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Exam Name: National Registry of Emergency Medical Technicians (NREMT) Paramedic Trauma Exam
Vendor: National Registry of Emergency Medical Technicians (NREMT)
Exam Duration: 2 hours 30 minutes
Number of Questions: 80-150 (adaptive format)
Passing Score: Determined by adaptive scoring; no fixed percentage
Language: English
Exam Delivery: Computer-based testing at Pearson VUE testing centers

- Trauma Overview (10-15% of Exam)
- Mechanism of Injury (MOI): Understanding how trauma occurs (e.g., blunt vs. penetrating trauma).
- Kinematics of Trauma: Analyzing forces involved in trauma (e.g., motor vehicle collisions, falls).
- Trauma Triage: Prioritizing patients based on injury severity (e.g., START triage).
- Golden Hour: The critical first hour after a traumatic injury.
- Trauma Systems and Centers: Role of trauma centers and regional systems.

- Hemorrhage Control and Shock Management (20-25% of Exam)
- Types of Shock:
- Hypovolemic (e.g., blood loss)
- Cardiogenic (e.g., heart failure)
- Distributive (e.g., septic, anaphylactic, neurogenic)
- Obstructive (e.g., tension pneumothorax, cardiac tamponade)
- Hemorrhage Control:
- Direct pressure, tourniquets, hemostatic agents
- Fluid Resuscitation:
- Crystalloids (e.g., normal saline, lactated Ringer's)
- Blood products (e.g., packed red blood cells)
- Signs and Symptoms of Shock:
- Tachycardia, hypotension, altered mental status, cool/clammy skin

- Thoracic Trauma (15-20% of Exam)
- Pneumothorax:
- Simple vs. tension pneumothorax
- Needle decompression and chest tube management
- Hemothorax: Accumulation of blood in the pleural cavity.
- Flail Chest: Paradoxical chest wall movement due to rib fractures.
- Cardiac Tamponade: Fluid accumulation in the pericardial sac (e.g., Beck's triad).
- Rib Fractures and Pulmonary Contusion: Complications and management.

- Abdominal and Genitourinary Trauma (10-15% of Exam)
- Solid Organ Injuries: Liver, spleen, and kidney injuries.
- Hollow Organ Injuries: Stomach, intestines, and bladder injuries.
- Pelvic Fractures: Associated hemorrhage and stabilization.
- Genitourinary Trauma: Kidney, bladder, and urethral injuries.
- Abdominal Evisceration: Management of protruding organs.

- Head, Facial, and Spinal Trauma (15-20% of Exam)
- Traumatic Brain Injury (TBI):
- Concussion, contusion, intracranial hemorrhage (e.g., epidural, subdural)
- Signs of increased intracranial pressure (e.g., Cushing's triad)
- Facial Trauma:
- Airway management in facial fractures
- Nasal and orbital injuries
- Spinal Trauma:
- Spinal immobilization techniques
- Cervical spine injury assessment (e.g., NEXUS criteria)
- Penetrating Head Injuries: Management and complications.

- Musculoskeletal Trauma (10-15% of Exam)
- Fractures:
- Open vs. closed fractures
- Reduction and splinting techniques
- Dislocations: Shoulder, hip, and knee dislocations.
- Compartment Syndrome: Signs, symptoms, and management.
- Crush Injuries: Systemic effects (e.g., rhabdomyolysis).

- Burn Trauma (5-10% of Exam)
- Burn Classification:
- Superficial, partial-thickness, full-thickness burns
- Rule of Nines: Estimating burn surface area.
- Inhalation Injuries: Carbon monoxide poisoning, airway burns.
- Fluid Resuscitation: Parkland formula for burn management.
- Electrical and Chemical Burns: Specific management considerations.

- Special Considerations in Trauma (5-10% of Exam)
- Pediatric Trauma: Unique anatomical and physiological considerations.
- Geriatric Trauma: Increased risk of complications in older adults.
- Pregnancy Trauma: Managing trauma in pregnant patients.
- Environmental Trauma: Hypothermia, hyperthermia, and drowning.

- Golden Hour: The critical first hour after a traumatic injury.
- Cushing's Triad: Bradycardia, hypertension, and irregular respirations (signs of increased intracranial pressure).
- Beck's Triad: Hypotension, jugular venous distension, and muffled heart sounds (signs of cardiac tamponade).
- Tension Pneumothorax: Life-threatening condition requiring immediate needle decompression.
- Rhabdomyolysis: Breakdown of muscle tissue releasing toxic substances into the bloodstream.
- Parkland Formula: 4 mL x body weight (kg) x % total body surface area (TBSA) burned = fluid requirement in the first 24 hours.

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NREMT Paramedic Trauma Exam
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Question: 691
During the assessment of a patient with a suspected compartment syndrome, which of the following findings would most support this diagnosis?
1. Normal capillary refill time
2. Pain with passive stretch of the affected muscles
3. Presence of a palpable pulse
er: B
nation: Pain with passive stretch of the affected muscles is a classic sign of compartment syn dicates increased intracompartmental pressure.
ion: 692
ent with blunt chest trauma presents with hypotension and tachycardia. Which of the followi gs would most likely indicate a hemothorax?
reased respiratory rate without distress perresonance on percussion
ar breath sounds bilaterally
llness to percussion on the affected side er: D
nation: Dullness to percussion on the affected side is characteristic of a hemothorax due to fl ulation in the pleural space.
ion: 693
Mild swelling of the limb Answ
Expla drome
and in
Quest
A pati ng
findin
1. Inc
2. Hy
3. Cle
4. Du
Answ
Expla uid
accum
Quest
You are treating a 50-year-old female with a gunshot wound to the abdomen. After applying direct pressure, you notice continued bleeding. What is the most appropriate next step in managing her hemorrhage?
1. Administer IV fluids immediately
2. Apply a tourniquet at the proximal arm
3. Utilize a hemostatic agent within the wound
4. Perform a rapid assessment for other injuries Answer: C
Explanation: If bleeding continues despite direct pressure, hemostatic agents can be utilized to promote clotting. Tourniquets should be applied only to extremities and not to abdominal wounds.
Question: 694
situation?
ntinuous positive airway pressure (CPAP) sopharyngeal airway placement opharyngeal airway placement
dotracheal intubation er: D
nation: In cases of severe facial trauma with airway compromise, endotracheal intubation is t nd most effective method to secure the airway.
ion: 695
ediatric trauma patient, which of the following is the most reliable indicator of shock?
art rate piratory rate od pressure
vel of consciousness er: C
nation: Blood pressure is the most reliable indicator of shock in pediatric patients, as they m nsate with tachycardia initially.
A patient presents with a severe facial fracture after a fall. She is able to speak but has difficulty breathing due to potential airway compromise. What is the first-line intervention for airway management in this
1. Co
2. Na
3. Or
4. En
Answ
Expla he
safest a
Quest
In a p
1. He
2. Res
3. Blo
4. Le
Answ
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compe
Question: 696
A firefighter suffers second-degree burns covering 25% of his body after a rescue operation. What is the most appropriate fluid resuscitation formula to use for this patient in the first 24 hours post-injury?
1. Parkland formula: 4 mL x %TBSA x weight (kg)
2. Modified Brooke formula: 2 mL x %TBSA x weight (kg)
3. Consensus formula: 3 mL x %TBSA x weight (kg)
4. Galveston formula: 4 mL x %TBSA x weight (kg) + maintenance fluids Answer: A
Explanation: The Parkland formula is the most commonly used for fluid resuscitation in burn patients, particularly in the first 24 hours, ensuring adequate hydration and perfusion.
Question: 697
ent is noted to have paradoxical movement of the chest wall after sustaining multiple rib frac the pathophysiological basis for this finding?
Loss of structural integrity of the rib cage
reased intrathoracic pressure during expiration apleural pressure exceeding atmospheric pressure paired diaphragm function
er: A
nation: The loss of structural integrity of the rib cage due to multiple rib fractures causes xical movement during respiration.
ion: 698
ent presents with a laceration to the neck that is actively bleeding. What is the most critical ention?
ply a pressure dressing
pare for immediate surgical airway ition the patient upright
form direct pressure to the wound
er: B
A pati tures.
What is
A.
1. Inc
2. Intr
3. Im
Answ Expla
parado
Quest A pati interv
1. Ap
2. Pre
3. Pos
4. Per Answ
Explanation: The risk of airway compromise necessitates preparation for a surgical airway due to potential vascular injury.
Question: 699
In a trauma system, what is the primary purpose of a regional trauma center?
1. To provide basic emergency care
2. To coordinate trauma care among various facilities
3. To serve as a research facility for trauma
4. To manage all types of medical emergencies Answer: B
Explanation: A regional trauma center's primary role is to coordinate trauma care, ensuring that patients receive the most appropriate care based on the severity of their injuries.
ion: 700
ng adult patient presents with tachycardia, hypotension, and altered mental status following a the priority intervention?
minister IV analgesics form a focused ultrasound
ain a complete blood count
ablish IV access and start fluid resuscitation er: D
nation: Establishing IV access and starting fluid resuscitation is critical to address hypovolem n a trauma patient.
ion: 701
the assessment of a patient with a suspected knee dislocation, which of the following findin most indicate the need for immediate reduction?
and swelling
bility to move the knee ising around the joint pliteal pulse absent
Quest
A you fall.
What is
1. Ad
2. Per
3. Obt
4. Est Answ
Expla ic
shock i
Quest
During gs
would
1. Pain
2. Ina
3. Bru
4. Po
Answer: D
Explanation: An absent popliteal pulse indicates potential vascular compromise, necessitating immediate reduction to restore circulation.
Question: 702
During a trauma assessment, you note that a patient has significant rib fractures leading to paradoxical
movement of the chest wall. What is this condition known as, and what is the best management approach?
1. Pulmonary contusion; provide supplemental oxygen
2. Flail chest; provide positive pressure ventilation and pain management
3. Hemothorax; perform needle decompression
4. Tension pneumothorax; monitor closely for respiratory failure Answer: B
ement includes positive pressure ventilation and adequate pain control to enhance respirator nics.
ion: 703
year-old female presents with severe abdominal pain and a history of liver disease. She is nsive, and her abdomen is distended. What should be your immediate intervention?
form a FAST exam and apply a binder minister IV fluids and prepare for surgery minister analgesics
pare for CT imaging er: A
nation: A FAST exam is crucial to assess for internal bleeding, and applying a binder can hel ze the abdomen.
ion: 704
ssessing a patient with a partial-thickness burn, you notice the presence of blisters. How w assify this type of burn?
Explanation: Flail chest is characterized by paradoxical movement of the chest wall, and the best manag y
mecha
Quest
A 31-
hypote
1. Per
2. Ad
3. Ad
4. Pre Answ
Expla p
stabili
Quest
While a ould
you cl
1. Deep partial-thickness
2. Superficial
3. Full-thickness
4. Fourth-degree Answer: A
Explanation: The presence of blisters indicates a deep partial-thickness burn.
Question: 705
A patient with a history of blunt abdominal trauma presents with hypotension and tachycardia. Which of the following physical findings would most likely indicate a splenic injury?
1. Ascites on ultrasound
2. Rebound tenderness in the right upper quadrant
dominal tenderness in all quadrants er: C
nation: Grey Turner's sign indicates retroperitoneal hemorrhage, which can occur with spleni
ion: 706
year-old female is involved in a motor vehicle collision and presents with a stable pelvic frac the most appropriate management step to minimize hemorrhage?
minister IV fluids
nitor vital signs closely ply a pelvic binder
pare for surgical intervention er: C
nation: Applying a pelvic binder helps stabilize the pelvis and can significantly reduce hemor elvic fractures.
ion: 707
Grey Turner's sign
3. Ab
Answ
Expla c
injury.
Quest
A 30- ture.
What is
1. Ad
2. Mo
3. Ap
4. Pre Answ
Expla rhage
from p
Quest
A 28-year-old female sustains a facial injury during a bar fight. You suspect a fracture of the maxilla. What should be your initial management priority, considering the risk of airway compromise?
1. Stabilize the cervical spine
2. Perform rapid sequence intubation
3. Assess for the presence of a foreign body
4. Apply a jaw-thrust maneuver Answer: D
Explanation: A jaw-thrust maneuver is essential to maintain airway patency in patients with potential maxillary fractures while assessing for airway compromise.
Question: 708
When assessing a trauma patient with an open fracture, what is the primary concern regarding the wound?
ne healing ection risk ve damage scle necrosis
er: B
nation: Open fractures expose the bone to the external environment, significantly increasing the ction, necessitating prompt surgical intervention.
ion: 709
auma patient with a suspected pelvic fracture, which assessment finding would most strongly the presence of significant hemorrhage?
art rate of 80 bpm
od pressure of 100/60 mmHg Mild abdominal tenderness
ymmetrical limb positioning er: B
nation: A blood pressure of 100/60 mmHg in the context of a pelvic fracture may indicate cant hemorrhage, necessitating immediate intervention.
Bo
Inf
Ner
Mu
Answ
Expla risk
of infe
Quest
In a tr suggest
1. He
2. Blo C.
D. As
Answ Expla
signifi
Question: 710
In managing a patient with suspected spinal cord injury, which of the following is the priority action?
1. Administration of high-dose steroids
2. Immobilization of the spine
3. Assessment of neurological function
4. Initiation of IV fluids Answer: B
Explanation: Spinal immobilization is critical to prevent further injury and stabilize the patient before further assessment or intervention.
Question: 711
arding. What is the most likely organ affected if the patient has a history of exact abdomin
?
mach
ge intestine all intestine dder
er: C
nation: The small intestine is the most commonly injured hollow organ, particularly after abd y, which can lead to perforation and subsequent peritonitis.
ion: 712
ent who fell from a ladder is found unresponsive with a GCS of 7. What is the most critical ment you should conduct immediately?
eck for spinal injuries
nduct a full neurological exam aluate circulation and pulse sess the airway and breathing
During your assessment of a patient with a suspected hollow organ injury, you note signs of peritonitis and gu al
surgery
1. Sto
2. Lar
3. Sm
4. Bla Answ
Expla ominal
surger
Quest
A pati assess
1. Ch
2. Co
3. Ev
4. As
Answer: D
Explanation: With a GCS of 7, the patient is at high risk for airway compromise; therefore, assessing and securing the airway is the top priority.
Question: 713
In a case of suspected acute limb ischemia, which intervention should be avoided?
1. Application of warm compresses
2. Immediate surgical consultation
3. Assessment of pulses
4. Administration of anticoagulants Answer: A
Explanation: Warm compresses can exacerbate ischemia and are contraindicated in acute limb ischemia management.

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References

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