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Which of the following most accurately describes the finding of jugular venous
distension in pneumothorax?
It is an early finding of even minor pneumothoraxes
It indicates relative hypovolemia in the thorax due to hemorrhage
It is indicative of high intrathoracic pressure
Pneumothorax is more likely to cause jugular vein flattening
JVD is typically a sign of increased intrathoracic pressure, but can be a very late finding. It presents when increased pressure on the great vessels in the thorax cause a backup of blood returning from the head. This typically presents in serious tension pneumothoraxes and does not appear in minor cases.
Beck’s triad is a combination of increased JVD, hypotension and muffled heart
tones and occurs in which of the following?
Traumatic brain injury
Beck’s triad is observed in cases of cardiac tamponade and is caused by the increase in pressure in the pericardial sac, which, in turn, causes the inability of the ventricles to expand fully. This results in hypotension systemically and a backup of blood in the jugular veins.
Upon arrival to the scene of a stabbing, you find a patient with a stab wound to
the left chest, midclavicular, 4th intercostal space. The patient is in peri-arrest, hypotensive, with a rapid, thready pulse and jugular venous distension. The
patient’s GCS score is 3. You perform bilateral needle decompression, but there is no rush of air or improvement in patient’s condition. The patient no longer has a pulse and now presents in PEA. Which of the following is suspected in assessing the patient?
Answer: D -Hypotension presenting with JVD and clear mechanism of traumatic injury is highly suspect for pericardial tamponade. Consideration for a hemothorax, pneumothorax, or hemopneumothorax should be made and can be differentiated by considering location of penetrating trauma, presence of Beck’s triad and clinical suspicion. Cardiac rupture is almost entirely caused by blunt force trauma, particularly in MVAs.
Other than rapid transport to a trauma center, which of the following is most
helpful for a patient suffering from pericardial tamponade?
Positive pressure ventilation therapy
Aggressive IV fluid administration
Remote ischemic conditioning
The best prehospital treatment for patients with pericardial tamponade is to maintain vital signs and keep perfusion up. Oxygenation is typically not a problem for these patients, but the increase in pressure around the heart requires that adequate preload be maintained.
Which type of mechanism of injury is not likely in patients with posterior rib
fractures of the second and third ribs?
Compression of the ribcage from the side
Relatively high force impact
All of the above.
Frontal impacts are more likely to cause lateral fractures, not posterior fractures. Posterior second and third rib fractures are usually a result of high velocity side impact to the chest. The first, second, and third ribs in healthy adults are strong and require a high degree of force to fracture. When posterior fractures do occur, it is usually from side impact.
You are called to the scene of an elderly patient female who slipped and fell, landing on her chest. She complains of dyspnea and chest pain that increases with
inspiration and palpation. She states that her symptoms are much better when she holds pressure on her left side. What is the most likely cause of her symptoms?
Hypovolemia from hip fracture
This patient likely has a fractured rib. Elderly patients are more vulnerable to rib fractures due to their bones becoming more brittle with age. The presentation of mild dyspnea with improvement in symptoms when being held is very typical of rib fractures.
You are called to the scene of an elderly patient female who is displaying classic
symptoms of a fractured rib. The patient’s GCS level is 15, oxygen saturation on room air is 93%. Heart rate is 112, blood pressure is 142/102. What is the most appropriate course of treatment for this patient?
Use rib binders for comfort, apply high flow O2, transport to a trauma center
Apply supplemental O2 via nasal cannula, monitor for ventilatory changes, transport to a trauma center
Bind the ribs for comfort, apply nebulized albuterol for dyspnea, give 324mg aspirin for chest pain, transport to a trauma center
Give nitroglycerine 0.4mg sublingual for chest pain, apply high flow O2, transport to a cardiac center
The optimal treatment for patients with broken ribs includes supplemental O2 as needed and monitor for changes during transport to trauma center. C-spine precautions should be considered per protocol. The use of chest binders is contraindicated as it can result in hypoventilation. This patient should receive an assessment for cardiac chest pain, but this etiology is unlikely given the mechanism of injury and nature of complaints.
Flail chest occurs when a segment of the rib cage is broken and detached
following trauma. This typically presents as a section of the rib cage moving out of sync and independent of from breathing motions. What is this phenomenon called?
Paradoxic chest wall movement
This pattern of chest wall movement is called paradoxic chest wall movement. This paradoxical movement causes significant pain and dyspnea and is usually accompanied by a pulmonary contusion, the latter of which and can lead to respiratory compromise.
What is the best management for a patient with flail chest who is deteriorating and developing severe respiratory distress?
Analgesia to reduce the pain of respiration
Needle thoracostomy to reduce internal pressure
Encouragement to hold their breath to increase the internal pressure
CPAP or positive pressure by BVM to internally splint the injury
Patients that are starting to develop severe respiratory distress require ventilation assistance in order to avoid complete respiratory compromise. By applying positive airway pressure carefully, the flail segment can become splinted internally, allowing for better ventilation. Analgesics would have been more applicable before a patient reaches this point. Needle thoracostomy would not help this patient.
Medical NREMT-PTE Exam (NREMT Paramedic Trauma Exam) Detailed Information
NREMT-PTE NREMT Paramedic Trauma Exam
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NREMT Paramedic Trauma Exam certification
EMT and Paramedic | NREMT-PTE Real Questions and VCE Practice Test
EMTs and paramedics are emergency scientific first responders, that means that they are always the primary on the scene of an accident. when you are interested in fitting an EMT or paramedic, you are going to need to meet formal practising and licensure necessities - keep analyzing to gain knowledge of greater.
Emergency scientific technicians (EMTs) and paramedics perform a must have scientific tactics with the intention to retailer lives. they are dispatched to the scene of a scientific emergency and provide care while transporting the patient to a hospital or other scientific facility. workers in this field fall into three classes: EMT-basic, EMT-Intermediate or EMT-Paramedic. you can explore the academic necessities and profession chances during this box by exploring study.com.
schooling and practising alternatives
EMT-simple (EMT-B) practicing lessons are often accessible via group schools and universities. type themes usually encompass human anatomy, affected person evaluation strategies and respiratory care. hands-on practising in an ambulance is constantly required. Most EMT-primary training lessons are designed to prepare students for certification during the country wide Registry of Emergency scientific Technicians (NREMT).
EMT-Intermediate (EMT-I) working towards courses may additionally ultimate from 3-6 months. standard classes consist of trauma injuries, pharmacology and airway administration innovations. EMT-Paramedic (EMT-P) classes frequently take 1-2 years to complete and might lead to an associate's degree. scientific practicums in an ambulatory setting are required in each the EMT-I and EMT-P program. each classes prepare people for the respective NREMT certification tests.
here pages give more suggestions on schooling alternatives for EMTs and paramedics.
online alternate options
Some programs offer EMT or paramedic training in part on-line, with required in-adult field experiences. Listed below is counsel about courses and classes so that you can comprehensive from your personal domestic.
in addition to completing practicing, all EMTs and paramedics ought to be licensed. appear over the pages beneath to study greater about licensing necessities.
career alternate options
Job titles vary based on your practicing. read the articles under to learn concerning the quite a few forms of emergency medical employees and the cures they may be qualified to give.
Employment Outlook and profits suggestions
based on the U.S. Bureau of Labor facts (BLS), the variety of employed EMTs and paramedics changed into expected to increase with the aid of 23% from 2012-2022, which is vastly quicker than general. EMTs and paramedics earned an average yearly income of $34,870 as of may additionally 2013, as stated through the BLS.
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