EMT Ch 15 Brady Lab Quiz

Which of the following patients would benefit from​ defibrillation? A. An​ unconscious, pulseless, apneic patient with a heart rhythm of ventricular tachycardia B. An​ unconscious, pulseless, apneic patient in asystole C. An​ unconscious, pulseless, apneic patient who has an organized heart rhythm D. An​ unconscious, apneic patient who has a slow pulse

A. An​ unconscious, pulseless, apneic patient with a heart rhythm of ventricular tachycardia The AED would be most beneficial for a patient in cardiac arrest who is​ unconscious, pulseless,​ apneic, and in either ventricular tachycardia or ventricular fibrillation. The AED will not shock a patient who is in asystole or has a slow pulse or any type of organized heart rhythm.

What does the current research indicate about the use of mechanical piston and​ load-distributing band CPR devices versus traditional​ CPR? A. Available evidence does not support the routine use of these devices. B. Evidence suggests that these devices should be used only on elderly patients. C. Evidence suggests that these devices should be used in EMS systems that have only two EMTs on cardiac arrest calls. D. Evidence indicates that these devices should be used only on pediatric patients.

A. Available evidence does not support the routine use of these devices. Although some research shows that the devices are better at providing cerebral and coronary perfusion than is traditional​ CPR, the available evidence still cannot support routine use of these devices.

Why are biphasic AEDs sometimes preferred over monophasic​ AEDs? A. Biphasic AEDs are thought to cause less damage to the heart. B. Monophasic AEDs carry only enough power to deliver one​ shock, where biphasic units can shock up to nine times. C. Biphasic AEDs tend to be considerably less expensive than their monophasic counterparts. D. The biphasic units come with two electrode pads rather than just one like most monophasic models.

A. Biphasic AEDs are thought to cause less damage to the heart. Some external defibrillators use the older monophasic waveform. Most now use the newer biphasic waveform. The monophasic AED delivers the energy at​ 200, 300, and 360 joules in one direction. The biphasic delivers lower energy​ (typically less than or equal to 150-200 ​joules) pulses. The lower energy delivered by the biphasic AED is thought to cause less heart cell damage yet is still more effective at terminating ventricular fibrillation.

What is the trigger that causes the body to initiate the compensatory mechanism that is seen in a shock​ state? A. Decreased vessel tension detected by the baroreceptors B. Peripheral vasoconstriction as determined by the capillary beds C. Elevation in the respiratory rate as detected by the phrenic nerve D. Increased heart rate as determined by the brainstem

A. Decreased vessel tension detected by the baroreceptors Recall the function of the baroreceptors. These are​ stretch-sensitive receptors that continuously measure the pressure inside the aorta and carotid arteries. When there is a reduction in blood volume or pump function or a massive vasodilation with a redistribution of blood volume away from the core​ circulation, the cardiac output decreases. This causes a decrease in pressure inside the aorta and carotid​ arteries, which results in a reduction in stretch or tension in the arterial walls. The baroreceptors sense the reduction in arterial wall tension and trigger compensatory mechanisms. The increase in the heart rate is part of the compensatory​ mechanism, not the cause of​ it, and the phrenic nerve innervates the​ diaphragm; it does not sense its activity.

Your patient has a history of gastric ulcers and GI bleeding. He is now​ tachycardic, hypotensive, and tachypnic. He admits to passing a lot of blood the past several days. What type of shock is this MOST​ likely? A. Inadequate blood volume B. Inadequate oxygen levels C. Inadequate pump function D. Inadequate vessel tone

A. Inadequate blood volume ​"Hypo-" means low or​ inadequate, "vol" refers to​ volume, and​ "-emic" pertains to blood.​ Thus, the term​ "hypovolemic shock" means shock that is caused from a low blood volume. Hypovolemic shock is the most common form of shock. It can be due to blood loss or loss of some other​ fluid; basically any condition or injury that decreases the blood content or the fluid portion of the blood. The most common cause of hypovolemic shock is hemorrhage. Cardiogenic shock results from a dysfunctional heart causing inadequate pumping​ action, distributive shock causes widespread​ vasodilation, and respiratory shock occurs when the body is unable to oxygenate the bloodstream.

You are preparing to transport a​ post-arrest patient with return of spontaneous circulation​ (ROSC) to the hospital. The hospital to which you are transporting is a​ 15-minute drive due west from your currently location. The closest ALS unit is 10 minutes​ away, coming toward you from the east. What should you​ do? A. Initiate transport to the hospital. B. Wait for the ALS service to arrive before transporting. C. Start transport to a hospital 30 minutes away but in the same direction as the incoming ALS service. D. Wait 5 more minutes to depart the​ scene, then tell the ALS service to expedite so that they can catch up with you.

A. Initiate transport to the hospital. Although this decision is often driven by​ protocol, the EMT should realize that the overall goal and the last link in the​ "Chain of​ Survival" is getting the patient ALS care as soon as possible. In this situation ALS care would be at the hospital. The best option would be to start transport to the hospital that is 15 minutes away without ALS intercept. All other options will delay arrival of the patient at the ED.

What should the EMT do in preparing to apply the AED to a patient in cardiac arrest who was found in a filled​ bathtub? A. Remove the patient from the water. B. Apply the electrodes without removing the patient from the water. C. Place the electrodes on the​ patient's arms or legs if they are dry. D. Apply the​ electrodes, but do not turn on the AED.

A. Remove the patient from the water. Water is an excellent conductor of electricity. The AED should not be operated if the machine or the patient is lying in​ water, the​ patient's chest is covered with​ water, or the patient is extremely diaphoretic. If the patient is lying in​ water, it may be necessary to move the patient to a safe area and dry the chest with a towel before using the AED.

Upon arrival for a patient who was found unresponsive by​ neighbors, you note that the skin is cool with​ mottling, the smaller joints of the hands are​ stiff, and the jaw seems to be locked into position. There are no environmental extremes in the ambient environment. What should you infer from this​ presentation? A. The patient has rigor. B. The patient is hyperthermic. C. The patient just went into arrest. D. The patient has arthritis.

A. The patient has rigor. Rigor is a condition in which the joints of the body start to stiffen from changes due to prolonged cardiac arrest. This is a finding that occurs hours after​ arrest, so this serves as a condition to not start resuscitation on the patient. Hyperthermia is caused by an increased core temperature and is not consistent with stiff joints. Arthritis can cause stiff joints but not cold and mottled skin.

Which of the following scenarios would be MOST unsafe for the EMT who is about to deliver a shock with an​ AED? A. The patient is lying on a metal surface. B. The patient is lying on a hotel room floor. C. The patient is lying outside in the yard. D. The patient has an implanted defibrillator.

A. The patient is lying on a metal surface. When you are using an​ AED, you are operating a device that delivers an electric shock. That shock can save the life of a cardiac arrest​ patient, but it can injure others who come into contact with it. Such shocks are unlikely to be​ lethal, but they should be avoided. Metal is a good conductor of electricity. Be careful with patients who are in contact with metal​ flooring, catwalks,​ stretchers, and other items with metal components. Before you administer a​ shock, either remove the patient from this surface or ensure that no one else is directly in contact with metal that is touching the patient.

You are caring for an​ 8-year-old male patient who was thrown from a car during a collision. The child has a blood pressure of​ 90/systolic, a heart rate of​ 98/min, and respirations of​ 20/min. How would you characterize the​ patient's shock​ state? A. The​ child's blood pressure is acceptable. B. The child is tachycardic. C. The child is in irreversible shock. D. The child is hypotensive.

A. The​ child's blood pressure is acceptable. Normal vital sign findings vary with age for pediatric patients. For children younger than 10 years of​ age, a systolic blood pressure of 70 mmHg plus two times the age in years is a lower limit of normal. A systolic blood pressure less than the lower limit would be considered hypotensive. Hypotension is a late finding in pediatric patients and often leads to cardiac arrest. In this​ patient, the low systolic value calculates to 86 mmHg. This means that the blood pressure is above the minimally acceptable value that would represent hypotension.

While you are caring for a patient with a heart​ attack, the patient is becoming tachycardic and hypotensive. Your partner asks you why this might be happening. What would be a logical​ explanation? A. The​ patient's stroke volume is probably diminished. B. The​ patient's lungs are no longer able to oxygenate the blood because of alveolar damage. C. The use of oxygen causes​ vasodilation, which will drop the blood pressure and cause the heart rate to increase. D. The patient is suffering from massive vasodilation secondary to the heart attack.

A. The​ patient's stroke volume is probably diminished. The heart is the pump that is responsible for generating the force necessary to move the blood throughout the body. If the pump​ fails, regardless of the blood​ volume, the delivery of oxygen and glucose to cells will be decreased. Pump function failure may result from an injury to the heart that reduces its ability to generate contractions strong enough to push the blood forward throughout the body. For​ example, a heart attack​ (myocardial infarction) deadens a portion of the heart muscle. Like any other​ muscle, a portion that is dead​ doesn't contribute to the force of contraction. If the heart attack has affected a large enough area of heart​ muscle, the pump will fail and lead to a shock state.

Sudden cardiac arrest in the patient with a relatively low level of cardiac disease is generally attributable​ to: A. disordered electrical conduction. B. hypertrophic cardiomyopathy. C. commotio cordis. D. myocardial infarction.

A. disordered electrical conduction. Cardiac​ arrest, the worst manifestation of cardiac compromise from an acute coronary​ event, occurs when the ventricles of the​ heart, for any of a variety of​ reasons, are not contracting or when the cardiac output is completely ineffective and no pulses can be felt. The normal electrical impulses are usually absent or​ disrupted, or the mechanical response to the electrical impulse does not occur. Instead of​ smooth, coordinated​ contractions, the heart shows a different type of​ activity, most commonly the uncoordinated twitching known as ventricular fibrillation. Pumping action​ ceases, and without oxygenated​ blood, the​ body's cells begin to die.

If the heart has an electrical rhythm but the circulatory system has lost so much blood that there is nothing to​ pump, the patient is said to be​ in: A. pulseless electrical activity. B. asystole. C. ventricular fibrillation. D. ventricular tachycardia.

A. pulseless electrical activity. In cases of pulseless electrical activity​ (PEA), the heart has an organized​ rhythm, but either the heart muscle is so weakened that it fails to​ pump, the heart muscle does not respond to the electrical​ activity, or the circulatory system has lost so much blood that there is nothing to pump. Defibrillation is not appropriate in these rhythms.

Bringing a patient back from potential or apparent death is​ called: A. resuscitation. B. sudden death. C. defibrillation. D. cardiac arrest.

A. resuscitation. The term​ "resuscitation" means bringing the patient back from potential or apparent death. The potential or apparent death may result from many different​ causes, including trauma and medical conditions. Resuscitation focuses on management of the​ airway, ventilation, and​ oxygenation, and restoring adequate circulation. Defibrillation is a care technique that may be used during​ resuscitation, and cardiac arrest and sudden death are both etiologies that would require resuscitation.

Which of the blood pressures is MOST indicative of a patient who is still in the compensatory stage of​ shock? A. ​106/88 mmHg B. ​120/80 mmHg C. ​102/64 mmHg D. ​110/78 mmHg

A. ​106/88 mmHg A key finding for early shock is that the systolic pressure is still acceptable​ (above 90​ systolic), but the pulse pressure is becoming more narrow. The patient with a blood pressure of​ 106/88 only has a pulse pressure of 18 mmHg whereas the rest of the patients have pulse pressures over 30 mmHg.

You are on the scene of a patient who severed his left leg distal to the knee in an industrial accident. When you​ arrive, the bleeding is still severe. What should you do with this hemorrhage during the initial phases of shock management on​ scene? A. Initiate an IV to replace lost fluid. B. Apply direct pressure and a tourniquet if necessary. C. Summon ALS and wait on scene until they arrive to control the bleeding. D. Place the patient on a backboard and initiate transport. Provide treatment to the bleeding leg while en route to the hospital.

B. Apply direct pressure and a tourniquet if necessary. The immediate goal for a major bleed while on scene is to stop it from occurring.​ First, attempt to stop the bleeding as quickly as​ possible, using direct pressure. If direct pressure is not​ effective, proceed to application of a tourniquet. Consider hemostatic agents to control hemorrhage if permitted by your local protocol.

Which of the following answers MOST accurately describes the cardiovascular effect resulting from the release of epinephrine and​ norepinephrine? A. Increased heart​ rate, bronchodilation, and smooth muscle dilation of the bowel B. Arteriole​ constriction, increased heart​ rate, and increased contractility C. Increased heart rate and contractility D. Increased contractility and bronchodilation

B. Arteriole​ constriction, increased heart​ rate, and increased contractility These two hormones increase peripheral vascular resistance by causing arteriole constriction and increasing heart rate and contractility​ (thereby increasing cardiac​ output). Collectively, this causes a rise in the blood pressure during a shock state. Bronchodilation and dilation of the bowel are not cardiovascular effects.

Which of the following things would NOT increase the strength or effectiveness of the Chain of​ Survival? A. Immediate 911 activation B. Discourage community CPR until the EMTs arrive C. Strategically placed AEDs D. ​Community-trained CPR providers

B. Discourage community CPR until the EMTs arrive ​Obviously, not allowing community members to intervene on the​ patient's behalf during an arrest situation would have a negative outcome on the likelihood of survival because of the longer delays in the​ patient's receiving CPR or AED use. The other steps​ (911 activation,​ community-trained CPR​ providers, and strategically placed​ AEDs) would enhance survival in the community.

The failure of what cellular metabolic activity in a shock state is essentially the start of the downward spiral that results in patient​ death? A. Failure to produce an increase in carbon dioxide production B. Failure to produce adequate adenosine triphosphate​ (ATP) C. Failure to produce adequate glucose levels D. Failure to produce an increase in hydrogen production

B. Failure to produce adequate adenosine triphosphate​ (ATP) Energy is needed to maintain the function of the​ cell's sodium/potassium pump. If the pump​ fails, the sodium is no longer removed from the cell in exchange for potassium. Potassium and lactic acid leave the cell and begin to collect in the interstitial fluid and blood. The sodium collects inside the cell and attracts water. The cell swells and eventually ruptures and dies. The acid released causes the failure of enzyme systems and the release of lysozymes. The lysozymes begin to attack the​ cell, leading to cell death and eventual organ death.

What is an advantage of a​ load-distributing band CPR device or vest CPR​ device? A. It allows for a​ 100% successful resuscitation rate. B. It improves coronary and cerebral blood flow in comparison to traditional CPR. C. It eliminates the need to ventilate the patient. D. It eliminates the need to intubate the patient or place any other advanced airway.

B. It improves coronary and cerebral blood flow in comparison to traditional CPR. Although some research shows that the devices are better at providing cerebral and coronary perfusion than is traditional​ CPR, the available evidence still cannot support routine use of these devices.

What is the underlying pathology that causes myocardial cell death in a patient who is in cardiac​ arrest? A. Failure of the​ sodium/chloride pump B. Lack of oxygen and glucose C. Lack of sodium and potassium D. Lack of oxygen and carbon dioxide

B. Lack of oxygen and glucose Time is a critical issue in cardiac arrest. As time​ passes, the heart continues to deteriorate from a lack of oxygen and glucose and begins to undergo changes that lead to severe myocardial cell ischemia and eventually organ death.​ Unfortunately, the time is in minutes and begins immediately upon the onset of cardiac arrest.

You arrive on scene for a traumatic cardiac arrest for a male patient who wrecked his motorcycle at a high rate of speed. You start resuscitation and attach the​ AED, which advises NO shock. Your partner has called medical direction and has given a brief report. The medical direction physician tells you to stop resuscitation. What should you​ do? A. Stop resuscitating the patient after another 10 minutes. B. Stop resuscitation efforts. C. Continue resuscitation but transport to a different hospital. D. Continue resuscitation anyway.

B. Stop resuscitation efforts. ​If, after you have begun​ resuscitation, your medical direction physician has ordered you to​ stop, that is what you should do.​ Essentially, the physician realizes that patients with traumatic arrests rarely survive because of their​ injuries, and transporting a dead body is a risk to the EMS providers and the public.​ Additionally, if the medical director has given the​ order, which also means that the medical director has assumed the responsibility.

Your patient has fallen from a horse and suffered a high cervical injury. This has resulted in a loss of sympathetic nervous​ tone, and the patient is becoming hypotensive. What is the underlying mechanism that is causing​ this? A. With a cord​ injury, the patient cannot​ breathe, which causes hypoxia and a drop in the heart rate and systemic vascular resistance. B. The lack of sympathetic tone causes the heart to slow and the vessels to​ dilate; both of these will drop blood pressure. C. The heart rate will start to​ increase, but the massive vasodilation still results in a blood pressure loss. D. Lack of autonomic tone causes bradycardia and​ vasoconstriction, which decreases blood pressure.

B. The lack of sympathetic tone causes the heart to slow and the vessels to​ dilate; both of these will drop blood pressure. With no sympathetic​ tone, the parasympathetic system will have a larger effect on the​ body, which causes a drop in the heart rate and peripheral vasodilation.​ Together, these can effectively put the patient in a hypotensive state.

The AED is designed to provide a shock to the patient with what underlying cardiac​ rhythm? A. pulseless electrical activity. B. ventricular fibrillation. C. atrial fibrillation. D. asystole.

B. ventricular fibrillation. AEDs should be applied to patients who you suspect are unresponsive and do not have a pulse. The AED is designed to assess for ventricular fibrillation or ventricular tachycardia and then recommend that the operator administer a shock or not administer one. A patient in​ asystole, any PEA​ rhythm, or atrial fibrillation will not prompt the AED to recommend a countershock.

During management of a patient who is in​ shock, what abnormal metabolic process is the EMT attempting to​ prevent? A. Hyponatremia B. Hypokalemia C. Anaerobic metabolism D. Aerobic metabolism

C. Anaerobic metabolism A lack of oxygen in the cell from a shock syndrome causes a shift from aerobic to anaerobic metabolism. Aerobic metabolism is the creation of ATP in the presence of oxygen. When there is a lack of available​ oxygen, anaerobic metabolism takes​ place, resulting in a drastically lower production of ATP and the creation of lactic acid as a​ by-product. This is the initiating event that causes cellular death and eventual organ failure and system failure. Both hyponatremia​ (low sodium​ levels) and hyperkalemia​ (low potassium​ levels) are​ conditions, not abnormal metabolic processes.

When does AED application and defibrillation have the BEST​ benefit? A. Any time after the​ 10-minute mark of cardiac arrest with ongoing CPR B. After 2 to 3 minutes of the heart being in ventricular fibrillation C. As soon after the onset of arrest as possible D. After 3 to 5 minutes of CPR has been performed

C. As soon after the onset of arrest as possible Defibrillation-but more​ important, early and rapid defibrillation​ (shock within ​minutes)-is another component in determining survival of cardiac arrest. Survival rates of patients in sudden cardiac arrest due to ventricular fibrillation decrease with every minute defibrillation is delayed.

In what locations are cardiac pacemakers MOST often implanted that may interfere with AED pad​ placement? A. In the upper right quadrant of the abdomen B. Directly in front of the heart on the anterior chest C. Beneath the clavicles D. In the upper left quadrant of the abdomen

C. Beneath the clavicles Cardiac pacemakers are usually positioned beneath one of the clavicles. They form a visible lump and can be palpated. If you detect a pacemaker in a cardiac arrest​ patient, you can still use the AED.​ However, be sure not to place an adhesive pad directly over the pacemaker.

What two care interventions are MOST likely to contribute to the successful resuscitation of a patient who is in ventricular​ fibrillation? A. Early ALS care and endotracheal intubation B. Airway maintenance and ventilatory support C. CPR and defibrillation D. Compressions and rapid transport

C. CPR and defibrillation Research by the American Heart Association reinforces the necessity of early defibrillation in the management of sudden cardiac arrest due to ventricular fibrillation.​ However, high-quality CPR focusing on immediate chest compressions with minimal interruption was found to be even more important. Additional research has shown that​ high-quality chest compressions with minimal interruption and early defibrillation are the best determinants of successful cardiac arrest management.

Your patient has a blood pressure of​ 88/46, shallow respirations of​ 38/min, a heart rate of​ 68/min, and a pulse ox reading of 96 percent on​ high-flow oxygen. Given these vital​ signs, what type of shock is this patient most likely​ experiencing? A. Obstructive shock from a thoracic injury B. Cardiogenic shock from a heart attack C. Distributive shock from a spinal cord injury D. Hypovolemic shock from blood loss

C. Distributive shock from a spinal cord injury With a spinal cord​ injury, the blood vessels may dilate from a lack of sympathetic tone causing hypotension.​ Additionally, because of the lack of sympathetic​ tone, the heart rate will be in the slow to normal range and not tachycardic. Hypovolemic​ shock, obstructive​ shock, and cardiogenic shock all result in narrowing pulse pressure and tachycardia.

What is the MOST important extra equipment that the EMT should carry with the​ AED? A. Extra razors B. An extra protective case C. Extra pads and batteries D. Extra retaining clips

C. Extra pads and batteries Scheduled maintenance of the AED is crucial for ensuring that the machine functions properly. Follow your local protocols and the​ manufacturer's directions when maintaining the AED. The​ AED, its​ batteries, and the​ system's self-check status indicator should be checked at the beginning of each shift.​ Extra, fully charged batteries should always be available.

What is the BEST reason for the EMT to have extra batteries available for the AED on each​ shift? A. In case you have two patients at one scene B. Because it is mandated by federal law C. In case the batteries in the machine fail D. In case the medical director is on scene and wants to ensure that you are following protocol

C. In case the batteries in the machine fail Scheduled maintenance of the AED is crucial for ensuring that the machine functions properly. Follow your local protocols and the​ manufacturer's directions when maintaining the AED. AED failure is most commonly attributed to improper​ maintenance, especially battery failure.​ Typically, if two arrested patients are on​ scene, you will have two ambulances and two AEDs. State​ law, not federal​ law, dictates equipment types.

During transport to the hospital of a patient who was successfully resuscitated from cardiac​ arrest, which of the following should the EMT​ do? A. Maintain a​ compression/ventilation ratio of​ 30:2. B. Do not transport the patient unless an ALS provider is in the ambulance with the EMT. C. Leave the AED attached to the patient. D. Provide ventilations at​ 20/minute.

C. Leave the AED attached to the patient. Patients who have been brought out of ventricular fibrillation through use of the AED have a high likelihood of deteriorating back into that state. Monitor these patients​ closely, and leave the AED attached so that it is ready to be used immediately if needed. Ventilating at​ 20/minute is too​ fast, and there is no need for compressions if the patient has a pulse.​ Finally, having ALS available is​ favorable, but if that will delay delivery of the patient to the​ hospital, transport should be initiated immediately.

You are managing a patient who fell off a roof and impaled himself on a metal bar. You suspect that the patient has significant internal bleeding. What is your overall goal for managing this​ patient? A. Initiating positive pressure ventilations B. Providing full spinal immobilization on a backboard C. Maintaining peripheral perfusion and rapid transport D. Applying oxygen to maintain the pulse ox​ > 94%

C. Maintaining peripheral perfusion and rapid transport The overall goal during the management of shock is to improve oxygenation of the blood and ensure delivery of oxygen and glucose to the cells. The steps in doing this are immobilizing as appropriate to prevent further​ injury, ensuring adequate​ ventilations, and maintaining a pulse ox reading greater than 94 percent.

Which type of shock would be associated with a condition in which the body tissues are unable to properly utilize the oxygen that is available to them in the​ bloodstream? A. Distributive B. Cardiogenic C. Metabolic D. Anaphylactic

C. Metabolic Respiratory or metabolic shock is a type of shock that is described as a dysfunction in the ability for oxygen to diffuse into the​ blood, be carried by​ hemoglobin, off-load at the​ cell, or be used effectively by the cell for metabolism. Certain​ poisons, such as​ cyanide, interfere with the​ cell's ability to use​ oxygen; the blood is carrying an adequate amount of​ oxygen, but the cyanide prevents the cell from using it. Carbon monoxide poisoning interferes with the ability of hemoglobin to carry oxygen. Carbon monoxide binds much more readily to the hemoglobin molecule than oxygen​ does, thus preventing oxygen from binding. Carbon monoxide cannot be used by the​ cells, so a severe hypoxic state is created in the blood and in the cells.

You are treating a patient whom you suspect has a tension pneumothorax. The patient has no external hemorrhage or suspected internal​ hemorrhage, yet he is hypotensive. What type of shock is most likely causing the drop in blood​ pressure? A. Cardiogenic shock B. Distributive shock C. Obstructive shock D. Hypovolemic shock

C. Obstructive shock Obstructive shock results from a condition that obstructs forward blood flow. The volume is​ adequate, the heart is not​ damaged, and the vessels are of a normal size with adequate resistance.​ However, an obstruction is not allowing the blood to move forward. For​ example, a large clot that obstructs blood flow in the lungs​ (pulmonary embolism) will prevent an adequate amount of blood from getting to the left atrium​ and, subsequently, the left ventricle. Two other conditions that are often associated with injury and can lead to obstructive shock are tension pneumothorax and pericardial tamponade.

To prevent a shift to anaerobic​ metabolism, the body needs to ensure adequate perfusion to the tissues of glucose as well as what other​ substance? A. White blood cells B. Platelets C. Oxygen D. Carbon dioxide

C. Oxygen To prevent the development of anaerobic​ metabolism, the body needs not only to have good perfusion to deliver glucose to the cells and remove carbon dioxide and other wastes from the​ cells, but also to deliver adequate amounts of oxygen so that aerobic metabolism can occur. White blood cells are part of the immune system and do not play a role in adenosine triphosphate​ (ATP) development, nor do platelets.

During the management of a patient in​ shock, which of the following patients will continue to compensate well on their own until they reach a point of compensatory exhaustionlong dashthey rapidly​ deteriorate? A. Female B. Male C. Pediatric D. Elderly

C. Pediatric Elderly persons and newborns do not compensate well for shock and therefore have a tendency to deteriorate rapidly. Children and young adults compensate very​ well, often exhibiting only minor signs and symptoms for a long period of time and then decompensating suddenly.

What is the fourth link in the Chain of Survival of which the EMT should remain cognizant whenever treating a patient in cardiac​ arrest? A. Apply the​ AED, and allow it to analyze the heart rhythm. B. Contact medical control. C. Summon ALS. D. Transport the patient to the hospital.

C. Summon ALS. With a patient in cardiac​ arrest, out of cardiac​ arrest, or even suspected of having been in cardiac arrest before your​ arrival, you should keep the American Hospital​ Association's Chain of Survival in mind. The fourth link of that chain is effective advanced cardiac life support​ (ACLS). It would make sense that an ALS provider may be able to provide other therapies such as medications to prevent the patient from deteriorating back into arrest.

A patient is in cardiac​ arrest, and the AED provided one​ shock, which was followed by the return of a pulse. The EMT should recognize that the heart was in what​ rhythm? A. Ventricular asystole B. Asystole C. Ventricular fibrillation D. Ventricular block

C. Ventricular fibrillation When the patient is initially in cardiac​ arrest, two common rhythms that may be present that require defibrillation by the AED are ventricular fibrillation and ventricular tachycardia without a pulse. Asystole is the absence of all electrical​ activity, and ventricular asystole is the absence of any ventricular contraction. Ventricular block is a fictitious term. The point is that the AED will shock only a rhythm that is either ventricular fibrillation or ventricular tachycardia.

Not only should the EMT provide a​ 30:2 ratio of compressions to ventilations to an adult patient in cardiac​ arrest, the EMT should​ also: A. remain on scene with the arrested patient until ALS arrives. B. provide a large ventilation with each squeeze of the​ bag-valve-mask device. C. push hard and push fast. D. pause compressions for 30 seconds while assessing for a pulse.

C. push hard and push fast. The American Heart Association advocates​ "push hard and push​ fast" to provide effective chest compressions. Doing this helps to ensure that the compressions are delivered at a rate of at least​ 100/minute, which has been shown to provide suitable blood flow to essential organs during cardiac arrest. Delivering large ventilations using a​ bag-valve-mask device can be​ detrimental, as can delaying compressions for 30 seconds while assessing for a pulse.​ Finally, do not wait on scene with an arrested patient if arrival of ALS is delayed.​ Instead, consider allowing them to intercept with you en route to the hospital.

You are managing an ROSC patient. While transitioning the patient to the​ ambulance, your partner dropped and broke the pulse oximeter. During​ transport, how much oxygen should be​ provided? A. 8 lpm B. 12 lpm C. 10 lpm D. 15 lpm

D. 15 lpm After return of spontaneous circulation​ (ROSC), check the​ patient's airway, and provide oxygen at 15 lpm by nonrebreather mask if the patient has signs of hypoxia or​ dyspnea, or the pulse ox reading is unavailable. If the​ patient's breathing is​ adequate, use a nonrebreather. If the​ patient's breathing is​ inadequate, provide positive pressure ventilation.

You have a patient in cardiac arrest with an unknown down time. What should be one of the initial interventions by the EMS​ crew? A. Initiation of PPV with a BVM B. Placement of an advanced airway C. Administration of medications by an ALS provider D. 2 minutes of CPR while the AED is being readied

D. 2 minutes of CPR while the AED is being readied If a patient goes into cardiac arrest in front of​ you, you should apply the AED and allow it to assess the patient to determine whether a shock is indicated.​ However, if the patient has been down for several minutes​ (or has been down for an unknown period of​ time) before your​ arrival, 2 minutes of CPR would be indicated before use of the AED so that the heart can be better perfused before application of the AED. Placement of an advanced airway or administration of medications by an ALS provider should be done only after​ high-quality CPR has been initiated and the AED has been applied and used as appropriate.

How does the body prolong the effects of the sympathetic nervous system during​ shock? A. By increasing the intravascular volume by creating more blood B. By constantly providing nervous stimuli to the heart and adrenal glands C. By promoting fluid reabsorption in the kidneys D. By releasing hormones from the adrenal glands

D. By releasing hormones from the adrenal glands During the initial stages of a shock​ syndrome, the sympathetic nervous system initially stimulates the heart and blood vessels to react through direct nerve stimulation to cause an immediate effect. To prolong this​ effect, the body also stimulates the adrenal medulla to release epinephrine and norepinephrine into the bloodstream. The release of the hormones is what causes the ongoing sustained effects of the sympathetic nervous system. While the kidneys will reabsorb volume during​ shock, this is not the mechanism by which the body propagates the sympathetic effect​ (it is actually an effect of​ it).

What is the phase of cardiac arrest in which the heart cells shift from aerobic to anaerobic​ metabolism? A. Metabolic phase B. ROSC phase C. Electrical phase D. Circulatory phase

D. Circulatory phase The circulatory phase begins at 4 minutes and lasts through 10 minutes after the cardiac arrest. During this​ phase, the oxygen stores have been​ exhausted, and the myocardial cells shift from aerobic to anaerobic metabolism. The electrical phase begins immediately upon cardiac arrest and ends 4 minutes afterward. During this early and initial​ phase, the heart still has a good supply of oxygen and​ glucose; therefore, aerobic metabolism is maintained with continued energy production for cell function and prevention of mass production of acid. The metabolic phase begins 10 minutes after cardiac arrest. At this​ point, the heart is starved of oxygen and glucose and has a large amount of acid buildup. The tissues are very ischemic and may begin to die. The chances of survival drop dramatically during this phase. ROSC is an abbreviation for​ "return of spontaneous​ circulation."

During which phase of cardiac arrest does the development of overwhelming acidosis from anaerobic metabolism​ start? A. Terminal phase B. Electrical phase C. Metabolic phase D. Circulatory phase

D. Circulatory phase The circulatory phase begins at 4 minutes and lasts through 10 minutes after the cardiac arrest. During this​ phase, the oxygen stores have been​ exhausted, and the myocardial cells shift from aerobic to anaerobic metabolism. This results in very little energy production for cell function in addition to the production of acid. The myocardial cells are becoming ischemic and are in need of oxygen and glucose. Because of the lack of oxygen and​ glucose, the heart is not prepared for defibrillation and is not prone to restarting.

In what stage of hemorrhagic might the EMT notice only subtle vital sign changes of tachycardia and narrowing pulse pressure. A. Irreversible B. Decompensated C. Late D. Compensated

D. Compensated Compensated shock is the stage that has the fewest changes to the vital signs. This is because the body is able to compensate for the lost volume. If the etiology of shock is reversed in this​ stage, such as by stopping the​ hemorrhage, the compensatory mechanisms will continue to maintain the blood pressure and perfusion and will eventually begin to signal the body to decrease its response as the pressure is restored. The blood pressure may appear to be relatively normal in compensated shock.​ However, you might also note a narrow pulse pressure. In decompensated and irreversible shock​ (sometimes called late​ shock), the body is unable to maintain normalcy due to the volume​ loss, and there is often a decreasing slope to the systolic blood pressure.

You are treating a patient who has an implantable cardioverter defibrillator​ (ICD) and is in cardiac arrest. How should the treatment for this patient​ proceed? A. Do not check for a pulse in case the ICD defibrillates the patient while you are touching her. B. Do not use your AED. C. Use of the AED is​ permitted, but do not initiate CPR. D. Do not place the AED pads over the implanted ICD.

D. Do not place the AED pads over the implanted ICD. Treatment for the unresponsive patient with an implantable cardioverter defibrillator​ (ICD) is the same as that for any other unresponsive cardiac patient.​ However, when applying the​ AED's adhesive pads in such​ patients, do not place them directly over the implanted ICD because the device has an insulated backing that will deflect the shock.

Which of the following findings generally indicates that the patient has transitioned from compensated shock to decompensated​ shock? A. Tachycardia B. Pale skin C. Tachypnea D. Hypotension

D. Hypotension Although all the findings could be present in decompensated​ shock, the specific finding that often delineates when that has occurred is systolic hypotension.​ Tachycardia, tachypnea, and pale skin are present in compensated shock as​ well, but hypotension is not.

You are caring for a patient who has overdosed on an unknown medication and as a result is hypotensive. Which of the following causes of shock is LEAST likely to explain why the blood pressure is​ low? A. Cardiogenic cause B. Distributive cause C. Anaphylactic cause D. Hypovolemic cause

D. Hypovolemic cause The least likely explanation for the shock would be​ hypovolemic, as this type of shock is often from blood loss due to hemorrhage. Cardiogenic shock could be the cause if the medication causes the heart to beat slower or more​ weakly, distributive shock could be a cause if the medication caused peripheral​ vasodilation, and anaphylactic shock could be a cause if the patient was allergic to the medication on which the patient overdosed.

Which of the following would be the LEAST likely to occur if there were a sudden drop in the perfusion to peripheral tissues of the​ body? A. Decreased carbon dioxide elimination from the tissues B. Elevation in anaerobic metabolism C. Diminished blood flow to body organs D. Increased aerobic metabolism

D. Increased aerobic metabolism If there were a sudden drop in the perfusion status of the​ body, it would result in poor blood flow to the​ body's tissues and​ organs, it could cause decreased carbon dioxide elimination from the tissues from poor blood​ flow, and there would be an increase in anaerobic metabolism from a lack of oxygen. The one thing that would be the least likely to occur would be increased aerobic​ metabolism, as this would require sufficient​ oxygen, which is lacking with poor perfusion.

The patient you are treating for trauma is now unresponsive with a dropping heart rate and unobtainable blood pressure. You also note that he is starting to bleed again from injuries that were already controlled and starting to clot. These findings are consistent with what stage of​ shock? A. Compensatory B. Decompensatory C. Progressive D. Irreversible

D. Irreversible Irreversible shock is the stage in​ which, regardless of the​ intervention, the patient outcome is death.​ Cell, tissue, and organ failure and damage are so pervasive and severe that no matter what treatment is​ provided, the shock cannot be reversed and organ death is inevitable. Microemboli begin to block capillaries throughout the​ body, leading to lung​ failure, kidney​ failure, and other multiple system organ failure​ (MSOF). Clotting factors are used in the formation of the microemboli in the blood. The body responds to the clots by releasing substances to attempt to break them up. Because the clotting factors were used up in the formation of the​ microemboli, the substances that are released to break down the clots are​ unopposed, and there is widespread uncontrolled bleeding from any wound that was previously clotted.

The change in which body process is the primary reason that the patient will progress through the stages of shock and eventually​ die? A. Diminishing respirations B. Decreasing alveolar ventilation C. Increasing heart rate D. Lack of adequate perfusion

D. Lack of adequate perfusion The primary change of the body that causes death in a shock syndrome is a lack in organ perfusion. With a lack of​ perfusion, cells,​ tissues, and organs become ischemic and start failing. A drop in perfusion to the heart results in its​ failure, and a drop in perfusion to the lungs results in ongoing hypoxia and hypercapnia. An increasing heart rate is a compensatory mechanism​ initially, and the changes to the respiratory rate and alveolar ventilation are the result of a failing pulmonary​ system, not the cause of the failing pulmonary system.​ Eventually, everyone dies when the heart rate​ stops, but the stopping of the heart is a consequence of the failing perfusion pressure.

What is an important difference between the pediatric Chain of Survival and the adult Chain of​ Survival? A. ​Post-arrest care B. Bystander CPR C. Rapid transport to the hospital D. Prevention of arrest

D. Prevention of arrest The American Heart Association pediatric Chain of Survival also has five​ links; however, the first three links emphasize slightly different elements of emergency cardiac care from those recommended for adults. This is based on the difference in the physiology and typical etiology of cardiac arrest in the pediatric patient. The steps of the pediatric Chain of Survival are prevention of​ arrest, early​ high-quality CPR, rapid activation of​ EMS, effective ALS care and​ transport, and integrated​ post-cardiac-arrest care.

What has research shown to be MOST beneficial in providing CPR to a patient in cardiac​ arrest? A. Perform the same ratio of compressions to ventilations for all age brackets. B. Start CPR only after the AED has been applied. C. Wait two minutes before starting CPR in case the patient converts and wakes up on his own. D. Push hard and push fast as soon as the arrest occurs.

D. Push hard and push fast as soon as the arrest occurs. The American Heart Association advocates​ "push hard and push​ fast" to provide effective chest compressions. Compressions that are delivered at a rate of at least​ 100/minute have been shown to provide suitable blood flow to essential organs during cardiac arrest. In cardiac​ arrest, not all age brackets receive the same ratio of compressions to​ ventilations, and there may be times when CPR is started before application of the AED.​ Finally, do not delay CPR under the assumption that the patient may wake​ up; this is simply not going to happen.

Of the following​ findings, which one is MOST likely to be present in both compensated shock and early decompensated​ shock? A. Altered mental status B. Irregular breathing C. Hypotension D. Tachycardia

D. Tachycardia During a shock​ syndrome, the body responds by employing the sympathetic nervous​ system, which will increase the heart​ rate, promote​ vasoconstriction, and release hormones to increase intravascular volume. The result is​ tachycardia, one of the earliest findings and consistent finding through shock stages. Irregular breathing occurs as the brain stem becomes ischemic during irreversible​ shock, and hypotension and altered mental status are more consistent with the decompensated and irreversible stages of shock.

During the​ body's attempt to compensate during​ hypoperfusion, there is usually an increase in the heart rate for what​ reason? A. To increase systemic vascular resistance B. To compensate for the peripheral vasodilation C. To improve coronary artery perfusion D. To increase cardiac output

D. To increase cardiac output During the initial stages of a shock​ syndrome, the sympathetic nervous system stimulates the adrenal medulla to release epinephrine and norepinephrine into the bloodstream. The primary effects of epinephrine and norepinephrine are an increase in heart rate and contractility as well as vasoconstriction in an attempt to increase the blood pressure and perfusion. The increase in the heart rate increases the cardiac output to improve the blood pressure.