Prehospital Emergency Care Chapter 33 Eye, Face, and Neck Trauma

1) When assessing a male patient who was punched in the face by another man, you detect blood in the white portion of his eye. Which optical structure has been injured?

A) Sclera

B) Cornea

C) Lens

D) Retina

Answer: A

2) A patient complaining of eye pain informs you that he was diagnosed with a corneal abrasion three days ago. He called 911 today because the discomfort has not yet resolved and he desires medical attention. Based on this information, which statement is most accurate?

A) The sclera must be infected.

B) The lens of the eye has been abraded.

C) The clear structure that covers the pupil has been damaged.

D) Fluid is leaking from the posterior chamber.

Answer: C

3) Which statement made by an EMT indicates an understanding of facial anatomy and/or injuries?

A) "The face has little blood supply but will readily swell when injured."

B) "Airway compromise is not a concern unless the neck is also injured."

C) "Injury to the eye(s) takes precedence over any and all other injuries."

D) "The only movable bone making up the face is the mandible."

Answer: D

4) A 21-year-old female has been struck in the left eye by a softball during a game. Which finding is most concerning for an eye injury?

A) Edema to the upper eyelid

B) Unusual sensitivity to light

C) Bruising and swelling to the orbit

D) Vision disturbance that resolves by blinking

Answer: B

5) A patient has been splashed in the face with battery acid. He now complains of being unable to see anything and of severe burning to his face. You observe that he is holding both eyes tightly shut and has significant burns on his cheeks and eyelids. In this situation, the EMT would assess the eyes:

A) Prior to assessing the airway.

B) After completing the primary assessment.

C) After determining the patient's level of consciousness.

D) Following implementation of spine motion restriction precautions.

Answer: B

6) A young male golfer has been struck in the right eye with a golf club. The upper and lower lids are swollen shut and ecchymotic. There are also blood clots between the two eyelids. What would be an indication that the EMT is providing proper care to this patient?

A) He gently opens the lids to assess for injury to the eye.

B) He places a numbing medication in the eye.

C) He irrigates blood from the eye with sterile saline solution.

D) He wipes any remaining blood from the face but not the eye.

Answer: D

7) A patient complains of pain and discomfort to the left eye after being hit in the face with a cloud of dust while working at a manufacturing complex. As you specifically assess the eye, you note some redness to the globe but do not see any obvious foreign object. The most appropriate care you can provide to this patient would be:

A) Covering both eyes with a bandage.

B) Carefully wiping the eye with a soft piece of sterile gauze.

C) Gently massaging the eye to promote tearing.

D) Applying gauze and direct pressure over the eye.

Answer: A

8) A young girl complains of eye pain after having sand thrown in her face by another girl at the park. When assessing her eyes, you note large particles of sand in the right eye. The sand appears to be on the conjunctiva, which also seems to be scratched and irritated. Your initial management of this injury would be:

A) Stop the tearing by applying gentle pressure to the eye.

B) Attempt to remove the larger pieces of sand using a cotton swab.

C) Flush the eye with clean water or sterile water from the ambulance.

D) Gently wipe the inner eye with sterile pieces of gauze.

Answer: C

9) A man grinding metal took his safety goggles off and was struck in the face with a shower of tiny metal fragments. He now complains of pain and visual disturbance in his right eye. When assessing the eye, you note that the globe is red, with several pieces of metal embedded in the tissue. Proper care of this patient would include:

A) Covering the affected eye and applying a cold pack over it.

B) Attempting removal of the metal with a sterile swab.

C) Covering both eyes with a bandage.

D) Flushing the eye with a sterile saline solution.

Answer: C

10) A baseball player was struck in the side of the face by a baseball. Assessment findings include swelling and numbness to the left side of the face and left eyelid, as well as crepitus in the same area. Assessment of the eye reveals no obvious injury. The patient denies any problem with his eyesight, but is having difficulty visually tracking your finger upward. What would be appropriate care for this injury?

A) Cold packs to the face and eyelid

B) Gentle pressure over the face and eye

C) Gentle cleansing of the eye with sterile water

D) Warm packs to the area of swelling

Answer: A

11) You suspect that a patient has a fracture of the left orbit. Which statement made by the patient would reinforce this suspicion?

A) "The light is hurting my eyes."

B) "I am seeing two of everything."

C) "Everything looks yellow."

D) "My eye feels like it is burning."

Answer: B

12) During an altercation, an intoxicated male was cut with a sharp knife. Assessment reveals a laceration, oozing dark red blood, across the right eyelid down to the right cheek. It also appears that the patient's eye was cut with the knife, a suspicion reinforced by the patient's complaint of eye pain and collection of blood in the sclera. The EMT would:

A) Clean the incision with sterile water and peroxide.

B) Apply direct pressure to the eyelid to control bleeding.

C) Apply cold packs to the eyelid to decrease swelling.

D) Cover the eye with a sterile dressing soaked in saline.

Answer: D

13) Which instructions would you provide to the Emergency Medical Responders when treating a patient who was punched in the eye and has blood visible in the anterior chamber?

A) "It is important to keep pressure down in the eye, so we will transport the patient in a sitting position."

B) "Let's apply a cold pack to the eye and immobilize the patient for transport."

C) "Let's put a shield over the eye and bandage it in place to apply some pressure to the eye."

D) "We will need to cover both eyes with patches before we transport the patient."

Answer: D

14) You have been called to a high school science lab, where a male student was splashed in the eye with an alkaline solution. The patient complains of burning to the eye as well as pain. After performing the primary assessment and finding no life-threatening conditions, you would:

A) Obtain a set of vital signs and determine whether the patient is taking medications or has any past medical problems.

B) Determine the exact compound that the patient was splashed with and the appropriate chemical antidote.

C) Hold the patient's eye open and begin flushing with large amounts of tap water, and continue this intervention throughout transport.

D) Cover both eyes with eye shields and move the patient to the ambulance for immediate transport.

Answer: C

15) You have arrived on the scene of an industrial plant where a female worker had a chemical splashed into her eye. She now complains of severe pain in the eye and is flushing it with tap water over a sink. Which question is it most important that the EMT ask first?

A) "What is your past medical history?"

B) "Are you wearing contact lenses?"

C) "Do you take any medications?"

D) "Have you ever had an eye injury before?"

Answer: B

16) A patient had an unknown chemical splashed into her left eye at a factory. You have been irrigating the eye on scene and are now getting ready to transfer the patient to the stretcher. Knowing that you will need to continue irrigation throughout transport, how will you position this patient on the stretcher?

A) Left lateral recumbent

B) Right-side-lying position

C) Prone with head turned to the patient's left side

D) Semi-Fowler's position

Answer: A

17) A young boy was running with a pencil and tripped. The pencil impaled the boy's left eye and remains lodged in place. He is in his mother's arms and both are crying hysterically. Appropriate care for the eye would include:

A) Stabilizing the impaled object and providing immediate transport.

B) Carefully removing the pencil from the eye to prevent the loss of vision, then providing immediate transport.

C) Applying ice to the affected eye to decrease pressure, swelling, and subsequent damage.

D) Applying gentle pressure to the pencil and eye to prevent movement, followed by immediate transport.

Answer: A

18) An elderly woman experienced a closed head injury when she fell down five steps. She is responsive to painful stimuli and her breathing is irregular and shallow. When evaluating her airway, you note that she has both upper and lower dentures. Her upper dentures are secure, but her lower dentures are loose. Prior to providing positive pressure ventilation, you would:

A) Make sure the lower dentures are secure.

B) Remove both the upper and lower dentures.

C) Remove the lower dentures.

D) Leave the dentures as you found them.

Answer: C

19) While running in a parking lot, a young boy tripped and fell. He hit his face and mouth on a curb, knocking one of his top front teeth from its socket. Bleeding has been controlled and the tooth found. Which instructions would you give your partner when caring for the tooth?

A) "Wrap the tooth in dry gauze and put it in a plastic bag placed in cool water."

B) "Scrub the tooth first to get the dirt off of it and then we will put it back in the socket."

C) "Make sure to touch it only by its root when scrubbing the dirt off it."

D) "Rinse the tooth first, then put it in a cup of saline for transport."

Answer: D

20) The name of the structure through which light enters the eye is called:

A) Cornea.

B) Sclera.

C) Iris.

D) Aqueous humor.

Answer: A

21) You are caring for a patient with a penetrating neck injury from an altercation. During the management, select all the interventions that may apply (but no more than three).

A) Cover the injury with an occlusive dressing

B) Consider need for spine motion restriction

C) Transport to a trauma center

D) Reassess the patient at least every 10 minutes if they are unstable

E) Remove the object if it is still impaled in the neck

Answer: A, B, C

3 multiple choice options

22) A 15-year-old female was struck in the mouth with a baseball bat. She has lost her front teeth and is spitting blood. The EMT's priority concern when caring for this patient would be:

A) Blood loss.

B) Jaw fracture.

C) Seizure activity.

D) Airway compromise.

Answer: D

23) A female patient struck her face on the steering wheel in a head-on motor vehicle collision and has deformity and crepitus to the bridge of her nose. Further assessment reveals bleeding deep within the nasal passages. Prior to your arrival, fire department EMRs have secured the patient to a long spine board and applied a cervical collar and straps. To best address the hemorrhage in the nasopharynx, the EMT would:

A) Suction blood from the airway as needed.

B) Transport the patient on the backboard with her feet elevated.

C) Apply ice packs to the bridge of the nose to control hemorrhage.

D) Carefully pack the nasal passages with rolls of sterile gauze.

Answer: A

24) A frantic mother dialed 911 for her 3-year-old daughter, who stuck a small, dried bean into her ear. Assessment shows the bean to be lodged firmly in the ear canal. When treating this patient, the EMT would:

A) Make one attempt to remove the bean with tweezers.

B) Gently flush the ear canal with sterile water until the bean is dislodged.

C) Reassure the mother and transport the patient to the emergency department.

D) Have the patient follow up with her family physician.

Answer: C

25) A 36-year-old male patient was involved in an altercation and now has a 2-inch laceration from a knife to the right side of his neck. Bleeding was controlled prior to your arrival by Emergency Medical Responders. Your paramedic partner has asked you to apply an occlusive dressing to the wound. You recognize that the primary benefit of the action is to:

A) Prevent the cervical collar from touching the wound, if one is applied.

B) Control the bleeding from large blood vessels so the patient does not become hypotensive.

C) Decrease the potential of air entry into the circulatory system.

D) Promote clot formation so as to stop bleeding.

Answer: C

26) A young boy riding an ATV did not see a chain stretched between two poles and hit it with his neck while traveling forward. Subsequently, he was thrown backward from the vehicle with significant force. He was not wearing a helmet. Emergency Medical Responders are with the patient and are holding manual spine motion restriction as well as administering oxygen. When you are assessing this patient, which sign would indicate the injury that must be addressed and managed first?

A) Difficulty speaking

B) Laceration to the forehead

C) Open fracture to the left arm

D) Partially avulsed ear

Answer: A

27) A 22-year-old male attempted to hang himself in a garage using chains suspended from the roof trusses. He was quickly found by family members and taken down to the ground. Currently, he is complaining of neck pain as well as mild difficulty breathing. Assessment shows his airway to be patent, breathing adequate, and skin warm and dry. His neck is red, but free of any subcutaneous air or swelling. Your partner has identified an abnormal bony protrusion to a couple of his cervical vertebrae. What should you do first when caring for this patient?

A) Place ice packs to his neck

B) Insert a nasal airway

C) Immediate transport

D) Initiate manual spine motion restriction

Answer: D

28) A construction worker has been shot with a nail gun, resulting in a long nail going through his cheek and becoming firmly embedded in the lower gum and jaw. There is considerable blood in his mouth, and the patient is in excruciating pain. Given this scenario, what would be your first priority?

A) Removing the nail from the cheek

B) Suctioning the airway of blood

C) Applying supplemental oxygen to maintain a pulse oximeter reading of 94% or greater

D) Placing a cervical collar

Answer: B

29) A 3-year-old child has stuck a crayon in his nose. Assessment reveals the crayon to be deeply embedded in the right nostril, with some irritation and swelling noted. His vital signs are pulse, 124 beats/min; respiration, 20 breaths/min; and SpO2, 99%. What would be most appropriate action to take when caring for this child?

A) Nonemergent transport to the hospital

B) Supplemental oxygen

C) Attempt removal of the crayon with forceps or tweezers

D) Place a warm pack to the bridge of the nose

Answer: A

30) A worker in a factory complex has a sliver of metal lodged in the colored portion of his eye. The EMT would recognize the foreign body as being embedded in the:

A) Cornea.

B) Iris.

C) Lens.

D) Sclera.

Answer: B

31) In a patient with conjunctivitis, the EMT would expect to observe a(n):

A) Inflamed and irritated cornea.

B) Infected lens.

C) Reddened membrane over the sclera.

D) Nonresponsive pupil.

Answer: C

32) The function of the lens of the eye is to:

A) Focus light onto the retina.

B) Allow light into the eye.

C) Protect the sclera.

D) Manufacture vitreous humor.

Answer: A

33) Blood in the anterior chamber of the eye is called:

A) Orbital hemorrhage.

B) Scleroderma.

C) Diplopia.

D) Hyphema.

Answer: D

34) What is a general guideline to use when deciding whether to remove a patient's contact lenses?

A) Remove only soft contact lenses, not hard lenses

B) Remove contact lenses only if the eye has been traumatically injured

C) Remove contact lenses only if the eye is traumatically injured and the patient is conscious

D) Remove contact lenses if the eye has been injured by a chemical burn

Answer: D

35) A construction worker complains of pain to both eyes after an extended period spent welding on a gas well. The light is bothering him, and he rates the pain as a 10/10. He states that this problem occurred once before and was caused by the intense light of his welding tool. The primary assessment reveals no deficits. The patient's vital signs are pulse, 80 beats/min; respirations, 14 breaths/min; blood pressure, 132/68 mmHg; and SpO2, 98%. Although the injury is very painful, his vision is not compromised. Which set of instructions indicates proper care of this patient?

A) "Why don't we flush the eyes with the sterile saline on the ambulance?"

B) "We will need to flush the eyes with bicarbonate to stop the burning."

C) "Applying direct pressure very gently to both eyes may provide pain relief."

D) "I do not think that we will need to provide supplemental oxygen.

Answer: D

36) A 21-year-old male has a stab wound to the left side of his neck. Emergency Medical Responders are holding manual spine motion restriction. As you approach the patient, you note blood on his shirt and pale-looking skin color. As team leader, which direction would you give first?

A) "Let's look for other injuries on his chest."

B) "Can someone start the patient on supplemental oxygen?"

C) "I need someone to place a gloved hand over that stab wound."

D) "Before we do anything else, we need to place a cervical collar on his neck."

Answer: C

37) A young male who was drinking heavily has been involved in a motor vehicle accident. As an unrestrained driver, his head went through the driver's-side window; in the process, a portion of his ear was severed. Blood is now coming from the remaining portion of his left ear. In overseeing the care of this patient, which action by another EMT would require corrective action?

A) A loose dressing placed over the left ear

B) Rolled gauze packed into the ear canal to slow bleeding

C) The severed ear wrapped in saline-soaked gauze

D) Emotional support provided to the patient while on scene

Answer: B

38) A female patient with a maxillary fracture has sustained injury to her:

A) Orbits.

B) Lower jaw.

C) Nose and orbits.

D) Upper jaw.

Answer: D

39) A conscious and alert 32-year-old male was assaulted and struck in the jaw with a baseball bat. He complains of tremendous jaw pain and exhibits an unstable mandible. His airway is patent, breathing adequate, and radial pulse normal. In caring for this patient and his injury, you would:

A) Wrap the neck and jaw securely with roller cling to stabilize the jaw.

B) Insert an OPA to assure airway patency.

C) Start positive pressure ventilation with supplemental oxygen.

D) Consider the need to implement spine motion restriction precautions.

Answer: D

40) A 23-year-old male struck his face on the steering wheel when his vehicle hit another car from behind. The patient's nose is deformed and actively bleeding. In his care, which intervention would be a priority?

A) Make one attempt to realign the nose

B) Pack the nares with sterile gauze

C) Suction the airway to keep it free of blood

D) Insert an NPA to prevent the nasal cavity from swelling shut

Answer: C

41) A 19-year-old female was assaulted by her intoxicated boyfriend. After punching her in the chest, he slashed her face with a knife. Assessment reveals the patient to be stable with a large laceration from beneath her right eye to her right ear. She is very upset and crying and repeatedly asks you if this injury will leave a permanent scar on her face. Your best response would be:

A) "You will be fine. You are lucky he didn't cut an artery."

B) "I am not worried about your looks; I am worried about preventing infection."

C) "When we get to the hospital, you can discuss this more thoroughly with the doctor."

D) "You will be fine. The stitches used today do not scar like they used to."

Answer: C

42) The best way to detect contact lenses for removal is to:

A) Shine a penlight into each eye at a slight angle and look for a shadow.

B) Turn on the overhead lights and look for your reflection over the iris.

C) Lightly run a gloved finger across the globe of the eye and sweep any lens to the corner.

D) Apply a sterile contact lens detector over the iris.

Answer: A