Upon arrival at a trauma scene, you should complete a(n):

Scene size-up

2. Prolonged scene times may reflect:

Ineffective team collaboration

3. Which of the following indicates a state of hyperventilation?

An end tidal carbon dioxide level less than 30 mmHg

4. A 23- year-old female fell from a 2nd floor balcony. Upon arrival, you find her lying in the grass. She
responds to verbal commands and your assessment reveals flat neck veins, & normal chest/abdomen/pelvic
examinations. Vital signs are: BP 74/40, P 54 & Weak, and R 16. You should suspect:
Relative hypovolemic (high-space) shock

Rationale:
The condition causing the vascular space to be too large for a normal amount of blood has been called
"shock", or relative hypovolemia. Neurogenic shock, commonly called spinal shock, is a form of relative
hypovolemia. The clinical presentation of neurogenic shock differs from hemorrhagic shock in that there is no
catecholamine release and this no pallor (vasoconstriction), tachycardia, or sweating. The patient will have a
decreased BP but the HR will be normal or slow, and the skin is usually warm, dry and pink

5. An unresponsive 34 y/o female was struck by a vehicle. You observe Asymmetrical chest wall movement with
a flail segment on the right. Following delegation of c-spine control and opening the airway, you should?
Stabilze the chest wall

6. Which of the following regarding PT positioning for external jugular cannulation is Incorrect?
Elevate the head to distend the vein and prevent air embolism

Rationale:
The PT must be in the supine position, preferably head down, to distend the vein and prevent air embolism.

7. Which of the following set of vital signs is most compatible with a diagnosis of isolated traumatic brain injury
with increasing ICP?
BP 170/100, P 50

Rationale:
When the ICP increases, the systemic BP increases to try to preserve blood flow to the brain. The body senses
the rise in systemic BP, and this triggers a drop in the pulse rate as the body tries to lower the systemic BP

8. Which of the following statements is incorrect regarding spinal motion restriction?

Neck traction should be applied to extend the neck upward during cervical collar application

9. A 15 y/o male was stabbed and has an abdominal evisceration. The PT is A/O, BP 112/68, P 94, R18. You
should? (A/O: aware and oriented or alert and oriented.)
Prepare PT for transport & establish vascular access during transport.

10. A 33yo female's leg was trapped in a piece of industrial equipment and has been extricated. She is now
complaining of secure lower leg pain. PT is A/O with no signs of external hemorrhage. Vital signs are: BP
132/78, P 96, R 20. Which of the following is indicated?
Administer pain medication

11. Establishing vascular access on scene is indicated:

To administer medication

12. Which of the following changes is most useful to monitor in the child with head injury?
Level of consciousness
 Rationale:
changing of LOC is the best indicator of traumatic brain injury

13. In the geriatric PT, which of the following findings is most likely caused by an acute injury?
Hypotension

14. A 31yo female was the restrained driver of a vehicle that hit a utility pole at moderate speed. The driver’s
side airbag deployed. She is A/O & anxious. She reports that she is 8mo pregnant and complain of abdominal,
chest and lower extremity pain. Her vital signs are BP 100/60, P 90, R 20. Your impression and interventions
are:
Early signs of shock. Treat with O2, fluid administration, at "keep open" rate.

Rationale:
Do not mistake normal vital signs in pregnant PTs. The pregnant PT has a normal resting pulse that is 10-15
beats faster than usual, and the BP is 10-15mmHG lower than usual. However, it is also important to realize
that a BP loss of 30% can occur in these PTs before there is a significant change in BP

15. A disoriented 23yo male is injured in a motorcycle collision. The PT appears to be intoxicated and does not
want medical attention despite a large laceration on his scalp, which is actively bleeding. You should:
Treat him as a head injury PT

16. What is the most common cause of cardiopulmonary arrest in the trauma PT?
Hypoxemia

Rationale:
Hypoxemia is the most common cause of traumatic cardiopulmonary arrest. Acute airway obstruction or
ineffective breathing will be clinically manifested in hypoxemia

17. You may have been exposed to a contaminant (air or fluid borne). You should:
Seek treatment within hours of the exposure

18. A brief neurologic exam of an AMS pt includes:

GCS, glucose check, pupil exam

19.A 24 yo male is involved in a head on collision. If you suspect:

A chest injury, obtain an EKG

Rationale:
Consider a bruised chest wall as a myocardial contusion that requires monitoring of cardiac rhythm and, if
available, a 12-lead ECG

20. Which of the following findings would indicate the airway needs to be suctioned?
Gurgling sounds with respiration

21. Overinflation of an LMA mask can cause all of the following except:
Vomiting

Rationale: Overinflation may cause malposition, loss of seal or trauma

22, A 54 y/o male is involved in a MVC. The steering wheel is bent. During your initial assessment, you note his
skin is pale, radial pulses are present and breath sounds are clear. Which one of the following is most
consistent with these findings:
Cardiac contusion/Rationale: Bruising of the heart is basically the same injury as an acute MI

23. Which of the following is NOT a potential complication of performing chest decompression?
Difficulty monitoring the site.
24. Which of the following is considered one of the four essential components to maintain normal perfusion?
Fluid levels

Rationale: It’s important to remember that BP requires a "steady state" activity of all the preceding factors.
The heart must be pumping, the blood volume must be adequate, the blood vessels must be intact, and the
lungs must be oxygenating the blood

25. What site is generally the easiest to landmark for IO access?

Proximal Tibia

26. As ICP rises after an isolated head injury, what does the systolic BP do?
Increases

Rationale:
When the ICP increases, the systemic BP increases to try to preserve blood flow to the brain. The body senses
the rise in systemic BP and this triggers a drop in the pulse rate as the body tries to lower the BP

27. Which MOI meets the exclusion criteria for spinal motion restriction?
A 14yo F with an isolated stab wound to the midaxillary chest wall

Rationale:
Immobilization onto a long backboard is not indicated in penetrating wounds of: Torso, neck, or head unless
there is clinical evidence of spine injury

28. Which of the following organs sic obtained in the retroperitoneal region of the abdomen?
Kidney

29. Which treatment is indicated for the PT who is entrapped for an extended period of time with an isolated
crush injury to the lower extremity?
Sodium Bicarbonate and IV fluids

Rationale:
Initial administration of Sodium Bicarb should be at 1 mEg/kg bolus, followed by an infusion of 0.25 mEq/kg
body weight/hr of the solution.

30. 16yo F is rescued from a burning house. She has 25% partial thickness burns, and the nursed areas are hot to
the touch. What is the appropriate treatment?
Apply clean water to burned areas for up to 5-10 mins.

31. An unresponsive 5yo F was struck by a car. She presents with retractions and nasal flaring. The airway is
patent, breathing is fast and shallow, and the carotid pulse is weak and slow. Which of the steps in her
management should be done first?
Initiate ventilatory assistance

Rationale:
If you have any doubt that the child is breathing adequately on his/her own, immediately assist the child's
breathing

32. Which of the following regarding trauma in the elderly is true?

Fatal outcomes are more likely in the elderly than in the young

33. Supine hypotension syndrome in the pregnant PT is caused by?

Uterine obstruction of venous blood flow

Rationale:
In supine hypotension syndrome, the hypotension is caused by the weight of the pregnant uterus pressing on
the inferior vena caba and decreasing the return of blood flow to the heart b 30%
34. Which of the following has a greater chance of surviving traumatic cardiopulmonary arrest?
PTs with non-dilated pupils

Rationale:
Trauma PTs who presented unconscious, without palpable pulse or spontaneous respiration, found that PTs
with Sinus rhythm and non-dilated (<4mm) reactive pupils had a good chance of survival

35. Which of the following concerning blast injury is true?

Secondary blast injury is caused by objects propelled by the explosion (shrapnel)

36. The purpose of ITLS primary survey is to:

Identify all immediate life threats within the first 2 mins.

37. Which of the following would be the most compelling reasons to intubate?
Inability to ventilate

38. The depth of the ET tube at the teeth should be approximately _____ times the diameter of the tube? :
3

Rationale:
The mark on the tube that is even with the teeth should be three times the diameter of the ET tube. Thus, an
8.0mm tube in an adult should be at 24cm

39. During transport, a trauma PT develops shallow and rapid breathing, cyanosis and a weak, rapid carotid pulse
with distended neck beings and diminished breath sounds on the right, you should:
Decompress the chest

40. A 23yo F fell from a 2nd floor balcony. Upon, you find her lying in the grass. She responds to verbal
commands and your assessment reveals flat neck veins, and normal chest, abdomen and pelvis examinations.
Her skin is cool, clammy and ashen; respirations are rapid and shallow; radial pulses are too rapid to count
and thready. You place her on the heart monitor and it shows a wide-complex tachycardia of about 280/min.
You should suspect:
Cardiogenic shock

Rationale:
If cardiac output falls (either due to dropping or a very fast HR or lowered stroke volume) blood pressure will
fall

41, Which of the following is the correct orientation for inserting an IO needle to the proximal tibia?
Medial to the midline, avoiding the growth plate

42. Barbiturates should not be administered as a sedative for the head-injured PT because they,
Decrease BP

43. In which situation should an Emergency Rescue be performed?

Sudden release of toxic fumes

44. Which of the following is the most common cause of abdominal trauma?
Blunt force trauma

45. a 16yoF receives 25% partial thickness thermal burns. You should:
Cool the burn and protect from heat loss

46. Proper immobilization of a forearm fracture includes splinting the:

Wrist, Elbow and Flex site
Rationale:
Use a splint that will immobilize one joint above and one joint below the injury site
47. A 3yoM fell 9 feet. He has decreased LOC and is making persistent "grunting" sounds with respirations.
Your initial treatment is to:
Provide ventilatory support with supplementary O2

48. A 78yoF driver struck a parked car while she was traveling at a low rate of speed. She is complaining of
shortness of breath and chest pain. Your assessment and treatment should include:
Breath sounds, Hx, & EKG

Rationale:
All elderly PTs should have cardiac monitoring, pulse oximetry and capnography

49. When transporting a 3rd trimester pregnant trauma PT in spinal motion restriction, you should:
Tilt or rotate the board or PT 15-30 degrees to the left.

Rationale:
Supine hypotension syndrome causes acute hypotension due to decreased venous return. Usually occurs when
PTs are in a supine position with a 20+ week uterus. The transport of all pregnant trauma PTs to alleviate
vena cava compression: Tilt/rotate board 15-30 degrees to PT left
Elevate R hip 4-6 inches with a towel and manually displace the uterus to the left

50. Which of the following statements regarding SPO2 is correct?

You should try to maintain a pulse oximeter reading of 95% or higher in your trauma PT