Emergency Care in the Streets: Assessment in Action
By Nancy Caroline
You and your partner respond to a patient who has fallen. On arrival, you find a 42-year-old man lying conscious and supine on the ground outside a home. A ladder is lying beside him, with paint spilled on the lawn. Neighbors say the patient fell at least 25' while painting the second-floor windows. On initial assessment, he complains of pain in his neck area and lower back. His respirations are 22 breaths/min; pulse, 58 beats/min; and blood pressure, 94/58 mm Hg. The skin is warm, red, and dry. He has no sensation below the navel. He cannot move his lower extremities and has no reflexes below the hip.
1. After the initial assessment reveals adequate ABCs, you should:
- A. inquire about history.
- B. notify the local hospital.
- C. apply manual in-line cervical spine immobilization.
- D. perform a neurologic exam.
2. You apply oxygen and apply a long backboard and rigid cervical collar. Now you must decide whether to treat on scene or transport. Which factor should you base your decision on?
- A. Distance of fall
- B. Patient preference
- C. Vital signs
- D. Mechanism of injury
3. You are beginning the transport. Where should the patient be transported to?
- A. The closest hospital
- B. A trauma center
- C. A local medical center
- D. None of the above
4. What is the maximum scene time for this patient?
- A. 5 minutes
- B. 10 minutes
- C. 15 minutes
- D. However long it takes to immobilize the patient safely
5.
Based on the vital signs and mechanism, what should you suspect is causing the hypotension?- A. Blood loss
- B. Head injury
- C. Neurogenic shock
- D. All of the above
6. What should your treatment actions be?
- A. Continue assessment and seek out other injuries.
- B. Determine the Glasgow Coma Scale score.
- C. Initiate IV therapy.
- D. All of the above
7. Based on the level of sensation, what area of the spine may be injured?
- A. C7
- B. L3
- C. T10
- D. S1
| Challenging Questions You respond to a motor vehicle crash. The vehicle struck a bridge abutment on the interstate, resulting in substantial damage to the car. The driver is unconscious and slumped over the steering wheel. He is breathing with difficulty. You suspect partial airway obstruction by his tongue. Smoke is coming from the car’s engine compartment. 8. What should you do? |
