21 Trauma Practice Questions & Answers

1. 1. A worker's leg was crushed by a forklift. Bright red blood is spurting from the thigh, and gurgling is heard with each breath. Which action should the paramedic perform first?

   • A.Suction the airway and insert an oropharyngeal airway
   • B.Apply a tourniquet proximal to the thigh wound✓ Answer
   • C.Establish vascular access for a crystalloid bolus
   • D.Deliver ventilations with a bag-valve mask device

   Trauma care follows the XABC sequence: exsanguinating external hemorrhage is controlled before the airway, because arterial bleeding from an extremity can kill within minutes — faster than airway compromise. Once the tourniquet stops the spurting bleed, the paramedic immediately turns to the gurgling airway.

   Source: PHTLS (9th/10th ed.) XABC priority — exsanguinating hemorrhage before airway; NREMT Paramedic trauma standardsReport a problem with this question

2. 2. A 30-year-old with a gunshot wound to the abdomen has a blood pressure of 84/60 mmHg, a weak radial pulse, and no head injury. How should crystalloid infusion be managed during transport?

   • A.Withhold fluids entirely until arrival at the hospital
   • B.Give boluses until the systolic pressure reaches 120 mmHg
   • C.Give small boluses titrated to keep the radial pulse palpable✓ Answer
   • D.Run two liters wide open regardless of the pressure

   With uncontrolled internal hemorrhage and no head injury, permissive hypotension applies: aggressive crystalloid dilutes clotting factors, cools the patient, and can 'pop the clot' by raising pressure. Fluids are therefore titrated in small boluses to a minimal perfusion endpoint — a palpable radial pulse — rather than to a normal blood pressure.

   Source: PHTLS damage-control resuscitation / permissive hypotension: titrate to radial pulse (~SBP 80-90 mmHg) when no TBIReport a problem with this question

3. 3. A 24-year-old fell from a ladder and has bruising over the left upper abdomen. Which finding appears EARLIEST in compensated hemorrhagic shock?

   • A.Systolic blood pressure falling below 90 mmHg
   • B.Unresponsiveness to verbal stimulation
   • C.Loss of the palpable peripheral pulses
   • D.Anxiety accompanied by a rising pulse rate✓ Answer

   Compensated shock begins with catecholamine release, producing tachycardia and anxiety while vasoconstriction keeps the blood pressure normal. Hypotension, absent peripheral pulses, and unresponsiveness are late findings of decompensation — waiting for them delays lifesaving treatment.

   Source: PHTLS shock stages: tachycardia and anxiety are early compensated signs; hypotension is a late, decompensated signReport a problem with this question

4. 4. A tourniquet placed 20 minutes ago has controlled hemorrhage from a partial leg amputation; the hospital is 30 minutes away. How should the tourniquet be handled en route?

   • A.Leave it tightened and document the application time✓ Answer
   • B.Remove it after a second intravenous line is flowing
   • C.Convert it to a pressure dressing once bleeding stops
   • D.Loosen it every 15 minutes to let the limb reperfuse

   Field doctrine holds that a tourniquet, once applied, is never loosened before definitive care: intermittent release restarts hemorrhage, dislodges forming clot, and adds ischemia-reperfusion injury with each cycle. The paramedic leaves it tight and documents the application time for the receiving team.

   Source: PHTLS/TCCC tourniquet doctrine: once applied in the field, do not loosen or remove; record time of applicationReport a problem with this question

5. 5. Shortly after intubation, a chest-trauma patient becomes progressively harder to bag. Breath sounds are absent on the left, the neck veins are distended, and the blood pressure drops to 70/50 mmHg. What should the paramedic do next?

   • A.Withdraw the endotracheal tube 2 to 3 centimeters
   • B.Apply an occlusive dressing over the chest injury
   • C.Pass a suction catheter to clear the tube lumen
   • D.Perform needle decompression of the left chest wall✓ Answer

   Rising bag resistance with unilateral absent breath sounds plus obstructive-shock signs — distended neck veins and hypotension — indicates tension pneumothorax, a clinical diagnosis treated by immediate needle decompression. A right mainstem tube would also silence the left side, but it would not cause hypotension, JVD, and climbing airway pressures.

   Source: PHTLS tension pneumothorax (clinical diagnosis, immediate decompression); DOPE mnemonic for post-intubation deteriorationReport a problem with this question

6. 6. A stab wound to the chest was sealed with an occlusive dressing. Ten minutes later the patient develops worsening dyspnea, distended neck veins, and falling blood pressure. What should the paramedic do first?

   • A.Reinforce the dressing with a second occlusive layer
   • B.Increase the ventilation rate and reassess in five minutes
   • C.Lift an edge of the dressing to vent the pleural space✓ Answer
   • D.Perform needle decompression on the uninjured side

   A fully sealed occlusive dressing over an open pneumothorax can trap air in the pleural space and convert the wound to a tension pneumothorax. The first corrective step is to lift ('burp') an edge of the dressing so the trapped air escapes — this often restores pressure and breathing before any invasive procedure is needed.

   Source: PHTLS open pneumothorax: occlusive dressing may convert to tension — lift (burp) the dressing firstReport a problem with this question

7. 7. A driver has a right-sided flail chest with adequate but painful respirations after striking the steering wheel. Which associated injury is the greatest threat to his oxygenation over the next hour?

   • A.Pulmonary contusion beneath the flail segment✓ Answer
   • B.Myocardial bruising from the sternal impact
   • C.Paradoxical movement of the loose chest segment
   • D.Laceration of intercostal vessels by the rib ends

   The bruised lung beneath the flail segment — pulmonary contusion — progressively fills with blood and edema and is the principal cause of hypoxemia after flail chest. Pain and paradoxical motion impair mechanics, but it is the contusion that worsens over the following hours and may demand positive-pressure ventilation.

   Source: PHTLS flail chest: underlying pulmonary contusion is the main cause of hypoxemia; support with positive-pressure ventilation if failingReport a problem with this question

8. 8. A stabbing victim is hypotensive with distended neck veins and muffled heart tones; breath sounds are clear and equal bilaterally. Which injury do these findings most indicate?

   • A.Tension pneumothorax
   • B.Cardiac tamponade✓ Answer
   • C.Traumatic diaphragmatic rupture
   • D.Massive hemothorax

   Beck's triad — hypotension, distended neck veins, and muffled heart tones — with normal, equal breath sounds points to cardiac tamponade: blood filling the pericardial sac restricts cardiac filling without changing lung sounds. Tension pneumothorax or a massive hemothorax would diminish breath sounds on the injured side.

   Source: Beck's triad (hypotension, JVD, muffled heart tones) with equal breath sounds = cardiac tamponade (PHTLS chest trauma)Report a problem with this question

9. 9. A head-injured patient opens his eyes only to painful stimulus, makes incomprehensible sounds, and withdraws from pain. What is his Glasgow Coma Scale score?

   • A.9
   • B.8✓ Answer
   • C.6
   • D.11

   Eye opening to pain scores 2, incomprehensible sounds score 2 on the verbal scale, and withdrawal from pain scores 4 on the motor scale, so the total is 2+2+4 = 8. A GCS of 8 or less defines severe brain injury and prompts consideration of an advanced airway.

   Source: Glasgow Coma Scale: Eye 4 / Verbal 5 / Motor 6; E2+V2+M4 = 8; GCS <=8 = severe TBIReport a problem with this question

10. 10. A patient with a severe TBI (GCS 6) is being ventilated by bag-valve mask. The pupils are equal and reactive and there is no posturing. What end-tidal CO2 range should ventilations target?

    • A.25 to 30 mmHg
    • B.45 to 55 mmHg
    • C.35 to 45 mmHg✓ Answer
    • D.30 to 35 mmHg

    TBI care aims to prevent secondary injury by keeping the brain perfused and normocapnic, so the target EtCO2 is 35 to 45 mmHg. Hyperventilation constricts cerebral vessels and worsens ischemia; the lower range of 30 to 35 mmHg is reserved for active herniation signs, which this patient does not have.

    Source: Brain Trauma Foundation prehospital guidelines: normocapnia (EtCO2 35-45 mmHg); mild hyperventilation only for herniationReport a problem with this question

11. 11. During transport of a closed-head-injury patient, which vital-sign pattern indicates brain herniation and justifies mild hyperventilation to an EtCO2 of 30 to 35 mmHg?

    • A.Rising blood pressure, rapid pulse, deep breathing
    • B.Rising blood pressure, slowing pulse, irregular breathing✓ Answer
    • C.Falling blood pressure, slow pulse, regular breathing
    • D.Falling blood pressure, rapid pulse, shallow breathing

    Cushing's triad — rising blood pressure with a widening pulse pressure, reflex bradycardia, and irregular respirations — reflects brainstem compression from herniation. It is the only field situation in which ventilating down to an EtCO2 of 30 to 35 mmHg is indicated; hypotension with tachycardia suggests hemorrhage elsewhere instead.

    Source: Cushing's triad = hypertension (widening pulse pressure), bradycardia, irregular respirations — herniation (PHTLS/BTF)Report a problem with this question

12. 12. After diving into shallow water, a patient cannot move his legs. The blood pressure is 78/40 mmHg, the pulse is 52, and the skin below the injury level is warm and dry. Which type of shock is most likely?

    • A.Cardiogenic shock
    • B.Hypovolemic shock
    • C.Neurogenic shock✓ Answer
    • D.Obstructive shock

    A cord injury interrupts sympathetic outflow, so vessels below the lesion dilate and the heart cannot mount a tachycardia: hypotension with bradycardia and warm, dry skin is the signature of neurogenic shock. Hypovolemic shock produces the opposite skin and pulse pattern — tachycardia with cool, clammy skin.

    Source: Neurogenic shock: hypotension + bradycardia + warm/dry skin below lesion from loss of sympathetic tone (PHTLS spinal trauma)Report a problem with this question

13. 13. An adult sustained partial-thickness burns covering the entire anterior torso and the entire right arm. Using the rule of nines, what is the estimated body surface area burned?

    • A.36%
    • B.45%
    • C.18%
    • D.27%✓ Answer

    By the adult rule of nines the anterior torso counts 18% and each arm counts 9%, so the total is 18 + 9 = 27%. Choosing 36% double-counts by adding the unburned posterior torso, while 18% omits the arm entirely.

    Source: Rule of nines (adult): anterior torso 18%, each arm 9% — 18 + 9 = 27%Report a problem with this question

14. 14. An 80-kg adult has partial- and full-thickness burns over 25% BSA. Using the 4 mL/kg per %BSA consensus formula, how much crystalloid should be given in the first 8 hours after the burn occurred?

    • A.8,000 mL
    • B.2,000 mL
    • C.4,000 mL✓ Answer
    • D.1,000 mL

    The formula yields 4 mL × 80 kg × 25 = 8,000 mL for the first 24 hours, and half of that total — 4,000 mL — is given in the first 8 hours counted from the time of the burn, not from EMS contact. Only partial- and full-thickness areas enter the calculation.

    Source: Parkland/consensus burn formula: 4 mL x kg x %BSA over 24 h; half in first 8 h from time of burnReport a problem with this question

15. 15. A man rescued from a burning bedroom has singed nasal hairs, a hoarse voice, and black-tinged sputum, but he is breathing comfortably with an SpO2 of 98%. Which approach to his airway is most appropriate?

    • A.Give nebulized bronchodilators and then reassess afterward
    • B.Withhold supplemental oxygen while the saturation is normal
    • C.Delay any airway decision until stridor actually develops
    • D.Prepare early for an advanced airway despite stable findings✓ Answer

    Singed nasal hairs, hoarseness, and carbonaceous sputum after an enclosed-space fire predict thermal injury to the upper airway, where edema can close the glottis within minutes to hours. A normal SpO2 is falsely reassuring — carbon monoxide makes oximetry unreliable — so the correct posture is early preparation for an advanced airway, plus high-flow oxygen, not watchful waiting.

    Source: PHTLS/ABLS inhalation injury: singed nares, hoarseness, carbonaceous sputum predict rapid airway edema — prepare early advanced airway; SpO2 unreliable with COReport a problem with this question

16. 16. At a multiple-casualty bus crash, a non-ambulatory adult breathes 24 times per minute, has a radial pulse with capillary refill under 2 seconds, but cannot follow simple commands. Under START triage, how is this patient categorized?

    • A.Minor (green)
    • B.Immediate (red)✓ Answer
    • C.Delayed (yellow)
    • D.Expectant (black)

    START assigns Immediate (red) to any casualty who fails one of the RPM checks: respirations over 30, absent radial pulse or capillary refill over 2 seconds, or inability to follow commands. This patient passes the breathing and perfusion steps but fails mental status, so he is tagged red.

    Source: START triage RPM criteria: cannot follow commands = Immediate (red) even with adequate breathing and perfusionReport a problem with this question

17. 17. A driver in a high-speed crash has a blood pressure of 88/60 mmHg and an unstable pelvis. A community hospital is 5 minutes away; a Level I trauma center is 25 minutes away. What is the best transport decision?

    • A.Remain on scene until fluid boluses improve the pressure
    • B.Transport him directly to the Level I trauma center✓ Answer
    • C.Stabilize him first at the nearby community hospital
    • D.Complete a detailed physical examination before moving him

    Field-triage guidance sends patients meeting physiologic criteria (systolic below 90 mmHg) or anatomic criteria (unstable pelvis) directly to the highest-level trauma center in the system, because hemorrhage control here is surgical. Scene delays and stops at non-trauma hospitals both raise mortality; scene time for critical trauma should stay near 10 minutes.

    Source: CDC/ACS Field Triage Guideline: physiologic (SBP<90) and anatomic (unstable pelvis) criteria -> highest-level trauma center; ~10-minute scene timeReport a problem with this question

18. 18. An unresponsive motorcyclist shows signs of shock, and a single gentle palpation reveals an unstable pelvis. How should the paramedic manage the pelvis before moving the patient?

    • A.Immobilize both legs in bilateral traction splints
    • B.Apply a circumferential binder or folded sheet around it✓ Answer
    • C.Compress the iliac crests again to confirm instability
    • D.Log-roll the patient onto a backboard to inspect it

    An unstable pelvic ring can hide liters of venous hemorrhage; early circumferential compression with a binder or sheet reduces pelvic volume and tamponades the bleeding before movement worsens it. Instability is assessed once at most — repeated compression or log-rolling can dislodge clots and restart hemorrhage, so a scoop stretcher is preferred.

    Source: PHTLS pelvic fracture management: early circumferential binder/sheet, single gentle assessment, scoop over log-rollReport a problem with this question

19. 19. A 6-year-old struck by a car is anxious, with a pulse of 152, respirations of 30, cool mottled legs, and a blood pressure of 102/68 mmHg. How should the paramedic interpret these findings?

    • A.Compensated shock that can deteriorate without warning✓ Answer
    • B.Normal responses for a frightened school-age child
    • C.Adequate perfusion shown by the normal pressure
    • D.A pain response that mainly requires analgesia

    Children in shock sustain a normal blood pressure through intense tachycardia and vasoconstriction, so tachycardia with cool, mottled extremities after major blunt trauma is compensated shock. Pediatric hypotension appears only just before arrest, which is why treatment must be aggressive now rather than after the pressure falls.

    Source: PALS/PHTLS pediatric shock: BP maintained by tachycardia; hypotension is a late, pre-arrest sign in childrenReport a problem with this question

20. 20. A woman 30 weeks pregnant is secured to a backboard after a crash and becomes hypotensive while lying flat. Which position change should the paramedic make?

    • A.Raise the head of the board until she sits upright
    • B.Tilt the board 15 to 30 degrees toward the right side
    • C.Elevate her legs while keeping the board flat
    • D.Tilt the board 15 to 30 degrees toward the left side✓ Answer

    After about 20 weeks the gravid uterus compresses the inferior vena cava in the supine position, cutting venous return (supine hypotensive syndrome). Tilting the secured patient 15 to 30 degrees to the LEFT — or manually displacing the uterus leftward — moves the uterus off the cava and restores preload, which leg elevation or a rightward tilt cannot do.

    Source: Supine hypotensive syndrome (>20 weeks gestation): 15-30 degree left lateral tilt or manual left uterine displacement (PHTLS/obstetric trauma)Report a problem with this question

21. 21. A 78-year-old man taking warfarin tripped and struck his head on a counter. He has a GCS of 15, a normal neurologic exam, and wants to stay home. What is the most appropriate action?

    • A.Urge transport for evaluation despite the benign exam✓ Answer
    • B.Accept a refusal because his examination is normal
    • C.Reassess him on scene for 20 minutes, then decide
    • D.Advise home rest with a family member observing

    Anticoagulated older adults can develop delayed intracranial bleeding after even minor head impacts, and a normal initial exam does not exclude it. Geriatric trauma standards therefore treat anticoagulant use plus head trauma as high-risk and call for strongly encouraging transport for evaluation rather than accepting refusal or observing at home.

    Source: CDC Field Triage special considerations / PHTLS geriatric trauma: anticoagulant use + head injury = high risk, transport for evaluationReport a problem with this question

Practice questions modeled on the NREMT paramedic examination specifications and the National EMS Education Standards. Drug doses, device settings, and other figures that national guidelines revise are deliberately not tested — always follow your medical director, current guidelines, and local protocols. Not medical advice, and not affiliated with or endorsed by the National Registry of Emergency Medical Technicians (NREMT) or NHTSA. Study the official materials at nremt.org. Official NREMT →