Prehospital Emergency Care Chapter 28 Bleeding and Soft Tissue Trauma

1) A 24-year-old male has cut his arm with a table saw. Assessment reveals dark red blood flowing steadily from the laceration. As an EMT, you would identify this bleeding as:

A) Arterial.

B) Capillary.

C) Venous.

D) Lymphatic.

Answer: C

2) While en route to a domestic violence incident with possible injuries, the police contact you and report that a male patient has arterial bleeding from a stab wound to the arm. Given this information, which bleeding characteristics do you expect?

A) Dark red blood flowing from the injury that is difficult to control

B) Bright red blood oozing from the injury site that is easy to control

C) Spurting blood that is dark red in color and difficult to control

D) Bright red blood that is spurting with each beat of the heart

Answer: D

3) You arrive at a meat packing plant to find a 30-year-old male patient who was cut in the wrist with a sharp knife. The patient appears pale, and blood is spurting from the laceration. Your immediate action would be to:

A) Assess and manage the airway.

B) Apply direct pressure to the laceration.

C) Provide supplemental oxygen.

D) Check the pulse and blood pressure.

Answer: B

4) As you approach a young male lying on the sidewalk who was called into 911 as an "unresponsive male," you observe an area of dark blood on his pants. He appears lethargic, pale, and diaphoretic. Your first action in caring for this patient would be to:

A) Apply oxygen.

B) Cut the pants.

C) Assess the airway.

D) Elevate the leg.

Answer: C

5) A middle-aged male's arm became caught in a grinding machine, and the arm was eventually extricated from the machine by coworkers. As you approach the patient, you note him to be holding a bloody towel over a severely deformed right arm. The patient is alert and anxious, and he has a patent airway. His breathing is adequate and his left radial pulse is fast and weak. You note his skin to be cool and diaphoretic. Given this information, which care would be provided first for this patient?

A) Start positive pressure ventilation

B) Perform a detailed secondary exam focusing on his arm

C) Insert an oropharyngeal airway and administer oxygen

D) Administer supplemental oxygen

Answer: D

6) Severe external bleeding should be controlled during which phase of the patient assessment?

A) Primary assessment

B) Scene size-up

C) Secondary assessment

D) Reassessment

Answer: A

7) The EMT is by the side of a young female who was cut while washing dishes. She has a jagged laceration to her left forearm that is bleeding steadily and heavily. When attempting to control the bleeding, the EMT would first:

A) Tightly wrap roller gauze around a large sterile dressing placed over the top of the injury.

B) Apply direct pressure to the elbow to slow the flow of blood into the distal arm.

C) Place a large sterile dressing over the site, with hand pressure applied over the top of the dressing.

D) Wrap the injury site tightly with roller gauze and apply a tourniquet above the laceration.

Answer: C

8) Direct pressure has failed to control an arterial bleed on a patient's lower leg caused by an industrial accident. What would the EMT's next action be?

A) Provide oxygen

B) Apply a tourniquet

C) Provide immediate transport

D) Splint the extremity

Answer: B

9) Which statement shows that the EMT understands the use of a tourniquet in controlling bleeding?

A) "A tourniquet should be applied tightly enough that arterial blood flow distal to the tourniquet is completely stopped."

B) "If the tourniquet appears to have stopped the bleeding, the EMT should loosen it slightly to allow a small amount of blood to perfuse the tissues."

C) "If a blood pressure cuff is used as a tourniquet, the EMT should inflate it approximately 50 mmHg above the patient's systolic blood pressure."

D) "Since arteries run close to the body's surface in a joint, the best place to apply a tourniquet is over the joint just above the site of hemorrhage."

Answer: A

10) A young male was riding a motorcycle when he lost control and was thrown from the bike. The patient is unresponsive and receiving positive pressure ventilation by on scene EMRs. Your assessment reveals bright blood flowing from an unrecognized femoral bleed. Initial management of this bleeding would include:

A) Application of a proximal tourniquet.

B) Direct pressure with a dressing applied.

C) Elevating the extremity and applying a cold compress.

D) Placing a tourniquet distal to the injury if direct pressure fails to stop the bleed.

Answer: B

11) Another crew has called for your assistance in extricating an obese male with a nosebleed from a third-floor bedroom. As you enter the room, which observation indicates proper management of the patient's condition?

A) The patient is supine, head turned to the side, blood draining from the nose and mouth, with a cold pack applied to the bridge of the nose.

B) The patient is sitting upright, head tilted back, with sterile gauze packed in each nostril.

C) The patient is lying on his side, a loose dressing has been applied below his nose, and a cold pack is on the bridge of his nose.

D) The patient is sitting upright, leaning forward, with nostrils pinched shut.

Answer: D

12) You have arrived at a scene where a young girl tripped while running and pushed her arms through a plate glass window while falling. She is responsive to painful stimuli and has blood spurting from a large laceration on her right upper arm. Your partner yells for you to immediately apply direct pressure to the laceration to prevent further blood loss, while he works to control the airway. You have yet to apply gloves, but your uniform shirt has long sleeves, and you normally wear prescription glasses. What would you do next?

A) Place a tourniquet above the laceration, being careful not to get blood on your hands

B) Apply gloves prior to applying direct pressure over the injury site

C) Control bleeding by pushing the skin of the laceration together until you can apply gloves

D) Apply direct pressure to the site with your forearm until someone with gloves can take over

Answer: B

13) Which statement demonstrates an understanding of shock caused by internal bleeding?

A) "Internal bleeding is a less serious life threat than external bleeding because the blood remains in the body."

B) "The EMT can control internal bleeding by applying direct pressure to the skin, over the top of the area of suspected internal bleeding."

C) "If a patient is bleeding internally, the signs of shock—such as a rapid heart rate and pale, cool, and clammy skin—are not as obvious."

D) "You should always suspect internal bleeding in a patient with the signs and symptoms of shock but no external bleeding."

Answer: D

14) You believe that a patient who has been shot in the lower abdomen is bleeding internally and is in an early stage of shock. The patient's mental status is decreasing. What would be appropriate prehospital care of this patient?

A) Semi-Fowler's position and direct pressure over the injury site

B) Supine position and administration of water by mouth

C) Oxygen therapy and rapid transport to the hospital

D) Oxygen therapy and cold packs to the abdomen

Answer: C

15) You are having a difficult time controlling bleeding from a small skin avulsion on a patient's ankle. Which statement made by the patient best explains why control has been difficult to achieve?

A) "I take Coumadin for my irregular heartbeat."

B) "My blood pressure sometimes runs a little high."

C) "I take steroids for my lung disease."

D) "I drank a lot of alcohol last night."

Answer: A

16) In the human body, which condition is present when a person is in shock?

A) The cells get glucose and other nutrients, but not oxygen.

B) The amount of oxygen to the cells is adequate, but CO2 is not being eliminated.

C) The blood has an adequate amount of oxygen, but not enough nutrients for cell survival.

D) The cells do not get enough oxygen and waste products start to accumulate.

Answer: D

17) Which statement made by your new EMT partner best describes the way to determine the severity of a patient's blood loss?

A) "I estimate the blood loss based on the fact that one cup of blood is about 250 mL."

B) "If the pulse rate is greater than 100 beats per minute, the patient has lost at least 200 mL of blood."

C) "I use the patient's signs and symptoms to judge the severity of the blood loss."

D) "I look at the blood pressure, and if it is less than 100 mmHg systolic, the patient has lost 500 mL of blood."

Answer: C

18) You have been dispatched to a residence where a woman lacerated her arm after falling while holding a drinking glass. She informs you that when she initially cut herself, blood spurted from the wound; then, within a second or two, it subsided to a mere trickle. She asks why this would happen. What is the correct response?

A) "Blood has the ability to clot within a second or two of injury."

B) "Blood vessels tend to constrict quickly once they are injured."

C) "Red blood cells will quickly repair the injury to the blood vessel."

D) "The skin around the injured blood vessels quickly swells and stops bleeding."

Answer: B

19) When performing the primary assessment, which sign or symptom best suggests that the patient is in shock?

A) Skin that is cool and diaphoretic

B) Radial pulse of 72 beats per minute

C) Bloody shirt from external bleeding

D) Pain at the site of injury

Answer: A

20) A patient is confused and anxious after falling 20 feet from a ladder onto the grass below. Which clinical finding described is most suggestive of shock?

A) Heart rate of 112 beats per minute

B) Deformity to the left arm

C) Large hematoma to the head

D) Constricted pupils

Answer: A

21) A young man fell down a flight of stairs and is now restless and confused. His airway is open, and he is breathing adequately at 20 times per minute. He has a radial pulse of 102 beats per minute, a blood pressure of 96/78 mmHg, and his skin is cool and diaphoretic. Your next action would be to:

A) Assess for injuries causing blood loss.

B) Administer supplemental oxygen.

C) Insert a nasal airway and start positive pressure ventilation with oxygen.

D) Place a cervical collar on the patient and secure him to a long back board.

Answer: B

22) Which sign or symptom of shock will be observed last?

A) Tachycardia

B) Increased respirations

C) Decreased blood pressure

D) Pale and diaphoretic skin

Answer: C

23) Which statement indicates an understanding of the EMT's prehospital role in caring for the patient in shock secondary to significant soft tissue trauma?

A) "The job of the EMT is to assume a trauma patient is in shock and get him or her to the hospital as quickly as possible."

B) "Because shock is a life-threatening condition, it is important that the EMT identify the exact cause so proper care can be given."

C) "If shock is in its early stage, it is not yet life-threatening and the EMT can take more time in assessing and treating the patient."

D) "Since trauma is best treated in the hospital, the EMT should provide care to maintain perfusion to the vital organs and transport."

Answer: D

24) Assessment findings for a driver who was ejected from his vehicle in a rollover-type collision include unresponsiveness and bruising to the abdominal and pelvic areas, along with an open femur fracture. The patient has an open airway and is breathing at 32 times per minute with absent alveolar breath sounds. His skin is cool and diaphoretic; the radial pulses are weak. Manual cervical spine motion restriction is being maintained. The EMT's next action would be to:

A) Obtain a heart rate and blood pressure.

B) Start positive pressure ventilation.

C) Examine the fracture site more closely.

D) Apply an appropriately sized cervical collar.

Answer: B

25) A 28-year-old male was cutting limbs from a tree when he lost his footing and fell 20 feet. He is unresponsive and breathing very poorly, at 28 times per minute. His radial pulse is weak and thready, and his skin is cool to the touch. Emergency Medical Responders (EMRs) have placed the patient on a nonrebreather face mask and are holding manual cervical spine motion restriction. A blanket has also been applied and covers the man. Based on these assessment findings, which instruction would you give to the EMRs?

A) "Since he is unresponsive, let's open the airway with the head-tilt, chin-lift maneuver."

B) "Let's uncover him since increased temperature will dilate his blood vessels and drop his BP."

C) "Let's move him to the stretcher for immediate transport to the hospital."

D) "Let's take off the oxygen mask and start positive pressure ventilation to assist his breathing."

Answer: D

26)While cleaning a gun, a 44-year-old man shot himself in the abdomen. On your arrival the patient is responsive to painful stimuli and lying on his side with legs to his chest. Blood is evident on his clothes. The vital signs are minimally acceptable and the SP02 94%. What is the correct sequence of events?

A) Perform a primary assessment & rapid secondary assessment move the patient to the stretcher for immediate transport & start positive pressure ventilation en route to the ER

B) Perform the primary assessment, administer supplemental oxygen, perform the secondary assessment, transfer the patient to the stretcher, and provide rapid transport

C) Transfer the patient to the ambulance, provide rapid transport, perform the primary and secondary assessments & avoid oxygen therapy en route to ER

D) Transfer the patient to the ambulance, perform the primary assessment, provide oxygen therapy & provide rapid transport

Answer: B

27) A 66-year-old female patient has been struck by a car. Your assessment reveals gurgling respirations, rapid breathing, and cool, diaphoretic skin. You also observe bruising to the chest and abdomen. What should you do most immediately?

A) Determine the blood pressure

B) Administer high-concentration oxygen

C) Evaluate for signs of shock

D) Suction the airway

Answer: D

28) You are called for a 2-year-old boy who has a nosebleed. While you are en route to the call, the dispatcher informs you that the patient has a disorder where the blood does not clot normally. As an EMT, you should recognize that:

A) The patient requires oxygen.

B) The patient's blood is infectious.

C) The bleeding may be significant.

D) A mask will need to be worn.

Answer: C

29) A male patient has been shot in the chest with a small-caliber gun. Which presentation indicates that he is in an early stage of shock?

A) Alert and anxious, pulse 96 beats/min, BP 134/88 mmHg, pale and cool skin

B) Slightly confused, pulse 116 beats/min, BP 112/90 mmHg, warm and flushed skin

C) Confused and anxious, pulse 144 beats/min, BP 82 mmHg/palpation, cool and mottled skin

D) Confused, pulse 44 beats/min, BP 110/68 mmHg, cool and cyanotic skin

Answer: A

30) A 24-year-old female was an unrestrained driver of a car that struck a guardrail, causing her to sustain blunt trauma to the chest and abdomen. Vital signs obtained by Emergency Medical Responders are pulse 120 beats/min, respirations 22 breaths/min, blood pressure 100/78 mmHg, and SpO2 96%. As you transport her to the hospital, which finding indicates that the patient is deteriorating?

A) Heart rate of 124 beats/min

B) Blood pressure 86/50 mmHg

C) Blood coming from an abdominal laceration

D) Restless and confused mental status

Answer: B

31) Which clinical finding is most suggestive of a patient who is decompensating?

A) Narrowing pulse pressure

B) Heart rate < 100 beats/min

C) Pulse oximeter reading < 96%

D) Skin that is pale, cold, and dry

Answer: A

32) A patient suffered abrasions to the legs after falling on a moving treadmill. In relation to the function of the skin, the EMT should be most concerned about:

A) Loss of body heat.

B) Risk for infection.

C) Formation of scar tissue.

D) Swelling and bruising

Answer: B

33) Which statement regarding contusions is true?

A) The epidermis is open and actively bleeding.

B) Blood vessels in the subcutaneous layer have been broken.

C) Blood vessels in the dermal layer have ruptured.

D) Blood vessels in the epidermis have broken but the skin is intact.

Answer: C

34) What are the three main layers of the skin?

A) Dermis, muscle, epidermis

B) Epidermis, subcutaneous, muscle

C) Dermis, subcutaneous, muscle

D) Subcutaneous, epidermis, dermis

Answer: D

35) When providing prehospital care to a female patient with a soft-tissue injury, which statement is true?

A) Gloves are needed only if the patient has an open soft-tissue injury.

B) Hands should be washed even if gloves were worn during care.

C) Sterile gloves are essential to prevent infection to the patient.

D) Double gloving is necessary to protect the EMT from blood borne diseases

Answer: B

36) When managing a patient with a soft tissue injury, it is essential that the EMT performs which action?

A) Thoroughly disinfect dirty lacerations

B) Control bleeding with a tourniquet if the bleeding is arterial in nature

C) Use the appropriate personal protective equipment

D) Cover hematomas with occlusive dressings

Answer: C

37) Assessment of an 88-year-old female who fell reveals bruising to her right buttock. The skin is intact and the patient complains of tenderness to the area when you palpate. As a knowledgeable EMT, you would recognize this patient has which type of injury?

A) Avulsion

B) Abrasion

C) Open injury

D) Contusion

Answer: D

38) When assessing a patient, you note a bruise to his chest. On the prehospital care report, this injury is properly documented as:

A) Ecchymosis.

B) Cyanosis.

C) Erythematic.

D) Hematoma

Answer: A

39) You are called for an 8-year-old boy who has fallen. At the scene, the boy's mother states that her son was running while flying a kite and tripped, striking his face on a rock. Assessment reveals a large reddish-blue lump with intact skin under his left eye. When alerting the hospital emergency department of your arrival, you should inform them that the patient has which type of injury?

A) Ecchymosis

B) Hematoma

C) Evisceration

D) Contusion

Answer: B

40) A patient sustained a crush injury after being pinned by a car that fell off jack-stands while the patient was underneath the car working on it. The injury occurred to the left upper quadrant of the abdomen. Assessment shows bruising to that area, with instability noted to the lowest rib. The EMT's highest concern regarding this injury should be:

A) Fractured rib.

B) Abdominal contusion.

C) Injury to the spleen.

D) Abdominal evisceration.

Answer: C

41) You are called for a 78-year-old female who fell earlier in the day. As you enter her kitchen, you observe her sitting in a chair with ecchymotic areas to her left cheek and left arm. There also appears to be blood on her pants. She is on home oxygen for COPD and is breathing in a moderately labored manner. The patient states that she fell a few hours ago, and now the pain and swelling in her arm are unbearable. She has also developed significant lower neck pain. What should you do first?

A) Take manual spinal motion restriction precautions

B) Place a cold pack to her cheek

C) Check her SpO2 level

D) Examine her arm for deformity

Answer: A

42) A 62-year-old male was the restrained driver of a car that was hit on the driver's side. Emergency Medical Responders have extricated the patient and provided spinal motion restriction precautions, including a cervical collar, long board, and straps. When asked, the patient complains of dizziness as well as left leg and left arm pain. Assessment reveals multiple contusions and deformity to his left forearm and a laceration with minor bleeding to the left side of his face. The patient's airway is open, and his breathing is labored. A rapid radial pulse is felt. Skin is cool and dry. Which assessment finding would the EMT address first?

A) Bleeding from facial laceration

B) Rapid pulse

C) Complaint of dizziness

D) Labored breathing

Answer: D

43) Which observations would cause the EMT to classify a patient's soft tissue injury as an abrasion?

A) Intact skin with ecchymosis noted; patient reports minor pain

B) Irregular break in the skin; bleeding is moderate but controllable

C) Intact skin with large accumulation of dark blood underneath

D) Skin is scraped and red; blood is oozing from the injury site

Answer: D

44) A 49-year-old male was climbing on a truck at a construction site when he fell backward to the ground. He presents with a 2-inch linear wound to the top of his head. Bleeding has been controlled and the skull can be seen through the wound. How should you document this injury on the prehospital care report?

A) Avulsion

B) Contusion

C) Crush

D) Laceration

Answer: D

45) Prior to your arrival on the scene of a motorcycle crash, an Emergency Medical Responder contacts you via radio and reports that there is one patient who has an avulsion to her left arm. As a knowledgeable EMT, which kind of injury should you anticipate?

A) Loose flap of skin torn on the patient's left arm

B) Torn skin with an underlying fracture

C) Bruised skin with a portion of bone protruding

D) Long and deep laceration with moderate bleeding

Answer: A

46) A young female was involved in an altercation and stabbed in the abdomen with an ice pick. After being stabbed, she quickly removed the ice pick. She states that there was not much bleeding but does say it "stings" quite a bit. Assessment reveals a small puncture wound to the lower right quadrant with some dried blood around the site. Which best describes the primary focus of the EMT in caring for this patient?

A) Keeping the entry site clean and free of infection

B) Assessing for internal blood loss or shock

C) Assessing for underlying injury to the spleen

D) Preventing air from entering the abdominal cavity

Answer: B

47) A patient was assaulted and sustained multiple injuries of various types. Which injury does the EMT recognize as presenting the greatest risk for infection?

A) Contusion to the chin

B) Closed crush injury to the knee

C) Abrasion to the right side of the face

D) Hematoma to the left foot

Answer: C

48) A patient has suffered an open crush injury to his elbow. As you approach him, you note the patient is sitting upright and holding a towel to his elbow. Although the towel is soaked with blood, the elbow does not appear to be actively bleeding. Your first action in caring for this patient should be to:

A) Apply supplemental oxygen.

B) Evaluate the patient's airway.

C) Place a sterile dressing over the injury.

D) Examine the patient's elbow.

Answer: B

49) You are transporting a male patient who was stabbed in the left upper quadrant of the abdomen. On scene, the patient was alert and oriented, with a patent airway and adequate respirations. There was minimal hemorrhage from the stab wound, which was covered with a sterile dressing. Oxygen was applied and transport was initiated. During the reassessment, which assessment finding should the EMT consider to be of the greatest concern?

A) Statement that the pain at the injury is increasing

B) Observation that blood is beginning to ooze from the injury

C) Increased redness and edema to the area surrounding the stab wound

D) Increased heart rate and unexplained restlessness

Answer: D

50) Which instruction is appropriate when helping a new EMT care for a male patient with a laceration to his left arm?

A) "When you are finished cleaning the laceration, apply some sterile gauze soaked in sterile saline."

B) "It is best to let the wound bleed some. This is the body's natural way of cleaning the wound."

C) "Don't worry about removing embedded dirt from the wound, just the dirt around the laceration."

D) "Do not cut away his sleeve over the top of the laceration as it will help control the bleeding."

Answer: C

51) A patient has suffered a small but jagged laceration to her left hand. When cleaning the wound, it is important that the EMT:

A) Use sterile gauze and wipe in a direction away from the site of injury.

B) Apply an antibiotic ointment prior to cleaning the injury.

C) Carefully remove any embedded particles from within the laceration.

D) Place saline-soaked gauze in the laceration.

Answer: A

52) A 40-year-old homeless male is found lying in the street. The physical examination reveals that the patient has a stab wound to the mid-chest. He is unresponsive and his skin is cool to the touch. His respirations are snoring at 40 breaths/min and his pulse is 120 beats/min. Which care should the EMT provide first?

A) Apply a sterile dressing to the wound

B) Start positive pressure ventilations

C) Perform a jaw-thrust maneuver

D) Listen to breath sounds

Answer: C

53) The EMT's initial concern when treating a patient with a gunshot wound to the chest is:

A) Evaluating for shock.

B) Ensuring an open airway.

C) Applying sterile bandages.

D) Looking for an exit wound.

Answer: B

54) A patient was building a bomb in his garage when it accidentally detonated. Assessment findings from the rapid secondary assessment reveal part of the intestines and a portion of the liver protruding from the right side of the abdomen. Proper care of this injury would include:

A) Careful replacement of the organs back into the abdominal cavity.

B) Direct but gentle pressure applied to the exposed organs to hold them in place.

C) Application of a dry sterile dressing covered with an occlusive dressing taped on three sides.

D) Covering the exposed organs with a large sterile dressing soaked with sterile water.

Answer: D

55) Which of these patients would the EMT recognize as suffering from an evisceration injury?

A) A female with a large flap of skin that has been torn loose from her scalp

B) A male patient with a knife impaled in his right upper abdomen

C) A male patient with a loop of intestine protruding from an open surgical wound

D) A female shot in the chest with "bubbling" coming from the wound as the patient breathes

Answer: C

56) While riding a bike, a young boy fell onto a stick protruding from the ground. The stick impaled him in the neck. The boy immediately pulled the stick out and ran home, where his mother called 911. Assessment reveals a gaping wound to the right neck. All hemorrhage has clotted off and manual cervical spine motion restriction is being maintained. Which instructions should you provide to the other EMTs on scene?

A) "Take some sterile gauze and carefully place it inside the open wound to prevent additional bleeding."

B) "Place an occlusive dressing over the wound and tape it on all four sides."

C) "Apply a sterile dressing over the wound and hold it in place by wrapping roller gauze around his neck."

D) "Do not worry about covering the wound; just place a cervical collar on the patient and carefully transfer him to the long board."

Answer: B

57) Which patient requires the EMT to remove an impaled object in the field?

A) A young female with a broken pencil through her cheek and into the oropharynx; blood from the injury is draining into her throat

B) A male patient with a 6-inch knife in his left upper quadrant; there is active bleeding around the injury site

C) A female with a knife on the right side of her chest; she is short of breath and coughing up blood

D) A male patient who fell on a screwdriver, which is impaled through his hand; the patient is in pain and requesting that you remove the screwdriver

Answer: A

58) A small metal rod was thrown from a metal lathe while it was in operation and is now impaled in a man's inner thigh. Assessment indicates that there is no active bleeding from the site, but the surrounding tissues are ecchymotic. The paramedic asks you to stabilize the rod with bulky dressings. You recognize this action is important because it will:

A) Prevent motion of the rod and further worsen any internal injury.

B) Control any internal hemorrhage that may be occurring.

C) Prevent bacteria from entering into the body.

D) Apply pressure to the broken blood vessels in the skin.

Answer: A

59) A patient presents with an arrow impaled in the right lower quadrant of his abdomen. He is in excruciating pain and states that he was accidentally shot by a friend while hunting. While there is no external bleeding coming from the injury, the surrounding skin is ecchymotic. Other assessment findings, such as the vital signs, indicate the patient is in early shock. Which action should the EMT perform first?

A) Carefully remove the arrow

B) Administer supplemental oxygen

C) Stabilize the arrow with an occlusive dressing

D) Establish manual cervical spine motion restriction

Answer: B

60) An alert and oriented patient has had a portion of his hand amputated by a table saw. Assessment reveals the patient to be in great pain, with a moderate amount of dark red blood still coming from the injury site. His airway is open, and his breathing is fast, but adequate. The radial pulse is rapid and strong, and his skin is warm and dry. The patient's amputated hand has been placed in a plastic bag and stored in a cooler with ice by factory EMRs. What should the EMT do immediately?

A) Insert a nasopharyngeal airway

B) Remove the amputated part from the ice

C) Control the bleeding with direct pressure

D) Obtain a full set of vital signs

Answer: C

61) A patient has had part of his right thumb amputated in an industrial accident. Coworkers have retrieved the thumb and wrapped it in a towel. The EMT demonstrates appropriate handling of the amputated part when he:

A) Places the thumb into ice water.

B) Keeps the thumb warm during transport.

C) Places the thumb in sterile saline.

D) Wraps it in a dry sterile dressing.

Answer: D

62) A female patient has been involved in a motorcycle crash. Your scene size-up reveals her to be unresponsive and lying in the roadway. It also appears that her left leg has been amputated at the knee. What should the EMT do immediately?

A) Assess the leg for bleeding

B) Perform a jaw-thrust maneuver

C) Cover the knee with a sterile dressing

D) Locate the amputated leg

Answer: B

63) You are called for an alert and oriented female who had a cesarean section several days ago. Today, the patient bent over and tore the surgical incision open. There is a moderate amount of bleeding coming from the site, but otherwise the patient is stable. What should the EMT do to control the bleeding?

A) Place a saline-soaked bandage over the top of the incision

B) Administer supplemental oxygen

C) Apply a multitrauma dressing over the incision

D) Pack sterile gauze dressings into the incision

Answer: C

64) A 54-year-old male patient has been involved in a car crash. Window glass has caused an open wound to his upper neck. Which dressing is best for this injury?

A) Sterile gauze

B) Self-adhering roller gauze

C) Moist sterile gauze

D) Occlusive dressing

Answer: D

65) Which statement made by the EMT shows an understanding of how an open wound should be bandaged?

A) "Bandages are sterile gauze pads used to stop bleeding."

B) "I use bandaging material to secure the sterile dressing in place."

C) "You must always make sure that the bandage is sterile."

D) "After you apply a bandage, you should place a dressing over it."

Answer: B

66) You have just applied a pressure dressing to the leg of a woman who suffered a deep laceration to her calf from a piece of broken glass. What should you do next?

A) Assess the blood glucose level to determine if hypoglycemia contributed to the accident

B) Obtain a follow-up blood pressure

C) Apply a tourniquet above the laceration

D) Assess for a pedal pulse

Answer: D

67) Which statement made by the EMT shows an understanding of dressing and bandaging a wound?

A) "When applying a bandage over a dressing, I apply it loosely so as not to interfere with circulation to the extremity."

B) "If bleeding from a wound cannot be initially stopped with direct pressure, I apply a bandage and dressing so I can take care of other injuries."

C) "I always leave the tips of the fingers or toes exposed when bandaging the arm or leg so future assessment of circulation is possible."

D) "I always bandage across the joint above the wound since this helps control bleeding by applying pressure to the proximal blood vessels."

Answer: C

68) Which statement about dressings and bandages is true?

A) Dressings must be airtight to prevent contamination.

B) Bandages should not be applied until bleeding is controlled.

C) Dressings are placed over bandages.

D) Dressings should be placed into open wounds.

Answer: B

69) A man has been bitten in his arm by his dog. He states that the bite occurred several hours earlier, when he accidentally stepped on the dog's paw. When asked, he tells you that the dog is up-to-date on all her shots, including the rabies vaccine. Assessment reveals two small puncture wounds to the hand with some bruising in the surrounding tissue. The patient wants to refuse treatment and transport. Given these assessment findings, what is the primary reason this patient should be seen in the emergency department?

A) Risk for infection

B) Possible shock from blood loss

C) Need to complete a police report

D) Prevent formation of a contusion

Answer: A

70) Which type of injury is most likely to result in capillary bleeding only?

A) Avulsion

B) Abrasion

C) Laceration

D) Penetration

Answer: B

71) A construction worker has a metal rod impaled in his right forearm. Assessment of the injury indicates heavy bleeding from around the impaled object. What should you do first?

A) Apply direct pressure around the rod

B) Place a tourniquet above the injury site

C) Attempt once to remove the metal rod

D) Apply pressure on the rod to stabilize it

Answer: A

72) What is the best description of a topical hemostatic agent?

A) A rapid-acting pill that promotes clotting in the body

B) A topical medication that reduces the risk of infection

C) A dressing that is specifically designed to stop bleeding

D) A liquid that stops bleeding by "gluing" the edges of a laceration together

Answer: C

73) A pregnant 31-year-old female has been shot in the neck during a domestic dispute. Currently, she is responsive to verbal stimuli, with an open airway and rapid, but adequate respirations. Her radial pulse is weak and fast. Vital signs are as follows: pulse 152 beats/min, respirations 22 breaths/min, blood pressure 92/76 mmHg, and SpO2 100% on high-concentration oxygen as initiated by the fire department EMRs. Which other intervention by the EMT will most benefit this patient?

A) Apply the pneumatic anti-shock garment (PASG)

B) Wait on scene for an ALS paramedic with an ETA of 10 minutes

C) Place an occlusive dressing on the neck and keep the patient warm during transport

D) Apply a bulky dressing to the neck and transport the patient in a semi-Fowler's position

Answer: C

74) A 48-year-old male is in shock from injuries sustained in a motor vehicle collision. Which assessment finding(s) is (are) most suggestive that the patient may have internal bleeding?

A) Heart rate of 148 beats/min

B) Patient responds to painful stimuli with a moan

C) Evisceration of abdominal contents

D) Pelvic instability with a BP of 78/48 mmHg

Answer: D

75) You respond to a single-car accident in which an unrestrained 3-year-old child was thrown from the back seat into the windshield, striking his head. As your partner applies spine motion restriction precautions, you note that the child has a patent airway, is breathing well, and is alert and oriented; however, you also notice that blood and fluid are draining from his right ear. How would you treat the bleeding?

A) Pack the external ear canal to control bleeding, being careful not to rupture the eardrum

B) Quickly cover the ear with your gloved hand

C) Apply a hemostatic agent to the ear canal

D) Apply a dressing loosely over the ear to absorb the blood and fluid

Answer: D

76) What are most high-pressure injuries caused by in the residential setting?

A) Dish washers

B) Home pressure washers

C) Garden hoses

D) Pressure sprinklers

Answer: B

77) What is the important assessment consideration for a high-pressure injection injury?

A) Recognition by the EMT that one has occurred

B) Determine need to administer acetaminophen or ibuprofen for pain relief

C) Providing immobilization to the injection site

D) Filling out a special report for OSHA

Answer: A

78) The EMT should apply pressure to an open wound that hemostatic gauze was used on for at least how long?

A) 1 minute

B) 3 minutes

C) 5 minutes

D) 7 minutes

Answer: B

79) An injury to what area of the body would most likely result in the EMT packing the wound?

A) Vaginal wound

B) Scalp wound

C) Neck wound

D) Junctional wound

Answer: D

80) What is the recommendation for the amount of gauze to use when packing a soft tissue injury?

A) 2 hemostatic gauzes

B) 1 large trauma dressing

C) 3 4 × 4 sterile gauze pads

D) As much gauze as it takes

Answer: D

81) What is the preferred type of material to use for wound packing?

A) Hemostatic gauze

B) 4 × 4 gauze dressings

C) Large trauma dressing

D) Occlusive dressing

Answer: A