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It is a warm fall evening. You are working on an ambulance with one ACP and one PCP. It has been a quiet evening until you are dispatched for a motor vehicle collision on a main street in your community. Your unit, a second ambulance, and a rescue unit from the local fire department are dispatched to the scene, as well as your local police service.

Your dispatcher informs you that you are responding for a motor vehicle collision consisting of a motorbike versus a minivan. You are told there are potentially two patients. Your response time is approximately five minutes, with a transport time of 15 minutes to a tertiary care centre, or 25 minutes to the closest trauma centre.

On arrival, you find your patient face down on the road. The patient appears unresponsive, and has snoring respirations, which can be heard from about 10 paces away. As you approach the patient, you note the patient’s helmet is severely damaged and pieces of the helmet are lying in front of the casualty’s head. You also note that there is a significant amount of blood pooling on the road around your patient’s head and face. When rolling the casualty over, you note massive facial trauma and profuse bleeding coming from the face area. The other driver is not injured but in shock. Your fire crew will assume control over her immediately.

Your initial vital signs for your casualty are:

  • Heart rate of 56 bpm
  • Respiratory rate of 6 per minute, shallow and laboured
  • Blood pressure is 166/56
  • SPO2 is 74 per cent on RA
  • Blood glucose level is 4.6 mmol/l
  • Cardiac monitor is sinus bradycardia
  • Pupils are unequal
  • GCS is 3
1. Finding this patient in a prone position is initially a concern for EMS providers because:
2. The proper way to move this casualty initially would be:
3. Using a triage acuity scale, this patient should be triaged as:
4. Initial management of this patient should be focused on:
5. The proper method, once your casualty is secured to a spine board, to initially maintain the patient’s airway would be:
6. The patient’s vital signs are indicative of what medical problem?
7. The medical diagnosis for the above answer would be:
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:
9. Suction at the PCP level for this patient would entail:
10. Oxygenation for this patient should be:
11. According to ITLS standards, treatment for increasing intracranial pressure should be focused at:
12. Normal ventilation rates for any patient requiring artificial respiration with a BVM are:
13. During the examination you find the chest flail on the left side. You would immediately:
14. The pelvis feels unstable on the initial exam. You should immediately:
15. The primary responsibility of the paramedic is to:
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:
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:
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:
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:
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.
21. The on-call physician has asked you to initiate Mannitol immediately. You know the dose would be
22. The unwanted side effect of Mannitol administration can be:
23. During transport, your patient’s heart rate decreases rapidly. You would immediately suspect:
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:
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.