UCLA PARAMEDIC COMPREHENSIVE EXAM 2026
QUESTIONS AND SOLUTIONS RATED A+
✔✔Posturing - ✔✔1. decorticate (pulling arms/hands in towards you)
- 60% mortality rate / signs of cerebral or upper brainstem injury
2. decerebrate (arms locked out with hands outward)
- 85% mortality rate / sign of cerebral or upper brainstem injury
✔✔Pupils blown/pressure - ✔✔If the right pupil is blown then the pressure is on the right
side or vice versa
✔✔Upper brainstem compression - ✔✔• Increasing blood pressure
• Reflex bradycardia
- Vagus nerve stimulation
• Cheyne-Stokes respirations
• Pupils become small and reactive
• Decorticate posturing
- Neural pathway disruption
✔✔Middle brainstem injury - ✔✔- widening pulse pressure
- increasing bradycardia
- CNS hyperventilation - deep and rapid
- bilateral pupil sluggishness or inactivity
- decerebrate posturing
✔✔Lower brainstem injury - ✔✔Pupils dilated and unreactive
Ataxic respirations
-Erratic with no pattern
Irregular and erratic pulse rate
ECG changes
Hypotension
Loss of response to painful stimuli
✔✔Management of ICP/herniation - ✔✔- airway, breathing, circulation
- head above 30-45 degrees (semi fowlers)
- supplemental O2
- mild hyperventilation to maintain EtCO2 (30-35)
- IV fluids to maintain SBP of 110mmHg (MAP: 85ish)
- decrease brain stimulation
- pain management
- be prepped to manage seizures and vomiting
✔✔Skull fractures - ✔✔linear, depressed, open, basilar
✔✔Skull fracture management - ✔✔- XABC
,- consider SMR
- lightly cover any brain exposures with sterile moistened dressing
- CSF leak - do not attempt to stop flow - apply dressing
✔✔Direct brain injuries - ✔✔focal
- occur at specific location of brain (ex. intracranial hemorrhage)
diffuse
- location of injury spreads over larger area (ex. concussion)
✔✔Impacts - ✔✔coup
- injury at site of impact (slamming head)
contrecoup
- injury on opposite side from impact (whiplash)
✔✔Cerebral concussion - ✔✔occurs when the brain is jarred in the skull
caused by either direct blow to the head or a blow to face, neck, or elsewhere on the
body with an impulsive force to the head
most symptoms resolve within 3 months, small number go to a year
✔✔Cantu concussion grading system - ✔✔Grade 1: mild
- no loss of consc.
- posttraumatic amnesia or s/s <30 mins
Grade 2: moderate
- loss of consc. < 1 min
- posttraumatic amnesia or s/s 30 mins to 24 hrs
Grade 3: severe
- loss of consc. > 1 min
- posttraumatic amnesia or s/s 24 hrs - 7ish days+
✔✔Concussion management - ✔✔- XABC
- possible SMR
- inquire about: cause, amnesia, ALOC/LOC, signs, seizure
✔✔Diffuse Axonal Injury (DAI) - ✔✔one of most common diffuse brain injuries
70% of all TBIs
high mortality rate
, most common cause of both posttraumatic unresponsiveness and a persistent
vegetative state after a TBI
caused by stretching, shearing, or tearing of nerve fibers with consequent axonal
damage
can be caused by rotational and angular forces secondary to rapid acceleration and
deceleration of the brain
✔✔DAI management - ✔✔treatment is primarily supportive
be cautious of airway compromise in an unresponsive pt
if signs of increased ICP, herniation management
✔✔Cerebral contusion - ✔✔the bruising of brain tissue in a local area
most commonly affected region is the frontal lobe
✔✔intracranial hemorrhage - ✔✔the cranial vault has no additional space, when there is
the accumulation of blood, it will lead to increased ICP
bleeding can occur in several areas:
- epidural (between skull and dura mater)
- subdural (between dura mater but outside the brain)
- intracerebral space (within parenchyma tissue)
- subarachnoid space (into the CSF, below the arachnoid and above pia mater)
✔✔Epidural hematoma - ✔✔a collection of blood in the space between the skull and
dura mater
nearly always due to the temporal bone
MMA can easily be sheared and will cause this (near temporal)
S/S:
LOC to lucid interval
headache
S/S similar to concussion
if ICP increases, signs of herniation
✔✔Subdural hematoma - ✔✔collection of blood under the dura mater (most common
intracranial hemorrhage)
common causes: falls or injuries involving strong deceleration forces
QUESTIONS AND SOLUTIONS RATED A+
✔✔Posturing - ✔✔1. decorticate (pulling arms/hands in towards you)
- 60% mortality rate / signs of cerebral or upper brainstem injury
2. decerebrate (arms locked out with hands outward)
- 85% mortality rate / sign of cerebral or upper brainstem injury
✔✔Pupils blown/pressure - ✔✔If the right pupil is blown then the pressure is on the right
side or vice versa
✔✔Upper brainstem compression - ✔✔• Increasing blood pressure
• Reflex bradycardia
- Vagus nerve stimulation
• Cheyne-Stokes respirations
• Pupils become small and reactive
• Decorticate posturing
- Neural pathway disruption
✔✔Middle brainstem injury - ✔✔- widening pulse pressure
- increasing bradycardia
- CNS hyperventilation - deep and rapid
- bilateral pupil sluggishness or inactivity
- decerebrate posturing
✔✔Lower brainstem injury - ✔✔Pupils dilated and unreactive
Ataxic respirations
-Erratic with no pattern
Irregular and erratic pulse rate
ECG changes
Hypotension
Loss of response to painful stimuli
✔✔Management of ICP/herniation - ✔✔- airway, breathing, circulation
- head above 30-45 degrees (semi fowlers)
- supplemental O2
- mild hyperventilation to maintain EtCO2 (30-35)
- IV fluids to maintain SBP of 110mmHg (MAP: 85ish)
- decrease brain stimulation
- pain management
- be prepped to manage seizures and vomiting
✔✔Skull fractures - ✔✔linear, depressed, open, basilar
✔✔Skull fracture management - ✔✔- XABC
,- consider SMR
- lightly cover any brain exposures with sterile moistened dressing
- CSF leak - do not attempt to stop flow - apply dressing
✔✔Direct brain injuries - ✔✔focal
- occur at specific location of brain (ex. intracranial hemorrhage)
diffuse
- location of injury spreads over larger area (ex. concussion)
✔✔Impacts - ✔✔coup
- injury at site of impact (slamming head)
contrecoup
- injury on opposite side from impact (whiplash)
✔✔Cerebral concussion - ✔✔occurs when the brain is jarred in the skull
caused by either direct blow to the head or a blow to face, neck, or elsewhere on the
body with an impulsive force to the head
most symptoms resolve within 3 months, small number go to a year
✔✔Cantu concussion grading system - ✔✔Grade 1: mild
- no loss of consc.
- posttraumatic amnesia or s/s <30 mins
Grade 2: moderate
- loss of consc. < 1 min
- posttraumatic amnesia or s/s 30 mins to 24 hrs
Grade 3: severe
- loss of consc. > 1 min
- posttraumatic amnesia or s/s 24 hrs - 7ish days+
✔✔Concussion management - ✔✔- XABC
- possible SMR
- inquire about: cause, amnesia, ALOC/LOC, signs, seizure
✔✔Diffuse Axonal Injury (DAI) - ✔✔one of most common diffuse brain injuries
70% of all TBIs
high mortality rate
, most common cause of both posttraumatic unresponsiveness and a persistent
vegetative state after a TBI
caused by stretching, shearing, or tearing of nerve fibers with consequent axonal
damage
can be caused by rotational and angular forces secondary to rapid acceleration and
deceleration of the brain
✔✔DAI management - ✔✔treatment is primarily supportive
be cautious of airway compromise in an unresponsive pt
if signs of increased ICP, herniation management
✔✔Cerebral contusion - ✔✔the bruising of brain tissue in a local area
most commonly affected region is the frontal lobe
✔✔intracranial hemorrhage - ✔✔the cranial vault has no additional space, when there is
the accumulation of blood, it will lead to increased ICP
bleeding can occur in several areas:
- epidural (between skull and dura mater)
- subdural (between dura mater but outside the brain)
- intracerebral space (within parenchyma tissue)
- subarachnoid space (into the CSF, below the arachnoid and above pia mater)
✔✔Epidural hematoma - ✔✔a collection of blood in the space between the skull and
dura mater
nearly always due to the temporal bone
MMA can easily be sheared and will cause this (near temporal)
S/S:
LOC to lucid interval
headache
S/S similar to concussion
if ICP increases, signs of herniation
✔✔Subdural hematoma - ✔✔collection of blood under the dura mater (most common
intracranial hemorrhage)
common causes: falls or injuries involving strong deceleration forces
