PARAMEDIC 230 CHAPTER 40 MANAGEMENT AND RESUSCITATION OF THE CRITICAL PATIENT

Which of the following volume expanders has been shown to interfere with platelet function and cause clotting problems?

Dextran

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

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

Which of the following would MOST likely allow you to reach the status of entry-level competence?

Interning with an experienced preceptor

You and your team are treating an unresponsive trauma patient. Which of the following questions would be the MOST relevant to ask your team when evaluating for the presence of a tension pneumothorax?

Is the patient becoming difficult to ventilate?

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

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 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

Parasympathetic nervous system stimulation results in:

a negative dromotropic effect.

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.

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.

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

atropine

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

bradykinin

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.

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.

A tendency to gather and rely on information that confirms your existing views and avoids or downplays information that does not confirm your preexisting hypothesis or field differential is called a(n) ___________ bias.

confirmation

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

drug toxicity

The Trendelenburg position is accomplished by

elevating the foot end of the backboard 6 to 12 inches.

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.

A 40-year-old man had a syncopal episode after receiving news of the death of a loved one. He complains of a headache and is unable to walk without becoming dizzy. You should be the MOST suspicious for

head injury

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

hemorrhagic

Systemic effects of epinephrine include:

increased afterload.

Which of the following occurs during compensated shock?

increased rate of breathing causes respiratory alkalosis

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.

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

isotonic crystalloid

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.

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

Baroreceptors function by:

sensing decreased blood flow and activating the vasomotor center.

Cardiac output is dependent upon:

stroke volume and heart rate

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.

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

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.

Carbonic acid is formed by the combination of:

water and carbon dioxide.

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

Which of the following scenarios would MOST likely cause a bias to decision making?

23-year-old male with crushing substernal chest pain and nausea

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

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

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

30, 50

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

30,50

You have given an 800-mL normal saline bolus to a patient in shock. How much of this fluid will remain in the intravascular space after 20 minutes?

320 mL

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

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

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 an element of the Fick principle?

An adequate number of red blood cells

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

Antidiuretic hormone is released by the pituitary gland.

Your primary assessment of a multisystems trauma patient reveals that he is unresponsive and is not breathing. What should you do next?

Assess for a pulse.

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?"

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 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 will be of MOST help to the paramedic when formulating a field diagnosis?

Considering or ruling out various conditions