10 free EMT practice questions: Orthopedic, Soft-Tissue & Burn Trauma

Place the amputated fingers directly into a container of ice: Fingers put right into ice freeze. Ice crystals form inside the cells and break them, and the surgeon gets frostbitten fingers that cannot be reattached. The cold has to reach the fingers through gauze and a sealed bag.

Submerge the amputated fingers in room-temperature water: Room-temperature water does not cool the fingers at all. The tissue keeps using oxygen at full speed with no blood supply. Soaking also waterlogs the tissue and makes it soft, and soft, waterlogged tissue is harder for the surgeon to work with.

Leave the amputated fingers uncovered in a warm location: Warmth speeds up the breakdown of tissue that already has no blood supply. Leaving the fingers uncovered also lets germs onto a surface the surgeon will have to close. Keeping warm is the right care for the patient. The fingers need the opposite.

Allow the water rinse to continue immediately: This chemical is a dry powder, and water poured onto dry powder can set off a reaction that makes heat. The water also washes the powder over more skin than it first touched. Flushing right away is for a liquid splash, where every second you wait is more time the chemical sits on the skin.

Apply a neutralizing agent before irrigating: Neutralizing agents belong in a lab and in hazmat planning, not in patient care in the field. A neutralizing reaction gives off heat, so it adds a thermal burn on top of the chemical burn. Looking for the right agent also wastes time the patient does not have. A large amount of water dilutes the chemical and does the same job, after the powder is brushed off.

Cover with a dry dressing and do not irrigate: Covering the powder without removing it leaves the chemical on the skin, and the burn keeps going under the dressing. Standard care for a powdered chemical on skin is brush off, then flush. Only a short list of dry chemicals should never get water.

Wait until the patient is fully extricated before taking any action: The four hours the firefighters reported already tell you the crush syndrome risk, and nothing you find after the release will change the need for ALS. Waiting means the request goes out right when the dysrhythmia risk is highest, and ALS arrives after the moment that mattered.

Tell rescuers to pull the debris off as fast as possible: In a four-hour crush, a sudden release of both legs with no one ready is the event that kills. The release has to be timed so the crew is ready for it. Directing the rescue technique is also not the EMT's call here, and your part is calling for resources.

Delay requesting resources until vitals are assessed: The EMT cannot reach the patient, so there are no vital signs to get. Vital signs taken before the release would also look falsely normal, because the potassium and myoglobin are still trapped in the legs.

Request an advanced life support (ALS) intercept for the deformity: Circulation, sensation, and vital signs are all normal in this patient, and nothing here is beyond EMT scope. Calling ALS because the ankle looks bad ties up a unit another patient may need. ALS is for an unstable patient or a need beyond EMT scope, like pain medicine for a badly displaced fracture on a long transport.

Realign the ankle to normal position before splinting: This foot is warm and pink with a strong pulse, so there is no lost blood flow to bring back. Moving the ankle can damage the nerves and vessels and turn a stable injury into a worse one. Gentle traction into a more normal position is for a limb that has lost circulation below the injury.

Withhold splinting until arrival at the hospital: A deformed ankle with no splint keeps moving during transport, causing more pain, more damage to the tissue and vessels, and more bleeding into the joint. This patient has no other injuries and stable vital signs, so nothing else needs those minutes. Skipping the splint is only for a rapid load-and-go, when a life threat comes first.

Only the joint distal to the fracture: The joint distal to the fracture, the one below it, is where you check pulse, motor function, and sensation after you splint. Splinting only the joint below leaves the joint above free to move. Movement at the joint above travels down the shaft into the break just as easily.

Only the joint proximal to the fracture: Splinting only the proximal joint, the one above the fracture, leaves the joint below free to swing. Any swing at the joint below moves the fracture site too. The splint has to hold both joints.

The entire limb without regard to adjacent joints: Wrapping the whole limb can look thorough. A splint that does not lock in both joints still lets the bone ends twist or bend at the break.

Place the patient supine to facilitate airway access and prepare for emergency airway management: Lying a patient supine gives you better access when you have to manage the airway. In a patient with early swelling in the oropharynx, lying flat narrows the airway even more. This patient's airway is open right now, and sitting upright helps keep the airway open.

Position the patient on his left side with knees bent to reduce aspiration risk: The left side with the knees bent is a position for preventing aspiration from vomiting. Nothing in this question says the patient is vomiting. The problem for this patient is keeping the airway open while the swelling gets worse.

Have the patient drink small amounts of water to soothe the throat and reduce swelling: Sips of water might sound soothing for a sore throat. Water by mouth raises the aspiration risk in a patient whose airway is swelling. Water does nothing to bring the swelling down either.

Crepitus: a grating or crackling you feel or hear. Broken bone ends rubbing together cause crepitus, and so does air under the skin. The question describes pain when you press, with nothing about grating.

Guarding: the patient tensing up or holding a body part still to protect it from movement. You can see guarding before you ever touch the area. This patient is reporting pain from your direct pressure on the injury, and point tenderness is the more specific name for that.

Referred pain: shows up away from the injured part, like shoulder pain from a ruptured spleen. This patient feels the pain exactly where you pressed on the forearm.

The patient is in decompensated shock and requires immediate high-concentration oxygen and rapid transport: Decompensated shock means low blood pressure or a badly altered mental status. This patient has neither. The blood pressure is 122/78, and the patient is oriented to person, place, and time. Oxygen and prompt transport are fine for any shock patient, but the decompensated label is wrong.

The patient is experiencing anxiety from the collision, and the rapid pulse and moist skin reflect an emotional response: Anxiety after a crash can speed up the pulse. Calling this an emotional response ignores the perfusion findings. A pulse of 110 with pale, moist skin in a patient with a broken femur points to early compensated shock, not anxiety alone.

The patient's blood pressure and respirations are within normal limits, indicating perfusion is currently adequate: A normal blood pressure and normal respirations can look like good perfusion. In early shock, compensation holds the blood pressure up. The pulse of 110 and the pale, moist skin show the compensation has already started.

Rinse with tap water, apply topical antibiotic cream, and cover with a clean cloth: Topical antibiotic cream is not an EMT medication, and a clean cloth is not sterile. The cloth would sit right on open tissue. Tap water for the rinse is fine when you have nothing sterile.

Do not rinse the wound; apply a sterile dressing immediately to seal it: The bleeding is already controlled, so now is the time to rinse. Sealing fence dirt under a sterile dressing traps bacteria against the tissue. Skipping the rinse is only for when the bleeding is the emergency, like an arterial bleed, where you control the bleeding first and clean later or not at all.

Scrub the laceration with antiseptic and gauze to remove all visible debris: The bleeding was just controlled, and scrubbing the laceration restarts it. Scrubbing also damages the wound edges, pushes dirt deeper into the tissue, and hurts the patient. Antiseptic scrubbing to remove dead tissue is done in surgery, under anesthesia.

The patient is in shock and cannot perceive pain signals: The pain is missing only in the charred, leathery skin, exactly where the burns are full thickness. Shock would dull pain all over the body because of poor perfusion, not just in the burned areas. That pattern points to destroyed nerve endings, not shock.

Full-thickness burns are less serious than partial-thickness burns since they hurt less: Hurting less does not make a burn less serious. Full-thickness burns are the deepest and most severe burns, and the charred, leathery skin shows this one went through both layers of skin. Partial-thickness burns hurt more only because their nerve endings are damaged but still alive.

The patient will experience severe pain once the burn begins to cool during transport: The nerve endings in these charred, leathery areas are destroyed, and destroyed nerve endings do not grow back during a transport. Cooling will not bring pain back to the full-thickness areas. Any pain that shows up on the way comes from partial-thickness burns around them.