Chapter 15: Shock and Resuscitation
A 66-year-old female patient has been struck by a car. Your assessment reveals gurgling respirations, rapid breathing, and cool, diaphoretic skin. You also note bruising to her chest and abdomen. What should you do immediately?
Suction the airway
You are assessing an elderly patient with a decreased level of consciousness. Your assessment reveals the patient to have a patent airway, labored respirations, and weak, rapid pulses. The skin is pale, cool, and cyanotic in the extremities. You also observe diaphoresis and a delayed capillary refill. Vital signs for this patient are heart rate, 136 beats/min; blood pressure, 66/40 mmHg; and respirations, 40 and shallow. Auscultation of the lungs reveals profound rales located throughout each lung. The patient's temperature is 99°F and there is obvious jugular vein distention and pedal edema. Additionally, family states that the patient has an extensive cardiac and diabetic history. Based on this information, you should suspect which kind of shock?
Cardiogenic
As you approach a seemingly unresponsive patient, you observe a 1- to 2-inch circle of dark blood on his shirt. He also appears pale and diaphoretic. What should you do first?
Assess his airway
A patient goes into cardiac arrest at 11:40 a.m. Which of these treatments gives the patient the best chance for recovery?
CPR at 11:41 a.m. and defibrillation at 11:43 a.m.
It is critical that the EMT never apply the AED to a person who is not in cardiac arrest because an accidental shock could
Cause the beating heart to go into cardiac arrest
You have been called to transport a patient in septic shock from the emergency department of a local hospital to the critical care unit of another hospital. Two nurses will be accompanying you. As a knowledgeable EMT, you recognize that this state of shock has been caused by:
Infection
Because of a shortage of paramedics at your ambulance service, it has been announced that there will be AEDs placed on every ambulance for use by EMT crews. Which of these statements indicates an understanding of how this policy will affect the EMTs?
"The AED will let us know whether to shock the patient."
A patient has fallen down a flight of stairs, and is now restless and confused. His airway is open, and he is adequately breathing, 22 times per minute, with a pulse oximetry reading of 90%. He has a radial pulse of 92 beats/min, which is moderate in strength. Emergency Medical Responders are maintaining manual spine motion restriction. What should your next action be?
Administer supplemental oxygen
You are reassessing a young female who sustained blunt trauma to the chest in a motor vehicle collision. Which of these assessment findings best indicates that she is deteriorating and in the decompensatory phase of shock?
Blood pressure of 88/50 mmHg
You have been called for an elderly male patient who suddenly collapsed. On scene, you find an 82-year-old man lying on the garage floor. Assessment reveals him to be unresponsive and not breathing. What should you do immediately?
Check for a carotid pulse
The EMT realizes that the best means of preventing failure of the AED is to:
Check the AED battery and its supplies at the beginning of each shift
You have applied the AED's electrodes to an obese male patient in cardiac arrest. When you press the analyze button, the AED gives you a "check electrode" message. In looking at the patient, which of these factors would most likely be responsible for this message?
Hairy chest
A patient has been involved in a very serious motor vehicle collision and is in shock. Assessment findings indicate that he sustained blunt trauma to the abdominal and pelvic areas. Which type of shock is the patient most likely suffering?
Hypovolemic
Why is defibrillation in the first few minutes of cardiac arrest so critical
If cardiac arrest is not treated within the first few minutes, ventricular fibrillation will convert to asystole, a nonshockable heart rhythm
One of the benefits of utilizing an automated chest compression device is that:
It frees up EMS providers to tend to other patient care tasks
You have arrived at the residence of a 66-year-old female patient who is in cardiac arrest. In the living room, you find Emergency Medical Responders performing CPR on the patient. They quickly report that they found the patient in cardiac arrest and have been doing CPR for 5 minutes. Which of these statements should you make at this time?
Let's stop CPR so I can check the airway, breathing, and circulation."
Which of these condition(s) is (are) as the most probable cause of cardiogenic shock?
Myocardial infarction
You are treating a 4-year-old child who sustained trauma after being ejected from a motor vehicle rollover. Your assessment has revealed a blood pressure of 72/52 mmHg, a heart rate of 118 beats/min, and respirations of 28 breaths/min and unlabored. The pulse oximetry reading on ambient air is 92%. How would you describe these findings?
Shock findings for this age
A "no shock advised" message is provided by the AED. The EMT understands that this could mean:
The patient has regained a pulse
A patient has just gone into cardiac arrest. His heart is most likely in which rhythm?
Ventricular fibrillation
Which cardiac arrest rhythm is the AED designed to shock?
Ventricular fibrillation
You are dispatched to a residence for an 82-year-old female who is not breathing. On arrival, the husband directs you to a second-floor bedroom. As you make patient contact, you note that she is rigored. What should your next step be?
Withhold CPR and contact medical command
Which of these remarks made by the patient best reinforces your suspicion that he is in the early stages of hypovolemic shock?
"I have had diarrhea for the past four days."
Immediately following the onset of cardiac arrest, brain cells begin to die after:
5 minutes
The EMT should request advanced life support (ALS) backup for a patient in cardiac arrest because:
ALS treatment decreases the possibility of the patient going back into cardiac arrest once successful defibrillation has occurred
When should the EMT transport the patient with cardiac arrest?
After three "no shock advised" messages are received
When performing the primary assessment, which sign or symptom best indicates that the patient is in hypovolemic shock?
Cool and diaphoretic skin
A patient arrests at 1313 hours. E-911 is activated and dispatches an ambulance at 1315 hours. The ambulance arrives on scene at 1319 hours, and the EMTs reach the patient's side and start care at 1321 hours. After transporting the patient, the patient is transferred to the ED staff at 1346 hours. Based on that information, which of these statements would be considered correct?
Down time is 8 minutes
Your ambulance service director has given you permission to replace an old fully automated AED with a new semi-automated AED produced by a different manufacturer. Before making the purchase, you must receive authorization to do so from the:
EMS system's medical director
Which of these statements about the AED and its use in the treatment of cardiac arrest is true?
Research has shown that the first shock delivered by an AED is often faster than the first shock delivered by a manual defibrillator
When in shock, the body has a slightly delayed compensation mechanism that utilizes:
The release of hormones
Which of these statements made by your EMT partner regarding care for the adult patient in cardiac arrest is accurate?
When using an AED, the machine should be turned on before applying the electrodes."
Which of these unresponsive patients would the EMT recognize as in cardiac arrest?
A female who has an occasional gasp for a breath but no palpable carotid pulse
you have been asked to describe the American Heart Association's Chain of Survival to a group of Emergency Medical Responder students. Which of these is the best description of this concept?
A sequence of events that, if enacted quickly, gives the patient the best chance of surviving cardiac arrest
A patient in shock with abdominal pain indicates he noticed a lot of blood in the toilet after having a bowel movement this morning. The EMT should suspect which type of shock?
Hemorrhagic hypovolemic
A 44-year-old male patient has been shot in the abdomen. Which assessment findings would lead you to believe that the patient is in compensated shock?
Alert and anxious, pulse 102, BP 114/88 mmHg, pale and cool skin
You are preparing to attach an AED when you notice that the patient has an implanted pacemaker. What should you do?
Apply the AED, but avoid placing the electrodes over the pacemaker
While using the AED to treat a patient in cardiac arrest, your partner informs you that he can feel a carotid pulse. What should you do immediately?
Assess the patient's airway and breathing adequacy
A driver was ejected from his vehicle in a rollover-type collision. Assessment findings reveal the patient to be unresponsive, with bruising to the abdominal and pelvic areas as well as an open femur fracture. The patient has an open airway and is breathing 32 times per minute. When you listen to breath sounds, you find them to be absent over the alveolar areas of the lungs. The patient's skin is cool and clammy and the radial pulses weak. Manual spine motion restriction is being maintained. What should your next intervention be?
Assist respirations
Which of these is most appropriate when two EMTs are performing CPR on an adult patient?
At least 100 compressions per minute
Which of these conditions could be responsible for causing obstructive shock
Blood clots in the lungs
A patient with a severe gastrointestinal bleeding is in shock. Which ALS or hospital interventions would best correct the patient's underlying problem?
Blood replacement
You suspect that a patient involved in a motor vehicle collision is in shock. Which sign or symptom of shock would you expect to see last?
Decreased blood pressure
The underlying pathophysiology of distributive shock is:
Dilation of the blood vessels
Which link of the American Heart Association's Chain of Survival must occur first, if a patient is to survive cardiac arrest?
Early activation
Resuscitation, when started during which phase of cardiac arrest, provides the patient with the best chance of survival?
Electrical
You are transporting a patient in cardiac arrest. The AED is being used and a shock has been advised. Prior to administering the shock, what should you do?
Ensure that no rescuer is touching the stretcher
At a continuing education seminar on shock, the presenter asks if there is a point where someone cannot recover from shock. Which statement made by an EMT is correct?
Even with treatment, if shock has reached the final stage when multiple organs start to fail, death will result."
As you arrive at a metal scrap yard for an unknown medical emergency, you observe a male supine on the ground with AED electrodes on his chest. The AED operator has just ordered coworkers to clear the patient because the AED is going to shock. Within seconds, the AED delivers a shock without the operator pressing a "shock" button. The EMT should recognize that which type of AED is being used?
Fully automated
A patient fell 20 feet from a ladder, and is now confused and anxious. Which of these signs/symptoms suggests that the patient is in shock?
Heart rate of 110 beats/min
Which of these are some of the major categories of shock that the EMT will likely encounter?
Hypovolemic, cardiogenic, obstructive, and distributive
When presenting information on cardiac arrest and automated external defibrillation to a community group, a man asks why people should perform CPR prior to the arrival of EMS if the EMS responders will provide a shock after they arrive. Your response would be:
Immediate CPR can prolong the period in which the heart can be successfully shocked into a perfusing rhythm following cardiac arrest."
A 28-year-old male patient was cutting limbs from a tree when he lost his footing and fell approximately 20 feet. He is unresponsive and has shallow breathing, with a rate of 28 breaths/min. His radial pulse is weak and thready, and his skin is cool to the touch. Emergency Medical Responders (EMRs) have placed him on a nonrebreather face mask and are holding manual spine motion restriction. His respirations are sonorous. Based on these assessment findings, which of these instructions would you next provide to the EMRs?
Let's take off the oxygen mask and try manually opening the airway.
When the body is in a shock state, which hormone released from the adrenal glands stimulates primarily alpha-1 and beta-1 receptors, but has no effects on beta-2 receptor sites?
Norepinephrine
When paramedics administer IV fluids as treatment for hemorrhagic shock, the fluids will:
Not be able to increase the oxygen-carrying capability of the blood
You believe that a young male patient, who has been shot in the lower abdomen, is bleeding internally and is in the early stage of shock. Which of these descriptions includes appropriate prehospital care of this patient?
Oxygen therapy and rapid transport to the hospital
A 47-year-old patient has been in cardiac arrest for 6 minutes. While you set up the AED, you would direct your partner to:
Perform CPR until the AED is ready
After you applied the AED to a patient in cardiac arrest, it delivered a shock. Immediately after the shock, what should you do next?
Provide 2 minutes of CPR, and then check the patient for a pulse
You have been called to a public pool for an unresponsive patient. On arrival, you find lifeguards performing CPR with a pocket mask and oxygen on a 67-year-old male swimmer. They report that the patient was in the water and was seen clutching his chest seconds before going unresponsive. He was immediately pulled from the water and CPR was initiated. The lifeguards estimate that CPR has been performed for 5 minutes. Assessment shows the man to be unresponsive, apneic, and pulseless. What should be your first response?
Resume CPR and let's take a towel and dry off his chest so we can apply the AED electrodes."
Which activity related to the use of an AED would a medical director carry out?
Reviewing cases in which an AED was used but no shock was advised
When a 52-year-old male patient collapsed on his front porch, his family dialed 911. When you arrive, the daughter informs you that the patient has been down for approximately 8 minutes. Assessment reveals him to be in cardiac arrest. What should you do immediately?
Start CPR while the AED is applied and readied for use
You are by the side of an unresponsive 6-month-old child with a history of congenital heart disease. The patient's airway is patent, but he is not breathing. A heart rate of 24 beats/min is noted. At this time, it is essential that you
Start cardiopulmonary resuscitation with compressions and ventilations
After the AED gives a "no shock advised" message, it is determined that the patient has a weak pulse and slow and shallow respirations. You would immediately:
Start positive pressure ventilation
You are transporting a 57-year-old male patient who went into cardiac arrest at home. After two shocks and CPR, he regained a pulse, but he remains unresponsive and in respiratory arrest. During transport, your reassessment reveals the absence of a carotid pulse. What should you do first?
Stop the ambulance and analyze the heart rhythm with the AED
Which of these is considered a benefit of the automated external defibrillator?
The ease and speed with which it can be used
our service has a new AED. During the in-service program on the new device, the instructor informs you that it is a semi-automated AED and uses a biphasic wave form, as opposed to the monophasic form used by the previous AED. As a knowledgeable EMT, you should recognize that:
The new AED will defibrillate the patient with smaller amounts of electrical energy
What is the primary difference between the 2015 American Heart Association's "Chain of Survival" for the adult patient versus the pediatric patient?
The pediatric chain emphasizes strategies for arrest prevention
A patient in cardiac arrest has regained a pulse after two shocks, but is still apneic. Which action would be appropriate next?
Transport the patient supine and secured to a long spine board as treatment is continued
Within 2 minutes of going into cardiac arrest, an AED is applied, the patient is shocked, and a pulse is restored. The EMT should recognize that the patient's heart was in:
Ventricular fibrillation and now is in an organized rhythm
The AED should never be applied to a patient who is not in cardiac arrest because some patients in:
Ventricular tachycardia may still have a pulse
Which of these statements about the heart rhythm of ventricular fibrillation is true?
When a patient's heart is in ventricular fibrillation, it is unable to pump blood throughout the body
You arrive on the scene of an "unknown medical emergency." The local fire department EMRs arrive simultaneously, so you now have five providers at the scene to help. The on-scene police officer tells you the patient is an elderly man who has attempted suicide by shooting himself in the head. As you enter the patient's room, you see the male patient with an extensive skull injury. A large portion of his right temporal and parietal skull is gone, and there are blood splatter and brain tissue on the wall behind him. Given this information, what should you do?
Withhold resuscitation
The owner of a day care center for adults with Alzheimer's disease calls you to ask about an AED at her facility. Specifically, she asks if she will need a physician to oversee the AED program. Your reply should be:
You will need to have a physician medical director since the AED can be used only with his or her permission under his or her license."
Which statement made by a patient's family member would cause the EMT to suspect that a patient is experiencing hypovolemic shock
"He cannot stop throwing up."
You are transporting an unresponsive 31-year-old female patient who suffered cardiac arrest. On scene, Emergency Medical Responders (EMRs) shocked the patient once with the AED and she regained a pulse. She remains unresponsive and has shallow respirations. Ventilation is being provided with a bag-valve mask. An EMR has agreed to ride to the hospital with you to provide assistance in caring for the patient. Which set of instructions given to the EMR next is most appropriate?
"Leave the AED on the patient, even though she is breathing and has a pulse.
If a cardiac arrest patient were in asystole, which message would the AED provide?
"No shock advised"
A 51-year-old male patient who experienced cardiac arrest has regained a pulse after one shock from the AED. The dispatcher informs you that the paramedic unit you have requested for assistance is coming from the eastern end of the county and has a 20-minute ETA. The hospital is 15 minutes west of your location. Which action would be most appropriate given this situation?
Start transport to the hospital and inform the ALS dispatcher of your intent
You have been dispatched to a residence for a male patient with a cardiac history who is complaining of chest pain. On scene, you find a 52-year-old man sitting in a chair. He is alert and oriented. He states that his chest pain feels like the last time he had a heart attack. He reports that in the hospital his heart stopped and the health care personnel had to shock him twice before it restarted. He is breathing adequately and has a strong radial pulse. Which of these actions would be appropriate in the assessment and/or management of this patient?
Obtain the patient's heart rate, respiratory rate, and blood pressure
An unrestrained 37-year-old female patient is in cardiac arrest after her vehicle struck a tree head-on at a high rate of speed. Assessment reveals that the patient suffered massive blunt trauma to the chest and abdomen. The patient is quickly extricated from the vehicle and placed in a supine position on the ground. It is estimated that the patient has been in cardiac arrest for approximately 10 minutes, during which time CPR was not performed. At this time, the EMT would:
Perform CPR and contact medical command for permission to use the AED
A 7-year-old boy choked on a grape at school. By the time the obstruction was removed, assessment revealed him to be in cardiac arrest. When you arrive, teachers are performing CPR. The school nurse informs you that CPR has been in progress for 6 minutes. You have an AED, but do not have a pediatric conversion device that reduces the energy of defibrillation from that of an adult to that of a child. What should you do immediately?
Place the adult AED electrodes on the boy's chest and follow the AED's prompts
Proper care of cardiac arrest for a 6-year-old pediatric patient when there are no available pediatric AED pads would include:
Placement and use of the adult pads with adult energy levels
When comparing the pediatric Chain of Survival to the adult Chain of Survival, the EMT would note that the pediatric version differs in which way?
Prevention of cardiac arrest
The AED has just been applied to a female patient in cardiac arrest. After analyzing the heart rhythm, it provides a "no shock advised" message. The EMT should immediately:
Resume cardiopulmonary resuscitation
You have been assigned to a football game to provide standby coverage. While taking a break, you decide to walk to a nearby concession stand for a soft drink. On the way, you come across a group of people standing around a male patient who collapsed and is on the ground. Your assessment reveals him to be unresponsive, not breathing, and pulseless. A bystander states that the patient just collapsed moments ago. An AED is located less than 1 minute from your location. The nearest EMT is 5 minutes from your location. What should you do immediately?
Retrieve the nearby AED
Which of these statements made by your EMT partner best indicates an understanding of the prehospital role in caring for the patient in shock?
Since shock is best treated in the hospital, the EMT should provide care to maintain perfusion to the vital organs and transport the patient."
You are treating a pediatric patient in cardiac arrest. The patient has a long congenital cardiac history and had a pacemaker implanted a year ago. How will this information change the EMT's use of the AED during arrest management?
The AED can be used, but the adhesive pad should not be placed directly over the pacemaker
After two cardiac arrests occurred on its premises over the last 6 months, a large home improvement center has purchased a fully automated AED. You have been asked to provide education on its use. During an instructional session, a student asks you what will happen when the AED indicates that a shock is indicated. Your response should be:
The AED will automatically charge and shock the patient."
Which of these actions performed by the EMT indicates appropriate care with the AED when treating a patient in cardiac arrest?
The EMT places, then quickly removes, a set of electrodes in an attempt to remove excessive hair from a patient's chest
You are instructing a first-aid class at a local chemical plant. The course includes instruction regarding an AED that is to be placed in the plant. Which point would you emphasize to the employees to help them avoid the most common cause of AED failure?
The batteries must be checked regularly."
When a person is in shock, what is occurring in the body?
The cells are not getting enough oxygen, and waste products are accumulating
You have just applied the AED to a female patient in cardiac arrest and the machine is ready to analyze the heart rhythm. Which of these instructions is appropriate to give at this time?
"Stop CPR and clear the patient."
Mechanical external compression devices are recommended:
When high-quality manual compressions are not possible
You have arrived at a residence where a 4-month-old baby was found in his crib in cardiac arrest. Emergency Medical Responders have been on scene for 5 minutes prior to arrival. They began CPR immediately on reaching the patient's side. You have an AED with adult pads with you, but not pediatric pads. After rechecking and confirming that the patient is in cardiac arrest, you would:
Place the AED on the patient and follow all prompts
A patient in early shock informs the EMT that he has had severe diarrhea and vomiting over the past four days. Given this history, the EMT should recognize the pathophysiology of the shock as:
Loss of plasma volume
While cleaning a gun, a 44-year-old patient accidentally shot himself in the abdomen. On arrival, you observe the patient on the floor lying on his side, with his legs drawn to his chest. His blood pressure and pulse oximetry reading are low, and his heart rate and respirations are high. Blood is evident on his shirt and pants. Which of these indicates the correct sequence of events when caring for this patient?
Perform the primary assessment, administer supplemental oxygen, perform a rapid secondary assessment, transfer the patient to the stretcher, provide rapid transport
You are treating a patient with severe crushing chest pain. She has had two heart attacks in the past, and you believe that she is currently in cardiogenic shock. Blood pressure is 86/66 mmHg, respirations are 20 breaths/min, heart rate is 102 beats/min, and room-air pulse oximetry reading is 91%. Which intervention is the most appropriate next action in this case
Supplemental oxygen
