10 free EMT practice questions: Head, Spinal & Nervous System Trauma

Apply restriction, since any collision mechanism requires it: Restricting every patient after any collision is the older, mechanism-based standard. Selective spinal criteria replaced that standard. This patient's whole exam is negative: alert, sober, no tenderness, and no deficits. A clean exam already answers the concern the mechanism raises, so the mechanism alone does not change the decision.

Apply a cervical collar for comfort only: With no neck complaint and no midline tenderness, there is no pain for a collar to relieve. A collar on a patient who meets every clearance criterion is restriction this patient does not need.

Withhold restriction only if neck range of motion is also pain-free: The prehospital criteria do not include a neck range of motion check, and this patient already meets every item in them. Adding a step the criteria never had keeps a cleared patient restricted for nothing. That step belongs to other clearance rules, like the Canadian C-Spine Rule.

Prevent the patient from opening the eye and cover it with a sterile eye pad; transport immediately without irrigation: Covering a painful eye and leaving fast can look like the safe move when the hospital is only 8 minutes away. The chemical is still on the cornea during the whole ride, and it keeps burning. A patch without irrigation protects nothing. Irrigation has to start now and keep going on the way.

Apply a topical anesthetic ointment to reduce pain so the patient can open the eye for examination: Numbing the eye would help if you needed the patient to open the eye for an exam. Topical anesthetics are outside EMT scope. A numbing ointment treats the pain from the splash, not the chemical burning the cornea, and it delays the irrigation that limits the injury.

Call poison control to identify the chemical before irrigating, as irrigation may worsen certain exposures: Calling poison control first sounds careful, because a few chemicals react with water. Irrigation is still safe with nearly every chemical in the eye. While you wait on the phone, an unknown acid or alkali keeps damaging the cornea. Call poison control on the way, after irrigation has started.

Have the patient swallow to clear blood and debris, then place him supine with his head turned to one side for transport: With the gums still bleeding and blood still pooling, swallowing blood risks vomiting and aspiration. Lying the patient supine with the head turned lets blood pool in the back of the throat instead of draining forward.

Attempt to remove the loose teeth and place them in a container of saline for potential replantation: These two front teeth are loose, not knocked out. Pulling them out makes a new place to bleed and takes your attention off the airway. Saline for replantation is for a tooth already knocked out of its socket, and loose teeth stay where they are.

Pack the mouth firmly with gauze to absorb blood and stabilize the loose teeth in place: Inside the mouth, firm packing can push the loose teeth further out of their sockets or back into the throat. The packing also blocks your view of the mouth, and you need that view to suction.

Leave the tooth where it fell so the fragile root is not damaged by handling, and have the family retrieve it for the dentist after transport: Leaving the tooth on the floor lets the tooth dry out. Dry periodontal ligament cells on the root die within 15 to 30 minutes. Picking the tooth up gently by the crown does not damage the root. Save the tooth and bring it with the patient.

Scrub the tooth clean under running tap water while holding it by the root, then place it back into the socket and have the patient bite on gauze: Scrubbing the tooth and holding it by the root both kill the periodontal ligament cells. Those cells are what a successful reimplant depends on. Handle the tooth by the crown and rinse it gently. Never scrub a knocked out tooth.

Wrap the tooth in dry sterile gauze inside a container and transport it with the patient, since the tooth remains viable for up to 4 hours when dry: A dry tooth loses its root cells fast. In dry gauze, the tooth lasts about 15 to 30 minutes, not 4 hours. Saline or milk keeps the root cells alive much longer during transport.

Gently pack sterile gauze into the ear canal to seal off the drainage pathway and prevent further loss of cerebrospinal fluid: Sterile gauze packed into the ear canal seals off the path the CSF is draining through. Sealing off CSF drainage can raise the pressure inside the skull and make the patient's neurological status worse. CSF drainage is never packed or blocked.

Apply direct manual pressure over the external ear, as for any external bleeding, until the drainage slows and stops: Direct pressure is how you control external bleeding. Clear fluid from the ear after a head injury is not bleeding. Holding pressure over the ear traps the fluid the same way packing does, and the pressure inside the skull goes up.

Irrigate the ear canal gently with normal saline to flush away debris and reduce the risk of infection during transport: Irrigating with saline is a way to flush debris out of an ear. This ear canal is an open path into the skull. Flushing saline into the canal brings in an infection risk, and irrigation is not part of managing CSF drainage.

Have the patient tilt the head back and apply pressure to the bridge of the nose: Tilting the head back drains blood straight into the back of the throat, and this patient already has blood running down the throat. That turns a bleed you can control into an airway problem. The pressure also belongs on the soft part of the nose below the bony bridge, where the bleeding vessels are.

Have the patient lie flat and apply ice to the forehead: Flat on the back is the worst position for an alert patient with an actively bleeding nose. Gravity carries the blood toward the airway instead of out of the nose. Ice on the forehead does nothing for the bleeding site or the airway.

Pack the nostrils tightly with gauze to stop the bleeding before transport: Packing is not an EMT skill. After a blow to the face, packing can push material where it does not belong if there is a fracture of the face or skull. The ED packs a nose when direct pressure will not stop the bleeding, or when the bleeding comes from the back of the nose.

Immobilize the jaw with a tight circumferential bandage to prevent any movement: A tight bandage holds the mouth shut on a patient who is already drooling and finds swallowing painful. Vomiting is common after facial trauma because patients swallow blood. If this patient vomits, the bandage keeps the mouth closed, and you have to cut the bandage off before you can suction. A jaw bandage is only for a fully alert patient with an open airway and no active bleeding.

Position the patient upright and encourage speaking to ensure the airway is open: Making the patient keep talking moves a painful, unstable jaw over and over. Talking also raises the risk of breathing in pooled saliva. Sitting upright helps blood and saliva drain forward, and you can check the airway just by watching the patient breathe.

Apply ice packs to reduce swelling, then transport without additional jaw support: The danger here is an unstable jaw over the next few minutes, and ice only slows swelling that builds over the next hour. Option D also transports the patient without any jaw support. If this patient's mental status drops on the way, nothing is holding the tongue forward.

Hands placed under the patient's chin and supporting the jaw: Hands on the jaw are how you do a jaw-thrust, the airway maneuver for a patient with a possible spine injury. Hands on the jaw alone cannot stop the skull from turning. Pressure under the chin can also push soft tissue into the airway when the face is injured. Opening the airway and holding the head still are separate jobs.

Hands grasping the patient's shoulders while using the arms to immobilize the head: Gripping the shoulders and squeezing the head between the forearms is a bracing hold used for a standing takedown or a seated rapid extrication. The hands are on the shoulders, so the hold controls the torso and not the skull. The head can still turn between the forearms.

One hand on the forehead, one hand on the occiput, applying gentle traction: A hand on the forehead and one on the back of the head controls the head tipping forward and back. That hold leaves turning and side bending free, and those are the movements this question asks about. Adding traction is also wrong, because pulling on the head can pull apart an unstable spine. Current teaching calls for neutral stabilization with no pulling force.

Stop the log-roll immediately and turn the patient's head to the side to allow vomit to drain: Turning the head to the side can drain vomit in a patient with no suspected spine injury. This patient has a suspected spinal cord injury, and the body is being held in line during the roll. Turning the head by itself against the body is the exact motion in-line stabilization is there to prevent. Rolling the whole patient as a unit drains the vomit just as well.

Pause the roll, apply a cervical collar to secure the airway, and then resume movement: A cervical collar is part of spinal motion restriction, and it limits how much the neck moves. A collar does not clear the airway or suction vomit. Stopping in the middle of the roll to put one on delays airway care while the patient is still vomiting.

Call for paramedics to intubate the patient before continuing care: Intubation can protect an airway, but it is outside EMT scope. Waiting for paramedics leaves vomit sitting in the airway right now. Suction and the roll are the tools you have.

The patient has a corneal abrasion that can be managed with a protective eye covering during routine transport: A corneal abrasion is a scratch on the surface of the eye. A corneal abrasion causes pain, tearing, and a feeling like something is in the eye. A scratch on the eye does not make the pupil bigger or slow its reaction to light. A pupil difference after head trauma is coming from inside the skull, not from the surface of the eye.

The pupil difference reflects physiologic anisocoria, which occurs naturally in a portion of the population: Physiologic anisocoria is real. Some healthy people have pupils that are slightly different sizes. You cannot make that call in the field on a patient with a fresh head injury. Treat a pupil that is newly unequal and sluggish after head trauma as a brain injury until the hospital proves otherwise.

The patient needs serial pupil checks, with transport upgraded only if both pupils become fixed and dilated: Repeat pupil checks are a good idea on this patient. Waiting for both pupils to become fixed and dilated means waiting for a late sign of herniation. The change in one pupil is already the early warning. This patient needs urgent transport now.