CSLB General Building (B) — All Questions

What is the first-line method to control severe, life-threatening external bleeding from an extremity?

• a.Direct pressure, and a tourniquet if pressure fails or bleeding is massive✓
• b.Elevation alone
• c.Applying ice
• d.Pressure points only

Severe extremity bleeding is first controlled with firm direct pressure; if that fails or the bleed is immediately life-threatening, apply a tourniquet. Rapid hemorrhage control is a top priority in trauma.

When applying a commercial tourniquet, you should tighten it until:

• a.It feels snug but bleeding continues slowly
• b.The bright red bleeding stops and the distal pulse is eliminated✓
• c.It is loose enough to slip a hand under
• d.Only venous oozing remains

A tourniquet must be tightened enough to stop arterial bleeding, which also eliminates the distal pulse. A tourniquet that only slows bleeding can worsen blood loss.

Which are early signs of shock (hypoperfusion)?

• a.Slow pulse and warm, flushed skin
• b.Falling blood pressure as the first sign
• c.Rapid pulse; pale, cool, clammy skin; and anxiety✓
• d.High blood pressure and dry skin

Early shock produces a rapid, weak pulse with pale, cool, clammy skin and restlessness or anxiety. Falling blood pressure is a late sign because the body compensates first.

After applying a tourniquet, you should note and communicate:

• a.The patient's name only
• b.Nothing further
• c.The color of the bandage
• d.The time the tourniquet was applied✓

The application time of a tourniquet must be documented and reported so hospital staff know how long the limb has been without circulation. Write it clearly, often on the patient or the device.

A patient with a suspected spinal injury who is breathing adequately should be:

• a.Manually stabilized in a neutral, in-line position✓
• b.Rapidly flexed to check range of motion
• c.Placed prone immediately
• d.Sat fully upright and asked to walk

Suspected spinal injuries are managed with manual in-line stabilization keeping the head neutral until fully immobilized or cleared. Unnecessary movement risks worsening a spinal cord injury.

How should a partial-thickness (second-degree) burn without gross contamination be initially covered?

• a.With butter or ointment
• b.With a clean, dry sterile dressing✓
• c.With a tight elastic wrap
• d.With ice packs applied directly on the skin

Burns are covered with a clean, dry sterile dressing to reduce contamination and pain. Avoid ointments, butter, ice, or breaking blisters, which can worsen injury or infection.

The 'rule of nines' is used to estimate:

• a.Blood loss volume
• b.Glasgow Coma Scale score
• c.The percentage of total body surface area burned✓
• d.Respiratory rate

The rule of nines estimates the percentage of total body surface area affected by burns. This helps gauge burn severity and guides triage and treatment decisions.

An impaled object in a patient's forearm should generally be:

• a.Removed quickly to control bleeding
• b.Pushed in deeper for stability
• c.Wrapped tightly against the skin
• d.Stabilized in place with bulky dressings✓

Impaled objects are stabilized in place and not removed in the field, because removal can cause severe bleeding or further injury. The exception is an object obstructing the airway or interfering with CPR.

The most appropriate position for a hypotensive trauma patient in shock (without spinal injury) is generally:

• a.Supine to maintain perfusion, keeping the patient warm✓
• b.Sitting fully upright
• c.Prone
• d.Standing to improve circulation

A patient in shock is usually kept supine to support perfusion of vital organs, along with oxygen and warmth. Preventing heat loss helps limit worsening of shock.

A patient with a suspected closed femur fracture should have the limb:

• a.Left free to move for comfort
• b.Immobilized, ideally with a traction or rigid splint, checking distal pulse, motor, and sensation✓
• c.Massaged to reduce swelling
• d.Elevated above the head

A femur fracture is stabilized with a splint to reduce pain, bleeding, and further injury, and distal circulation and sensation are checked before and after. Femur fractures can cause significant internal blood loss.

Which finding suggests a serious chest injury requiring rapid transport?

• a.Pink, warm skin with normal breathing
• b.A small superficial scratch
• c.Severe difficulty breathing with unequal chest rise after chest trauma✓
• d.Mild soreness with clear lungs

Severe dyspnea with unequal chest rise after chest trauma suggests a serious injury such as a collapsed lung and needs rapid transport. Early recognition and oxygen support are essential.

An open chest wound (sucking chest wound) should be treated by an EMT with:

• a.A tight circumferential wrap
• b.Direct firm pressure packed into the wound
• c.Nothing but transport
• d.An occlusive dressing, monitoring for worsening breathing✓

An open chest wound is covered with an occlusive dressing to prevent air entering the chest, while watching for signs of increasing pressure. If breathing worsens, a side of the dressing may be lifted to release trapped air.

The primary goal of treating shock in a trauma patient in the field is to:

• a.Maintain oxygenation and perfusion and prevent heat loss during rapid transport✓
• b.Raise blood pressure with oral fluids
• c.Give the patient food and water
• d.Delay transport until vitals normalize

Field management of shock focuses on oxygen, controlling bleeding, keeping the patient warm, and rapid transport to definitive care. EMTs cannot fully reverse shock, so time to the hospital is critical.

Bright red blood that spurts from a wound in time with the pulse indicates:

• a.Venous bleeding
• b.Arterial bleeding✓
• c.Capillary bleeding
• d.Minor bleeding that will stop on its own

Spurting, bright red blood synchronized with the heartbeat is arterial bleeding, which is the most serious and rapid. It requires immediate control with direct pressure and possibly a tourniquet.

A helmet on a patient with a possible spine injury should generally be removed by EMTs when:

• a.It always stays on no matter what
• b.It never needs removal
• c.It interferes with airway management or assessment, or does not hold the head snugly✓
• d.The patient asks, regardless of fit

A helmet is removed if it prevents airway control or adequate assessment, or if it does not fit snugly enough to immobilize the head. Otherwise a well-fitting helmet holding the head steady may be left in place with the head stabilized.

To estimate the severity of a head injury, an EMT commonly assesses:

• a.Only the blood pressure
• b.Skin temperature alone
• c.Pupil size only, ignoring mental status
• d.Level of responsiveness (AVPU/GCS), pupils, and any change over time✓

Head injury severity is judged by monitoring level of responsiveness, pupil response, and trends over time. A declining mental status is a critical warning sign of worsening brain injury.