Trauma Overview presentation lecture notes

Lecture notes on trauma

1. Chapter 23
Trauma Overview

2. Trauma
Applies fundamental knowledge to provide
basic and selected advanced emergency care
and transportation based on assessment
findings for an acutely injured patient.
National EMS Education
Standard Competencies (1 of 3)

3. Trauma Overview
•Pathophysiology, assessment, and
management of the trauma patient
–Trauma scoring
–Rapid transport and destination issues
–Transport mode
National EMS Education
Standard Competencies (2 of 3)

4. Multisystem Trauma
•Recognition and management of
–Multisystem trauma
•Pathophysiology, assessment, and
management of
–Multisystem trauma
–Blast injuries
National EMS Education
Standard Competencies (3 of 3)

5. Introduction (1 of 2)
•Traumatic injuries are leading cause of
death and disability in the US for people
under 40.
–Proper prehospital evaluation and care
minimizes risks.
–You must know how injuries occur and affect
the human body to properly size up crash
scenes and assess patients.

6. Introduction (2 of 2)
•Mechanism of injury (MOI) provides an
index of suspicion.
–Concern for potentially serious underlying and
unseen injuries.
•Energy events produce certain injury
patterns.
•Injury severity determined by:
–Amount of energy exchanged
–Anatomic structures involved

7. Energy and Trauma (1 of 5)
•Traumatic injury occurs when the body’s
tissues are exposed to energy levels
beyond their tolerance.
•Mechanism of injury (MOI)
–The way traumatic injuries occur
–Describes the forces that cause injury

8. Energy and Trauma (2 of 5)
•Three concepts of energy
–Potential energy
–Kinetic energy
–Work
•Energy
–Can be converted or transformed
–Cannot be created or destroyed

9. Energy and Trauma (3 of 5)
•Work = force acting
over a distance
•Work causes injury
when forces bend,
pull, or compress
tissues beyond
their limits.
Courtesy of Rhonda Beck

10. Energy and Trauma (4 of 5)
•Kinetic energy
–Work of a moving object
–Reflects relationship between mass and velocity
–Amount of kinetic energy converted to do work
on the body dictates severity of injuries
•Potential energy = mass  gravity  height
–Usually associated with energy of falling objects

11. Energy and Trauma (5 of 5)
•Newton’s Laws of Motion
–First law: Objects at rest tend to stay at rest and
objects in motion tend to stay in motion unless
acted on by some outside force.
–Second law: mass × acceleration = force =
mass × deceleration
–Third law: For every action, there is an equal
and opposite reaction.

12. Mechanism of Injury Profiles
•Different MOIs produce different injuries.
•Significant injuries include:
–Falls
–Multisystem trauma
–Motor vehicle and motorcycle crashes
–Gunshot wounds and stabbings
•Whether one system or more is involved,
maintain a high index of suspicion.

13. Blunt and Penetrating Trauma
•May occur from a variety of MOIs
•Penetrating trauma
–Injury by objects that primarily pierce and
penetrate the surface of the body
•Blunt trauma
–Results from object making contact with the
body, causing injury to soft tissues
–Motor vehicle crashes and falls are most
common MOIs

14. Vehicular Collisions (1 of 7)
•Motor vehicle crashes are classified as:
–Frontal (head-on)
–Rear-end
–Lateral (T-bone)
–Rollovers
–Rotational (spins)
•Principal difference is direction of the force
of impact.
–Spins and rollovers may have multiple impacts.

15. Vehicular Collisions (2 of 7)
•Crashes consist of a
series of three
collisions:
–Vehicle against object
–Passenger against the
interior of the vehicle
–Passenger’s internal
organs against the
body
Courtesy of Rhonda Beck

16. Vehicular Collisions (3 of 7)
•Vehicle against
vehicle, tree, or
other object
–Vehicle damage
has indirect effect
on patient care
–Assessment of
vehicle often
determines MOI
Source: © Jack Dagley Photography/ShutterStock, Inc.

17. Vehicular Collisions (4 of 7)
•Passenger against
the interior of the
vehicle
–Common injuries
include:
•Lower extremity
fractures
•Flail chest
•Head trauma
Source: © Jack Dagley Photography/ShutterStock, Inc.

18. Vehicular Collisions (5 of 7)

19. Vehicular Collisions (6 of 7)
•Passenger’s internal
organs against solid
structures of the
body
–Internal injuries not
obvious, but most
life threatening
–Coup-countercoup
injuries can occur

20. Vehicular Collisions (7 of 7)
•Significant MOIs include
–Death of an occupant in the vehicle
–Severe deformity of vehicle or intrusion into
vehicle
•Especially front, rear, lateral, and
rotations/rollovers
–Altered mental status
–Ejection from the vehicle

21. Frontal Collisions (1 of 4)
•Evaluate supplemental restraint system.
–Seat belts and air bags are effective in
preventing a second collision.
–Seat belts may decrease the severity of the
third collision.
•Despite air bags, suspect injuries to:
–Extremities
–Internal organs

22. Frontal Collisions (2 of 4)
•Children shorter than 4' 9"
–Should ride in rear seat in cars
–In a pickup truck or single-seated vehicle,
passenger air bag should be off.
•If the air bag(s) did not inflate during crash,
it may deploy during extrication.

23. Frontal Collisions (3 of 4)
•Supplemental
restraint systems
can cause harm
whether used
properly or
improperly.
•Inspect vehicle
interior for signs of
injuries.
Courtesy of ED, Royal North Shore Hospital/NSW Institute of Trauma & Injury

24. Frontal Collisions (4 of 4)

25. Rear-End Collisions
•Known to cause
whiplash-type injuries
•Body propelled forward;
head and neck left
behind
•Acceleration-type injury
to brain is possible.
–Third collision of brain
with skull
Source: © Crystalcraig/Dreamstime.com

26. •Side impacts
•Very common COD in
vehicular crash
•Vehicle usually struck
above its center of
gravity
•Rocks away from side of
impact
•Passenger sustains
lateral whiplash injury
Source: © Dan Myers
Lateral Collisions (T-bone)
(1 of 2)

27. Lateral Collisions (T-bone)
(2 of 2)
•If substantial intrusion into passenger
compartment, suspect:
–Lateral chest and abdominal injuries on side of
impact
–Possible fractures of lower extremities, pelvis,
ribs
–Organ damage from third collision

28. Rollover Crashes
•Usually involve large trucks and SUVs
•Injuries depend on whether passenger was
restrained.
–Most common life-threatening event is ejection
or partial ejection.
•Even when restrained, passengers can
sustain severe injuries.
–Injury patterns more predictable in restrained
passengers

29. Rotational Collisions (Spins)
•Conceptually similar to rollovers
•Multiple opportunities for the vehicle to
strike objects
–Such as utility poles
•Injuries are the result of a combination of
frontal and lateral impacts.

30. Vehicle Versus Pedestrian
(1 of 2)
•Three phases of impact
–Initial vehicle-pedestrian impact
–Pedestrian rotates onto the hood
–Pedestrian rolls off onto the ground
•Injuries are often graphic and apparent.
•Maintain a high index of suspicion for
serious unseen injuries.

31. Vehicle Versus Pedestrian
(2 of 2)
•Determine
–Speed of the vehicle
–Whether the patient was thrown through the air
and at what distance
–Whether the patient was struck and pulled
under the vehicle
•Evaluate the vehicle for structural damage.
•Multisystem injuries common
–Summon paramedic backup for significant MOI.

32. Vehicle Versus Bicycle (1 of 2)
•Evaluate MOI like
vehicle-versus-
pedestrian collision.
–Also evaluate the
damage to and
position of the
bicycle.
–Inspect helmet for
damage.
Source: © Robert Byron/Dreamstime.com

33. Vehicle Versus Bicycle (2 of 2)
•Presume patient has sustained an injury to
spinal column or spinal cord until proven
otherwise at hospital.
–Initiate and maintain spinal stabilization.
•When practical, patient should be log rolled
on to his/her side to allow for appropriate
assessment to posterior side of the body.

34. Motorcycle Collisions (1 of 3)
•Protection is from:
–Helmet
•Does not protect against
severe cervical injury
–Leather or abrasion-
resistant clothing
•Protects mostly against
road abrasion
•No protection against blunt
trauma
–Boots
Courtesy of Rhonda Beck

35. Motorcycle Collisions (2 of 3)
•When assessing the scene, give attention
to:
–Deformity of the motorcycle
–Side of most damage
–Distance of skid in the road
–Deformity of stationary objects or other vehicles
–Extent and location of deformity in the helmet

36. Motorcycle Collisions (3 of 3)
•Four types of motorcycle impacts
–Head-on collision
–Angular collision
–Ejection
–Controlled crash

37. Falls (1 of 4)
•Injury potential is related to:
–Height from which the patient fell
•Greater height of fall, greater potential for injury
–Surface of impact
–Objects struck during fall
–Body part of first impact
•Internal injuries pose gravest threat to life.
•Consider medical causes of fall
(eg,syncope).

38. Falls (2 of 4)
•Patients who land on
their feet may have less
severe internal injuries.
–Their legs may have
absorbed much of the
energy.
–Maintain an index of
suspicion for serious
injuries to the lower
extremities and pelvic
and spinal injuries.

39. Falls (3 of 4)
•Patients who fall
on their heads will
likely have serious
head and/or spinal
injuries.
•Falls from
significant heights
are serious events
with great injury
potential.

40. Falls (4 of 4)
•Take the following factors into account:
–The height of the fall
–The type of surface struck
–Any object struck
–The part of the body that hit first, followed by the
path of energy displacement

41. Penetrating Trauma (1 of 7)
•Second leading cause
of death after blunt
trauma
–Classified as low,
medium, or high energy
•Low-energy causes
–Accidentally by
impalement
–Intentionally by a
weapon
Courtesy of AAOS

42. Penetrating Trauma (2 of 7)
•Injuries caused by sharp edges of object moving
through the body
–Knives may have been moved around internally,
causing more damage than wounds suggest.
•Difficult to determine entrance/exit wounds from
projectiles in prehospital setting.
–Determine number of penetrating injuries.
–Combine that information with what you know about
the pathway of penetrating projectiles to form index of
suspicion.

43. Penetrating Trauma (3 of 7)
•Path the projectile takes is its trajectory.
•In medium- and high-velocity penetrating
trauma, the path of the projectile may not be
easy to predict.
–Bullet may flatten out, tumble, or ricochet.
–Fragmentation will increase damage.
–Pressure waves emanate from bullet.

44. Penetrating Trauma (4 of 7)
•Cavitation can result in serious injury to
internal organs.
–Temporary cavitation caused by acceleration of
the bullet
–Permanent cavitation caused by the bullet path

45. Penetrating Trauma (5 of 7)
•Area damaged by projectiles can be much
larger than the diameter of the projectile.
•Energy available for a bullet to cause
damage is more a function of its speed than
its mass.
•Organs injured vary depending on the
projectile’s pathway.
•There is an entrance wound and,
sometimes, an exit wound.

46. Penetrating Trauma (6 of 7)
Medium velocity High velocity

47. Penetrating Trauma (7 of 7)

48. Blast Injuries (1 of 7)
•See in
–Military Conflict
–Mines
–Shipyards
–Chemical plants
–Terrorist attacks
–Methamphetamine
laboratory
explosions

49. Blast Injuries (2 of 7)
•Four different injury mechanisms
–Most patients have some combination.
•Primary blast injuries
–Due entirely to the blast itself
–Most easily overlooked form
•Secondary blast injuries
–Damage to the body from being struck by flying
debris

50. Blast Injuries (3 of 7)
•Tertiary blast injuries
–Victim hurled by force of explosion
–“Blast winds” cause further injury.
•Miscellaneous blast injuries, including:
–Burns from hot gases or fires started by blast.
–Respiratory injury from inhaling toxic gases.
–Crush injury from the collapse of buildings.

51. Blast Injuries (4 of 7)
•Organs that contain air are most susceptible
to pressure changes.
–Middle ear (most sensitive)
–Lung
–Gastrointestinal tract
•Junction between tissues of different
densities/exposed areas (head and neck
tissues) are also prone to injury.

52. Blast Injuries (5 of 7)
•Tympanic membranes are a sensitive
indicator that help determine the presence
of other blast injuries.
•Patient may report:
–Ringing in the ears
–Pain in the ears
–Some loss of hearing
•Blood may be visible in the ear.

53. Blast Injuries (6 of 7)
•Pulmonary blast injuries result from short-
range exposure to the detonation of
explosives.
–Consist of contusions and hemorrhages
–Pneumothorax is common.
•May require emergency decompression by
paramedics
–Pulmonary edema may ensue rapidly.

54. Blast Injuries (7 of 7)
•Arterial air embolisms can produce:
–Disturbances in vision
–Changes in behavior
–Changes in state of consciousness
–Variety of other neurologic signs
•Neurologic injuries and head trauma are the
most common causes of death.
•Extremity injuries are common.

55. Multisystem Trauma
•Traumatic injuries in more than one body
system
–Head and spinal trauma
–Chest and abdominal trauma
–Chest and multiple extremity trauma
•Alert medical control and transport rapidly.

56. Golden Principles of
Prehospital Trauma Care (1 of 3)
•Your main priority is to ensure the safety of
yourself, your crew, and the patient.
•Determine need for additional personnel or
equipment.
•Evaluate the kinematics of the MOI.
•Identify/appropriately manage life threats.

57. Golden Principles of
Prehospital Trauma Care (2 of 3)
•Focus on patient care
–ABCs
–Shock therapy
–Backboard
•Transport immediately to appropriate facility.
–Notify the facility as soon as possible.
•Definitive care requires surgical intervention.
–Limit on-scene time to the platinum 10.

58. Golden Principles of
Prehospital Trauma Care (3 of 3)
•During transport, obtain a SAMPLE history
and complete a secondary assessment.
–Most care can be provided in transport.
–Order in which you provide treatment may need
to be adjusted based on patient’s needs.
•Consider paramedic intercept and/or air
medical transportation.

59. Patient Assessment
•Perform patient assessment.
•If patient has significant MOI and is in
serious or critical condition, perform a rapid
full-body scan or rapid head-to-toe
examination.
•If patient has nonsignificant MOI, focus
assessment on the chief complaint.

60. Injuries to the Head
•Disability and unseen injury to the brain
may occur.
–Bleeding or swelling inside the skull is often life
threatening.
–Include frequent neurologic examinations in
your assessment.
•Some patients will not have obvious signs
or symptoms.

61. Injuries to the Neck and Throat
(1 of 2)
•Serious or deadly injuries
•Airway problems may result.
•Look for DCAP-BTLS in the neck region.
–Assess for jugular vein distention and tracheal
deviation.

62. Injuries to the Neck and Throat
(2 of 2)
•Possible injuries include:
–Swelling may prevent blood flow to brain and
cause injury to central nervous system.
–Penetrating injury may result in air embolism.
–Crushing injury may cause the cartilages of the
upper airway and larynx to fracture.

63. Injuries to the Chest (1 of 2)
•Chest contains heart, lungs, large blood
vessels.
•Life-threatening injuries include:
–Broken ribs may hinder breathing.
–Heart may be bruised.
–Large vessels may be torn.
–Lungs may become bruised.
–Air may collect between the lung tissue and the
chest wall, known as a pneumothorax.

64. Injuries to the Chest (2 of 2)
•Penetration or perforation of the chest is
called an open chest wound.
–Regardless of injury, assess chest region every
5 minutes.
–Assessment should include DCAP-BTLS, lung
sounds, and chest rise and fall.
–Some patients will not have obvious signs or
symptoms.

65. Injuries to the Abdomen (1 of 2)
•Vital organs of abdomen require a very high
amount of blood flow.
•Organs of abdomen and retroperitoneum fit
into two categories:
–Solid organs, such as liver and kidneys
•May tear, lacerate, or fracture
–Hollow organs, such as stomach and urinary
bladder
•May rupture and leak acidlike digestive chemicals

66. Injuries to the Abdomen (2 of 2)
•Rupture of large blood vessels can cause
serious unseen bleeding.
•Patient who reports abdominal pain or
whose vital signs worsen may have
abdominal bleeding.
•Reassess using DCAP-BTLS.

67. •Scene time
–Survival of critically injured trauma patients is
time dependent.
–Limit on-scene time to the platinum 10.
–Criteria of a critically injured patient
•Dangerous MOI
•Decreased level of consciousness
•Threats to airway, breathing, or circulation
Management: Transport and
Destination (1 of 7)

68. Management: Transport and
Destination (2 of 7)
•Type of transport usually fit into one of two
categories:
–Ground EMS units staffed by EMTs, AEMTs,
and paramedics
–Air EMS units or critical care transport units
staffed by critical care nurses and paramedics
•Ensure patient(s) meets the criteria for use of
emergency air medical services before requesting
air transport.

69. Management: Transport and
Destination (3 of 7)
•Destination selection
–Level I facility
•Serves large cities/heavily populated areas
•Provides every aspect of trauma care
•Usually university-based hospitals
–Level II facility
•Located in less population-dense areas
•Provides initial definitive care
•Academic institutions or public/private
community facilities

70. Management: Transport and
Destination (4 of 7)
•Destination selection (cont’d)
–Level III facility
•Provides assessment, resuscitation,
emergency care, and stabilization
•Transfers patients to Level I or Level II facility
when their needs exceed facility resources
–Level IV facility
•Found in remote outlying areas
•Provides advanced trauma life support prior
to transfer to a higher level trauma center

71. Management: Transport and
Destination (5 of 7)
•There are criteria
for Level I trauma
patient
classification and
recommendations
for Level II
patients.

72. Management: Transport and
Destination (6 of 7)

73. Management: Transport and
Destination (7 of 7)
•Special considerations
–Remain calm.
–Complete an organized assessment.
–Correct life-threatening injuries.
–Do no harm.
–Never hesitate to contact paramedic backup or
medical control for guidance.

74. •Mechanism of injury is the way in which
traumatic injuries occur.
–It describes the forces (or energy transmission)
acting on the body that cause injury.
•Determine the mechanism of injury (MOI)
as quickly as possible.
–This will assist you in developing an index of
suspicion for the seriousness of your patient’s
unseen injuries.
Summary (1 of 12)

75. •Significant MOIs for adults include:
–Ejection from a vehicle
–Death of another person in the same vehicle
–A fall of greater than 15' to 20' or 3 times the
patient’s height
–Vehicle rollover
Summary (2 of 12)

76. •Significant MOIs for adults include (cont’d):
–High-speed (≥ 35 mph) vehicle crash
–Vehicle-pedestrian collision or motorcycle crash
–Unresponsiveness or altered mental status
following trauma
–Penetrating trauma to head, chest, or abdomen
Summary (3 of 12)

77. •Index of suspicion is concern for potentially
serious underlying and unseen injuries.
•Always maintain a high index of suspension
for serious unseen injuries.
•Three concepts of energy are typically
associated with injury: potential energy,
kinetic energy, and work.
•Traumatic injuries can be described as blunt
trauma or penetrating trauma.
Summary (4 of 12)

78. •In every crash, three collisions occur:
–Vehicle against another object
–Passenger against the interior of the vehicle
–Passenger’s internal organs against the body
•Motor vehicle crashes are classified
traditionally as frontal (head-on), rear-end,
lateral (T-bone), rollover, and rotational
(spins).
–Determine whether the passenger was restrained,
and note whether the air bag deployed.
Summary (5 of 12)

79. •In collisions involving a vehicle and a
pedestrian, the pedestrian is likely to have
unseen injuries.
–Estimate the speed of the vehicle.
–Determine whether the patient was thrown
through the air and at what distance or whether
the patient was struck and pulled under the
vehicle.
–Evaluate the vehicle for structural damage that
might indicate contact points with the patient.
Summary (6 of 12)

80. •In a vehicle-versus-bicycle collision:
–Evaluate MOI.
–Evaluate damage to and the position of the
bicycle.
–Assume spinal injury.
–If there is damage to the rider’s helmet, suspect
potential injury to the head.
Summary (7 of 12)

81. •When you are assessing the scene of a
motorcycle crash, note:
–Any deformity of the motorcycle
–The side with the most damage
–The distance of skid in the road
–The deformity of stationary objects or other
vehicles
–The extent and location of deformity in the
helmet
Summary (8 of 12)

82. •The injury potential of a fall is related to the
height from which the patient fell, the
surface of the impact, objects struck during
the fall, and the body part of first impact.
–The greater the height of the fall, the greater the
potential for injury.
•Penetrating trauma is classified as low
energy, medium energy, or high energy.
–A projectile that impacts the body may fragment
and cause cavitation.
Summary (9 of 12)

83. •Maintain a high index of suspicion for
serious injury in the patient who has:
–Been involved in a motor vehicle collision with
significant damage to the vehicle
–Fallen from a significant height
–Sustained a high-velocity penetrating trauma
injury
–You should also maintain a high index of
suspicion in the patient who is the victim of an
explosion or blast.
Summary (10 of 12)

84. •Multisystem trauma describes the condition
of a person who has been subjected to
multiple traumatic injuries involving more
than one body system.
–Recognize these patients and provide rapid
treatment and transportation.
•Limit on-scene time to the minimum amount
necessary to correct life-threatening injuries
and package the patient (platinum 10).
Summary (11 of 12)

85. •The type of transport needed will vary
based on the patient’s condition.
–Transportation options include EMS ground
transport or critical care transport.
•Determine the most appropriate destination
for trauma patients based on local
protocols.
–There are four levels of trauma centers in the
US: Levels I, II, III, and IV.
Summary (12 of 12)

86. Review
1.Kinetic energy is a calculation of:
A.weight and size.
B.weight and speed.
C.mass and weight.
D.speed and force.

87. Review
Answer: B.
Rationale: Kinetic energy is a calculation of
mass (weight) and velocity (speed). Energy
can neither be created nor destroyed, only
converted or transformed.

88. Review (1 of 2)
1.Kinetic energy is a calculation of:
A.weight and size.
Rationale: Weight is part of the formula, but
size would also mean weight.
B.weight and speed.
Rationale: Correct answer

89. Review (2 of 2)
1.Kinetic energy is a calculation of:
C.mass and weight.
Rationale: Weight is part of the formula, but
weight and mass are the same.
D.speed and force.
Rationale: Force is the product of mass times
acceleration, all part of Newton’s second law.

90. Review
2.A 20-year-old man has major open facial
injuries after his vehicle struck a tree head-
on. Which of the following findings within
the car would MOST likely explain his
injury pattern?
A.Deployed air bag
B.Bent steering wheel
C.Nonintact windshield
D.Crushed instrument panel

91. Review
Answer: C.
Rationale: The mechanism of injury and
condition of the vehicle’s interior suggest likely
areas of injury. Head and neck injuries are
likely to result when the head and face impact
the windshield.

92. Review (1 of 2)
2.A 20-year-old man has major open facial
injuries after his vehicle struck a tree head-
on. Which of the following findings within
the car would MOST likely explain his
injury pattern?
A.Deployed air bag
Rationale: This typically results in abrasions
of the face, head, and arms.
B.Bent steering wheel
Rationale: This typically indicates the
presence of chest injuries.

93. Review (2 of 2)
2.A 20-year-old man has major open facial
injuries after his vehicle struck a tree head-
on. Which of the following findings within
the car would MOST likely explain his
injury pattern?
C.Nonintact windshield
Rationale: Correct answer
D.Crushed instrument panel
Rationale: This typically indicates the
presence of leg and hip injuries.

94. Review
3.Which of the following would MOST likely
result from the third collision in the “three-
collision” effect that occurs during a high-
speed, frontal impact motor vehicle crash?
A.Extensive damage to the automobile
B.Flail chest and lower extremity fractures
C.Massive external trauma with severe bleeding
D.Aortic rupture or compression injury to the
brain

95. Review
Answer: D.
Rationale: During the third collision, the
body’s internal organs collide with the inside
of the body. These injuries are usually not as
obvious, but are often the most life
threatening. Injuries that may result from this
include internal injuries of the brain
(compression injuries) and aortic tears,
resulting in massive internal bleeding.

96. Review (1 of 2)
3.Which of the following would MOST likely
result from the third collision in the “three-
collision” effect that occurs during a high-
speed, frontal impact motor vehicle crash?
A.Extensive damage to the automobile
Rationale: This would occur in the first
collision.
B.Flail chest and lower extremity fractures
Rationale: This would occur in the second
collision.

97. Review (2 of 2)
3.Which of the following would MOST likely
result from the third collision in the “three-
collision” effect that occurs during a high-
speed, frontal impact motor vehicle crash?
C.Massive external trauma with severe bleeding
Rationale: This would occur in the second
collision.
D.Aortic rupture or compression injury to the
brain
Rationale: Correct answer

98. Review
4.A young male experienced severe blunt
chest trauma when his passenger car
struck another vehicle head-on. During
your inspection of the interior of his vehicle,
you would MOST likely find:
A.deployed air bags.
B.steering wheel deformity.
C.starring of the windshield.
D.a crushed instrument panel.

99. Review
Answer: B.
Rationale: Blunt chest injuries during a motor
vehicle crash typically occur when the chest
impacts the steering wheel. Therefore, your
inspection of the vehicle’s interior will most
likely reveal a deformed steering wheel.

100. Review (1 of 2)
4.A young male experienced severe blunt
chest trauma when his passenger car
struck another vehicle head-on. During
your inspection of the interior of his vehicle,
you would MOST likely find:
A.deployed air bags.
Rationale: Typically, this will cause abrasions
to the face, head, and arms.
B.steering wheel deformity.
Rationale: Correct answer

101. Review (2 of 2)
4.A young male experienced severe blunt
chest trauma when his passenger car
struck another vehicle head-on. During
your inspection of the interior of his vehicle,
you would MOST likely find:
C.starring of the windshield.
Rationale: Typically, this indicates the
presence of head, face, and neck injuries.
D.a crushed instrument panel.
Rationale: Typically, this indicates the
presence of leg and hip injuries.

102. Review
5.An unrestrained driver collided with a bridge
pillar. Upon inspection of the interior of his
vehicle, you note that the lower dashboard
is crushed. During your assessment of the
patient, you will MOST likely encounter:
A.trauma to the pelvis.
B.blunt abdominal trauma.
C.a severe closed head injury.
D.penetrating thoracic trauma.

103. Review
Answer: A.
Rationale: Impact points are often obvious
from a quick inspection of the vehicle’s
interior. During a frontal collision, the
unrestrained occupant’s knees often impact
the lower dashboard. With this type of impact,
energy is transferred from the knees, to the
femurs, and then to the pelvis or hip.

104. Review (1 of 2)
5.An unrestrained driver collided with a bridge
pillar. Upon inspection of the interior of his
vehicle, you note that the lower dashboard is
crushed. During your assessment of the
patient, you will MOST likely encounter:
A.trauma to the pelvis.
Rationale: Correct answer
B.blunt abdominal trauma.
Rationale: This is usually a result of striking
the steering wheel.

105. Review (2 of 2)
5.An unrestrained driver collided with a bridge
pillar. Upon inspection of the interior of his
vehicle, you note that the lower dashboard is
crushed. During your assessment of the
patient, you will MOST likely encounter:
C. a severe closed head injury.
Rationale: This is usually the result of striking the
windshield.
D. penetrating thoracic trauma.
Rationale: This is usually caused by flying debris,
collision with parts of the vehicle, or other
movable objects.

106. Review
6.Whiplash injuries are MOST common
following _________ impacts.
A.rear-end
B.rollover
C.frontal
D.lateral

107. Review
Answer: A.
Rationale: Whiplash injuries of the neck are a
common occurrence following rear-end
collisions. As the vehicle is suddenly thrust
forward, the occupant’s head is thrust
backward. Properly positioned headrests can
minimize the severity of whiplash injuries.

108. Review (1 of 2)
6.Whiplash injuries are MOST common
following _________ impacts.
A.rear-end
Rationale: Correct answer
B.rollover
Rationale: This typically causes life-
threatening injuries.

109. Review (2 of 2)
6.Whiplash injuries are MOST common
following _________ impacts.
C.frontal
Rationale: This typically causes chest, head,
abdominal, and extremity injuries.
D.lateral
Rationale: You should suspect lateral chest
and abdominal injuries on the side of impact,
as well as pelvic injuries.

110. Review
7.Death from a rollover motor vehicle crash
is MOST often secondary to:
A.crushing injuries.
B.air bag-related trauma.
C.multiple collisions to the interior of the car.
D.ejection of the patient from the motor vehicle.

111. Review
Answer: D.
Rationale: Rollover crashes are the most
unpredictable with regard to injuries sustained
by the patient. An unrestrained passenger
may have struck multiple points within the
vehicle. However, the most life-threatening
event in a rollover is ejection or partial ejection
of the patient from the vehicle.

112. Review (1 of 2)
7.Death from a rollover motor vehicle crash
is MOST often secondary to:
A.crushing injuries.
Rationale: These injuries occur during
ejection or partial ejection.
B.air bag-related trauma.
Rationale: Air bags significantly reduce the
risk of death in motor vehicle crashes.

113. Review (2 of 2)
7.Death from a rollover motor vehicle crash
is MOST often secondary to:
C.multiple collisions to the interior of the car.
Rationale: This makes the prediction of injury
patterns difficult but is not the most common
life-threatening event in a rollover.
D.ejection of the patient from the motor vehicle.
Rationale: Correct answer

114. Review
8.Severe abrasion injuries can occur when
motorcycle riders are slowed after a
collision by road drag. Road drag is most
often associated with which type of
motorcycle impact?
A.Head-on collision
B.Angular collision
C.Ejection
D.Controlled crash

115. Review
Answer: C.
Rationale: During an ejection, the rider will
travel at high speed until stopped by a
stationary object, another vehicle, or road
drag. Severe abrasion injuries (road rash)
down to bone can occur with drag.

116. Review (1 of 2)
8.Severe abrasion injuries can occur when
motorcycle riders are slowed after a collision by
road drag. Road drag is most often associated
with which type of motorcycle impact?
A.Head-on collision
Rationale: Road drag can occur in a head-on
collision but is more often associated with an ejection.
B.Angular collision
Rationale: Road drag can occur in an angular
collision but is more often associated with an ejection.

117. Review (2 of 2)
8.Severe abrasion injuries can occur when
motorcycle riders are slowed after a collision
by road drag. Road drag is most often
associated with which type of motorcycle
impact?
C.Ejection
Rationale: Correct answer
D.Controlled crash
Rationale: Road drag can occur in a controlled
crash but is more often associated with an
ejection.

118. Review
9.When assessing a stab wound, it is
important for the AEMT to remember that:
A.stabbings to an extremity are rarely
associated with an exit wound.
B.the majority of the internal trauma will be near
the path of the knife.
C.most stabbings are unintentional and cause
less severe internal injury.
D.more internal damage may be present than
the external wound suggests.

119. Review
Answer: D.
Rationale: With low-velocity penetrations,
injuries are caused by sharp edges of the
object moving through the body and are
therefore close to the object’s path. Weapons
such as knives, however, may have been
deliberately moved around internally, causing
more internal damage than the external
wound suggests.

120. Review (1 of 2)
9.When assessing a stab wound, it is
important for the AEMT to remember that:
A.stabbings to an extremity are rarely
associated with an exit wound.
Rationale: The question did not state that the
wound was to an extremity.
B.the majority of the internal trauma will be near
the path of the knife.
Rationale: This is true, but EMS providers
must have a high index of suspicion for
extended injuries due to movement.

121. Review (2 of 2)
9.When assessing a stab wound, it is
important for the AEMT to remember that:
C.most stabbings are unintentional and cause
less severe internal injury.
Rationale: Any stabbing that penetrates an
individual’s skin must be considered severe
until ruled out by a hospital physician.
D.more internal damage may be present than
the external wound suggests.
Rationale: Correct answer

122. Review
10.A 40-year-old man was standing near a building
when it exploded. He has multiple injuries,
including a depressed skull fracture, severe
burns, and an impaled object in his abdomen.
His head injury MOST likely occurred during the
___________ phase of the explosion.
A.blast
B.primary
C.secondary
D.tertiary

123. Review
Answer: D.
Rationale: Blast injuries are associated with
three phases: the primary (blast) phase, the
secondary phase, and the tertiary phase. During
the primary (blast) phase, ruptured eardrums and
hollow organ rupture are common. During the
secondary phase, impaled objects and shrapnel
injuries are common. The tertiary phase occurs
when the victim is thrown into a solid object,
resulting in blunt trauma to virtually any part of
the body.

124. Review (1 of 2)
10.A 40-year-old man was standing near a building
when it exploded. He has multiple injuries,
including a depressed skull fracture, severe
burns, and an impaled object in his abdomen.
His head injury MOST likely occurred during the
___________ phase of the explosion.
A.blast
Rationale: This is not nomenclature used in
describing one of the three phases of an
explosion.
B.primary
Rationale: This causes injury to the eardrums,
lungs, and hollow organs.

125. Review (2 of 2)
10.A 40-year-old man was standing near a building
when it exploded. He has multiple injuries,
including a depressed skull fracture, severe
burns, and an impaled object in his abdomen.
His head injury MOST likely occurred during the
___________ phase of the explosion.
C.secondary
Rationale: The common injuries in this phase are
caused by flying debris.
D.tertiary
Rationale: Correct answer

126. Credits
•Chapter Opener: © Mark C. Ide
•Background slide images: (yellow) © Mark
C. Ide; (dark blue, red) Courtesy of Rhonda
Beck.
•Review slide image: Courtesy of Rhonda
Beck