Premier Advanced Emergency Care and Transportation of the Sick and Injured 4e

Flashcards from Premier Advanced Emergency Care and Transportation of the Sick and Injured 4e Lecture Notes

A 29-year-old male with a history of type 1 diabetes presents with excessive urination and marked thirst. These signs indicate that the:

Renal system is excreting excess glucose.

A 42-year-old male is found unresponsive on his couch by a neighbor. During your assessment, you find no signs of trauma and the patient's blood glucose level is 75 mg/dL. His blood pressure is 168/98 mm Hg, his heart rate is 45 beats/min and bounding, and his respirations are 8 breaths/min and irregular. The patient is wearing a medical alert bracelet that states he has hemophilia. You should:

Suspect that he has intracranial bleeding, assist his ventilations, and transport rapidly to an appropriate hospital.

Common findings in patients with blood disorders include all of the following, except:

Flushed skin and bradycardia.

In which of the following situations would a diabetic patient most likely develop hypoglycemic crisis (insulin shock)?

Heavy exertion following a small meal

Fifty percent dextrose (D50) is indicated in all of the following situations, except:

An asymptomatic patient with a blood glucose of 60 mg/dL.

Adrenocorticotropic hormone targets the adrenal and causes it to release .

Cortex; cortisol

Insulin is produced when:

Absorbed carbohydrates stimulate the beta cells of the pancreas.

You are dispatched to a residence for a 60-year-old diabetic male who is unresponsive. As you are assessing the patient, your partner attempts to obtain a blood glucose reading; however, the glucometer reads “error” after two attempts. You should:

Start an IV and administer 50 mL of 50% dextrose.

When managing a semiconscious patient with adequate breathing, you should administer oxygen and:

Position the patient on his or her side and have suction ready.

A 56-year-old male is found unresponsive by a neighbor. Your assessment reveals that he is diaphoretic, pale, and breathing rapidly and shallowly. His blood glucose reading is 49 mg/dL. The most appropriate management for this patient includes:

Assisted ventilation, 50 mL of D50 IV, and oropharyngeal suctioning as needed.

You respond to a residence for a patient who is “not acting right.” As you approach the door, the patient, a 35-year-old male, begins shouting profanities at you and your partner while holding a baseball bat. The man is confused and diaphoretic and is wearing a medical identification bracelet. You should:

Retreat at once and call law enforcement.

Diabetic ketoacidosis (DKA) occurs when:

The body's cells metabolize fat as an immediate energy source.

Which of the following statements regarding sickle cell disease is correct?

In sickle cell disease, the red blood cells are abnormally shaped and are less able to carry oxygen.

A 22-year-old female with type 1 diabetes is unresponsive and has a blood glucose level of 29 mg/dL. She is receiving high-flow oxygen, and several attempts to establish IV access have failed. You should:

Administer 0.5 to 1 mg of glucagon via the intramuscular route.

The cells convert glucose into energy through the Krebs cycle and:

Glycolysis.

You are caring for a 27-year-old male with suspected ketoacidosis. He is unresponsive and his blood glucose level, as measured by glucometer, reads “high.” His blood pressure is 80/50 mm Hg, pulse is 130 beats/min and weak, and respirations are 40 breaths/min and shallow. Which of the following represents the most appropriate treatment approach?

Assisted ventilation, 20-mL/kg crystalloid boluses to maintain perfusion, transport, and consider an advanced airway

Excessive eating caused by cellular “hunger” is called:

Polyphagia.

A 45-year-old female with type 1 diabetes presents with an altered mental status. Her skin is pale and moist, and her respirations are rapid and shallow. You should:

Provide ventilatory assistance with 100% oxygen.

Which of the following statements regarding hyperosmolar hyperglycemic syndrome (HHS) is correct?

HHS is not associated with a fruity odor on the patient's breath.

Which of the following complications is most commonly associated with hypoglycemic crisis (insulin shock)?

Seizures

The chemical mediators that cause an allergic reaction are released by:

Basophils and mast cells.

In addition to widespread urticaria, is a common response in patients experiencing a severe allergic reaction.

Bronchospasm

A 46-year-old female presents with respiratory difficulty, facial swelling, and widespread hives after she was stung by an unknown type of insect. Her blood pressure is 88/58 mm Hg; auscultation of her lungs reveals diffuse expiratory wheezing. The patient has a prescribed EpiPen, but has not used it. After administering 100% oxygen, you should:

Assist the patient with her EpiPen in accordance with your protocols.

Decreases in cardiac output and blood pressure in a patient with anaphylactic shock are the result of:

Systemic vasodilation.

In contrast to anaphylaxis, an anaphylactoid reaction:

Can occur without previous exposure to the offending agent.

Treatment for anaphylactic shock secondary to an insect sting may include all of the following, except:

Leaving the stinger in place.

An allergic reaction is most accurately defined as a(n):

Exaggerated response of the body's immune system to a foreign stimulus.

Assuming that previous exposure and sensitization has occurred, which of the following patients will likely experience the most severe allergic reaction?

A 40-year-old female who was stung by a yellow jacket

The AEMT should transport any patient with an allergic reaction, even if he or she is able to stop the reaction with epinephrine, because:

The patient's symptoms could recur up to 8 hours later.

A 29-year-old male experienced multiple fire-ant bites to his lower extremities. He is conscious and alert, and denies respiratory distress. His skin is warm, dry, and without urticaria and his breath sounds are clear and equal bilaterally. Appropriate management for this patient includes:

Applying ice to the bites and observing for signs of an allergic reaction.

You are assessing a 32-year-old female who was stung by a scorpion. She is unresponsive and has stridorous, severely labored respirations. Your partner, who is assisting the patient's ventilations with a bag-mask device, tells you that he is meeting significant resistance with each ventilation. You should:

Insert an advanced airway device to protect her airway.

Allergic reactions to oral medications:

May cause a severe reaction after 30 minutes or more following ingestion.

A 50-year-old male was stung two times by a yellow jacket. He has a history of coronary artery disease and thinks that he is allergic to yellow jackets. Your assessment reveals a fine rash to his trunk and arms. His breath sounds are clear and equal bilaterally, his vital signs are stable, and he denies shortness of breath. Treatment for this patient should include all of the following, except:

Epinephrine via auto-injector.

Because the is the body's first line of defense, signs of anaphylaxis typically manifest there first.

Skin

Epinephrine is a critical treatment for patients with severe allergic reactions (anaphylaxis) because it:

Works rapidly to raise the BP by constricting the vasculature and improves ventilation by dilating the bronchioles.

A 30-year-old man presents with widespread urticaria after being bitten numerous times by fire ants. He is conscious and alert and denies respiratory distress. Further assessment reveals that his breath sounds are clear and equal bilaterally. He tells you that his wife has a prescribed epinephrine auto-injector because she is allergic to hornets. However, he does not have a prescribed auto-injector of his own. You should:

Administer oxygen as needed and transport promptly.

Unlike the honeybee, wasps and hornets:

Can sting multiple times, because their stinger is not left imbedded in the skin.

You should attempt to remove an imbedded stinger from a patient who was stung by a bee because:

It can inject venom for up to 20 minutes after the initial sting.

The ability of the body to recognize a foreign substance the next time it is encountered is called:

Sensitivity.

Natural immunity occurs when a person's body:

Produces antibodies after being exposed to and experiencing all the symptoms of a disease.

The self-administration of licit or illicit substances in a manner that is not consistent with approved medical or social practice is called:

Substance abuse.

A 47-year-old male ingested an unknown type of medication. After ensuring scene safety, you approach the patient and begin to assess him. Which of the following questions would be of least pertinence with regard to the acute management of this patient?

“Why did you take the medication?”

General management for a patient who has overdosed on a benzodiazepine includes:

Maintaining airway patency, supporting ventilations as needed, and transporting.

Patients with cyanide poisoning often have breath odor that resembles:

Bitter almonds.

With regard to substance abuse, tolerance is defined as a:

Physiologic adaptation to the effects of a drug such that increasingly larger doses are required to achieve the same effect.

A 67-year-old female complains of nausea, vomiting, and abdominal pain that woke her from her sleep. As you and your partner enter her residence, you immediately note the smell of natural gas. Suspecting carbon monoxide toxicity, you quickly remove the patient from her home and place her in the ambulance. When assessing her, it is important to remember that:

A pulse oximetry reading that is high does not rule out significant hypoxemia.

What is the mechanism of action of activated charcoal when administered to a patient who has ingested a poisonous substance?

It adsorbs the toxic substance and delays the digestive process.

A 32-year-old male ingested a large quantity of an opioid. Which of the following clinical signs would you most likely encounter during your assessment?

Respiratory depression and hypotension

You should not administer emergency care to a patient who inhaled a toxic substance until:

He or she has been properly decontaminated.

Which of the following scenarios is an example of an intentional poisoning?

A 24-year-old female sprays mace into the eyes of a perpetrator during a burglary attempt.

A 6-year-old, 44-lb male ingested an unknown quantity of aspirin approximately 20 minutes ago. He is conscious and alert and has stable vital signs. The appropriate dose of activated charcoal for this child is:

20 g.

During your assessment of a 19-year-old male who has abused an unknown type of drug, you note severe deformity to his hand. The patient, who is very agitated, states that he bent his fingers back in an attempt to break them. This abnormal behavior is most consistent with the use of:

PCP.

The vast majority of all poisonings, intentional and unintentional, occur via:

Ingestion.

You and your partner are standing by at the scene of a structural fire when two firefighters carry a patient to you that they rescued from one of the rooms inside the house. The patient is not moving and has no obvious burns. You should:

Determine if the patient's airway is patent and then assess ventilatory effort.

A 20-year-old female, who is a known IV drug abuser, has overdosed on heroin. Your assessment reveals that she is semiconscious, bradycardic, and hypotensive. Her respirations are slow and shallow. As your partner is assisting her ventilations, you should start an IV and give:

0.4 mg of naloxone, followed by a reassessment.

Carbon monoxide (CO) causes severe tissue hypoxia because it:

Binds to the hemoglobin molecule and inhibits cellular oxygenation.

In an attempt to kill herself, a 56-year-old female ingested a large quantity of Darvon. Your primary survey reveals that she is semiconscious; has slow, shallow respirations; and has a heart rate of 40 beats/min. Further assessment reveals that her BP is 80/50 mm Hg. Initial management for this patient includes:

Assisted ventilation with a bag-mask device and 100% oxygen.

A 55-year-old male ingested a large quantity of bourbon whiskey. He is deeply unconscious and has slow, shallow breathing. His “drinking buddy” tells you that the patient frequently abuses alcohol. You should:

Insert an oral airway, assist his ventilations, assess his blood glucose level, transport, and start an IV line en route.

Which of the following statements regarding ethyl alcohol (ETOH) is correct?

ETOH dulls the sense of awareness and slows reflex times.

You are dispatched to the residence of a 30-year-old female who complains of severe weakness and vomiting. During your assessment, you note that she is incontinent of urine, has copious oral secretions, and is tearing. Her BP is 88/58 mm Hg, pulse is 40 beats/min and weak, and respirations are 24 breaths/min with adequate depth. You should suspect:

Organophosphate poisoning.

During your assessment of a 43-year-old male with suicidal thoughts, he becomes agitated and appears uncomfortable. You should:

Continue talking to him while your partner requests police backup.

You are dispatched to a residence for an elderly female with “mental status changes.” During your assessment of the patient, you should first:

Determine the patient's baseline mental status.

Which of the following emotionally disturbed patients could legally refuse EMS treatment and transport?

A 77-year-old male who is severely depressed over the death of his wife

You are dispatched to an apartment complex for a young male experiencing an “emotional problem.” Law enforcement is at the scene when you arrive. You should:

Confer with a police officer before making patient contact.

Which of the following would provide you with the least amount of information about the emotional state of a 20-year-old male who will not respond to any of your questions?

Hair length

When caring for a patient with a behavioral emergency, it is important for you to:

Let the patient tell you what happened in his or her own words.

To minimize the risk of legal implications when managing an emotionally disturbed patient, you should:

Gain his confidence so that he consents to care.

When performing your assessment of a 40-year-old male who is agitated and displaying bizarre behavior, you should:

Limit the number of personnel around the patient.

General safety guidelines to follow when caring for a patient with a behavioral emergency include all of the following, except:

Spending as little time as possible at the scene.

Which of the following situations is not an example of a patient with a mental illness?

A 55-year-old male who experiences a panic attack after being diagnosed with cancer

Common physical signs and symptoms of agitated delirium include:

Hypertension, tachycardia, and diaphoresis.

A behavioral crisis occurs when:

A reaction to an event interferes with daily living activities.

Behavior is most accurately defined as:

How a person responds to his or her environment.

You arrive at the residence of a young female who is experiencing an apparent psychotic episode. Law enforcement is on scene and has ensured that it is safe. You find the patient sitting in a chair, rocking back and forth. You should:

Clearly identify yourself and your partner and tell her you are there to help.

A 31-year-old man has signs and symptoms of excited delirium. When assessing his orientation, memory, and ability to concentrate, you should:

Ask him simple questions, such as “When did you first notice these feelings?”

Which of the following is the most reliable sign of a potentially violent patient?

Physical activity

The single most significant factor that contributes to suicide is:

Significant depression.

Alzheimer disease is an example of a(n):

Organic psychiatric disorder.

Which of the following findings does not indicate the potential for violence?

Large physical body size

A violent patient should never be restrained in a prone position because:

You cannot effectively monitor the patient's airway.