EMT Section 5 Exam

(T/F):

Irreversible shock is the last stage during which a transfusion will not save the pt's life.

True

During the primary assessment, a(n) ______ suggests compensated shock.

rapid pulse

You are called to the residence of a 67-yr-old man who is complaining of chest pain. He is alert & oriented. During your assessment, the pt tells you he has had two previous heart attacks. He is taking medications for fluid retention. As you listen to his lungs, you notice that he has fluid in his lungs. This condition is known as pulmonary:

edema

You are called to a construction site where a 27-yr-old worker has fallen from the second floor. He landed on his back & is drifting in & out of consciousness. A quick assessment reveals no bleeding or blood loss. The pt's blood pressure is 90/60 mm Hg w/ a pulse of 100 beats/min. His airway is open & his breathing is within normal limits. You realize the pt is in shock. The pt's shock is due to an injury to the:

spinal cord

You respond to the local nursing home for an 85-yr-old woman who has an altered mental status. During your assessment, you notice that the pt has an elevated body temperature. She is hypotensive & her pulse is tachycardiac. The nursing staff tells you that she has been sick for several days & they called for EMS assistance b/c her mental status continued to decline. You suspect the pt is in septic shock. The shock is due to:

widespread dilation

You are called to a motor vehicle collision. Your pt is a 19-yr-old woman who was not wearing her seatbelt. She is conscious but confused. Her airway is open & respirations are within normal limits. Her pulse is slightly tachycardiac but regular. Her bp is within normal limits. She is complaining of being thirsty & appears very anxious. You know that the last measurable factor to change to indicate shock is:

blood pressure

The term "shock" is MOST accurately defined as:

cardiovascular collapse leading to inadequate perfusion

Which of the following is a basic physiologic cause of shock?

pump failure, low fluid volume, & poor vessel function

A 39-yr-old man present w/ cool & clammy skin, a blood pressure of 88/60 mm Hg, and a fever of 104.5 F (40.3 C). He has been fighting a bacterial infection for 3 days. Which of the following types of shock do you suspect?

Septic

What is the last measurable factor to change when a pt is in shock?

blood pressure

(T/F):

Compensated shock is related to the last stages of shock.

False

(T/F):

Decompensated shock occurs when the systolic blood pressure falls below 120 mm Hg.

False

You respond to a 17-yr-old football player who was hit by numerous opponents and, while walking off the field, became unconscious. He is currently unconscious. You take c-spine precautions & start your assessment. You know that in the treatment of shock you must:

secure & maintain an airway, provide respiratory support, & assist ventilations

A 20-yr-old man was kicked numerous times in the abdomen during an assault. His abdomen is rigid & tender, his heart rate is 120 beats/min, & his respirations are 30 breaths/min. You should treat this pt for:

hypovolemic shock

A 33-yr-old woman presents w/ a generalized rash, facial swelling, & hypotension approx. 10 mins after being stung by a hornet. Her BP is 70/50 mm Hg & her heart rate is 120 beats/min. In addition to high-flow oxygen, this pt is in the MOST immediate need of:

epinephrine

Perfusion is the circulation of blood in:

adequate amounts

What are the three components of the "perfusion triangle"?

heart, blood vessels, blood

A 25-yr-old woman who was not wearing a seatbelt struck the steering wheel of her car w/ her chest when she hit a tree while traveling at a high rate of speed. She has signs & symptoms of shock, which you suspect are the result of intrathoracic bleeding. Which of the following interventions will provide this pt w/ the greatest chance for survival?

rapid transport to a trauma center

A 70-yr-old woman was recently discharged from the hospital following a total hip replacement. Today, she presents w/ restlessness, tachycardia, & a bp of 100/64 mm Hg. Her skin is warm & moist. You should be MOST suspicious that she is experiencing:

septic shock

When should nonlifesaving interventions be performed for your multisystem trauma pt?

en route to the hospital

As you approach a pt lying at the side of the roadway, you observe severe bleeding from the leg. What should you first action be?

control the bleeding

Your pt is in shock, but the body's defense mechanisms are currently able to maintain adequate circulation. This is called _________.

compensated shock

You suspect your pt is in shock. You note the pt's skin is pale. This is likely due to __________.

peripheral vasoconstriction

A 56-yr-old man is found semiconscious by his wife. Your assessment reveals that his respirations are rapid & shallow, his pulse is rapid & irregular, & his bp is low. The pt's wife states that he complained of left arm pain & nausea the day before, but would not allow her to call 9-1-1. The MOST likely cause of this pt's present condition is:

cardiogenic hypoperfusion

Which of the following clinical signs is unique to anaphylactic shock?

wheezing

Which of the following injuries would MOST likely cause obstructive shock?

cardiac tamponade

Foods, medications, & insects are common causes of _________.

anaphylactic shock

In infants & children, a capillary refill time (CRT) of greater than ________ second(s) is a sign of poor peripheral perfusion.

2

All of the following conditions would make you suspect shock, EXCEPT:

tachycardia

Inadequate circulation of blood throughout the body is called _______.

shock

Your pt has a decreased cardiac output & poor myocardial contractility. This will likely lead to ________.

cardiogenic shock

When the body senses a state of hypoperfusion, the sympathetic nervous system releases epinephrine, the effects of which include:

tachycardia

Pulmonary edema & impaired ventilation occur during:

cardiogenic shock

A 19-yr-old was stung multiple times by fire ants. He is experiencing obvious signs & symptoms of anaphylactic shock. You administer 100% oxygen & give him epinephrine via subcutaneous injection. Upon reassessment, you determine that his condition has not improved. You should:

repeat the epinephrine injection after consulting w/ medical control

Which of the following MOST accurately describes septic shock?

bacterial damage to the vessel wall, leaking blood vessels, & vasodilation

When you are assessing a pt w/ signs & symptoms of shock, it is MOST important to remember that:

blood pressure may be the last measurable factor to change in shock

In an acute injury setting, neurogenic shock is commonly accompanied by:

hypothermia

Clinical signs of compensated shock include all of the following, EXCEPT:

absent peripheral pulses

A 27-yr-old man was stabbed in the chest during a disagreement at a poker game. As you approach him, you see a knife impaled in his chest. Before you begin treatment, it is MOST important to:

follow standard precautions

Shock due to severe infection is called ____________.

septic shock

Which of the following is a potential contraindication for placing a pt in the Trendelenburg position?

head injury

Signs of decompensated shock include:

labored or irregular respirations, ashen gray or cyanotic skin color, weak or absent distal pulses, dilated pupils, & profound hypotension

Shock usually is in an advanced stage by the time:

a drop in bp is detected

Anticipate shock in pts who may have:

severe infection, significant blunt force trauma or penetrating trauma, massive external bleeding or index of suspicion for major internal bleeding, spinal injury, chest or abdominal injury, major heart attack, and/or anaphylaxis

How should you treat pediatric or geriatric pts in shock?

Just like any other shock pt

perfusion requires:

an intact cardiovascular & a functioning respiratory system

Most types of shock are caused by:

dysfunction in the heart, blood vessels, or volume of blood

Shock

the collapse & failure of the cardiovascular system, when blood circulation slows & eventually stops

systolic pressure

is the peak arterial pressure, or pressure generated every time the heart contracts

diastolic pressure

include cardiogenic, obstructive, septic, nuerogenic, anaphylactic, psychogenic, & hypovolemic

Types of shock include:

cardiogenic, obstructive, septic, neurogenic, anaphylactic, psychogenic, & hypovolemic

Signs of compensated shock include:

anxiety or agitation; tachycardia; pale, cool, moist skin; increased respiratory rate; nausea & vomiting; & increased thirst

When should you treat a pt for shock?

If there is any question on your part; never wrong to treat a pt for shock

You should suspect shock in all of the following situations EXCEPT:

a mild allergic reaction

In anaphylactic shock, the combination of poor oxygenation & poor perfusion is a result of:

widespread ventilation

An insufficient concentration of _______ in the blood can produce shock as rapidly as vascular causes.

oxygen

Hypovolemic shock is a result of:

low volume

Neurogenic shock is caused by:

a radical change in the size of the vascular system

In septic shock:

there is an insufficient volume of fluid in the container, the fluid that has leaked our often collects in the respiratory system, & there is a larger-than-normal vascular bed to contain the smaller-than-normal volume of intravascular fluid

Neurogenic shock usually results from damage to the spinal cord at the:

cervical level

(T/F):

Shock occurs only w/ massive blood loss from the body.

False

(T/F):

Shocks occurs only w/ massive blood loss from the body.

False

(T/F):

Metabolism is the cardiovascular system's circulation of blood & oxygen.

False

(T/F):

Septic shock is a combination of vessel & content failure.

True

(T/F):

A person in shock, if left untreated, will most likely survive.

False

(T/F):

Shock occurs when oxygen & nutrients cannot get to the body' cells.

True

(T/F):

Life-threatening allergic reactions can occur in response to almost any substance that a pt may encounter.

True

_________ develops when the heart muscle can no longer generate enough pressure to circulate the blood to all organs.

Cardiogenic shock

Basic causes of shock include:

poor pump function, blood or fluid loss, & blood vessel dilation

Perfusion requires having a working cardiovascular system as well as:

adequate oxygen exchange in the lungs, adequate nutrients in the form of glucose in the blood, & adequate waste removal

Regulation of blood flow is determined by:

cellular need

The autonomic nervous system regulates involuntary functions such as:

sweating, digestion, & constriction & dilation of capillary sphincters

Blood flow through the capillary beds is regulated by:

the capillary sphincters

shock

hypoperfusion

homeostasis

balance of all systems of the body

perfusion

sufficient circulation to meet cell needs

sphincters

regulate blood flow in the capillaries

autonomic nervous system

regulates involuntary body functions

blood pressure

provides a rough measure of perfusion

During diffusion, oxygen molecules move from _______ into _________.

alveoli; blood

The body's attempt to maintain balance of all systems of the body is called ___________.

homeostasis

Shock is the result of:

hypoperfusion to the cells of the body

A construction worker fell approximately 30 feet. He is semiconscious with rapid, shallow respirations. Further assessment reveals deformity to the thoracic region of his spine. His blood pressure is 70/50 mm Hg, his pulse is 66 beats/min and weak, and his skin is warm and dry. In addition to spinal immobilization and rapid transport, the MOST appropriate treatment for this patient includes:

assisted ventilation, thermal management, and elevation of the lower extremities.

You respond to a residence for a patient with a severe leg injury following an accident with a chainsaw. When you arrive, you find the patient, a 44-year-old male, lying supine in the backyard. He has a partial amputation of his right lower leg that is actively bleeding. The patient is conscious and breathing adequately; however, he is restless and his skin is diaphoretic. You should:

apply direct pressure to the wound.

Which of the following will assume control of involuntary functions during shock?

sympathetic nervous system

One of the primary waste products of normal cellular metabolism that must be removed from the body by the lungs is:

CO2

In order to recognize and treat early shock, the EMT must ___________.

understand the pathophysiology of shock

When perfusion to the core of the body decreases:

blood is shunted away from the skin

Widespread vasodilation, increased capillary permeability, and bronchoconstriction are the result of ___________.

anaphylaxis shock

Which of the following is a non-hemorrhagic cause of hypovolemic shock?

diarrhea