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Exam 31: Head Trauma

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Question 1

Multiple Choice

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An unresponsive patient was ejected from a car as it rolled at a high rate of speed. The primary assessment is complete and you are providing positive pressure ventilation with high-concentration oxygen. The patient has a significant deformity to the right side of his head, and both pupils are equal but slow to react to light. He also has deformity to the forearms. Vital signs are: pulse 144, respirations 24 and inadequate, blood pressure 90/50 mmHg, and SpO₂ 97%. Based on this presentation, the EMT should:

A) look for evidence of bleeding in an area of the body other than the brain.
B) reassess the pupils and treat the patient for a severe head injury.
C) splint both arms and reassess the vital signs prior to departing the scene.
D) apply a nonrebreather face mask and prepare for possible seizure activity.

E) B) and D)
F) A) and B)

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A

Question 2

Multiple Choice

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A construction worker was accidentally shot with a nail gun. The nail penetrated the skull approximately ½ inch through the temporal region. Before your arrival, coworkers pulled the nail free. Based on the mechanism of injury, which sign provides the strongest evidence that the meningeal layers have been broken?

A) Blood draining from the puncture wound
B) Crepitus of the skull at the injury site
C) Deformity and depression at the injury site
D) Cerebrospinal fluid oozing from the puncture wound

E) A) and C)
F) All of the above

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Question 3

Multiple Choice

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When using the Glasgow Coma Score (GCS) , the EMT understands that:

A young male patient was running through a park and struck his head on a low-lying branch of a tree. Emergency Medical Responders have already immobilized the patient to a long board and are providing supplemental oxygen through a nonrebreather face mask. During transport, which one of the following assessment findings obtained during your reassessment would best indicate that the patient has suffered a concussion?

You are assessing a patient who has sustained blunt trauma to the head. Which would be most indicative of the loss of cerebrospinal fluid (CSF) ?

Your patient is a young adult male in police custody after he crashed his car into a utility pole. There is minor front-end damage to the vehicle, and the air bags deployed. The patient was not wearing a seat belt and has an abrasion on his forehead. He is awake and oriented to person, time, and place. His speech is slurred and he has an odor of alcohol on his breath. The arresting officer states that he just wants you to check the patient out before he transports him to jail. Which one of the following is most appropriate?

A 14-year-old male fell 10 feet from a retaining wall and hit his head on a metal post. He is responsive to verbal stimuli with incomprehensible speech. The secondary assessment indicates blood and fluid coming from inside the patient's left ear. You should do which one of the following?

An intoxicated teenage male with a diabetic history fell down five stairs and is now responding to a shoulder pinch with garbled speech. Manual stabilization of the cervical spine is being maintained. The primary assessment reveals an open airway, adequate breathing, and strong radial pulse. Vital signs are pulse 122, respirations 18, blood pressure 108/60, and SpO₂ 97%. His skin is warm and dry. Which action would be performed next?

As brain herniation occurs, the body responds by:

Which finding indicates that a patient who received a blow to the head is suffering from something other than a concussion?

A woman has fallen from a second-story window onto the concrete sidewalk below. She is unresponsive and has a large depression to the back and top of her skull. Additional findings include abdominal bruising and an angulated left ankle. Your partner reports that the patient's vital signs are: pulse 68, respirations 14 and irregular, blood pressure 198/110 mmHg, and SpO₂ 91%. Based on these assessment findings, which one of the following should the EMT recognize?

A 41-year-old male patient has been struck in the head with a metal pipe. As you approach the patient, you note that he is combative and has blood on the left side of his face and head and on his shirt. His breathing appears to be labored and he is incontinent of urine. Which one of the following would you perform immediately?

A patient involved in an altercation has been struck on the side of the head with a baseball bat, in addition to suffering several blows to the arms and legs. When assessing this patient, which of the following signs or symptoms best indicates the patient has suffered a brain injury?

You are transporting a patient with a past medical history of a meningeal tumor (tumor on the meninges) . You would recognize the tumor as being located:

A 61-year-old male has fallen off a roof. Your primary assessment findings include unresponsiveness, agonal breathing, and a slow and weak radial pulse. His skin is cool and dry. Emergency Medical Responders are maintaining manual in-line spinal stabilization. Which one of the following would you do immediately?

Which statement is true regarding linear skull fractures?

A woman strikes her forehead against the dashboard of her car as it strikes a tree. Immediately following the impact, her brain bounces back and forth within her skull. Based on the anatomy and physiology of the skull, which of the following is true?

When assessing a head-injured patient, what finding is most indicative of increasing pressure within the skull?

Which finding is most consistent with a basilar skull fracture?

You are transporting a patient with a right-sided head injury after a large refrigerator fell and pinned his head between the appliance and the floor. On scene, the patient was responsive to verbal stimuli with the following vital signs: pulse 96, respirations 16, blood pressure 134/66, and SpO₂ 95%. During transport, as you reassess the patient, what would be the most indicative sign that the head injury is worsening?