Chapters 39-40, Review

In addition to high-quality CPR, which of the following interventions has clearly made a positive and measurable difference in survival from sudden cardiac arrest?

Defibrillation

Which of the following premorbid conditions would MOST likely occur in an otherwise healthy adult?

Drug toxicity

Which of the following substances or elements reinforces red blood cells, creating the final step in the formation of a blood clot?

Fibrinogen

By which of the following mechanisms do patients with septic shock become hypovolemic?

Fluid leakage out of the vascular space

In which of the following situations would endotracheal intubation MOST likely be indicated?

Following return of spontaneous circulation, the patient remains comatose.

What effect would the restoration of normotension have on a patient with internal bleeding and a blood pressure of 70/54 mm Hg?

Formed clot dislodgement and worsened internal bleeding

Which of the following components represent the perfusion triangle?

Heart, blood, blood vessels

After approximately 6 minutes of attempted resuscitation, your patient experiences a return of spontaneous circulation. He remains unresponsive and apneic, and the cardiac monitor reveals sinus tachycardia. In addition to continuing ventilations, what should be done next?

Hypothermia treatment

Which of the following occurs during compensated shock?

Increased rate of breathing causes respiratory alkalosis

Following return of spontaneous circulation, a patient remains comatose. Which of the following interventions would MOST likely be performed?

Induced hypothermia

Which of the following roles would the code team leader MOST likely perform?

Interpreting the ECG

Which of the following solutions is preferred for fluid resuscitation of a patient in shock in the prehospital setting?

Isotonic crystalloid

Which of the following assessment findings should increase your index of suspicion for obstructive shock?

Jugular venous distention

Which of the following is the BEST indicator of tissue perfusion during compensated shock?

Level of responsiveness

Which of the following hemodynamic parameters decreases, regardless of the etiology of the shock?

Mean arterial pressure

Full recoil of the chest in between compressions enhances blood return to the heart by which of the following mechanisms?

Negative intrathoracic pressure

An unresponsive, apneic, and pulseless man presents with a regular rhythm on the cardiac monitor. In addition to information regarding the events that led to his arrest, which of the following assessment findings would cause you to suspect that cardiac tamponade is the underlying cause of his condition?

No pulse with CPR and jugular venous distention

Which of the following statements regarding gas exchange in the lungs is correct?

Oxygen molecules move from the alveoli into the blood by diffusion.

Which of the following depicts a positive orthostatic tilt test?

The patient becomes dizzy upon standing

Which of the following is a disadvantage of using a crystalloid solution when treating a patient with hemorrhagic shock?

They do not have oxygen-carrying capacity

Which of the following statements regarding the use of vasopressin during cardiac arrest is correct?

Vasopressin may be substituted for the second dose of epinephrine.

How does CPR change after an advanced airway device is inserted?

Ventilations should be asynchronous with chest compressions.

Which of the following is an example of a peri-arrest condition?

Ventricular tachycardia and a systolic blood pressure of 60 mm Hg

Which of the following clinical signs would differentiate septic shock from hypovolemic shock?

Warm or hot skin

Which of the following is the MOST accurate definition of distributive shock?

Widespread dilation of the resistance and capacitance vessels

You have been attempting resuscitation of an 80-year-old woman for approximately 15 minutes. An advanced airway has been placed, ventilations have been delivered at the appropriate rate, high-quality CPR was performed with minimal interruptions, and rhythms-specific medications were administered. Despite your efforts, the patient remains in asystole. Which of the following statements regarding this scenario is correct?

You have clearly performed all the appropriate interventions and termination of resuscitative efforts should be strongly considered

A "code" runs MOST efficiently when:

a designated team leader is assigned

Parasympathetic nervous system stimulation results in:

a negative dromotropic effect.

You and your team are attempting to resuscitate a 45-year-old man who is in cardiac arrest. After 2 minutes, you assess his cardiac rhythm and determine that he is in asystole. After instructing your team to resume CPR, you should:

administer 1 mg of epinephrine 1:10,000 after obtaining vascular access.

A patient remains in pulseless ventricular tachycardia despite two shocks, a dose of epinephrine, high-quality CPR, and 300 mg of amiodarone. Following the next shock, you should resume CPR and then:

administer 150 mg of amiodarone.

The force or resistance against which the heart pumps is called:

afterload

Infection, hypertensive crisis, and medication noncompliance are differential diagnoses that should be considered when treating a patient who presents with:

altered mental status.

In addition to IV fluids, treatment for a patient in neurogenic shock may include:

amiodarone.

A characteristic sign of neurogenic shock caused by a spinal injury is:

an absence of sweating below the level of the injury.

Afterload is increased following alpha-1 stimulation because of:

arteriolar constriction.

While en route to the scene of a patient in cardiac arrest, the emergency medical dispatcher advises you that she has the caller on the phone, but the caller refuses to do CPR on the patient. With an estimated time of arrival at the scene of 5 minutes, you should:

ask the dispatcher to inform the man to do chest compressions only.

After determining that an unresponsive adult patient is not breathing, you should:

assess for a carotid pulse for no longer than 10 seconds

During the attempted resuscitation of a patient in cardiac arrest, you look at the cardiac monitor and note that the patient's end-tidal CO2 has abruptly increased from 17 mm Hg to 40 mm Hg. You should:

assess for a pulse for up to 10 seconds.

During multiple-organ dysfunction syndrome, the release of __________, a potent vasodilator, leads to tissue hypoperfusion and may contribute to hypotension.

bradykinin

Your assessment of a 68-year-old man reveals an organized cardiac rhythm at a rate of 80 beats per minute and an absent carotid pulse. Treatment for this patient may include all of the following, EXCEPT:

cardiac pacing

An adult patient presents with a blood pressure of 78/60 mm Hg, a pulse rate of 120 beats/min and irregular, and labored breathing. Further assessment reveals pale, cool, moist skin and diffuse crackles in all lung fields. You should suspect:

cardiogenic shock.

Intrinsic causes of cardiogenic shock include:

cardiomyopathy.

When an adult patient with hemorrhagic shock loses more than 40% of his or her blood volume:

cardiovascular deterioration cannot be reversed by compensatory mechanisms.

Tissue perfusion is primarily a function of the:

cardiovascular system.

Defibrillation of a patient who is in asystole is detrimental to the patient because it:

causes an unnecessary interruption in chest compressions.

You are the team leader in the attempted resuscitation of an adult man in ventricular fibrillation. An advanced airway device has been inserted and vascular access has been obtained. As you observe the actions of your team members, you should ensure that:

compressions are hard and fast, with full chest recoil between compressions.

Impedance threshold devices, such as the ResQPOD, function by:

creating a vacuum in the chest, which increases blood flow to the heart.

A 6-year-old, 40-pound child remains in ventricular fibrillation after an initial defibrillation and 2 minutes of CPR. Vascular access has not been obtained. Your next action should be to:

defibrillate with 70 joules.

You are performing one-rescuer CPR on a 50-year-old woman in cardiac arrest. A bystander returns with an AED. You ask the bystander to attach the pads to the patient's chest as you continue CPR. After rhythm analysis, the AED states, "Shock advised." You should:

deliver a single shock and immediately resume CPR.

You and your partner are performing CPR on a 60-year-old woman who was initially in asystole. After 2 minutes, you look at the cardiac monitor and determine that she is in ventricular fibrillation. Your next action should be to:

deliver a single shock and instruct your partner to resume chest compressions while you resume ventilations.

When using an impedance threshold device during cardiac arrest, it is important to:

deliver each ventilation over a period of 1 second.

The Trendelenburg position is accomplished by:

elevating the foot end of the backboard 6 to 12 inches

The negative target-organ effects of anaphylactic shock are reversed with:

epinephrine

The MOST immediate treatment for the patient with a tension pneumothorax is to:

evacuate air from the pleural space

You have just defibrillated an adult woman who is in pulseless ventricular tachycardia. After performing CPR for 2 minutes, you reassess her cardiac rhythm and determine that she is experiencing torsade de pointes; she also remains pulseless. It has been approximately 2 minutes since you administered the last dose of epinephrine. You should next:

give 1 to 2 g of magnesium sulfate without interrupting chest compressions.

Hyperventilation of a patient who is in cardiac arrest:

has been shown to reduce coronary artery perfusion

Shock in the trauma patient should be considered _____________ until proved otherwise.

hemorrhagic

Systemic effects of epinephrine include:

increased afterload.

Anaerobic metabolism is the process in which:

inefficient cellular metabolism produces lactic acid.

Accumulating acids and other waste products in the blood:

inhibit hemoglobin from binding with and carrying oxygen.

If a cardiac arrest patient's airway is maintained with an oral airway and ventilation with a bag-mask device is producing adequate chest rise, then:

insertion of an advanced airway device is not a high priority.

Your partner returns with the AED as you are performing CPR on a 5-year-old child. As he opens the AED, he tells you that there are no pediatric pads, only adult pads. You should:

instruct him to apply the adult pads as you continue one-rescuer CPR.

Your team is attempting resuscitation of a man in cardiac arrest. One of the team members intubates the patient and confirms proper placement of the endotracheal tube. Your MOST appropriate next action should be to:

instruct the person ventilating to provide one breath every 6 to 8 seconds while chest compressions are continuous.

As you are administering 40 units of vasopressin to an adult woman in ventricular fibrillation, your team members continue CPR. After 2 minutes, you reassess her and determine that she is still in ventricular fibrillation. You should:

instruct your team to continue CPR as the defibrillator is charging.

When administering IV fluid boluses to an elderly patient in shock, it is especially important to monitor his or her:

lung sounds.

The MOST common cause of cardiogenic shock is:

myocardial infarction.

When communicating an intuitive decision and obtaining feedback to your team, you should FIRST advise your team:

of what you think the patient's problem is.

Disseminated intravascular coagulation is defined as a(n):

pathological condition in which the proteins that normally control blood clotting become active.

Paramedic intuition is BEST described as:

pattern recognition and matching based on past experience.

The capillary "washout" phase occurs when:

postcapillary sphincters relax, releasing accumulated hydrogen, potassium, carbon dioxide, and thrombosed red blood cells.

Premorbid conditions are those that:

precede the onset of a disease.

A young woman experiences a sudden nervous system reaction that produces temporary, generalized vasodilation and causes her to faint. This is MOST descriptive of _____________ shock

psychogenic

Clinical indicators of sympathetic nervous system discharge include:

pupillary dilation.

Incomplete glucose breakdown leads to an accumulation of:

pyruvic acid.

Hypotension during anaphylactic shock is caused primarily by:

relative hypovolemia.

During anaerobic metabolism, the precapillary sphincters __________ in response to __________.

relax, lactic acid buildup

The paramedic should consider extending the resuscitation effort of a patient with refractory cardiac arrest if:

return of spontaneous circulation of any duration occurred.

Baroreceptors function by:

sensing decreased blood flow and activating the vasomotor center.

Cardiac output is dependent upon:

stroke volume and heart rate.

When practicing a "code," whether in the prehospital or in-hospital setting, the primary focus should be on:

teamwork and minimal interruptions in CPR.

You and your partner are off duty and are playing golf. Suddenly, you see an elderly man grab his chest and collapse to the ground. You should:

tell your partner to call 9-1-1 as you proceed to assess the man.

According to the Frank-Starling mechanism:

the length of myocardial fibers determines force of cardiac contraction.

Relative bradycardia during neurogenic shock occurs because:

the sympathetic nervous system is not stimulated to release catecholamines

The chance for return of spontaneous circulation is BEST when:

timely chest compressions are performed with little or no interruption.

A 6-year-old male was struck in the abdomen. He is restless; his skin is cool, pale, and clammy; and his blood pressure is 94/60 mm Hg. After applying high-flow oxygen and keeping him warm, you should:

transport promptly and establish vascular access en route.

A patient with severe dehydration is found to be hypotensive during your assessment. The MOST important intervention in this case is:

transport with fluid resuscitation en route.

In medicine, intuition would MOST likely be used to:

triage a patient to a higher category.

Signs and symptoms of multiple-organ dysfunction syndrome may include:

uncontrollable bleeding.

Epinephrine is primarily administered during cardiac arrest because its ________effects cause ________.

vasoconstrictive, enhanced coronary blood flow

Carbonic acid is formed by the combination of:

water and carbon dioxide.

Anterior-posterior placement of the defibrillation pads should be used if the patient is younger than ___ year(s) of age or less than ___ kg.

1-10

What is the mean arterial pressure of a person who has a blood pressure of 140/90 mm Hg?

107 mm Hg

The recommended approach for fluid resuscitation of a patient in shock is ___ mL/kg until ______.

20, radial pulses become stronger

A trauma patient has lost an estimated 1.5 L of blood through external bleeding and is hypotensive. How much normal saline or lactated Ringer's solution should he receive?

3 to 4.5 L

Adequately perfused kidneys produce at least ___ to ___ mL of urine per hour.

30, 50

The blood pressure of an infant or child can be maintained with blood loss of up to:

35% to 40%.

The mean arterial pressure must be greater than or equal to ____ mm Hg to ensure that the brain, coronary arteries, and kidneys remained perfused.

60

If the left ventricle fills with 85 mL of blood and ejects 60 mL during a contraction, the ejection fraction is approximately ___%.

70

If you can feel a pulse over the femoral artery of an adult, but are unable to feel a pulse over the radial artery, his or her systolic blood pressure is MOST likely between ___ and ___ mm Hg.

70, 80

Which of the following blood pressures is MOST consistent with a pericardial tamponade?

90/70 mm Hg

Which of the following is a normal response of the body to hypoperfusion?

Antidiuretic hormone is released by the pituitary gland.

Which of the following vital signs values are MOST consistent with neurogenic shock?

Blood pressure, 80/60; pulse, 50; respirations, 24

When attempting to resuscitate a patient in cardiac arrest, which of the following questions would you pose if you suspect that the patient is hyperkalemic?

"Does this patient undergo dialysis?"

You and your partner arrive at the scene of an unresponsive middle-aged man. Your primary assessment reveals that he is apneic and pulseless. Which of the following interventions will provide the BEST chance of survival for this patient?

CPR at the appropriate rate and with minimal interruptions

What is formed when carbon monoxide binds to the hemoglobin molecule?

Carboxyhemoglobin

Which of the following injuries or conditions would cause obstructive shock?

Cardiac tamponade

Which of the following lists, in the correct order, the smallest to largest units of life?

Cells, tissues, organs, organ systems, organism

Which of the following interventions is emphasized the MOST in the 2010 guidelines for emergency cardiac care?

Chest compressions

Which of the following is the MOST accurate definition of multiple-organ dysfunction syndrome?

Combined failure of two or more organs or organ systems that were initially unharmed by the acute disorder or injury that caused the patient's initial illness

Which of the following should occur when integrating a mechanical CPR device into your resuscitation attempt of an adult patient?

Compressions should be continuous after an advanced airway device is inserted.