Description

PAR 100 Volume 4 Chapter 1 Trauma & Trauma Systems

1. Which level of trauma facility stabilizes and prepares to transport trauma pt’s to a higher level facility but does NOT necessarily have surgical capabilities?
2. A trauma center that is committed to special emergency department training and has a dregree of surgical capability but that usually stabilizes and transfers seriously injured pt’s in a level ___ trauma center
3. Which of the following accounts for the highest number of trauma deaths?
4. Which of the following is NOT an example of trauma
5. Which of the following means “the anticipation of injury to a body region or organ”?
6. Which of the following is NOT true of trauma triage criteria?
7. A trauma system is based on the principle that serious trauma is a ______ disease.
8. Which of the following is more relevant to the assessment of a trauma pt that to the assessment of a medical pt?
9. As a paramedic, your role in trauma care consists of all the following EXCEPT:
10. The purpose of determining the MOI and the index of suspicion for the trauma pt at the same time is to allow you to:
11. Which of the following requires immediate transport to a trauma center?
12. Which of the following MOI does NOT call for immediate transport to a trauma center?
13. In addition to handling all types of specialty trauma, which level of trauma center provides continuing medical and public education programs?
14. The leading cause of death in people under age 44 is:
15. Which of the following is important to the assessment of the trauma pt but not to the medical pt?
16. Which of the following is NOT considered a significant MOI for a pediatric pt?
17. Which of the following pts is not a candidate for air medical transport?
18. Written and verbal communication of the MOI and suspected injuries prevents under triage and insures the pt will receive the appropriate level of care.
19. Which of the following physical findings indicates the need for immediate transport?
20. Which of the following is an acceptable way of reducing prehospital time to maximize the use of the “golden hour” for trauma pts
21. Which of the following pts does NOT require specialty center capabilities beyond that offered by a trauma center?
22. Which level of trauma facility has minimal surgical support but can stabilize before transferring to a higher level trauma facility?
23. Which level of trauma facility can handle the most common trauma emergencies but for more specialized care will have to transfer the pt to a regional trauma center?
24. Upon arriving on a scene where the MOI indicates a potentially life threatening injury and transport time is prolonged, which of the following interventions will best help deliver the care that is needed?
25. Which of the following is not a consideration when assessing a trauma pt?
26. Which of the following acts resulted in the development of modern EMS systems?
27. Which of the following is the best, most cost effective way for EMS personnel to help reduce trauma related morbidity and mortality?
28. Which of the following mechanisms would yield the greatest index of suspicion for injury?
29. Which of the following statements about trauma is true?

PAR 100 Volume 4 Chapter 2 Blunt Trauma

1. In frontal impact collisions, which pathway of patient travel results in higher mortality?
2. In falls, which section of the spinal column is the most prone to compression?
3. Which of the following statements about the impact of motorcycle helmet usage is true?
4. Which of the two following factors proportionately affect the kinetic energy of a bullet fired from a gun?
5. People in which of the following age groups are prone to significant trauma due to falls?
6. Which of the following injuries is associated with the pressure wave produced by a blast?
7. Which of the following impacts the severity of injury sustained in a motor vehicle collision?
8. Which of the following injuries is most likely in a resr-end collision?
9. Applying Newtons second law of motion to a vehicle traveling 70 miles per hour, crashing into which of the following would transfer the most force to the patient?
10. Upon arriving at the scene of a single vehicle collision in which the vehicle struck a utility pole, you note that the windshield is spidered, or starred, and that the driver was not restrained.  Which of the following injuries is most likely?
11. You are dispatched to a building collapse with an entrapped patient who will require a lengthy extrication.  Which of the following meds should you consider for this patient while awaiting extrication?
12. In which of the following types of impact should you have a higher index of suspicion because the degree of injury may be greater than the damage alone indicates?
13. Which of the following mechanisms in a motor vehicle collision would most likely result in a tear of the liver at the ligamentum teres?
14. Which of the following best defines the term energy?
15. Which of the following paper bag syndrome injuries may occur due to sudden compression of the thorax or abdomen?
16. Vehicle airbags are meant to :
17. Which of the following injuries is associated with the tertiary phase of a blast?
18. Which of the following traumas contributes most significantly to motor vehicle collision mortality?
19. Which of the following contributes to a greater degree of injury than anticipated from vehicle damage alone in a lateral impact motor vehicle collision?
20. You are called to the scene of a vehicle crash in which a car was rear ended while stopped at a stop sign.  Which of the following laws of physics serves as the basis for analyzing the mechanism of injury and the associated suspicion of index for injuries?
21. Which of the following is true of the differences between adult and pediatric pedestrians when struck by a vehicle?
22. In a motor vehicle collision, when the drivers chest strikes the steering wheel, what produces injury next?
23. Which of the following is true of supplemental restraint systems?
24. Your patient, a 23 yo woman who is 6 months pregnant, was the unrestrained driver of a vehicle that rear ended a parked car.  The airbag deployed.  For which of the following injuries should you maintain a high index of suspicion?
25. Which of the following factors is NOT a consideration in the severity of injury related to falls?
26. Which o the following best describes what happens to the kinetic energy of a vehicle traveling at 65 mph when it collides into a concrete barrier wall?
27. Which of the following is true of motorcycle collisions?
28. Frontal impacts in which the patient takes a down and under pathway typically result in which of the following injury patterns?
29. Which of the following statements about lateral impact collisions is true?
30. Which of the following is NOT a complication of crush syndrome?
31. The two factors that refer to the rate of change of speed are
32. Axial loading is most likely to occur in which type of impact?
33. Which of the following best describes why the occupants of a vehicle moving at 50 MPH will be injured when the vehicle strikes a tree but not when it brakes to stop?
34. Which of the following injuries is NOT associated with the use of vehicle restraint systems?
35. A vehicle is struck in its right front as it passes through an intersection, resulting in a rotational impact.  Which of the passengers is subjected to the greatest acceleration forces?

PAR 100 Volume 4 Chapter 3 Physics of Penetrating Trauma

1. Which of the following statements about stab wounds is true?
2. As the mass of an object increases, which of the following occurs?
3. Which of the following statements about bullets is true?
4. Which of the following increases a bullets profile?
5. Your patient is a 60 yo male with a gunshot wound in the second intercostals space anteriorly on the left.  You note that he has frothy blood coming from his mouth.  For which of the following must you have the highest index of suspicion?
6. The path a projectile follows during a flight is called its:
7. Which of the following is true of shotgun ammunition?
8. To gain an appreciation for the potential for trauma from high velocity projectiles, it is important to remember that the shock wave produced can exceed atmospheric pressure by up to —– times.
9. Penetrating trauma to the face can complicate airway management by which of the following mechanisms?
10. The initial assessment of a patient with a gunshot wound to the chest should focus on detecting which of the following/
11. Which of the following is typical of the trajectory of a knife when a female assailant stabs someone/
12. Which of the following is true of the shock wave that accompanies high velocity penetrating trauma?
13. Which of the following is NOT considered penetrating trauma?
14. Which of the following organs would be most likely to be injured by a stab wound to the 6^th intercostals space in the Midaxillary line on the right side?
15. Your patient is a construction worker who fell 15 feet and has a 3 foot metal concrete reinforcement bar (rebar) impaled in his right thigh.  Which of the following is the best action?
16. Which of the following bullet characteristics would create the most damage?
17. Which of the following characteristics of stab wounds is associated with a male attacker?
18. Which of the following is considered a high velocity weapon?
19. As the energy from a medium or high velocity projectile pushes tissue from its path, which of the following occurs?
20. Greater velocity of a bullet will cause a ____ path of travel and a ____trajectory.
21. You have arrived on the scene of a 17 yo male with a gunshot wound to the thigh.  Police are on the scene.  There is significant ongoing hemorrhage from the wound.  The patient is screaming for someone to help him.  Which of the following should you do first?
22. Which of the following is true of body armor use?
23. Which two factors related to kinetic energy proportionately affect the damage a projectile will do?
24. Which of the following abdominal organs is the least affected by the pressure wave associated with penetrating trauma?
25. Which of the following statements about entrance and exit wounds is true?
26. Which of the following statements about low velocity penetrating trauma is true?
27. Which of the following organs is most susceptible to damage from the pressure wave when a bullet enters it?
28. Which of the following is most important when assessing the damage done by a gunshot?
29. Your patient is an 8 yo male with a pencil impaled 2 centimeters inferior to the xiphoid process.  You note that the pencil is pulsating.  Which of the following is the best action?
30. A penetrating injury to which of the following organs is LEAST likely to result in severe hemorrhage?
31. Which of the following statements is true of the permanent cavity created by penetrating trauma?
32. During the scene size up on a call for a patient with a penetrating trauma due to a stab wound, which of the following should you do?
33. Your patient is a 50 yo male with a gunshot wound to the right anterior chest.  He is unresponsive.  Which of the following should you do first?
34. Your patient is a 30 yo female with a stab wound to the neck.  She is sitting up and appears very anxious and SOB.  There is minimal external bleeding noted, but there is bubbling from the wound.  Which of the following should you suspect, based on the mechanism of injury and assessment findings?
35. As a bullet tumbles, its potential to inflict damage:
36. Which of the following is best described as the area of contused tissue resulting from penetrating trauma that may be slow to heal due to disrupted blood flow and tissue damage?
37. Which of the following is associated with assault rifle wounds but not hunting rifle wounds?
38. Your pt has a gunshot wound to the left posterior thorax.  Which of the following is not appropriate in your initial assessment?
39. When assessing a pt with a gunshot wound to the chest, which of the following findings would tell you the most about the amount of damage?
40. Which of the following is most likely to occur when military ammunition is used?
41. Which of the following is true of the temporary cavity formed by penetrating trauma?
42. Which statement about ballistics is true

PAR 100 Volume 4 Chapter 4

1. Which of the following mechanisms is responsible for accumulating lactic acid in shock?
2. Which of the following substances has the most rapid effect when compensating for hemorrhage?
3. Which layer of the arteries controls the diameter of the vessel?
4. Which of the following types of wound facilitates the effectiveness of normal blood-clotting mechanisms?
5. Your patient is a 29-year old male who works in a meat-processing plant.  He received a knife wound in the proximal antero-medial thigh,  which is continuing to bleed on your arrival.  He is restless, thirsty, and has pale, cool skin.  He has a weak radial pulse of 130 and a blood pressure of 118/88.  this patient is exhibiting signs and symptoms consistent with stage _____ hemorrhage.
6. Your patient is an obese 39-year old woman involved in a lateral-impact motor vehicle collision.  Which of the following should you remember when assessing and treating this patient?
7. Which of the following is true of the elderly trauma patient?
8. When cells become hypoxic and the amount of carbon dioxide in them increases, reducing tissue pH, which of the following occurs to restore homeostasis?
9. rapid volume replacement is best achieved under which of the following conditions?
10. For which of the following mechanisms of should you maintain the highest index of suspicion for hemorrhagic shock?
11. The increase in myocardial contraction as a result of increased blood return to the heart best describes:
12. Managing a laceration with arterial bleeding most often requires:
13. Which of the following guidelines applies to the prehospital administration of IV fluids in the patient with hemorrhagic shock?
14. Your patient is a 23 yo male with a gunshot wound to the abdomen and an exit wound in the right flank.  He responds to verbal stimuli; has pale, cool, diaphoretic skin; a heart rate of 128; resp. at 24; and a B/P of 82/60.  These findings indicate which of the following kind of shock?
15. Which of the following, located in the aortic arch, monitor blood pressure and send feedback to the medulla oblingata to maintain homeostasis?
16. Under normal circumstances, at any given moment, most of the blood is in the___ system.
17. Which of the following fluids is appropriate for the prehospital management of hypovolemic shock?
18. The phase of blood clotting in which the smooth muscle of an injured blood vessel contracts is known as the ____ phase.
19. A hematoma resulting from a fracture of the humerus may contain enough blood to make it a Stage —— hemorrhage.
20. Which of the following best describes the importance of O2 in cellular metabolism?
21. Which of the following impairs blood clotting?
22. Septic shock is a form of which of the following types of shock?
23. Which of the following indicates that a patient has transitioned from compensated to decompensated shock?
24. Which of the following results from anaerobic metabolism in shock/
25. Which of the following is NOT a benefit of PASG?
26. Even with intervention, survival is unlikely with blood loss over____ percent of the total blood volume.
27. Which of the following best describes definitive care for the trauma patient with ongoing, significant hemorrhage?
28. Anaphylactic shock is a form of ____shock.
29. Which of the following results from the Beta-1 actions of epi in response to shock?
30. Your patient is a 42 yo male with multiple lacerations on his arms, head and torso after falling through a plate glass window.  On your arrival, he appears to be unresponsive, lying prone on the sidewalk.  Which of the following is the correct sequence of actions in caring for this patient?
31. Which of the following is the preferred fluid for resuscitation in hemorrhagic shock?
32. Which of the following results from relaxation of the postcapillary sphincters in shock?
33. Which of the following is NOT a characteristic of arterial bleeding?
34. Your patient has a possible pelvic fracture from a frontal MVC.  She has a blood pressure of 78 palp, and a HR of 130 and responds only to painful stimuli.  Before you arrived, BLS providers immobilized the patient to a long backboard.  Which of the following should your do next?
35. Red blood cells make up approximately ____ percent of whole blood volume.
36. Which of the following measures effectively controls bleeding in body cavities?
37. Which of the following early signs of shock is easily missed?
38. A fracture of the femur may result in a hematoma that contains enough blood to make it a Stage ____ hemorrhage.
39. Which of the following vessels has the greatest ability to change diameter?
40. In a previously healthy individual, which of the following types of shock may NOT result in the typical signs of cool, pale, moist skin; tachycardia, and narrowed pulse pressure?
41. Assuming all of the following pts have experienced significant blood loss and are hypotensive, in which would the use of PASG be absolutely contraindicated?
42. Which of the following terms is best described as the loss of blood from the vascular space?

PAR 100 Volume 4 Chapter 5 Soft Tissue Injuries

1. Which of the following statements about crush injuries is true?
2. The most common type of trauma is:
3. You are called to a commercial creamery where an employee got his arm trapped in the ice cream mixing machinery.  You note that the skin has been pulled off his hand and arm from the midforearm down.  The pts muscles, tendons, and bones are exposed.  This type of injury is a(n):
4. Your pt is a 15 year old soccer player who was kicked in the calf by another player.  She has a contusion on her calf, but the amount of pain she is experiencing seems out of proportion to the apparent injury.  You note that, although you can palpate a pedal pulse, there is swelling in the foot and ankle, and the skin is cool to the touch.  You should suspect which of the following at this time?
5. For most open, soft tissue wounds managed by the paramedic in the prehospital setting, which of the following are desirable characteristics of the dressing and bandaging materials?
6. The layer of skin that contains adipose tissue is the:
7. Which of the following best describes a wound in which pathogens may be introduced deep into the tissues, increasing the risk of infection?
8. In which type of soft tissue injury is the skin cut or torn, leaving a flap of skin attached?
9. You are on the scn where a 35 year old male has his leg trapped under a section of concrete.  While awaiting removal of the concrete, which type of IV fluid is indicated for administration to this pt?
10. You arrive on the scene of a pt with severe blunt trauma to the face.  You hear gurgling as you approach the pt.  What should your next action be?
11. Your pt is a 3 year old male who has struck his head on a concrete patio.  He has a wound that penetrates the dermis and is approximately 2cm long.  This wound would be best described as an:
12. A laceration that is perpendicular to the tension lines of the body is more likely to:
13. Which of the following best explains why capillary oozing from minor, open, soft tissue trauma may not stop immediately?
14. Your pt is a 45 year old type 2 diabetic who has had a nonhealing wound on his right foot.  You note that the right leg is discolored, edematous, and has subcutaneous emphysema and a foul odor.  Which of the following should you suspect?
15. The tough, fibrous sheaths that bundle skeletal muscle are called:
16. Which of the following is best described as the accumulation of a pocket of blood in the tissues?
17. Which of the following best describes the skeletal muscle degeneration secondary to crushing trauma that causes the release of metabolic by products?
18. You have responded for an injured person at an address you know to be a motorcycle clubhouse.  Your pt was attacked by another party with a broken beer bottle.  Your pt has a large laceration on her neck with moderate bleeding.  Which property of your dressing material is most important in caring for this pt
19. In which of the following ways does the integumentary system protect the body against pathogens?
20. You are assessing an assault victim and note a contusion over the abdomen.  Which of the following should you remember while caring for this pt?
21. Which of the following may result from an improperly applied tourniquet?
22. When caring for an amputated part, which of the following principles apply?

PAR 100 Volume 4 Chapter 6 Burns

1. During which phase of a burn injury does extravasation of proteins, water, and electrolytes occur, resulting in edema and potential hypovolemia?
2. Which of the following body structures is the best electricity conductor?
3. Which of the following is true of the heat generated when electricity flows through the body?
4. Alkalis generally cause_____ extensive burns because they result in ______ necrosis of the tissue.
5. Your patient has circumferential full-thickness burns of the thorax.  He is intubated, and you have noticed an increase in resistance as you bag him.  His skin is very tight and inflexible as you try to ventilate.  Which of the following is required to improve this patient’s ventilatory status?
6. Which of the following body areas warrant special attention when burned?
7. For which of the following burn patients could you use local cooling?
8. Which of the following afents is indicated for pain control in a patient with 4.5 percent partial-thickness burns?
9. Which tissue layer is affected by partial-thickness burns?
10. You are dispatched to a structure fire at which there is a report of a burned person.  Your patient is a 32 yo male with blisters on his anterior chest and circumferential superficial burns to both lower extremeties.  Using the Rules of Nines, what percent of burn does this patient have?
11. The three primary factors that determine the severity of radiation are:
12. The first step for treating a patient who has been contaminated with dry lime is to:
13. The type of electricity supplied to homes is ___ current.  Contact with this type of current may result in ____.
14. According to Jacksons theory of thermal wounds, which of the following zones has suffered the greatest damage?
15. Based on total body surface area and burn depth, you have determined that an 88 yo female has a moderate burn.  Considering the age of the patient, you should consider this burn.
16. Which of the following factors increases the criticality of burn injuries?
17. An area of burned tissue that is not painful is most likely a _____ burn.
18. Which of the following has contributed most significantly to the decline in U.S. burn mortality?
19. Despite the declining incidence of burn injuries in the U.S., burns remain the ____ leading cause of death in children under 12 and the ____ leading cause of trauma deaths in the overall population.
20. Patients who survive the first several days of a moderate to critical burn are most likely to die from which of the following complications?
21. Which of the following stages of burn injury is best described as including a pain response, an outpouring of catecholamines, tachycardia, tachypnea, mild hypertension, and anxiety?
22. A burn patient who has signs and symptoms of inhalation injury with associated respiratory compromise should be classified as:
23. Most inhalation injuries in bury patients are due to which of the following?
24. Your patient is a 23 yo female who was rescued from a burning house.  She was asleep in a back room when the fire started, and there was no smoke alarm.  During transport, you monitor her EKG and pulse ox, as well as her vital signs.  She has a pulse ox reading of 99% after receiving O2 by NRB.  In which of the following ways is the finding significant?
25. You are caring for a patient with 30% full and partial thickness burns.  He is an 80kg male.  According to the Parkland formula, he should receive ——- liters of fluid over 24 hours, with ——- liters infused in the first 8 hours.
26. Paralysis of the muscle of respiration may occur when there is body contact with electrical currents as low as _____ mA.
27. You are assessing a 17 yo male patient with a burn on the lateral aspect of his thigh.  Which of the following guidelines is most helpful when estimating the percentage of total body surface area involved?
28. Which of the following best describes the pathophysiology of most burns to the human body?
29. Which of the following represents the modified body surface area percentages in the rule of nines for pediatric patients?
30. Which classification of burn is characterized mainly by blisters?

PAR 100 Volume 4 Chapter 7 Muscular Skeletal

1. Which of the following best describes the percentage of musculoskeletal trauma in multisystems trauma patients?
2. Not considering other injuries, which of the following musculoskeletal findings warrants immediate transport of your patient?
3. Which of the following types of fractures occurs in pediatric age groups but not in adults?
4. Which of the following is the highest priority when managing a patient with bilateral closed femur fractures?
5. The use of the PASG is indicated in the treatment of which of the following musculoskeletal injuries?
6. Musculoskeletal trauma is best described as  ___________ life threatening.
7. The pain associated with skeletal fractures is transmitted by nerves in the ______.
8. Joints that allow free movement of the articulated bones are known as ______
9. Upon assessing a patient with a hip injury, you find that his right lower extremity is moved away from the midline of the body.  You should describe the lower extremity as being:
10. Which of the following supplies articular cartilage with oxygen and nutrients?
11. Which of the following is NOT part of the axial skeleton?
12. The most commonly fracture bone(s) in the human body is/are the:
13. Tendons connect ________ to _________.
14. One of the earliest indications that compartment syndrome is developing in an injured extremity is:
15. A sprain is an injury best defined as which of the following?
16. Your patient is a 7-year-old male with a fracture of the proximal tibia.  Which of the following is the most likely and serious complication of this injury?
17. When assessing a long bone injury, you should assume you are dealing with a joint injury when the site of injury is within ______ inch(es) from the joint?
18. Your patient is a 50-year-old motorcyclist who received a lateral impact from an automobile as he went through an intersection.  He has a deformity of the right midthigh and an open right tibia/fibula fracture.  He also has a fracture of his left forearm and some abrasions.  He was wearing a helmet and suffered no loss of consciousness.  He currently has a strong radial pulse of 100, his skin is warm and moist, and he has adequate respirations at 20 per minute.  Which of the following is the best way to manage this patient’s lower-extremity trauma?
19. Your patient is a 27-year-old male ice skater whose left skate was planted when he was struck and knocked down by another skater.  He is agitated and complaining of severe pain in his leg.  Your examination reveals an open fracture 6 inches proximal to the ankle joint.  Which of the following describes the most appropriate management of this patient?
20. Your patient is a 60-year-old female driver of a vehicle involved in a moderate-speed frontal collision.  She was unrestrained, but airbags deployed.  There is no damage to the windshield, but the bottom of the steering wheel ring is deformed.  On your initial approach to the vehicle, an EMT is in the back seat with manual cervical spine stabilization.  The patient is anxious and complaining of pain “in her legs.” She appears pale, her skin is cool but dry, she has a radial pulse of 116, respirations of 24, and clear, equal bilateral breath sounds.  Her abdomen is soft and nontender, and there is no pain or instability on assessment of the pelvis.  Which of the following is the best management of this patient?
21. Your pt is a football player who had his right foot planted and was tackled from the left rear, causing his body to rotate around the axis of his right lower extremity.  This mechanism is most consistent with which of the following types of fractures?
22. Your pt has an abrasion on the bony prominence on the inside of her right ankle.  This abrasion should be described as being over witch of the following structures?
23. A dislocated knee is most likely to damage which of the following vascular structures?

PAR 100 Volume 4 Chapter 8 Head, Facial, Neck Trauma

1. Which of the following best describes the percentage of mortality from penetrating trauma to the cranium?
2. Which of the following groups is not among those with the highest incidence of serious head trauma?
3. Which of the following features of the cranium exacerbates the severity of intracranial trauma?
4. Based on your knowledge of anatomy of the head, which of the following statements is true?
5. Which of the following is true of the basilar skull?
6. Which of the following is the largest element of the nervous system?
7. Your pt states that he had a traumatic brain injury from a motorcycle collision 3 years ago.  You notice that his gait is unsteady and his movements are a bit jerky.  You suspect that he has damage to which of the following structures?
8. The term head injury refers to which of the following?
9. When caring for a pt with a basilar skull fracture in the prehospital setting, which of the following would be an unexpected finding?
10. The shearing, stretching, and tearing associated with rapid acceleration/deceleration forces acting on the brain result in which of the following types of brain injury?
11. Which of the following mechanisms causes indirect brain injury?
12. Which of the following are the two most important prehospital considerations for reducing secondary brain injury?
13. You are caring for a 20 year old skateboarder who crashed into a brick retaining wall at the bottom of a steep hill.  He has blunt trauma to his face with nose deformity, loose teeth, and bleeding from the nose and mouth.  Although you have answered him several times, he keeps repeating to you, “what happened? It seems like I’m having a bad day”.  This is most indicative of which fo the following
14. Your pt has received blunt facial trauma due to an assault.  For which of the following injuries would you maintain a high index of suspicion?
15. You are caring for a 22 year old amateur boxer who complained of a sudden obstruction of part of his visual field.  This complaint is most consistent with which of the following conditions?
16. Your pt is a 12 year old male who was struck in the right temporal area of the head with a baseball.  He had a brief loss of consciousness and is alert on y our arrival.  You note that he is becoming drowsy and has a strong radial pulse of 60, a blood pressure of 140/70, and a RR of 12.  Which of the following best describes this pts condition?
17. Your pt is a 45 year old male with extensive blunt trauma to the face.  He has decorticate posturing in response to pain; weak, irregular respiratory effort at 6 per minute; and a heart rate of 50 with a good radial pulse.  The pt appears to have nasal and mandible fractures, and an OPA is insufficient to keep the tongue from the posterior pharynx.  Which of the following has the MOST potential to negatively impact the pt?
18. The ______ cranial bone is fractured most often
19. Normal intracranial pressure is _____ mmHg.
20. Your pt is a 37 year old male unrestrained driver of a vehicle.  You find him with his upper body across the console and his head hanging down into the passenger’s side floor board area.  You note pooled blood from a scalp wound.  After immobilizing him and loading him into the ambulance where you have more light for you examination, you note that he has a large, full thickness avulsion of the scalp.  The pts heart rate is 112, RR 20, BP 82/50.  Which of the following statements about this pt is/are true?
21. Which of the following may confound the assessment of the pt who has a MOI consistent with significant brain injury?
22. During the initial assessment of the pt with suspected traumatic brain injury, which of the following best describes the approach to assessing the pts neurological functioning?
23. Which of the following GCS scores indicates serious brain injury?
24. Which of the following about the use of prehospital fluid resuscitation in the pt with a traumatic brain injury is true?
25. Which of the following parameters should be used to guide the oxygenation and ventilation of the pt with a traumatic brain injury?
26. Which of the following best describes consensual reactivity of the pupils?
27. A growing lesion in the right crainial hemisphere will most likely result in which of the following?
28. The cerebral perfusion pressure is represented by which of the following equations?
29. Your pt is a 22 year old female assault victim.  She has blunt trauma to the face with swelling around the right eye and zygomatic area.  Upon assessing her eye movement, you note that the right eye cannot follow your finger and does not move.  Which of the following most likely explains this finding?
30. Which of the following would explain tachycardia and hypotension in the pt with a closed traumatic brain injury?
31. Which of the following is NOT a component of the Glasgow Coma Scale?
32. For the head injury pt without signs of herniation, adjust ventilation rates to maintain and end tidal CO2 reading of between:
33. Which of the following best describes the effect of hyperventilation in the brain injured pt?
34. Which of the following skull fractures are most common?
35. The normal level of intracranial pressure does not impede cerebral blood blow unless the MAP is less than _____ mmHg.
36. Drowsiness following trauma to the head is indicative of dysfunction of which of the following
37. Central herniation syndrome typically results in which of the following?
38. Which of the following may result from seizure, worsening the condition of the pt with a traumatic brain injury
39. Which of the following statements about the administration of dextrose to the pt with a traumatic brain injury is true?
40. Which of the following represents the mean arterial pressure?

PAR 100 Volume 4 Chapter 9 Spinal Trauma

1. Which of the following places the pts spine in a neutral position?
2. A pt who was involved in a frontal motor vehicle crash in which is face struck the windshield is most likely to have which of the following types of injuries?
3. Your pt is a 30 year old male who was playing a backyard game of football and was tackled forcefully from the left side by his brother at the level of the shoulder.  Based on this MOI, you should suspect which of the following patterns?
4. Which of the following is noted in the pt with a positive Babinski reflex?
5. Which of the following is NOT considered a significant mechanism of injury in pediatric pts
6. Which of the following is the proper sequence for securing the pts body and head to a long backboard?
7. When assessing an individual who has lost sensation below the umbilicus, at what level do you suspect injury?
8. Which of the following best explains the presentation and prognosis of partial spinal cord transaction injuries?
9. Which of the following is NOT included in the prehospital neurological examination of the pt with a potential spinal cord injury?
10. A pt who had a spinal cord T4 injury 2 years ago calls 911 for pounding headache, blurred vision, and flushing.  On arrival, vital signs include a blood pressure of 240/120 and a pulse of 58.  What is this condition called?
11. Which of the following statements about the pt in neurogenic shock is NOT true?
12. Which of the following mechanisms is involved in neurogenic shock
13. The diaphragm is controlled by peripheral nerve roots _____ through _____
14. A spinal cord lesion that results in paralysis of both lower extremities is known as:
15. Which of the following is a function of the sympathetic nervous system?
16. When palpating the spine of a pt during your assessment, your are feeling the:
17. As you are palpating a pts spine beginning at the base of the skull and moving inferiorly, the bony prominence palpated is the:
18. Which of the following is most prominent MOI associated with spinal cord injuries?
19. The spinal cord is continuous from the brain to the level of:
20. Recent research has provided evidence of which of the following regarding spinal injury assessment?
21. The phrenic nerve consists of peripheral nerve roots _____ through _____
22. Which of the following best explains the presentation and prognosis of partial spinal cord transaction injuries?
23. Which of the following best describes the goals of manual cervical spine stabilization?

PAR 100 Volume 4 Chapter 10 Thoracic Trauma

1. The location of the neurovascular bundles containing the intercostals arteries is best described as the bundle that runs along the:
2. Which of the following are the most commonly fractured ribs?
3. The finding of jugular venous distension in the pt with thoracic trauma is least likely to be associated with which of the following?
4. Which of the following is the primary concern in the pt with a hemothorax?
5. Which of the following best describes the threat to life associated with traumatic rupture of the esophagus?
6. Your pt is a 27 year old male with one stab wound at the 5^th intercostals space posteriorly, on the right.  He is ambulatory at the scene, but dyspneic, and has air movement at the site of the injury.  Which of the following is the best sequence of actions in caring for this pt?
7. You have just inserted a large bore catheter into the chest of a pt with a tension pneumothorax and received a return of air.  Which of the following should NOT be done?
8. Your pt is a 38 year old male who is pinned beneath the frame of a vehicle when it slipped off the makeshift jacks he was using to elevate it.  The pts brother feels he may have been trapped for up to 20 minutes.  The rescue unit is preparing to use airbags to lift the vehicle off the pt.  Which of the following medications could you consider giving this pt?
9. You have arrived on the scene of a paramedic who was shot as she approached a residence on a call.  The scene has since been secured.  You pt is a 38 yr old female with one GSW to the left side of the chest at the 5^th intercostals space in the midaxillary line.  She is pale, cool, and awake but agitated.  She is diaphoretic and complaining of pian in her left side and difficulty breathing.  The pts EMT-B partner has applied oxygen by nonrebreathing mask and an occlusive dressing over the entry wound before your arrival.  As you continue your assessment, the pts level of consciousness decreases.  She responds to verbal stimuli.  Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side.  The pt lacks a radial pulse, and her abdomen is nonguarded and nontender.  Which of the following best explains the presentation of this pt?
10. The level of the diaphragm is _____ when it relaxes during the _____ phase of breathing.
11. As the diaphragm _______, the intrathoracic pressure ______.
12. The primary muscle of ventilation is the:
13. The trachea divides into the right and left mainstem bronchi at the:
14. The morbidity associated with simple pneumothorax is primarily due to which of the following?
15. Which of the following will result in an open pneumothorax?
16. You are on the scene of a 13 year old male whose playmate accidentally stabbed him in the chest with a pitchfork while they were playing in the barn.  The pt has penetrating wounds at the 2^nd, 4^th, and 7^th intercostals spaces on the left side of the chest anteriorly.  Which of the following injuries should be suspected and assessed for in this pt?
17. You are treating a pt whose open chest wound has been sealed by EMTs on the scene before your arrival.  During transport, the pt becomes more dyspneic, tachycardic, and hypotensive.  There are no breath sounds on the affected side, and the pt has JVD.  Which of the following is the best action
18. Your pt was the unrestrained driver of a motor vehicle without airbags.  The vehicle struck a large utility pole at about 45 miles per hour.  Your pt has a contusion over his chest, and upper abdomen consistent with the shape of the steering wheel.  You should suspect which of the following types of injury in this pt?
19. Thoracic trauma accounts for approximately ______ percent of motor vehicle collision mortality?
20. The central area in the thorax that contains the heart, great vessels, trachea, esophagus is the:
21. All of the following injuries are commonly associated with penetrating thoracic trauma EXCEPT:
22. Which of the following best describes the finding of tracheal deviation in the trauma pt?
23. Which of the following statements is NOT true of pericardial tamponade?
24. The amount of air that enters and exits the lungs during a normal breath is the ____
25. Which of the following statements about the effect of age on thoracic injury patterns is true?
26. The finding of jugular venous distension in a pt with thoracic trauma would be most consistent with which of the following?
27. Your pt has been shot in the anterior right chest with a .38 caliber handgun.  He has an exit wound just below the right scapula.  Which of the following should you suspect?
28. Traumatic asphyxia is a ______ type of injury
29. Which of the following statements about the mortality of thoracic injuries is true?
30. Which of the following best describes the pleural space?
31. You have arrived on the scene of a paramedic who was shot as she approached a residence on a call.  The scene has since been secured.  You pt is a 38 yr old female with one GSW to the left side of the chest at the 5^th intercostals space in the midaxillary line.  She is pale, cool, and awake but agitated.  She is diaphoretic and complaining of pian in her left side and difficulty breathing.  The pts EMT-B partner has applied oxygen by nonrebreathing mask and an occlusive dressing over the entry wound before your arrival.  As you continue your assessment, the pts level of consciousness decreases.  She responds to verbal stimuli.  Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side.  The pt lacks a radial pulse, and her abdomen is nonguarded and nontender.  Which of the following best explains the presentation of this pt?
32. Your pt is a 24 year old male who was struck just below the left scapula with a 3 inch diameter metal pipe.  He is awake but having difficulty breathing.  His pulse is 112 at the radial artery, and his RR is 28 per minute and shallow.  His breath sounds are present bilaterally but diminished on the left.  He has a BP of 108/68.  The pt is coughing up some bloody sputum.  He has no other complains, and a rapid trauma survey reveals no additional life threatening injuries.  Which of the following represents the best sequence of intervention for this pt?
33. The average tidal volume of a 70 kg male is _____ ml
34. Your pt is a 31 year old female with blunt trauma to the chest.  You noted a contusion over the sternum and, during transport, the pt develops ventricular tachycardia.  She has a radial pulse and a BP 110/60.  Which of the following is the best course of action?
35. Another name for an open pneumothorax is:
36. Which of the following serves as the medial attachment of the 1^st rib?
37. Abdominal trauma should be suspected with penetrating thoracic wounds below the ____ rib anteriorly and the _____ rib posteriorly
38. Which of the following best describes the incidence of pericardial tamponade?
39. Considering the mechanics of ventilation, which of the following is true?
40. The angle of louis serves as a landmark for performing needle thoracostomy at which of the following locations?

PAR 100 Volume 4 Chapter 10 Abdominal Trauma

1. Which of the following best describes shear injuries to the abdominal organs?
2. Which of the following can reduce the potential for abdominal injury?
3. The suspicion of blunt abdominal trauma should be based primarily on:
4. The largest reserve of blood of any body organ is contained in the:
5. Which of the following is true abdominal trauma?
6. The injury in which abdominal organs protrude through a large, deep laceration of the abdominal wall is best described as:
7. Your pt is 17 year old male driver of a vehicle that received a lateral impact at the drivers side door.  There are no side impact airbags, and there is about 8 inches of intrusion into the passenger compartment at the left door.  Your pt is complaining of left shoulder pain and pain in his left side.  He has a contusion on the left shoulder and deformity of the left clavicle.  He has erythema over the left lateral thorax from ribs 6 through 12 with crepitus on palpation.  Which of the following injuries should you suspect?
8. Which of the following describes definitive care of the pt with traumatic intra-abdominal hemorrhage?
9. Which of the following is a special consideration when managing the pregnant trauma pt?
10. Which of the following organs is NOT part of the digestive system?
11. Which of the following pts may have trauma to abdominal organs ?
12. A 30 year old construction worker who fell from a second story roof but managed to land on his feet
13. A 17 year old male with a GSW to the right buttock
14. A 50 year old male with a stab wound 4cm posterior to the right scapula
15. A 45 year old female restrained driver of an SUV with a moderate speed frontal
16. Which of the following is NOT part of the prehospital examination or the pt with suspected abdominal trauma
17. Which of the following is most likely to occur as a result of rapid deceleration without actual contact between the pts body and the interior of the vehicle?
18. Which of the following changes in NOT of concern in the pregnant trauma pt?
19. Which of the following may impact the pattern of injury in abdominal trauma?
20. Your pt is a 60 yr old female restrained driver involved in a moderate speed, frontal impact collision.  When you arrive at the scene, she is sitting up in the driver’s seat with a chief complain of a burning sensation of her face.  You note abrasions from deployment of the airbag.  After immobilizing the pt on a long backboard, you begin transport.  As you perform a detailed examination, the pt complains of developing right shoulder pain.  Which of the following should you suspect?
21. Your pt is an 18 year old male who was slashed across the abdomen with a machete.  He has a mass of omentum and small bowel protruding form the wound.  Which of the following is your primary concern with this pt?