Trauma Scene Size-Up and Survey - NREMT AEMT Level

1. Identify the correct priority when both airway compromise and uncontrolled massive bleeding are present.

   Control exsanguinating hemorrhage first (X), then airway. In trauma protocols, controlling massive external hemorrhage takes precedence to prevent rapid blood loss before securing the airway.

2. Which assessment is part of circulation in the primary survey besides hemorrhage control?

   Assess pulse, skin signs, and signs of shock. These assessments evaluate perfusion and detect hypovolemic shock early, guiding fluid resuscitation and transport decisions.

3. In XABCDE, what does the "X" represent and what is the immediate action?

   Exsanguinating hemorrhage; control bleeding immediately. X prioritizes stopping massive external bleeding to prevent rapid exsanguination before addressing airway or other components.

4. Which condition is a classic contraindication to nasopharyngeal airway placement in trauma?

   Suspected basilar skull fracture or severe facial trauma. These conditions risk intracranial insertion of the NPA due to disrupted anatomy, potentially worsening brain injury.

5. What is the correct initial airway approach for a trauma patient with possible spinal injury?

   Manual in-line stabilization and jaw-thrust maneuver. This approach maintains cervical spine alignment while opening the airway without hyperextension in suspected spinal trauma.

6. Which airway adjunct is typically used when the patient has an intact gag reflex?

   Nasopharyngeal airway (if not contraindicated). NPA is tolerated in conscious or semi-conscious patients with a gag reflex, providing airway support without triggering vomiting.

7. Identify the correct action when direct pressure fails to control severe extremity bleeding.

   Apply a tourniquet proximal to the wound. A tourniquet occludes arterial flow to stop life-threatening hemorrhage when simpler methods fail.

8. What does the "E" (exposure) step require during the primary survey?

   Expose to find injuries and prevent hypothermia. Full exposure allows identification of hidden injuries, while covering prevents heat loss in vulnerable trauma patients.

9. Which finding in size-up most strongly indicates the need for additional resources early?

   Multiple patients or a patient needing extrication. These scenarios often exceed a single responder's capacity, requiring extra personnel or equipment for safe and effective management.

10. What does BSI stand for, and when should it be applied during a trauma call?

    Body substance isolation; before patient contact. BSI protects against infectious exposure by using barriers like gloves and masks prior to any potential contact with bodily fluids.

11. Identify the correct intervention for a trauma patient who is apneic with a pulse.

    Provide ventilations with a BVM and high-flow oxygen. Apnea requires assisted ventilation to oxygenate and ventilate the patient while maintaining circulation.

12. Which mental status scale is commonly used for rapid disability assessment in trauma?

    AVPU (or GCS if time allows). AVPU provides a quick mental status evaluation, with GCS used for more detailed assessment when feasible.

13. Identify the correct decision: unstable trauma patient with life threats found in primary survey.

    Treat immediate threats and prioritize rapid transport. Immediate threats must be stabilized minimally before expedited transport to a trauma center for definitive care.

14. Which bleeding control method is preferred first for severe extremity hemorrhage?

    Direct pressure (then tourniquet if uncontrolled). Direct pressure is the initial method as it effectively controls most bleeding without causing further tissue damage.

15. Which airway adjunct is generally contraindicated when a gag reflex is present?

    Oropharyngeal airway (OPA). Presence of a gag reflex indicates potential for vomiting or aspiration if an OPA is inserted, making it unsafe.

16. What is the immediate intervention for an open chest wound found during the breathing assessment?

    Apply an occlusive dressing and monitor for tension PTX. An occlusive dressing seals the wound to prevent air entry while monitoring avoids complications like tension pneumothorax.

17. Which airway adjunct is appropriate for an unconscious trauma patient without a gag reflex?

    OPA (with spinal precautions as indicated). OPA maintains airway patency in unconscious patients lacking a gag reflex, with precautions to avoid spinal movement.

18. What is the primary goal of the trauma primary survey?

    Identify and treat immediate life threats rapidly. The primary survey focuses on quickly detecting and addressing conditions that could lead to immediate death if untreated.

19. Which action best prevents trauma-induced hypothermia after exposure?

    Cover patient, warm environment, and warm IV fluids if used. These measures maintain core body temperature, as hypothermia exacerbates coagulopathy and worsens outcomes in trauma.

20. Which option best describes when spinal motion restriction should be initiated in trauma?

    When MOI or exam suggests possible spinal injury. Spinal precautions are applied based on injury mechanism or clinical signs to prevent further neurological damage.

21. Which action is the first priority in a trauma scene size-up before approaching the patient?

    Ensure scene safety (identify and mitigate hazards). Scene safety is prioritized to prevent additional injuries to responders and patients before any assessment or intervention begins.

22. Which sequence is used for the trauma primary survey assessment priorities?

    XABCDE (or ABCDE with c-spine control). This mnemonic ensures systematic evaluation of life-threatening issues in trauma, starting with hemorrhage control if applicable.

23. What is the primary purpose of determining the mechanism of injury (MOI) during size-up?

    Predict injury patterns and guide priorities/resources. MOI evaluation helps anticipate potential injuries based on forces involved, allowing for efficient resource allocation and focused care.

24. Which lung sound finding during the primary survey is most concerning for pneumothorax?

    Unilateral decreased or absent breath sounds. This finding suggests air accumulation in the pleural space compressing the lung, requiring prompt intervention to restore ventilation.

25. Identify the correct action when gurgling respirations are heard during airway assessment.

    Suction the airway immediately. Gurgling indicates fluid obstruction, and suction clears the airway to restore patency and prevent aspiration.

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