Trauma Assessment and Management, Exams of Nursing

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PHTLS - Thoracic Trauma (CH12), PHTLS

Pretest, PHTLS Pre Test 8th Edition, Phtls

8th Test 2024-25. Quizs & Ans. Graded A+

a 20 yr old female was ejected from her vehicle during a high speed roll- over motor vehicle collision. She has significant bleeding from a large laceration. Your initial assessment reveals a GCS score of 7, systolic bp of 70 and pupils that are equal but respond sluggishly to light. After establishing two large bore IV lines, you should titrate the infusion rate to achieve a target bp of at least - ANS90 mmHg A 38 male sustained a large wound to his right thigh while at work what are the following actions is the most important initial step? - ANSHemorrhage control A 55-year-old male is found unconscious after being assaulted. Assessment reveals snoring respirations, bradypnea, facial swelling, and unequal pupils. What is the most appropriate first step? - ANSJaw thrust maneuver A burn with reddened, glistening base that may have blisters is most characteristic of a - ANSSECOND degree burn. A chemical solution with a pH of 4.0 is considered an ACID and causes damage to the tissues via - ANSCOAGULATION NECROSIS. A fractured femur can result in___________________mL of hemorrhage. - ANS1000 TO 2000 A hemothorax is differentiated from a tension pneumothorax by: -

ANSDULL PERCUSSION ON THE AFFECTED SIDE. A male patient suffered a stab wound to his left flank. He is found to be in stage III shock. During the 25 minute transport to the trauma center, intravenous fluids should be administered at a rate sufficient to maintain a: - ANSSYSTOLIC BP OF 80 TO 90. A patient who sustained extensive blunt trauma to his trunk has absent lung sounds on the right, marked respiratory distress, tachycardia and hypertension. What is the most appropriate intervention? - ANSNeedle decompression After falling from The high bar, a gymnast has loss of senstation from the nipples down what area of the spine is most likely damage? - ANST4 After falling from the third story at a construction site, a 27-year-old male is found in contrast with unequal pupils and a regular respirations. Which of the following is most appropriate rate of ventilations? - ANS20 BPM an 18 yr old female was struck by a car and has sustained an apparent left femur fracture. communication with her is hampered because she only speaks a foreign language. which finding, by itself, does not mandate immobilization of the cervical spine? - ANSmechanism of injury an adult male sustained a deep laceration to his distal thigh. Bright red blood is spurting from the wound. Direct pressure is not controlling the bleeding. What is the most appropriate next step? - ANSapply a tourniquet and tighten it until

bleeding stops An electrical burn caused by superheated air near the source of electricity is an - ANSARC burn. Assessment - ANSCapnograph bilateral femur fractures are most often associated with which type of motorcycle crash? - ANShead-on impact Cardiac tamponade is suspected with the findings of muffled heart sounds___________, and___________ known as___________. - ANSJUGULAR VEIN DISTENTION, and HYPOTENSION, known as BECK'S TRIAD. Care of the trauma patient in the field is an involving science and should be evidence-based. As lifelong learners, we must be prepared to adapt our practices based on research. This is because research may lead to which of the following? - ANSChange in our current practices D - ANStongue During pregnancy, signs and symptoms of shock may appear _______ due to an _________ in maternal blood volume. - ANSLATER, INCREASE During the assessment of the trauma patient, auscultation of the lung sounds is first performed during: - ANSTHE PRIMARY SURVEY. during the primary survey of a trauma patient, you note that the patient is agitated and confused, and has multiple injuries from an altercation. what is the most appropriate first treatment priority? - ANScorrection of possible hypoxia EMS arrived on scene and finds a emergency medical responder to immobilize a pediatric patient onto a long backboard. They know that

the patient's head is in a flex position. Which of the following actions is most appropriate? - ANSPlace padding under the patients torso EMS is treating an unrestrained driver of an automobile involved in a high- speed crash who struck his chest against the steering column. Prehospital providers no paradoxical movement of a portion of the patient's chest wall. The patient's respiratory rate is 16 and oxygen saturation is 94%. What is the most appropriate action? - ANSProvide supplemental oxygen and observe EMS response and adult barista who spilled a cup of hot coffee and sustained partial thickness burns to the abdomen and right leg. The patient ran cool water over the branch which of the following interventions is most appropriate next up? - ANSCover burn area with dry sterile dressing's EMS response for a patient who has sustained a blunt injury to the head. She had a period of consciousness followed by a brief period of consciousness and then became unresponsive just as EMS arrived. Based solely on this information, what is the most likely injury? - ANSEpidural hematoma EMS response for patient valve in a motor vehicle versus car collision. The patient is unresponsive with vital signs of BP 82/palpitation, are our 24, pulse 128. What is the most likely type of shock? - ANSHypovolemic Endotracheal intubation is a technique that requires which of the

following? - ANSSubstantial training to maintain proficiency essential airway skills include manual clearing of the airway, manual maneuvers, suctioning and what? - ANSoropharyngeal airway Excessive fluid resuscitation of the trauma patient can result in which of the following?

• ANSIncreased blood loss Hypotension due to spinal cord trauma occurs due to interruption of the _______________nervous system pathway. - ANSSYMPATHETIC Hypotension in hemothorax is associated with: - ANSTHE ABILITY OF EACH SIDE OF THE THORAX TO HOLD UP TO 3 LITERS OF BLOOD. hypotension of unknown etiology in a trauma patient should be assumed to result from what? - ANSblood loss In addition to direct pressure, tourniquets and immobilizing fractures, which of the following is most effective by controlling hemorrhage - ANSHemostatic agents In addition to oxygen what is required to maintain the metabolic processes of life and energy production? - ANSGlucose In addition to using appropriately sized equipment, frequently reassessing the patient, employing age-appropriate Imobilization techniques, prehospital providers should do which of the following when managing pediatric patients? - ANSPreserve body heat In trauma care, a Principle is defined as which of the following? - ANSWhat needs to be done Inadvertent hyperventilation of a patient with suspected traumatic brain injury may

lead to which complication? - ANSCerebral vasoconstriction IV fluids administered to patients in shock should be _______ in order to ______________ ______________. - ANSWARM, PREVENT HYPOTHERMIA. Management of flail chest includes: - ANSPAIN MANAGEMENT VENTILATORY SUPPORT 100%O2 medication used by trauma patients for pre-existing conditions may cause what? - ANSbeta- blockers may prevent tachycardia with blood loss Minute volume of ventilation is best represented as - ANSTIDAL VOLUME x ventilatory rate PASG is contraindicated in patients with - ANSCHEST TRAUMA. Prehospital providers have treated a sucking chest wound with an occlusive dressing. During transport to the hospital, the patient developed increasing respiratory distress with increased respirations and absent lung sounds are noted on repeat auscultation. What is the most appropriate next intervention? - ANSRemove the occlusive dressing Prehospital providers respond we 16-year-old male who punched a glass window and sustained a large laceration to his arm that is bleeding heavily. He is restless, diaphoretic and was a weak, 30 pulse. What is the most appropriate action? - ANSApply direct pressure Prehospital the writers respond to a male patient lying on the ground after being struck by a high-speed motor vehicle. The patient is apneic and pulseless. What

is the most appropriate action? - ANSDeclare the patient dead....(This was the actual answer on the test...) Pulmonary Volumes - ANSlly stiff. Spinal cord injuries can lead to hypotension due to which of the following physiologic changes? - ANSVasodilation below the level of injury the body initially compensates for blood loss through activation of what? - ANSsympathetic nervous system The greatest threat to life from injury to hollow abdominal organ is - ANSPERITONITIS. The most appropriate for airway maneuver for trauma patients as which of the following? - ANSTrauma jaw thrust The most common fractured ribs are ribs: - ANS4 THROUGH 8. The most common threat to life among trauma patients is? - ANSINTERNAL HEMORRHAGE The most common type of shock in trauma patients is - ANSHYPOVOLEMIC. the most immediate life threatening condition resulting from injury to solid abdominal organs is what? - ANShemorrhage The patient presents with a blunt trauma injury to the chest. On exam, he has absent breath sounds on the one side of his chest and respiratory distress which additional sign would indicate that the patient has a tension pneumothorax? - ANSHemodynamic compromise the potential for death or serious injury is greatest in which of the following motor vehicle collisions? -down and under -ejection from vehicle -lateral compression -up and over - ANSejection from

vehicle The preferred fluid for resuscitation of the patient with significant burns is: - ANSLACTATED RINGER'S SOLUTION. The prehospital assessment of the trauma patient begins of which of the following? - ANSInformation provided by the dispatcher the target blood pressure for a trauma patient with suspected intraabdominal hemorrhage is what? - ANS80-90 mmHg Thoracic Trauma - Physiology - ANSTwo components of chest physiology that are most likely to be impacted by injury - BREATHING and CIRCULATION Ventilation - mechanical act of drawin in air through the mouth and nose to the trachea and bronchi then to lungs to alveoli. Respiration - delivery of oxygen to the cells. Thoracic Trauma - Blunt Cardiac Injury - ANS Thoracic Trauma - Blunt Force Injury - ANS Thoracic Trauma - Cardiac Tamponade - ANS Thoracic Trauma - Commotio Cordis - ANS Thoracic Trauma - Diaphragmatic Rupture - ANS Thoracic Trauma - Flail Chest - ANS Thoracic Trauma - Hemothorax - ANSPathophysiology - Occurs when blood enters the pleural space. Because this space can accommodate a large volume of blood (2500-3000 ml), hemothorax can represent a source of significant blood loss and the loss of this circulating blood volume into the pleural space is a greater physiologic insult to the patient than the collapse of the lung that the hemothorax

produces. Assessment: Presentation - some distress, chest pain and SOB are prominent features, generally signs of significant shock (tachycardia, tachypnea, confusion, pallor and hypotension.) Breath sounds on side of injury are diminished or absent (percussion note is DULL). Pneumothorax may be present in conjuction with hemothorax, increasing the likelihood for cardiorespiratory compromise. **Because of loss of circulating blood volume, JVD often are NOT present. Management: Constant observation to detect physiologic deterioration while providing appropriate support. High flow O2 Ventilation support via BVM or ETT if indicated. Hemodynamic status monitored. IV access an appropriate fluid therapy provided with a goal of maintaining adequate perfusion without large volumes (SBP 80-90) Rapid Transport to appropriate facility for surgical intervention. Thoracic Trauma - Penetrating Injury - ANSObjects of varying size transgress the chest wall, enter the thoracic cavity, and possibly injure the organs within the thorax. When a penetrating wound creates a communication between the chest cavity and the outside world, air tends to rush into the pleural space through the wound during inspiration when the pressure inside the chest I lower than the outside, and because the resistance to airflow through the wound is often less that that through the airways. Thoracic

Trauma - Pneumothorax (Simple, Open, Tension) - ANS Thoracic Trauma

• Pulmonary Contusion - ANS Thoracic Trauma - Rib Fractures (Assessment) - ANSPatients with simple rib fractures may have few symptoms. Most often they will complain of: Chest Pain and DIB Present with: Labored respirations Chest wall tenderness and crepitus Vital signs Respiratory rate and depth of breathing Pulse Ox Capnography Thoracic Trauma - Rib Fractures (Management) - ANSPain relief - Primary goal in initial management IV access IV narcotic analgesics Monitor Vitals especially Resp. Rate and Depth. Encourage patient to take deep breaths and cough to prevent the collapse of the alveoli (atelectasis) and the potential for pneumonia and other complications. Thoracic Trauma - Rib Fractures (pathophysiology) - ANSUpper ribs are broad, thick and particularly well protected by the shoulder girdle and muscles. Requires great energy to fracture the upper ribs and patient is at risk for significant injuries such as traumatic disruption of the aorta. Rib fractures occur most often to Ribs 4-8 laterally, where they are thin and have less over lying musculature. Broken ends of ribs may tear muscle, lung and blood vessels with possibility of an associated pulmonary contusion. Simple rib fractures are rarely life threatening in adults, may be deadly in the elderly patient. Compression of the lung may rupture

the alveoli and lead to pneumothorax. Fracture of the lower ribs may be associated with injuries of the Spleen and Liver and may indicate the potential for intra-abdominal injuries. These injuries may also present with signs of blood loss or shock. Thoracic Trauma - Tracheobroonchial Disruption - ANS Thoracic Trauma - Traumatic Aortic Disruption - ANS Thoracic Trauma - Traumatic Asphyxia - ANS Units responding to a motor vehicle accident on the highway should consider which of the following as part of their pre-arrival assessment? - ANSWeather conditions what best describes shock? - ANSgeneralized inadequate tissue perfusion what best explains the mechanism by which gas exchange is impaired in pulmonary contusion? - ANSblood in the alveoli what is a key finding that differentiates cardiac tamponade from tension pneumothorax? - ANSequal breath sounds What is most likely source of hemorrhage in a patient with unexplainable signs of shock? - ANSIntra-abdominal injury What is the best method for confirming proper placement of an endotracheal tube in a trauma patient that has a palpable pulse? - ANSCapnography What is the most common cause of airway obstruction in the unconscious trauma patient? - ANSTongue What is the most common cause of death from trauma patients over 75 years of age? - ANSFalls What is the most common type of shock resulting from

trauma? - ANSHemorrhagic What is the most important physical finding a patient with a suspected traumatic brain injury? - ANSAbnormal levels of consciousness what is the most important reason to maintain an open airway in the trauma patient? - ANSprevents hypoxemia and hypercarbia what is the preferred adjunct device for verifying placement of an ET tub in a patient with a perfusing rhythm? - ANSend-tidal CO2 monitoring what is the preferred fluid for resuscitation of hemorrhagic shock in the prehospital setting? - ANSlactated ringers what is the preferred prehospital wound management for a patient which a 36% body surface area flame burn? - ANSdry sterile dressings What percentage of blood volume loss in an adult patient is associated with findings of tachycardia (>120/beats/minute), tachypnea (30-40 Breaths/min), and hypotension (systolic BP <90mmHg)? - ANS30 TO 40 When administering isotonic crystalloid solution, about ___________ will remain in the vascular system after 1 hour. - ANSONE-THIRD When approaching a trauma patient what is the first thing must be made? - ANSScene safety When energy produced by cells occurs during the state of inadequate oxygenation, it is referred to as which of the following conditions? - ANSAnaerobic metabolism When should the secondary survey be accomplished? - ANSWhen the time and situation allow When the

application of kinetic energy to the body from either a blunt or penetrating mechanism displaces tissue, this is known as - ANSCAVITATION which assessment is most beneficial in differentiating hemorrhagic shock from neurogenic shock in the prehospital setting? - ANSskin Which best describes the goal of airway management? - ANSProvide for adequate exchange of oxygen and CO2 Which injury is most likely to be sustained by the driver in a lateral impact collision to the left side of the vehicle with no side impact airbags (assuming the driver sits on the left)? - ANSFRACTURED LEFT CLAVICLE. Which of the following best describes shock? - ANSA state of inadequate energy production/ low perfusion Which of the following best guides the decision to provide spinal immobilization? - ANSHistory and complaint Which of the following findings indicate the need for immobilization when using a selective spinal immobilization protocol? - ANSPain or tenderness along the spine Which of the following findings is not expected in assessment of a pregnant patient? - ANSA DECREASED BLOOD PRESSURE IN THE THIRD TRIMESTER. Which of the following groups of findings represents Cushing's phenomenon? - ANSBRADYCARDIA ABNORMAL RESPIRATORY PATTERN ELEVATED BLOOD PRESSURE Which of the following indicates that a trauma patient

is having trouble breathing? - ANSThe patient breathing is noticeable Which of the following is a golden principle of trauma care? - ANSProvide adequate pain relief Which of the following is a preventable cause of secondary brain injury? - ANSSystemic hypoxia Which of the following is an example of the tertiary phase blast injury? - ANSCRUSHING INJURY DUE TO STRUCTURAL COLLAPSE. Which of the following is contraindicated in the management of a pregnant trauma patient in the third trimester? - ANSSUPINE POSITION. Which of the following is indicated for the prehospital management of a circumferential second degree burn extending from the wrist to the elbow in a 70 Kg patient? - ANSA DRY STERILE DRESSING ANALGESIA Which of the following is the earliest signs of deterioration in a patient with a flail chest? - ANSrespiratory rate increase Which of the following is the most common cause of spinal injuries? - ANSMOTOR VEHICLE COLLISIONS. Which of the following mechanisms is most likely to result in cardiac tamponade? - ANSA PATIENT IS STRUCK IN THE LEFT ANTERIOR CHEST BY A NAIL EJECTED FROM A NAIL GUN. Which of the following organs are most sensitive to hypotension? - ANSBrain Which of the following patients should be treated first in a blast-related multiple patients situation? - ANSA 30-year-old female with altered level of

consciousness and decreased capillary refill Which of the following signs of shock is not found during the primary survey? - ANSLow blood pressure measurement Which of the following types of traumatic brain injury is most likely to be associated with hemorrhage from the middle meningeal artery? - ANSEPIDURAL HEMATOMA Which subset of patients compensates for blood loss the longest? - ANSPediatrics While caring for a patient who was involved in an altercation, he vomits and his airways totally obstructed with vomitus and blood. What is the maximum amount of time that you can suction his airway? - ANSUntil his airways clear You arrive at the scene of a motor vehicle collision in which a vehicle struck a tree. Which is the best indicator of potential injury? - circumference of vehicle -diameter of the tree -mass of the vehicle - speed of the vehicle - ANSspeed of the vehicle You respond for a patient who is sustained a GSW to the right upper thorax he is barely responsive, pale, and diaphoretic which of the following is most appropriate for transport? - ANSScoop stretcher You're call to treat a patient who was knocked unconscious when he slipped and fell on a wet floor striking his head. it is now several hours later he is awake but confused, does not recall the incident, and is vomiting with a headache. which of the following injuries is most likely? - ANSConcussion your

patient has a deep laceration to his antecubital fossa with significant bleeding. What is the most appropriate initial action? - ANSapply direct pressure your patient is a 20yr old male who struck his head on a teammates knee while diving to catch a football. He was not wearing a helmet. He demonstrates decerebrate posturing and has a GCS score of

4. His heart rate is 58, blood pressure 180/102 and his left pupil is dilated. What is the best ventilation rate to use when managing this patient? - ANS20 breaths per minute Your patient is a 32 year old female who was thrown from a horse and struck her head on the ground. She was not wearing a helmet. She does not respond verbally or open her eyes to painful stimuli, but responds to painful stimuli with decerebrate posturing. Her right pupil is dilated and does not react to light. Her respirations are 6 per minute and irregular, pulse 56, blood pressure 188/98. You should ventilate the patient at a rate of? - ANS20 BPM. your patient is a middle aged male who crashed his motorcycle. He is unresponsive. After opening the airway using a modified jaw thrust, you note the patient has respirations at a rate of 6. Auscultation reveals breath sounds are absent on the left side. What is the most appropriate next intervention? - ANSbegin ventilation with BVM Your patient is an 82 year old female who was an unrestrained front seat passenger in a

motor vehicle collision. Which of the following is the most reliable indication of shock in this patient? - ANSLEVEL OF CONSCIOUSNESS. Your patient is an injured construction worker bleeding profusely from a large laceration to the left thigh. He is confused and has pale, moist skin. Direct pressure applied to the wound by a first responder has failed to control the bleeding. The next step in controlling bleeding is to apply: - ANSA TOURNIQUET TO THE LACERATION.