nervous system

Back 84

A) Skeletal muscles

Front 85

36. Which of the following injuries or conditions would MOST likely overwhelm the body's hemostatic response and result in death?
A) Ruptured aortic aneurysm
B) Laceration to the spleen
C) Bleeding within the brain
D) Laceration to the liver

Back 85

A) Ruptured aortic aneurysm

Front 86

37. What is the rationale for restricting IV fluid boluses in patients with a pulmonary contusion?
A) Pulmonary contusions rarely cause severe hypovolemia.
B) Fluids may cause pulmonary edema or increased bleeding.
C) Rapidly increasing the blood pressure may inhibit hemostasis.
D) Excessive fluid boluses may result in a tension pneumothorax.

Back 86

B) Fluids may cause pulmonary edema or increased bleeding.

Front 87

38. Diffuse (global) swelling of the abdomen is MOST suggestive of:
A) acute bowel obstruction.
B) intraabdominal bleeding.
C) peritoneal inflammation.
D) perforation of the liver.

Back 87

B) intraabdominal bleeding.

Front 88

39. Which of the following statements regarding trauma to the kidneys is correct?
A) Injuries confined to the kidneys are common following blunt force trauma.
B) You should suspect a ruptured aorta when the MOI suggests kidney injury.
C) Kidney injury is usually associated with injury to other abdominal organs.
D) The kidneys are well protected in the abdomen and rarely sustain injury.

Back 88

Kidney injury is usually associated with injury to other abdominal organs.

Front 89

40. When treating a patient with a suspected diaphragmatic rupture, you should:
A) apply 100% oxygen with a nonrebreathing mask.
B) avoid administering more than 500 mL of crystalloid.
C) avoid placing the patient in a Trendelenburg position.
D) assist ventilations with a bag-mask device if needed.

Back 89

assist ventilations with a bag-mask device if needed.

Front 90

41. Priority management for a patient with an amputated penis and stable vital signs includes:
A) locating the amputated part.
B) rapid transport to a trauma center.
C) controlling any active hemorrhage.
D) placing moist dressings on the wound.

Back 90

C) controlling any active hemorrhage.

Front 91

42. Patients with internal bleeding are in MOST need of:
A) high-flow oxygen.
B) IV fluid boluses.
C) surgical intervention.
D) thermal management.

Back 91

C) surgical intervention.

Front 92

43. You are dispatched to a local nightclub for a patient who has been stabbed. After arriving at the scene and ensuring you and your partner's safety, you find the patient sitting on the ground. He is conscious, screaming in pain, and attempting to control bright red blood that is spurting from his groin area. After taking standard precautions, you should:
A) ensure that the patient's airway is patent.
B) apply 100% oxygen via a nonrebreathing mask.
C) obtain baseline vital signs and treat for shock.
D) apply direct pressure to control the bleeding.

Back 92

D) apply direct pressure to control the bleeding.

Front 93

injuries associated with improper seat belt location

Back 93

lumbar spine fractures; great vessel damage; damaged abdominal organs

Front 94

what are the bony landmarks of the abdomen?

Back 94

pubic symphysis;

costal arch;

ilac crests;

anterior superior ilac spines

Front 95

pneumoperitonitis

Back 95

air in peritoneal cavity causes inflammatory reaction

Front 96

what muscles are used for guarding?

Back 96

rectus abdominus (pubis to xiphiod)

Front 97

what is a massive hemothorax?

Back 97

>1500 ml blood in pleural space

Front 98

why do you restrict fluids in pulmonary contusions?

Back 98

to prevent pulmonary edema.

Front 99

you might see bulging of intercostal muscles in what condition?

Back 99

tension pheumothorax

Front 100

beck triad

Back 100

narrowing pulse pressures,

JVD,

muffled heart sounds

Front 101

symptoms of traumatic asphyxiation

Back 101

JVD
facial cuanosis
bulging eyes
hemorrage of conjunctiva

Front 102

Define scaphoid abdomen

Back 102

ruptured diaphram causes abdominal contents to shift into thoraic cavity

Front 103

pulsus paradoxus

Back 103

pulses drop > 10 mm during inspiration

Front 104

nerves that enervate the diaphram

Back 104

phrenic

Front 105

where are peripheral chemo receptors located?

Back 105

carotid and aortic bodies

Front 106

where are central chemo receptors located

Back 106

medulla

Front 107

respiratory alkalosis does what to ph?

Back 107

raises it