A large collection of blood under the skin is known as:
Answer(s): C
A hematoma is a large collection of blood, caused by larger blood vessels being damaged. A hematoma often is located between layers of tissues. A contusion is generally a smaller collection of blood within tissue such as the dermis. A bruise is a generic term which is often used interchangeably between a contusion and a larger hematoma.
Your trauma patient has her left hand caught between rollers on a conveyor belt. Extrication takes 30 minutes. Evaluation of the injury during extrication showed delayed capillary refill distal to the injury. Post extrication shows rapid capillary refill distal to the injury deformity mid-palm. There are no obvious fractures, no lacerations, and minor swelling. Knowing that crush injuries can cause all kinds of problems, which is NOT considered a crush injury complication?
Crush injuries occur when tissue is caught between two objects causing increased pressure. When this pressure is exerted over a long period of time, tissues are damaged resulting in lacerations, fractures and anaerobic injuries. When blood flow is cut off, oxygen does not make it to the tissues which will revert to anaerobic metabolism generating lactic and pyruvic acids. In time, this damages more tissues causing the release of more acids and by-products of incomplete metabolism, eventually causing more swelling and coagulation problems, loss of tissue and loss of life.
Loss of tissue in a traumatic event can either be just soft tissue, a portion of or an entire extremity. If your patient has lost the distal 1/3 of a lower extremity what would that injury be called?
Answer(s): D
Loss a partial or entire extremity is classified as an amputation and loss of tissue from any area is considered as an avulsion. Any lost tissue must be protected with moist dressings and then placed in cold saline.
In any traumatic event where there is tissue damage which is bleeding, the bleeding needs to be controlled. What are the proper steps to bleeding control?
Answer(s): B
Direct pressure stops 90% of all bleeding. If direct pressure does not work in the first minute or two, digital pressure should be applied next. Next steps include elevation and finally a tourniquet for uncontrolled or excessive bleeding. Pressure dressings should only be used once bleeding has stopped.
Your 16-year-old trauma patient has what appears to be a mid-shaft femur fracture. You notice that there is a laceration directly over the suspected fracture. Bleeding is controlled. What type of fracture would this be?
Any time there is open skin over a fracture is considered an open fracture. A greenstick is generally found in children whose bones have not fully ossified. Comminuted is a fracture resulting from extreme forces causing many smaller fractures at the site of the fracture.
In route to the hospital, you intubate the patient. During your assessment of tube placement, you hear wheezing in the upper lung fields. What is most likely causing this wheezing?
Answer(s): A
An inhalation injury inferior to the glottis can result in wheezing and bronchospasm. An inhalation injury superior to the glottis can cause a hoarse voice and stridor. Inhalation of the byproducts of combustion can cause wheezing but this would still be classified as an inhalation injury to the lower airway.
Following the immobilization of an extremity fracture to the lower right arm, what step should the paramedic perform in the last turn?
The last part of immobilizing the arm fracture (or any suspected fracture for that matter), is the assessment of distal motor, sensory, and perfusion status. This is done to assure there was no additional trauma from the immobilization process, and to assure the splint was not put on incorrectly (for example an air splint inflated too high). If there is a loss in the motor, sensory, perfusion findings following immobilization, the paramedic should immediately reassess the splinting process and correct any errors.
You are treating a 24-year-old female with a gunshot wound to the right side of the back. No exit wound is visible. She is awake but confused. Her skin is pale and diaphoretic with cyanosis noted to the oral mucosa. Breath sounds are clear and equal bilaterally. Jugular vein distention is present. Blood pressure is 90/78 mm Hg, heart rate is 124 beats per minute, and respiratory rate is 28 per minute and labored. Sinus tachycardia is seen on the cardiac monitor.What condition do you think is most likely present with this patient?
Pericardial tamponade causes decreased cardiac output as seen by pale skin and hypotension. In addition, jugular vein distention may be seen along with a narrowed pulse pressure. Other signs and symptoms include tachycardia, respiratory difficulties, and cyanosis of the face, neck, and arms. With tension pneumothorax or a significant hemothorax, decreased or absent breath sounds will be present.
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