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: A cervical collar for comfort fits a patient who has neck pain and finds the support soothing. This patient has no neck complaint and no midline tenderness. There is no pain for a collar to relieve.

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

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

Have the patient lie flat and apply ice to the forehead: Lying flat with ice fits a bruised face with no active bleeding, where the cold limits swelling. 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: Nasal packing is real care in the ED. The ED packs a nose when direct pressure will not stop the bleeding, or when the bleeding comes from the back of the nose. 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.

Immobilize the jaw with a tight circumferential bandage to prevent any movement: A bandage around the jaw and over the head is a real way to support a broken mandible. That bandage fits a fully alert patient with an open airway and no active bleeding. A tight bandage in the field 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.

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

Apply ice packs to reduce swelling, then transport without additional jaw support: Ice helps with swelling and fits a simple bruised jaw with no airway concern. Swelling builds over the next hour, but the danger here is an unstable jaw over the next few minutes. 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.

Flat on the stretcher with the head supported by a pillow: Lying flat is what you use when low blood pressure or spinal precautions will not let you raise the head. Nothing in this question keeps you from raising the head. A flat head gets no help from gravity draining blood out through the veins. This patient's intracranial pressure is already rising, and losing that drainage lets the pressure climb more.

Trendelenburg position (head lower than feet) to maintain cerebral perfusion: Trendelenburg puts the head lower than the feet. Head down makes it harder for blood to drain out of the head, so the pressure inside the skull goes up. Higher pressure in the skull lowers blood flow to the brain, the opposite of what option B claims. Routine head-down positioning is no longer used for shock either.

Right lateral recumbent to improve venous drainage: The recovery position, lying on the side, is for a patient who cannot keep the airway clear. On the side, secretions and vomit drain out of the mouth. This patient's airway is open and oxygenation is adequate. Lying on the right side keeps the head level with the body, so the side position does not help blood drain out of the head.

The Glasgow Coma Score measures an infant's mental capacity across eye opening, verbal response, and motor response, and below 10 is severe.: The GCS is not only for infants. The GCS works for a patient of any age, and the GCS measures level of consciousness, not mental capacity. Severe is 8 or below, not below 10. The name is also wrong, because the tool is the Glasgow Coma Scale, not Score.

The Glasgow Coma Scale measures an infant's mental capacity across eye opening, verbal response, and motor response, and below 8 is severe.: Scale is the right name, and below 8 is close to the real cutoff. The GCS is still not limited to infants, and the GCS does not measure mental capacity. "Below 8" also leaves out a score of exactly 8. A score of 8 is severe, not moderate.

The Glasgow Coma Score measures a patient's level of consciousness across eye opening, verbal response, and motor response, and 10 or below is severe.: Option D has level of consciousness and the three parts right. Option D also calls the tool a Score instead of the Glasgow Coma Scale. A cutoff of 10 or below pulls in part of the moderate range, which runs from 9 to 12. Severe starts at 8 and counts down.

Place both hands on the sides of the head, pressing firmly against the face: Hands on the sides of the head is the right placement. Pressing firmly against the face is what makes this option wrong. Pressure on the face covers the mouth and nose and pushes on the jaw. You may need to manage this patient's airway, and pressure on the face and jaw works against you.

Support the neck from underneath, lifting slightly to align the airway: Lifting the neck to open the airway is a real maneuver for a medical patient with no suspected spinal injury. This patient has a suspected cervical spine injury. Lifting the neck is the exact movement spinal motion restriction is supposed to prevent. Neutral alignment already holds the airway open, so you get the airway without moving the spine.

Place one hand under the neck and one on the forehead: A hand under the neck with a hand on the forehead is head tilt positioning. Head tilt is for opening the airway of an unresponsive patient with no trauma. This is a trauma patient with a suspected neck injury. A hand under the neck tilts the head back and gives the spine a point to bend over.

Apply the collar, then establish manual stabilization afterward: A collar limits neck movement, so putting the collar on fast sounds like the priority. This patient already has manual stabilization holding the head neutral. Letting go before the collar is fully seated can shift an unstable fracture.

Apply the collar after the patient is secured to the stretcher: The collar goes on before the log roll and before the patient is strapped to a backboard or stretcher. Waiting until after the strapping leaves this alert patient's neck unsupported during every move in between.

Release manual stabilization to place the collar, then resume it: The hands holding the head look like they are in the way of the collar. Stabilization stays on the head the whole time. The chin piece goes on first, and then the back piece slides in behind the neck. The hands come off only once the patient is secured to a board.