mock exam 3
your five year old patient fell from the top of a large bookshelf in her home. a fall from what height is considered a significant MOI in children?
> 10 feet. **childrens heads are larger in proportion to the rest of their bodies. when they fall, they tend to land on their head. a fall of greater than 10 feet (2-3 times the childs height) is considered a significant MOI in pediatrics. when treating a patient that fell, its important to take into consideration the height of the fall, what type of surface the patient landed on, and what part of the body struck the ground first.**
Which of the following are common signs and symptoms of acute myocardial infarction?
left arm pain, nausea, & chest pain. **An acute myocardial infarction has several symptoms that are typically seen in multiple patients. Common symptoms are chest pain, shortness of breath, arm pain, jaw pain, nausea, and a feeling of heartburn. An acute MI does not cause abnormal heart sounds.**
The key perfusion measurement that can detect shock and is displayed on most cardiac monitors is:
mean arterial pressure (MAP). **mean arterial pressure (MAP) is crucial in the detection oof shock. The MAP indicates arterial pressure in systole and diastole.** **stroke volume (SV) is the volume of blood expelled from the left ventricle with each contraction. cardiac output (CO) is the volume of blood pumped by the heart in one minute. systematic vascular resistance (SVR) is the resistance in the heart that creates blood pressure.**
Your four-year-old female patient is very lethargic and has a high fever. She is very slow to answer questions and is able to say her head hurts. Her mother states she recently had an upper respiratory infection. You suspect:
meningitis. **meningitis is an infection and inflammation of the meninges covering the spinal cord and brain. the signs and symptoms are fever, altered level of consciousness, headaches, confusion, & lethargy.** **hypoglycemia is low blood sugar and presents with a decreased level of consciousness. hypoglycemia does not cause a fever. pneumonia commonly occurs after an infection. it does not cause the extreme decrease in consciousness exhibited by this patient. pertussis is the common name for whooping cough. the patient does not present with symptoms of whooping cough.**
which pairings of cranial nerves and their corresponding numbers are accurate?
X - vagus nerve II - optic nerve IV - trochlear nerve **Cranial nerves send impulses to the neck, face, and torso. I - Olfactory nerve II - Optic nerve III - Oculomotor nerve IV - Trochlear nerve V - Trigeminal nerve VI - Abducens nerve VII - Facial nerve VIII - Vestibulocochlear nerve IX - Glossopharyngeal nerve X - Vagus nerve XI - Spinal accessory nerve XII - Hypoglossal nerve**
An adult patient is complaining of severe chest pain and shortness of breath. He states the pain began an hour ago, shortly after he finished working out at the gym. He is diaphoretic and pale. What should you suspect?
acute myocardial infarction. **the patient exhibits signs and symptoms of acute myocardial infarction (AMI). the pain has been continuous for the past hour and began after exertion. diaphoresis and pallor are compelling signs of AMI.** **unstable angina is chest pain that occurs without exertion, and stable angina is chest pain that occurs with exertion. the pain in both types of angina subsides with rest or nitroglycerin. congestive heart failure is not an acute problem. if the patient had a dissecting aneurysm, he would typically exhibit intense lower back or abdominal pain and rapidly develop shock. however, considering the duration of pain lasting for an hour, this scenario seems improbable.**
according to HIPAA, personal health information (PHI) is protected. there are reasons for disclosure that are covered under HIPAA. select the allowed reasons to share PHI below.
an ambulance billing office reads a patient care report for medicare reimbursement, you advise the receiving physician of the patients medical history and the treatment you provided, & you must answer questions about your child abuse patient in deposition. **PHI may be disclosed for reasons of patient care continuity, billing purposes, and operations. You may share patient information with the healthcare providers directly involved in your patient's care. The billing office of an ambulance agency must read patient care reports to report information for billing purposes accurately. If subpoenaed to court, you may be required to answer questions about the treatment provided.** **You may not provide patient information to anyone asking for sensitive information over the phone.**
You are called to the residence of a seven-year-old boy who fell off their backyard swing and hit his head on the ground. The patient is A&Ox4 and has a small laceration on his forehead. You note that the patient has unequal pupils. The boy's parents advise that the patient was born with unequal pupils, which is not an abnormal finding for him. What is the term for a person born with unequal pupils?
anisocoria. **anisocoria is a condition of unequal pupils as a normal baseline in a patient. these patients are born with this condition.** **astigmatism is a curvy characterisitic of the cornea or the lens of the eye, which causes blurriness at distances. horners syndrome is a rare nueorlogical syndrome that affects the eye and the surrounding areas only on one side of the face. glaucoma is blurriness and blindness secondary to chronic deterioration of the optic nerve.**
your patient is complaining of severe chest pain and shortness of breath. the patient tells you that the pain feels like his heart attack. what medication has been proven to reduce acute myocardial infarction (AMI) mortality?
aspirin. **aspirin has been clearly shown to reduce mortality in heart attacks. aspirin should be given immediately to a chest pain patient, as long as they are not allergic to aspirin.** **nitroglycerin does have a purpose in a heart attack, but it is not proven to reduce mortality like aspirin has been. lasix is a diuretic, and metroprolol is a beta-blocker. neither is indicated in the prehospital treatment of a heart attack.**
A 48-year-old female complains of shortness of breath. She is sitting in a tripod position and is cyanotic in her lips and fingertips. Her respiratory rate is 28 and she has wheezing on exhalation. You place her on oxygen at 15 LPM via a non-rebreather. What should you do next?
assist the patient with her albuterol inhaler. **the patient is in obvious respiratory distress, as seen by the tripod position and the cyanosis. the wheezing indicates bronchospasm and the treatment for this is albuterol. albuterol is a beta agonist and will dilate the bronchioles.** **its not appropriate to place the patient in the recovery position and transport without intervention. the patient is not complaining of chest pain and shows no indication of requiring nitroglycerin administration. it is not advised to tell the patient to contact her PCP. the patient requires treatment and transport to the hospital.**
en route to the emergency department, your adult patient becomes unresponsive. her respirations decrease to 8 and are shallow, and she has cyanosis to her lips. you attempt to wake her, but she only moans with painful stimulation. what should you do?
assist ventilations with a bag mask device and continue transport. **a patient in respiratory failure requires assisted ventilations with a bag mask device and 100% oxygen. the patient has a decreased mental status and shallow respiration, which are indicative of respiratory failure.** **placing the patient on a non rebreather will not improve the patients ventilation status. re-assessing the vital signs and driving faster is not addressing the patients respiratory failure. it must be treated immediately. CPAP is contraindicated in this patient because the patient is unresponsive.**
Your 26-year-old male patient is in cardiac arrest from choking on a hot dog. You are unable to visualize the piece of food and note that his airway is patent. When you attempt bag-mask ventilations, you are unable to ventilate. What should you do next?
begin chest compressions. **if your patient is unresponsive, begin CPR. if ventilation does not cause chest rise and fall, the perform 30 chest compressions. open the airway and look for the obstruction. if it is visible, then remove it with your fingers. **back blows and abdominal thrusts are only recommended in responsive patients. a blind finger sweep is never recommended for any patient.**
a stroke is a serious medical condition and requires immediate medical attention. there are medical conditions that can mimic stroke because of their similar symptoms. select the conditions that may mimic a stroke.
bell's palsy, hypoglycemia, & postictal state. **Signs and symptoms of a stroke include: facial drooping, unilateral weakness, slurred speech, weakness, dizziness, vision disturbances, aphasia, headache, and decreased level of responsiveness.** **Hypoglycemia mimics a stroke because it causes weakness and an altered level of consciousness. A postictal state occurs immediately following a seizure. Patients may have an altered level of consciousness, weakness, and even combativeness. Neither hypoglycemia nor a postictal state will cause facial drooping or unilateral weakness or paralysis. Hypoglycemia can be ruled out by a blood sugar check and a postictal state will resolve itself within minutes. Bell's Palsy is an infection or injury to one of the nerves that control muscles in the face.** **A myocardial infarction (MI) will not cause the same symptoms as a stroke, as it will not cause slurred speech, dysphasia, unilateral weakness, and an altered mental status.**
You are dispatched to the Biology lab of the local high school for an incident involving a chemical. Your patient is a 17-year-old female complaining of a burning sensation on her right arm. She states she spilled some sort of powdery substance on her arm but is unaware of what it is. After completing your primary assessment, you should:
brush off the powder substance. **if a dry powder comes in contact with the skin, its important to brush it off, flush the area with water for up to 20 minutes and then wash with soap and water.** **do not try to wash it with sterile water or normal saline, or any type of liquid. some powders react with water and make the reaction worse. do not just cover the powder on the skin with a dressing.**
Your adult patient was shot at close range by a small caliber handgun. While assessing the injury, it is essential to acknowledge that additional damage will be directly caused by the bullet moving inside the body, but not along the direct pathway. What is this phenomenon called?
cavitation. **cavitation occurs from the changes in tissues and fluid pressures that occur rapidly as the bullet travels through the body at a very high rate of speed. this is similar to the pressure wave caused by an explosion. cavitation can be temporary or permanent. both types can cause serious damage.** **trajectory is defined as the past the bullet takes as it speeds through the body. drag is referred to as air resistance, which slows the bullet as it movs through the body.**
this breathing pattern is typically seen in patients with increased intracranial pressure. this pattern is irregular, with increases in depth and rate, followed by an apnea period. what is this breathing pattern?
cheyne-stokes. **cheyne-stokes is commonly seen in patients with serious head injuries. there is an increased rate and depth of respirations, then a period of apnea.** **kussmal respirations are characteristics of diabetic ketoacidosis. they are deep and rapid respirations. ataxic respirations are irregular and ineffective and have no discernible pattern. agonal respirations are slow, gasping breaths.**
your patient is a 73 year old female, who is overweight and complaining of shortness of breath. you note central and peripheral cyanosis. upon auscultation, you hear rhonchi and wheezing bilaterally. the patient is also complaining of coughing up thick mucus. what should you suspect?
chronic bronchitis. **chronic bronchitis is defined a s a productive cough lasting longer than three months and keeps re-occurring for two consecutive years. it presents with shortness of breath, peripheral and central cyanosis, rhonchi, wheezing, obesity, and a productive cough.** **emphysema presents with a dry cough, not a productive cough. flash pulmonary edema presents with crackles in the lungs, secondary to the fluid buildup, and occurs suddenly. congestive heart failure presents with wet lung sounds.**
A group of employees at a federal agency has been exposed to anthrax. What medication should they be given for treatment?
ciprofloxacin. **anthrax is caused by bacteria. the most common routes of transmission are inhalation, cutaneous, & gastrointestinal. the inhalation form is the most deadly. antibiotics are used to treat anthrax exposure. cipro is a common choice, along with doxycycline and levofloxacin.** **epinephrine is an alpha and beta agonist and is indicated in cardiac arrest and anaphylaxis. narcan is an opiod antagonist used in the treatment of narcotic overdose. flumazenil is the antidote for benzodiazepine toxicity.**
While hunting, your 23-year-old male patient injured his leg in a fall from a tree stand approximately 6.5 hours earlier. He waited until now to call 911 because the pain had become too severe. His right leg, below the knee, is severely swollen, the skin is stretched and reddened, and there is decreased sensation in the injured area. What do you suspect?
compartment syndrome. **compartment syndrome occurs when localized tissue swelling occurs within the muscle compartment. this can be caused by excessive bleeding or swelling. when this occurs, blood flow is disrupted, and ischemia occurs. anaerobic metabolism is activated, but the decrease in oxygenation to the tissues kills the muscle cells. **crush syndrome occurs when an area of the body is crushed or compromised for four hours or longer. when the tissues are crushed, the lack of oxygen to the tissues causes the muscle cells to die. deep vein thrombosis is a blood clot that forms in the leg. it is caused by immobilization, recent surgery, or a recent injury. it is not caused by immediate trauma, as described in this scenario. a femur fracture would not cause swelling and reddening in the lower leg as it would in the upper leg.**
Heatstroke is a serious, life-threatening emergency. If untreated, it can lead to death. Select the signs and symptoms of heatstroke.
confusion, hypotension. **Heatstroke is a serious life-threatening emergency. The first sign is commonly confusion or a change in mental status. The patient may become unresponsive and possibly have a seizure. The rapid pulse quickly becomes slow and weak. The patient's respiration increases due to the high body temperature. The blood pressure decreases. A classic sign is the lack of perspiration. The body loses its thermoregulatory mechanism.**
you are dispatched to a pedestrian versus car accident. you arrive to find a 26 year old male lying supine in the roadway in front of a car. your patient is A&Ox4 and complaining of severe abdominal pain. when you cut off the patients shirt, you note an evisceration to the left lower abdomen. how do you treat the evisceration?
cover with sterile gauze, moist with saline solution, and secured with an occlusive dressing. **an abdominal evisceration is when a patients abdominal organs are exposed due to injury. it is important to cover the open wound with sterile gauze, wet it with a saline solution, and then secure it with an occlusive dressing.** **it is important not to touch the exposed organs. do not attempt to push the exposed organs back into the cavity. do not pack the wound with gauze. its important to keep the wound covered and warm. when placing an occlusive dressing, it is important to tape it down on all four sides.**
which of the following statements about cyanide is false?
cyanide poisoning will not affect a patients pulse oximetry reading. **cyanide prevents the body from offloading oxygen molecules. it binds to the cells and prevents the use of oxygen by the body. this creates a false pulse oximetry reading. patients with shortness of breath from cyanide exposure may have normal pulse oximetry, which is not a true picture of the respiratory status.** **cyanide is found in the pits of several fruits, but its in very low quantities, so there is no danger. low doses of cyanide cause dizziness, lightheadedness, vomiting, and headaches. higher doses cause shortness of breath, tachypnea, coma, flushed skin, tachycardia, altered mental status, and possible seizures. cyanide possesses a smell similar to almonds and is a colorless agent.**
all of the following are shared signs and symptoms between chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF), except:
distended neck veins. **wheezing, coughing, and difficulty breathing are experienced by both chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF).** **distended neck veins are only seen in the presence of CHF.**
An acute myocardial infarction (AMI) may show a range of signs and symptoms in a patient. Select the symptoms below associated with an AMI.
dyspnea, nausea, & chest pressure. **Chest pressure, nausea, and dyspnea are all common symptoms of acute myocardial infarction. Other symptoms include weakness, diaphoresis, chest pain, and radiation of pain.** **Jugular vein distention (JVD) and ascites are not associated with AMI. JVD is associated with a backup of blood in the superior vena cava. Ascites is fluid buildup in the abdomen and is associated with right-sided heart failure.**
You are dispatched to the residence of a female complaining of difficulty breathing. Upon your arrival, you find a 73-year-old female sitting on the edge of the bed in obvious respiratory distress. She has labored respiration at a rate of 24, with wheezing noted bilaterally. She's on home oxygen at 2 LPM via nasal cannula. She complains of a non-productive cough and states that her breathing treatments are not working. What should you suspect?
emphysema. **emphysema is a chronic condition in which the alveoli are destroyed, and no surface area is available for gas exchange. the patient will experience shortness of breath, wheezing, non productive cough, and a barrel chest appearance and will be underweight.** **chronic bronchitis is a chronic condition in which the bronchioles are filled with an over production of mucus. the lung sounds may have both wheezing and crackles. pulmonary edema is fluid in the lungs. pulmonary edema is an acute problem. a pulmonary is a clot in the lungs that will produce wheezing or a non productive cough.**
your patient complains of an itchy rash on his abdomen, eye irritation, and shortness of breath. you note audible wheezing when you approach the patient. vital signs are BP 99/68, P 107, R 20. which treatment would you perform in your primary assessment?
ensure a patent airway. **in every patient, the airway is always addressed in the primary assessment. a patient having an allergic reaction is no exception to this rule. ensuring a patent airway is performed in the primary assessment.** **this patient may require oxygen, but not via bag mask ventilation. there is no sign of failure with ventilation in this patient. there is no indication of an epinephrine auto injector at this time. if there was, it is the responsibility of the EMT to assist the patient with the administration. administering benadryl is outside the scope of practice for the EMT.
The respiratory anatomy is divided into the upper and lower airways. Select the structures of the upper airway below.
epiglottis, larynx. **The upper airway consists of the nose, mouth, jaw, oral cavity, pharynx, mouth, epiglottis, and larynx. The upper airway ends at the larynx. The lower airway consists of the trachea, bronchi, bronchioles, alveoli, and pulmonary capillaries.**
Patients with chronic bronchitis are commonly called "blue bloaters." Select the signs and symptoms of chronic bronchitis.
excessive mucus production, obesity, & hypoxemia. **Chronic bronchitis patients are commonly obese. They have excessive mucus production, which creates airway obstructions. They also have hypoxemia, difficulty with expiration, and carbon dioxide retention.** **Emphysema patients commonly look emaciated.**
a primary assessments purpose is to identify and treat life and limb threatening conditions and injuries. select the injuries addressed in the primary assessment.
femoral artery laceration & sucking chest wound. **All life-threatening and limb-threatening injuries must be addressed, and treatment must start in the primary assessment. A sucking chest wound, femoral artery laceration, and burns to the airway should be treated in the primary assessment. A sucking chest wound allows air to enter the chest cavity and causes a tension pneumothorax. It will require immediate treatment. A femoral artery laceration will require a tourniquet to stop the bleeding. Burns to the airway can cause severe airway inflammation and is an immediate life threat.** **Bilateral humerus fractures are a distracting injury. The secondary assessment is the place for the treatment of this injury.**
A Level I trauma center is capable of providing complete care for every injury and every aspect of injury. Which of the following are part of the five key elements that define a Level I trauma center?
have readily available physicians in all specialties at all times, have 24 hour in house coverage by general surgeons. **There are key elements for all levels of trauma centers. A Level I trauma center must: - have 24-hour in-house coverage by general surgeons - have coverage from physicians in orthopedics, emergency medicine, radiology, neurosurgery, anesthesiology, internal medicine, and critical care - include the availability of specialized services, such as cardiac surgery, hand surgery, and microvascular surgery, and also must have capabilities to perform hemodialysis - have a robust continuing education program for all trauma team members and provide leadership and education in the local communities - include a detailed and comprehensive QA program and research all levels of trauma Acceptance of any patient transfer request is not a key element of a Level I trauma center. Several factors are considered before a transfer request is approved, and no facility is required to accept every request.**
allergic rhinitis is an allergic response to a trigger that causes cold like symptoms, such as congestion, runny nose, cough, and sinus pressure. what is the common name for this condition?
hayfever. **hayfever is a common name for allergic rhinitis. it is typically caused by outdoor and indoor allergens. these allergens trigger an allergic response which causes cold like symptoms.** **anaphylaxis is a severe allergic reaction that involves two or more body systems. influenza is a virus with several different strains. emphysema is a chronic lung disease in which the alveoli are damaged.**
all of the following are types of distributive shock, except:
hemorrhagic shock. **distributive shock is a result of poor vessel function. septic, neurogenic, anaphylactic, & psychogenic shock are all types of distributive shock.** **hemorrhagic shock is a type of hypovolemic shock.**
Your patient is a 19-year-old female with diabetes. She is complaining of nausea, extreme thirst and hunger, and abdominal pain. Her vital signs are BP 122/82, P 118, R 26. What should you suspect?
hyperglycemia. **hyperglycemia presents with extreme thirst (polydipsia), increasing hunger (polyphagia), and excessive urination (polyuria). other presenting signs and symptoms are warm and dry skin, deep and rapid respiration (kussmaul), rapid HR, abdominal pain, abnormal mental status, nausea, and restlessness.** **influenza may cause nausea and abdominal pain, but it would not present with polyuria, polydipsia, and polyphagia. hypoglycemia presents with snoring respiration, cool and clammy skin, and decreased mental status. diverticulitis is an infection or inflammation of the diverticula that form in the intestines.**
you are off duty and witness a person go into cardiac arrest. there are specific steps to take for one rescuer adult CPR. list the steps below.
if no breathing or pulse is noted, perform CPR until AED arrives, establish unresponsiveness and call for help, & use a face-guard and provide 2 breaths and observe for chest rise. **There are steps to take in One Rescuer Adult CPR. 1. Don PPE and confirm unresponsiveness and then call for help. 2. Check for breathing and a carotid pulse at the same time. Check for a pulse for no more than 10 seconds. 3. If there is no pulse and no breathing, perform CPR until an AED arrives at patient side. Provide compressions at a rate of 100-120 per minute, in increments of 30 compressions. 4. Open the airway. 5. Provide two ventilations and not chest rise and fall. Continue the cycle of 30 compressions and 2 ventilations. Continue this process until additional help arrives. 30 seconds is too long to check for a carotid pulse. You must check for no longer than 10 seconds.**
A six-year-old female was struck by a vehicle while crossing the road near her home. Police are unable to reach her parents. Which of the following provides authorization for you to treat and transport the patient?
implied consent. **as the EMT, you are covered under the legal principle of implied consent. it is implied that the parents would want their child treated and transported to the hospital in this specific situation.** **medical control is assistance received from your medical director or the receiving physician. involuntary consent is consent for treatment and transport by an individual granted legal rights for another individual. standing orders are protocols for the treatment of patients; consent is not covered by standing orders.**
your patient fell from his roof, hitting his head on a picnic table and then landing on the grass. his signs and symptoms include cheyne-strokes respiration, decreased mental status, bradycardia, and a widened pulse pressure. you should suspect:
increased intracranial pressure. **increased intracranial pressure causes bradycardia, decreased mental status, cheyne-strokes or biots respiration, widening pulse pressure, nausea, posturing, and headache. ** **hypoglycemia does not cause widened pulse pressure; the patients history indicates a traumatic brain injury. hemorrhagic shock would not present in this manner, and there is no mention of blood loss in this patient. a postical state occurs after a seizure. the patient may be confused with a decreased mental status. it does not cause all the symptoms mentioned above.**
your 17 year old male patient was stabbed in the chest during an assault. there is a large penetrating wound noted to the left anterior chest, with minimal bleeding and bubbling noted. his respirations are 6 and shallow, and he has a weak carotid pulse. his airway is patient, and first responders have the patient on oxygen via a non rebreather. what should you do first?
place a vented chest seal over the wound. **a sucking chest wound, as described in the scenario above, is a true, life threatening emergency. after clearing the airway and providing oxygen, the sucking chest wound must be covered with a vented chest seal or an occlusive dressing to prevent air from entering the chest. preventing the air from entering the chest will prevent the development of a tension pneumothorax.** **its important to cover the chest wound before initiating bag mask ventilation. if assisting ventilations with an open chest wound, its possible that air will escape through the wound. youll first need to address the breathing problem before packing the patient and transporting. maintaining the oxygen via a non rebreather will not improve the patients status if the wound is not covered with a vented chest seal or occlusive dressing.**
your elderly female patient is complaining of difficulty breathing. she can only speak in 2-3 word bursts. you note pallor and cyanosis to her lips and fingertips. her vital signs are BP 164/90, P 109, R 24, and SPo2 74%. she is on home oxygen at 4 LPM via nasal cannula, what should you do?
place the patient on a non rebreather at 15 LPM. **the patient is in severe respiratory distress and showing symptoms of impending failure. the patient requires oxygenation. the patient should be placed on oxygen at 15 LPM via a non rebreather.** **increasing the oxygen at 6 LPM via a nasal cannula will not effectively oxygenate this patient. there is no indication that the patient requires assisted ventilations. this is an oxygenation problem, not a ventilation problem. you must treat the lack of oxygenation. not treating the patient and re-evaluating after another set of vital signs is not acceptable.**
your patient is 32 weeks pregnant and complaining of spontaneous vaginal bleeding. she states she has soaked three pads in the past hour. she states she has no abdominal pain but does feel dizzy and lightheaded. you should suspect:
placenta previa. **placenta previa is a late stage pregnancy bleeding emergency. the placenta develops over the cervix and blocks the opening. this emergency requires rapid transport to the hospital. it presents with bright, red bleeding, and it is painless.** **abruptio placenta is a late state pregnancy bleeding emergency. it is very painful and causes vaginal bleeding. gestational diabetes is high blood sugar during pregnancy. there is no bleeding associated with it. a spontaneous abortion occurs prior to 20 weeks of pregnancy.**
your 48 year old female patient complains of chest pain, shortness of breath, and nausea. she is diaphoretic and states the pain began 45 minutes ago. shes states she is out of her nitroglycerin tablets but takes her husbands when she has chest pain. she requests you grab his nitro bottle and assist her in taking one now. her vital signs are BP 134/92, P 83, R 16, SPo2 96% ORA. you should:
monitor the patient and transport rapidly top the hospital. **the patient is showing signs and symptoms of a possible acute myocardial infarction. nitroglycerin administration is recommended in patients with chest pain. although this patient states she has a prescription for nitroglycerin that is currently out, this does not make it acceptable to assist her in taking her husbands nitroglycerin. prior to administering nitroglycerin, you are responsible for ensuring the medicine is in date and is prescribed to the patient. because the patient does not have a current nitroglycerin prescription on hand, you must forego the administration of nitroglycerin, continue to monitor the patient, and transport rapidly to the hospital.** **the EMT is not responsible for contacting the patients physician for a refill. this would not help the patient at this time. it is not advised for the EMT to encourage the patient to take a prescription for another person.**
the upper airway is separated from the lower airway by the larynx. select the structures of the upper airway.
mouth, nasopharynx, & pharynx. **the upper airway consists of the nasopharynx, nasal air passage, pharynx, oropharynx, mouth, epiglottis, and larynx.** **the carina is part of the lower airway. it is the point at which the main bronchus branches into the right and left bronchi.**
your patient, an unrestrained driver in a head on collision, exhibits signs and symptoms of cardiac tamponade. cardiac tamponade is an example of what type of shock?
obstructive shock. **obstructive shock is caused by an anatomical or physiological obstruction that prevents adequate blood volume from reaching the rest of the body. cardiac tamponade is an example of obstructive shock. the pressure on the heart, created from the cardiac tamponade, prevents adequate blood flow from being distributed to the rest of the body.** **a pump failure of the heart causes cardiogenic shock. distributive shock is caused by inadequate blood flow secondary to widespread vasodilation. hemorrhagic shock is caused by an excessive loss of blood, which is not caused by cardiac tamponade.**
You are dispatched to a possible overdose. Upon arrival, you find a 23-year-old female, lying on the couch unresponsive. There are two empty bottles of hydrocodone lying next to the patient. You should:
open and maintain the airway. **it is established that the patients level of consciousness is unresponsive, so the next step is to ensure the patient has a patent and an open airway.** **it is important to ask questions to the family members and bystanders on the scene, but that is not the priority with this patient. intranasal naloxone is indicated in this patient because hydrocodone is a narcotic, but the patients airway is the priority. checking blood sugar is indicated in all altered mental status patients. but, it is not the priority. airway comes first.**
Which of the following are side effects of epinephrine administered by an auto-injector device such as an Epi-Pen?
palpitations, tachycardia, & diaphoresis. **Epinephrine is a sympathomimetic hormone and acts on the body the same as the fight or flight response. It is indicated for the treatment of anaphylactic reactions. The side effects are tachycardia, pallor, headache, dizziness, palpitations, and sweating. Pain at the site of the injection is also possible.** **Bradycardia and flushed skin are not side effects. These are the opposite effects of the medication.**
You are dispatched to a long-term living facility for an 83-year-old female with a fever and shortness of breath. Lung sounds reveal rhonchi and crackles in the bilateral lower lobes. The patient has a Foley catheter with 250 cc of clear urine, and she was recently discharged from the hospital after treatment for a kidney infection. What should you suspect?
pneumonia. **pneumonia is an infection of the lungs. signs and symptoms of pneumonia are fever, shortness of breath, productive coughing, chest discomfort, headaches, body aches, wheezing, and/or rhonchi, and tachycardia. common causes of pneumonia include bacteria, viruses, fungi, immobility due to hospitalization or surgery, chemical injury, or lung injury.** **urinary tract infections (UTI's) are common in patients with catheters, but the foley catheter has clear urine noted. a UTI would not cause abnormal lung sounds. chronic obstructive pulmonary disease (COPD) is a chronic lung disease and does not cause a productive cough or crackles. congestive heart failure (CHF) can produce crackles and shortness of breath, but the patient shows all signs and symptoms of an infection, primarily pneumonia.**
you are performing triage at a mass casualty accident and encounter a 29 year old male with a traumatic amputation of the right forearm. a tourniquet is applied, and minimal bleeding is noted. the patient is A&Ox4, has a respiratory rate of 12 that is not labored, and his skin is pale and diaphoretic. what color would the patient be tagged as?
red. **the patient would be tagged red (immediate) because he is showing symptoms of shock. although the tourniquet is controlling bleeding at this time, his skin is showing signs of shock.**
Your adult patient requires assisted ventilations with a bag-mask device. As you are manually ventilating the patient, you note that ventilating is becoming difficult and there is no more rise and fall of the chest. What should you do next?
reposition the patients head. **if the patients chest is not rising and falling with each breath, your first step is to reposition the head. if this does not correct the chest rise, you may need to insert an airway adjunct. if there is air escaping under the seal of the mask, reposition the mask to gain a better seal.** **you may want to re-assess breath sounds, but it is not the first step when noticing the chest is not rising and falling. after you reposition the mask for a better seal, reposition the head and then check for airway obstruction, and determine that there is still no rise and fall of the chest, then you change to mouth to mask ventilation or another alternate method.**
a 23 year old female is having difficulty breathing and trouble speaking . you note that her hands, fingers, and toes are all contracted and drawn up. her respirations are 34 and labored. what condition do you expect?
respiratory alkalosis. **respiratory alkalosis is a primary cause of hyperventilation syndrome. hyperventilation syndrome causes anxiety, numbness and tingling of hands and feet, and spasms in the feet and hands. patients will have trouble breathing because they may feel like they cant catch their breath. respiratory alkalosis is a buildup of carbon dioxide and a buildup of the excess base in body fluids. respiratory acidosis occurs from excess carbon dioxide buildup from inadequate ventilation. conditions such as opioid overdose or head injuries can cause respiratory acidosis. **
chronic obstructive pulmonary disease (COPD) includes emphysema, chronic bronchitis, and chronic asthma. select the signs and symptoms of COPD.
rhonchi, hypoxemia, & tripod positioning. **Rhonchi, tripod positioning, and hypoxemia are all signs and symptoms of chronic obstructive pulmonary disease (COPD).** **Distended neck veins are seen in congestive heart failure (CHF).**
Acute coronary syndrome (ACS) is an umbrella term to describe a specific group of symptoms caused by myocardial ischemia. Select the conditions associated with ACS.
stable angina pectoris & acute myocardial infarction. **Acute coronary syndrome (ACS) describes symptoms that indicate myocardial ischemia. Angina pectoris is pain caused by a brief moment of lack of oxygen to the heart's tissues. Stable angina pectoris is pain that occurs in response to exertion that increases cardiac oxygen demand and is relieved by rest or nitroglycerin. Unstable angina is pain occurring with an absence of exertion that increases cardiac oxygen demand. It is also relieved with rest or nitroglycerin. Acute myocardial infarction is the death of cardiac cells due to obstructed blood flow. The pain is not relieved by rest or nitroglycerin.** **Cardiogenic shock is not grouped with ACS. It is a failure of the heart to effectively pump blood to the rest of the body.**
which of the following burn injuries would be classified as moderate?
superficial burns covering 50% TBSA, full thickness burns involving 2-10% TBSA, & partial thickness burns covering 15-30% TBSA. **Burns are classified into three categories for adults: severe, moderate, and minor.** **Severe burns include full-thickness burns to hands, feet, face, genitalia, airway, or circumferential burns, full-thickness burns covering more than 5% of total body surface area (TBSA), partial-thickness burns covering more than 20% TBSA, burns paired with traumatic injuries, and burns to patients younger than five years or older than 50 years.** **Moderate burns include full-thickness burns involving 2-10% TBSA, partial-thickness burns covering 15-30% TBSA, and superficial burns covering more than 50% TBSA.** **Minor burns include full-thickness burns covering less than 2% TBSA, partial-thickness burns covering less than 15% TBSA, and superficial burns covering less than 50% TBSA.**
When assessing your unresponsive patient, you note that he has snoring respirations. This is indicative of upper airway obstruction. What is the most common upper airway obstruction?
tongue. **snoring respirations are indicative of upper airway obstruction. the tongue is the most common upper airway obstruction.** **foreign bodies are common causes of upper airway obstruction but are not the most common.**
the incident command system is a universal, multi faceted management system commonly used in large scale disasters. all of the following are positions on the command staff, except:
transportation officer. **the command staff of the ICS consists of the public information officer, the safety officer, and the liaison officer** **transportation is categorized under the operations branch of the general staff.**
You arrive on the scene of an explosion with multiple casualties. Because you are first on the scene, you must begin triage. Of the following patients, which patient would be tagged as Immediate (red in color)?
unresponsive 19 year old female with bradycardia and shallow respirations. **immediate patients, red in color, are the first priority and should be treated and transported first. these patients have problems with the airway, breathing, or circulation. the unresponsive 19 year old female requires treatment for her airway and breathing.** **the 26 year old man would be tagged minimal. minimal patients are next to last priority, termed "walking wounded", and are green in color.** **the pulseless and apneic 22 year old male would be tagged expectant, black in color, since the patient is deceased.** **the 32 year old with abdominal pain would be tagged delayed, which is yellow, because the patient requires transport, but not at this exact moment.**
Which of the following are components of ventilation?
vital capacity, dead space, & alveolar minute volume. **Ventilation is the process of moving air in and out of the lungs. Components of ventilation include dead space, vital capacity, and alveolar minute volume. Alveolar minute volume is the volume of air that reaches the alveoli. The number is calculated by the tidal volume and subtracting the amount of dead space. Dead space is the portion of the tidal volume that does not participate in gas exchange. Vital capacity is the amount of air forcibly exhaled after taking a deep breath.** **External respiration refers to the process of exchanging oxygen and carbon dioxide between alveoli and blood and is a factor in respiration, not ventilation.**
Asthma is the most common chronic disease in children over the age of 1 year. It is important for an EMT to recognize the signs and symptoms of asthma to treat a patient suffering from an asthma attack effectively. Choose the signs and symptoms of asthma.
wheezing, anxiety, & tachypnea. **Asthma is an acute condition or a chronic disease in which the airway passages constrict due to inflammation and fill with an over-production of mucus. A patient will exhibit wheezing, tachypnea, and anxiety.**
Which of the following lung sounds would most likely result from bronchial constriction?
wheezing. **wheezing suggests bronchospasm and a narrowing of the lower airways. wheezing could also indicate obstruction. wheezing can be heard audibly and through auscultation.** **rales indicate fluid such as pulmonary edema. stridor is an upper airway sound indicating obstruction or narrowing. rhonchi describes lung congestion. it is similar to blowing bubbles underwater.**
you are assessing a patient complaining of severe pain. when you palpate the abdomen, the patient screams in pain. which of the following questions is most appropriate for you to ask the patient first?
"how would you describe your abdominal pain?" **two different types of nerves supply the peritoneum, which is the lining of the abdominal cavity. because of these two nerves, abdominal pain can have several different qualities. therefore, asking the patient to describe their abdominal pain is most important. the quality of the pain is important in diagnosing the source of the pain.** **you may ask if the patient has eaten lately, how the pain began, and if he has experienced constipation recently. however, there are more appropriate and highest priority questions to be asked to the patient.**
