NREMT Trauma Flashcards

Question 1

Why cold makes trauma patients bleed more

Accepted Answer

Clotting enzymes and platelets work poorly as body temperature falls, and hypothermia joins acidosis and coagulopathy in a vicious cycle. Prevent heat loss from first contact: cover, warm, warm fluids.

Question 2

Uncal herniation pupil

Accepted Answer

Dilated, sluggish pupil on the SAME side as the lesion (CN III compression), often with contralateral weakness and posturing.

Question 3

Lucid interval then rapid decline after a blow to the temple?

Accepted Answer

Epidural hematoma — arterial bleeding, often from the middle meningeal artery. Slow decline over days suggests subdural.

Question 4

Avulsed tooth

Accepted Answer

Handle by the crown only. Do not scrub the root. Keep moist in milk or saline and transport with the patient.

Question 5

Needle decompression sites and limits

Accepted Answer

2nd ICS at/lateral to midclavicular line (medial = heart, great vessels) OR 4th–5th ICS anterior axillary line, not below the nipple line (diaphragm). Go over the top of the rib.

Question 6

Lap-belt sign across the abdomen

Accepted Answer

The belt is the fulcrum: hollow organ rupture plus a lumbar flexion-distraction injury. Two injuries, one bruise.

Question 7

Obstructive shock: causes and fix

Accepted Answer

Tension pneumothorax, cardiac tamponade, massive PE: blood flow physically blocked, so output falls despite a full tank. Fluids only buy time; the cure is relieving the obstruction.

Question 8

Field triage 2021 — red vs yellow

Accepted Answer

Red: injury patterns (penetrating torso, pelvic fx, flail/chest instability, proximal amputation) + abnormal mental status/vitals. Yellow: mechanism (ejection, fall >10 ft, death in compartment).

Question 9

Proximal humeral IO: arm position and landmark?

Accepted Answer

Arm against the body, elbow bent, hand on the abdomen; insert into the greater tubercle angled toward the opposite hip.

Question 10

Traumatic aortic injury clues

Accepted Answer

High-speed deceleration, chest or back pain, BP or pulse difference between arms or arms vs legs, hoarseness. Avoid raising BP, limit fluid, rapid transport to a trauma center.

Question 11

Narrowing pulse pressure in hemorrhage

Accepted Answer

Vasoconstriction raises diastolic pressure while stroke volume falls, so pulse pressure narrows before systolic drops. An early sign of compensated hemorrhagic shock.

Question 12

Crush injury: danger at release

Accepted Answer

Reperfusion washes potassium, myoglobin and acid into circulation: sudden hyperkalemic arrest and kidney injury. Monitor ECG, give IV fluid before release, watch for peaked T waves.

Question 13

TBI secondary insults to prevent

Accepted Answer

Hypoxia (SpO2 <90%), hypotension (peds: SBP <70 + 2×age), hyperventilation (keep EtCO2 35–45 unless herniation signs). A single episode worsens outcome.

Question 14

Incomplete cord syndromes

Accepted Answer

Central: arms > legs, hyperextension, older adults. Anterior: motor + pain/temp lost, position sense kept. Brown-Sequard: same-side motor, opposite-side pain/temp.

Question 15

Estimating a patchy burn

Accepted Answer

The patient's own palm is about one percent of their body surface. The rule of nines assumes whole regions and overestimates a scattered pattern.

Question 16

Hyperventilation in TBI: the cost

Accepted Answer

Low CO2 constricts cerebral vessels, lowering ICP but also cutting brain blood flow. Reserve brief controlled hyperventilation for signs of herniation, guided by ETCO2; otherwise ventilate to normal.

Question 17

Junctional bleeding

Accepted Answer

Pack the wound and hold pressure on the packing — a tourniquet cannot get proximal.

Question 18

Compartment syndrome positioning and pulses

Accepted Answer

Keep limb at heart level (elevation cuts inflow). Loosen constricting splints. A pulse does not rule it out — pulselessness is late.

Question 19

Why the pulse pressure narrows first

Accepted Answer

Vasoconstriction lifts the diastolic while a falling stroke volume holds the systolic down. It narrows before the systolic ever falls.

Question 20

Amputated part care

Accepted Answer

Control stump bleeding first. Rinse debris, wrap in saline-moist sterile gauze, seal in a plastic bag, place bag in ice water. Never directly on ice or immersed.

Question 21

Compartment syndrome — the early signs

Accepted Answer

Pain out of proportion and pain on passive stretch, while the pulse is still THERE. A pulseless limb is late. Do not elevate above the heart and do not ice it.

Question 22

Permissive hypotension — endpoints

Accepted Answer

Torso bleed, no TBI: titrate small boluses to radial pulse + improving mentation, not normal BP. Higher pressure dislodges clots and dilutes factors. Not used with TBI.

Question 23

Electrical burns

Accepted Answer

Skin wounds underestimate deep muscle injury -> rhabdo, compartment syndrome, dysrhythmia. Monitor ECG; formulas underestimate fluid needs.

Question 24

Smoke inhalation: hidden poisons

Accepted Answer

CO: pulse ox falsely normal; give high-flow O2. Cyanide: altered, hypotensive, lactic acidosis; hydroxocobalamin binds it to cyanocobalamin.

Question 25

Splint as found vs realign

Accepted Answer

Joints: splint as found. Angulated long-bone shaft: gentle in-line traction toward alignment. Check distal pulse, motor and sensation before and after.

Question 26

Hemothorax vs tension pneumothorax: percussion

Accepted Answer

Both reduce breath sounds on one side. Hemothorax is dull to percussion with flat neck veins if blood loss is large; tension pneumothorax is hyperresonant, often with JVD and hypotension.

Question 27

Traumatic cardiac arrest — what actually helps

Accepted Answer

Fix the mechanical cause: stop the bleeding, oxygenate and ventilate, decompress a tension, give volume, compress while you do it. The rhythm on the monitor is not the question.

Question 28

Blunt cardiac injury: ECG clues

Accepted Answer

Unexplained sinus tachycardia, PVCs, new right bundle branch block, atrial fibrillation or ST changes after blunt chest trauma. Monitor continuously and obtain a 12-lead.

Question 29

The four phases of blast injury

Accepted Answer

Primary = the pressure wave on gas-filled organs (lung, bowel, ear). Secondary = flying fragments. Tertiary = the body thrown. Quaternary = burns, toxic gas, crush from collapse.

Question 30

TBI: the two secondary insults to prevent

Accepted Answer

Hypoxia (SpO2 < 90%) and hypotension (SBP < 90). A single episode of either raises mortality. Keep EtCO2 35–40 unless herniating.

Question 31

Why decompression fails

Accepted Answer

Catheter too short for the chest wall (most common), kinking, clotting or dislodgement. No rush of air in a large patient does not exclude tension — retry at the lateral site.

Question 32

Neurogenic vs hemorrhagic shock

Accepted Answer

Neurogenic: warm, dry, bradycardic, hypotensive — sympathetic tone lost. Hemorrhagic: cool, pale, tachycardic. Exclude bleeding before you accept a neurogenic cause.

Question 33

Beck's triad

Accepted Answer

Hypotension, distended neck veins, muffled heart tones — and breath sounds stay EQUAL, because the lungs are untouched. That equality is what separates it from a tension.

Question 34

Driver-side lateral impact — expected injuries

Accepted Answer

Left chest wall and ribs, spleen, lateral pelvis, lateral neck flexion. Intrusion into the compartment raises suspicion further.

Question 35

Hypotension with an 'isolated' head injury

Accepted Answer

Look elsewhere. An isolated brain injury does not drop the pressure until very late.

Question 36

Fat embolism — when to think of it

Accepted Answer

A day or two after a long-bone fracture: hypoxia, confusion and a petechial rash over the chest and axillae. The rash is what separates it from a venous clot.

Question 37

Smoke inhalation: cyanide clues and antidote

Accepted Answer

Altered, hypotensive or in arrest after enclosed-space fire, with high lactate despite good SpO2. Cyanide blocks cellular oxygen use. Antidote: hydroxocobalamin; give high-flow oxygen too.

Question 38

Why a neck wound gets an occlusive dressing

Accepted Answer

The neck veins sit above the heart and go negative on inspiration — an open one can suck air in and embolize it. Occlusive cover plus direct pressure, and never compress both sides.

Question 39

Tension vs hemothorax vs tamponade

Accepted Answer

Tension: hyperresonant, absent sounds, JVD. Hemothorax: dull, absent sounds, flat veins. Tamponade: equal sounds, muffled tones, JVD, pulsus paradoxus.

Question 40

Pelvic binder — where it sits and why

Accepted Answer

Center over the greater trochanters, not the iliac crests. Don't re-rock an unstable pelvis; minimize log-rolls.

Question 41

Trauma in late pregnancy

Accepted Answer

Supine, the uterus compresses the vena cava and the pressure drops. Tilt or manually displace the uterus to the left. Resuscitating the mother is how you resuscitate the fetus.

Question 42

Burn fluid concepts

Accepted Answer

Count partial + full thickness only. Half of 24-h estimate in first 8 h FROM TIME OF BURN. Titrate to urine output; avoid 'fluid creep'.

Question 43

Crush syndrome threats and treatment classes

Accepted Answer

Release floods K+, acids, myoglobin -> dysrhythmia, arrest, kidney failure. Fluid before release; calcium, bicarbonate, beta-2 agonist for hyperkalemia.

Question 44

Electrical injury — the hidden path

Accepted Answer

The entry and exit wounds are the smallest part. Everything between them is injured: dysrhythmia and muscle breakdown are the real threats.

Question 45

Shock index

Accepted Answer

HR ÷ SBP. > 1.0 suggests significant hemorrhage even with a 'borderline' BP. Beta-blockers and age blunt the heart-rate response.

Question 46

Distributive shock: hemodynamic signature

Accepted Answer

Low vascular resistance with blood pooling: early warm, flushed skin and wide pulse pressure. Septic, anaphylactic and neurogenic shock. Needs fluid plus cause-specific treatment or vasopressors.

Question 47

Traumatic asphyxia — what it looks like

Accepted Answer

Chest compressed for minutes: deep blue-purple swollen face and neck, pinpoint hemorrhages in the skin and eyes, and a sharp line where the load stopped. Blood forced backward out of the chest.

Question 48

Bagging a hypovolemic trauma patient too hard

Accepted Answer

Each breath raises intrathoracic pressure and steals the preload the patient is already short of. Fast, big breaths drop the pressure further. Slow down and use smaller volumes.

Question 49

Trauma arrest: what comes before compressions

Accepted Answer

Fix reversible causes first: hemorrhage control, bilateral decompression, oxygenation, volume. Compressions can't fill an empty or obstructed heart.

Question 50

Hyphema

Accepted Answer

Blood in the front chamber after blunt eye trauma. Elevate the head, rigid shield without pressure, limit eye movement.

Question 51

Spinal shock vs neurogenic shock

Accepted Answer

Spinal shock: temporary loss of reflexes/tone below injury. Neurogenic shock: loss of sympathetic tone → hypotension, bradycardia, warm dry skin.

Question 52

Needle decompression — key points

Accepted Answer

2nd ICS midclavicular or 4th–5th ICS anterior/mid-axillary; over SUPERIOR rib border (bundle runs under the rib). Secure catheter; reassess — it can kink and tension recurs.

Question 53

Tension pneumothorax vs tamponade

Accepted Answer

Both raise venous pressure and drop output. Tension gives ABSENT breath sounds on one side; tamponade leaves them intact.

Question 54

Hip fracture vs posterior hip dislocation

Accepted Answer

Fracture: shortened + externally rotated. Posterior dislocation: shortened, flexed, adducted, internally rotated. Splint the dislocation as found; no traction splint.

Question 55

Long lie after a fall

Accepted Answer

Tea-colored urine and weakness after hours on the floor = muscle breakdown. AEMT: IV isotonic fluid per protocol, watch for high potassium effects.

Question 56

Antifibrinolytic in hemorrhage

Accepted Answer

Blocks plasminogen → plasmin, so formed clots aren't broken down. Time-sensitive: benefit is greatest early after injury.

Question 57

Older adult trauma — hidden shock

Accepted Answer

Beta blockers blunt tachycardia; a 'normal' BP may be low for a hypertensive patient; anticoagulants turn minor falls into major bleeds.

Question 58

Compartment syndrome: early vs late

Accepted Answer

Early: pain out of proportion, pain on passive stretch, tense compartment. Late: pallor, paralysis, pulselessness. A pulse does not exclude it.

Question 59

Kehr's sign

Accepted Answer

Left shoulder-tip pain from blood irritating the diaphragm — think splenic injury after LUQ trauma.

Question 60

Falling end-tidal CO2 in a bleeding patient

Accepted Answer

With ventilation unchanged, it tracks pulmonary blood flow — so it falls as cardiac output falls. In hemorrhage the capnograph is a perfusion monitor, not just an airway one.

Question 61

The lethal triad

Accepted Answer

Hypothermia · acidosis · coagulopathy. Each worsens the other two — keep the patient WARM.

Question 62

Secondary brain injury

Accepted Answer

Hypoxia and hypotension. The impact is done; these are the parts you can still prevent.

Question 63

Signs of inhalation injury

Accepted Answer

Singed nasal hair, soot, hoarseness, facial burns. Swelling is progressive — the window closes.

Question 64

The base of the neck, below the cricoid

Accepted Answer

Continuous with the thoracic inlet: subclavian and carotid vessels, trachea, lung apex. Bleeding there may not be compressible at all.

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