1. Finding this patient in a prone position is initially a concern for EMS providers because:
it is difficult to communicate with the patient.
prone positioning makes it harder to manage any airway compromise.
it is difficult to do a proper head to toe assessment.
it is uncomfortable for the patient.
2. The proper way to move this casualty initially would be:
to log roll him onto his back to allow for better assessment.
to move him due to the potential for a pelvic fracture using a scoop stretcher.
to log roll him immediately to a long spine board with enough rescuers.
to perform extremity carries to the stretcher.
3. Using a triage acuity scale, this patient should be triaged as:
4. Initial management of this patient should be focused on:
rapid extrication and transport.
immobilizing the patient to a long spine board.
all of the above.
5. The proper method, once your casualty is secured to a spine board, to initially maintain the patient’s airway would be:
head tilt with chin lift with suctioning and OPA insertion.
jaw thrust with suctioning along with an OPA insertion.
head tilt with chin lift, suctioning and NPA insertion.
jaw thrust with suctioning and NPA insertion
6. The patient’s vital signs are indicative of what medical problem?
7. The medical diagnosis for the above answer would be:
increased intracranial pressure.
8. We know that statistically, about 11 per cent of severe head injury patents have C-spine fractures and another 40 per cent of these have pelvic fractures. Initial management after securing the patient to a long spine board and managing the patient’s airway would be directed at:
controlling airway bleeding.
immobilization of any extremity fractures.
starting two large bore IVs at 20cc/kg boluses.
positioning the patient Trendelenburg to assist with the hypotension.
9. Suction at the PCP level for this patient would entail:
using a French style catheter inserted until the patient coughs and then applying suction while removing the catheter.
nasotracheal suctioning of the casualty with a French style suction catheter, applying suction.
using a tonsil tip suction catheter, inserted only as far as you can see, suctioning for 10 seconds while removing the catheter.
using a tonsil tip suction catheter, inserted only as far as you can see, suctioning for 15 seconds while removing the catheter.
10. Oxygenation for this patient should be:
NRB at 10 lpm.
NRB at 15 lpm.
BVM at 10 lpm.
BVM at 15 lpm.
11. According to ITLS standards, treatment for increasing intracranial pressure should be focused at:
hyperventilating the patient at 20 to 30 respirations per minute.
hyperoxygenating the patient with high flow oxygen only.
hyperoxygenating and ventilating the patient at 12 to 20 respirations per minute.
nothing. No treatment can be done at the PCP level for someone with increasing ICP.
12. Normal ventilation rates for any patient requiring artificial respiration with a BVM are:
1 breath every 3-5 seconds for a rate of 12-20 respirations per minute.
1 breath every 6-8 seconds for a rate of 6-10 respirations per minute.
1 breath every 1-3 seconds for a rate of 20-60 respirations per minute.
1 breath every 4-6 seconds for a rate of 10-15 respirations per minute.
13. During the examination you find the chest flail on the left side. You would immediately:
not worry about it as you are already managing the airway.
support the chest wall immediately with a rescuer with a gloved hand.
support the chest with a bulky dressing along with tape to secure the chest wall.
perform B and C.
14. The pelvis feels unstable on the initial exam. You should immediately:
bind the pelvis using a blanket or a commercial supplied binding device.
apply the patient onto a scoop for transport.
not worry about it as the patient is on a long board already.
apply a bilateral traction splinting device.
15. The primary responsibility of the paramedic is to:
perform BVM ventilations.
perform an emergency cricothyrotomy immediately.
apply NRB at 15 lpm until your secondary is done.
16. The patient has snoring respiration already, so as soon as you log roll your patient supine on the spine board you might have major complications. The priority before log rolling would be to:
prepare your ALS airway devices.
get your suction device ready.
make sure you have extra assistance to appropriately manage a difficult airway.
do all of the above.
17. While log rolling the patient, the person on the head is having difficulty holding the head from moving. The person by the chest notices an open laceration to the neck with an arterial spray. The best method to stop the bleeding would be to:
apply a bulky dressing immediately to the laceration.
leave the laceration until after the log roll, then apply a bulky dressing.
just worry about the laceration after you have secured an ALS airway.
do B and C only.
18. The ACP member has two IVs running now. The patient has a strong bite down on the inserted OPA already in position. The best way to intubate this patient who refuses to stop biting on the OPA would be to administer:
versed 5 mg IVP.
fenatnyl 100 mcg IV.
anectine 1.5 mg/kg.
all of the above.
19. The patient BP maintains around 142/70 post-intubation. The ideal BP in a head injury patient would be to maintain a BP of at least:
70 to 80 systolic.
80 to 90 systolic.
100 to 110 systolic.
20. The patient’s BP and pulse are important to survival of any head injury patient with a GCS less than 8/15. The _______ is also a good predictor of outcomes in a head injury patient as when it’s elevated the mortality rate also increases when they are above the normal range.
A and D
21. The on-call physician has asked you to initiate Mannitol immediately. You know the dose would be
0.25 to 1 gm/kg over 30 minutes with a filter.
0.5 to 1 gm/kg over 30 minutes with a filter.
2 grams/kg over 30 minutes with a filter.
100 grams IV over 10 minutes.
22. The unwanted side effect of Mannitol administration can be:
fluid and electrolyte imbalances.
all of the above.
23. During transport, your patient’s heart rate decreases rapidly. You would immediately suspect:
displacement of the endotracheal tube, obstruction of the endotracheal tube, pneumothorax, and equipment failure or extubation.
hypotension or cardiac arrest.
that the intracranial pressure is increasing now.
all of the above.
24. Being the initial GCS is 3/15 and it is now a 2/10 post-intubation, the chances of this patient surviving the crash would be:
poor at best.
25. The estimated blood loss is approximately 1,500 ml. The amount of IV crystalloid fluid resuscitation would be _____ ml or if you had blood products you would be able to administer _________ml.
4,500 and 1,500
1,500 and 4,500
20 ml/kg and 60 ml
60 ml/kg and 20 ml