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

Place the amputated fingers directly into a container of ice: Cold is the right idea for an amputated part. Putting the fingers right into ice freezes them. Ice crystals form inside the cells and break them, and the surgeon gets frostbitten fingers that cannot be reattached.

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: Flushing right away is correct for a liquid chemical splash. With a liquid, every second you wait is more time the chemical sits on the skin. This chemical is a dry powder, so the order flips. 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.

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: A dry dressing with no water is right for a short list of dry chemicals where water should never be used. Standard care for a powdered chemical on skin is brush off, then flush. Covering the powder without removing it leaves the chemical on the skin. The burn keeps going under the dressing.

Wait until the patient is fully extricated before taking any action: Waiting until the patient is out is reasonable in most trauma, where you learn how bad things are by examining the patient. Crush syndrome is different, because the four hours the firefighters reported already tell you the risk. Nothing you find after the release will change the need for ALS. Waiting also means the request goes out right when the dysrhythmia risk is highest, and ALS arrives after the moment that mattered.

Have rescuers remove debris faster, with no coordination: Getting the debris off fast makes sense when the object is causing ongoing bleeding or blocking the airway. 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. Your part is calling for resources.

Delay requesting resources until vitals are assessed: Getting vital signs before calling for help makes sense when the numbers will change the plan. 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. The potassium and myoglobin are still trapped in the legs, so the numbers have not changed yet.

Request an advanced life support (ALS) intercept for the deformity: An ALS intercept makes sense when the patient is unstable or needs something beyond EMT scope. Pain medicine for a badly displaced fracture on a long transport is one example. This patient's circulation, sensation, and vital signs are all normal. Calling ALS because the ankle looks bad ties up a unit another patient may need.

Realign the ankle to normal position before splinting: Realigning is for a limb that has lost circulation below the injury. Gentle traction into a more normal position may bring the blood flow back. 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.

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

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.

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.

Assume spinal precautions are needed for all back pain and apply full C-spine immobilization: Immobilizing every back pain patient comes from older teaching that restricted the spine until an injury was ruled out. This patient denies trauma and has a normal neuro exam. Those two findings already answer the spine injury question. Applying the old rule anyway skips the assessment you just did.

Immobilize the patient as a precaution because he is elderly: Older patients do have a higher risk of fractures from minor falls and bumps. This patient reports no mechanism at all, only a flare of chronic pain. Age alone, without trauma or abnormal exam findings, is not a reason to immobilize.

Advise the patient to stay home and rest; do not transport unless pain is severe: Some chronic pain flares are mild enough to manage at home. This patient called 911 during the flare, and nothing in the question says the pain is minor. The crew does not get to decide alone that a patient who called for help stays home. The decision not to transport belongs to the patient and medical direction.

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

Do not rinse the wound; apply a sterile dressing immediately to seal it: Putting a dressing on without rinsing is right when the bleeding is the emergency. With an arterial bleed, you control the bleeding first and clean later, or not at all. In this question, the bleeding is already controlled, so now is the time to rinse. Sealing fence dirt under a sterile dressing traps bacteria against the tissue.

Scrub the laceration with antiseptic and gauze to remove all visible debris: Scrubbing a wound with antiseptic is done in surgery under anesthesia to remove dead tissue. In the field, scrubbing restarts the bleeding you just stopped. Scrubbing also damages the wound edges, pushes dirt deeper into the tissue, and hurts the patient.

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

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

The patient will experience severe pain once the burn begins to cool during transport: Pain coming back later would fit a burn where the nerve endings are still alive. Here the nerve endings 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.

Flush for 2 to 3 minutes from the outer corner of the eye toward the inner corner: Two to three minutes of flushing fits a mild irritant that stays on the surface. An alkali keeps soaking in until it is diluted, so that is not long enough here. Option B also runs the water from the outer corner toward the inner corner. Water going that way pushes the chemical toward the tear duct and the other eye.

Cover both eyes with moist dressings and begin irrigation on arrival at the hospital: Covering both eyes with moist dressings and waiting for the hospital is right for a penetrating eye injury. In that case you protect the eyeball and avoid putting pressure on it. This patient has a chemical splash, not a penetrating injury. Waiting to flush lets the alkali keep burning deeper the whole way to the hospital.

Irrigate both eyes at the same time, directing the flow from the outer corners inward: Flushing both eyes fits a patient who got the chemical in both eyes. It also fits a case where the chemical is likely to spread to the other eye. This question says the solution splashed into one eye, so only that eye needs flushing. Option D also runs the water from the outer corners inward. That direction can carry the chemical into the eye that was not splashed.