EMS1055 FINAL REVIEW QUESTION AND ANSWERS
Know how to read blood pressure - Answers - Systolic pressure: high reading during
contraction (systole)
Diastolic pressure: low reading during relaxation (diastole)
"Normal" depends on the patient (not necessarily 120/80)
Width: 40% of upper arm circumference
Length: 80% of upper arm circumference
When taking blood pressure:
First sound = systolic blood pressure
Disappearance of sound = diastolic blood pressure
Know the pulse points and what they mean in regards to SBP - Answers - 1. Carotid
(neck)
2. Femoral (groin
3. Radial (wrist)
4. Pedal (top of foot)
Carotid pulse - Answers - Pulse felt along the large carotid artery on either side of the
neck, 60 mmHg
Femoral pulse - Answers - Pulse felt on/near the groin, 70mm Hg
Radial pulse - Answers - Pulse felt at the wrist, 80 mmHg
Pedal pulse - Answers - The pulse felt on the top of the foot, 90-100 mmHg
Know the types of shock - Answers - 1. Cardiogenic
2. Hypovolemic
3. Distributive (septic, anaphylactic, neurogenic)
4. Obstructive (mechanical)
5. Insulin
Cardiogenic shock - Answers - -Not enough oxygen is delivered to the tissues of the
body
-Caused by low output of blood from the heart
-It can be a severe complication of a large acute myocardial infarction (and other
conditions)
-AMI is most common cause
-Other causes are myocarditis, myocardial contusion
,-"Pump Problem"
-Decreased CO leads to hypoperfusion
-Heart begins to fail
-Standard shock treatment applies
-The patient may not tolerate supine or trendelenburg position
-Treatment is advanced and complicated
-Transport to a cardiac facility critical
Hypovolemic shock - Answers - -Severe blood or other fluid loss makes the heart
unable to pump enough blood to the body
-Volume issue due to blood loss in trauma
-Very young and very old are more susceptible
Anaphylactic shock - Answers - -Severe reaction that occurs when an allergen is
introduced to the bloodstream of an allergic individual
-Symptoms include bronchoconstriction, labored breathing, widespread vasodilation,
circulatory shock, and sometimes sudden death
-BIG 3 wheezes, urticaria, pruritus
Obstructive (mechanical) shock - Answers - -Air trapped in the thoracic cavity with the
shifting of mediastinal structures
-Life threatening
-Absent lung sounds on affected side
-Causes include pericardial tamponade and tension pneumothorax
-Fluid buildup in the pericardial causes compression of the heart
-Beck's Triad (low blood pressure, distention of the jugular veins and decreased or
muffled heart sounds on cardiac auscultation)
-Narrowing pulse pressure
-Muffled heart sounds
-Jugular vein distention
-Clinical signs: Distended neck veins, Cyanosis, Catecholamine effects, Pallor,
tachycardia, diaphoresis
Insulin shock - Answers - -Not a true shock
-Also called hypoglycemic shock due to low blood glucose levels
-Common cause is when a patient injects insulin, but does not eat in time
-Can affect non-diabetics
-Patients have their own glucometers (normal BGL = 70-110 mg/dL, BGL below 40
mg/dL will show LOW on glucometer, BGL above 500 mg/dL will show HIGH on
glucometer)
-Can look similar to shock
-Symptoms = pale, cool, diaphoretic, altered mental state, confused, unconscious,
seizures
-If the patient is able to swallow = oral glucose, juice with added sugar, patient MUST
eat afterwards
-If the patient cannot swallow = immediate transport, needs IV glucose
, Neurogenic shock - Answers - -Anything that stimulates parasympathetic activity or
inhibits sympathetic activity of smooth vascular muscles can cause neurogenic shock
-Results in widespread and massive vasodilation
-Spinal cord injury above T6
-Spinal anesthesia
-Vasomotor center depression
-May take hours to appear
-Different than typical shock
-Symptoms = skin warm and dry, bradycardia, poikilothermia, unable to control body
temperature
Septic shock - Answers - -Distributive type of shock
-Caused by severe infection that becomes systemic
-Very common in the ICU setting
-Patients often febrile (have fever)
-Antibiotics are needed to treat the infection
-More gradual onset, starting with SIRS (lots of inflammation)
Beck's triad for cardiac tamponade - Answers - Muffled heart sounds, distended neck
veins (JVD), hypotension
Know the signs and symptoms of Basilar Skull Fracture - Answers - -Signs = Raccoon
eyes, battle signs, positive HALO test, injury (trauma) to the side of the head
-Symptoms = pain, head injury, headache
Know how to use an OPA and NPA - Answers - -Oropharyngeal airway (OPA): used in
patients with NO gag reflex
-Displaces the tongue and opens the airway
-Insert with the tip pointing to the top of the head then rotate 180 degrees
-Measure from edge of mouth to angle of jaw
-Nasopharyngeal airway (NPA): can be used in patients WITH a gag reflex
-Displaces the tongue and opens the airway
-Use surgical lube to help with insertion
-RIGHT nare is typically the largest
-Use a twisting motion as you insert
-Tip of nose to tip of earlobe
Signs of inadequate breathing - Answers - -If they are breathing then they have a pulse
-Signs = cyanosis, accessory muscle usage
grunting, see-saw respirations, nasal flaring, tripoding
Know the indications for each oxygen delivery device (BVM, NRBM, NC, Venturi) -
Answers - -Bag valve mask (BVM) = do not use with Boots (beards, obesity, older,
toothless, snores, or stridor), typically unconscious patients
Know how to read blood pressure - Answers - Systolic pressure: high reading during
contraction (systole)
Diastolic pressure: low reading during relaxation (diastole)
"Normal" depends on the patient (not necessarily 120/80)
Width: 40% of upper arm circumference
Length: 80% of upper arm circumference
When taking blood pressure:
First sound = systolic blood pressure
Disappearance of sound = diastolic blood pressure
Know the pulse points and what they mean in regards to SBP - Answers - 1. Carotid
(neck)
2. Femoral (groin
3. Radial (wrist)
4. Pedal (top of foot)
Carotid pulse - Answers - Pulse felt along the large carotid artery on either side of the
neck, 60 mmHg
Femoral pulse - Answers - Pulse felt on/near the groin, 70mm Hg
Radial pulse - Answers - Pulse felt at the wrist, 80 mmHg
Pedal pulse - Answers - The pulse felt on the top of the foot, 90-100 mmHg
Know the types of shock - Answers - 1. Cardiogenic
2. Hypovolemic
3. Distributive (septic, anaphylactic, neurogenic)
4. Obstructive (mechanical)
5. Insulin
Cardiogenic shock - Answers - -Not enough oxygen is delivered to the tissues of the
body
-Caused by low output of blood from the heart
-It can be a severe complication of a large acute myocardial infarction (and other
conditions)
-AMI is most common cause
-Other causes are myocarditis, myocardial contusion
,-"Pump Problem"
-Decreased CO leads to hypoperfusion
-Heart begins to fail
-Standard shock treatment applies
-The patient may not tolerate supine or trendelenburg position
-Treatment is advanced and complicated
-Transport to a cardiac facility critical
Hypovolemic shock - Answers - -Severe blood or other fluid loss makes the heart
unable to pump enough blood to the body
-Volume issue due to blood loss in trauma
-Very young and very old are more susceptible
Anaphylactic shock - Answers - -Severe reaction that occurs when an allergen is
introduced to the bloodstream of an allergic individual
-Symptoms include bronchoconstriction, labored breathing, widespread vasodilation,
circulatory shock, and sometimes sudden death
-BIG 3 wheezes, urticaria, pruritus
Obstructive (mechanical) shock - Answers - -Air trapped in the thoracic cavity with the
shifting of mediastinal structures
-Life threatening
-Absent lung sounds on affected side
-Causes include pericardial tamponade and tension pneumothorax
-Fluid buildup in the pericardial causes compression of the heart
-Beck's Triad (low blood pressure, distention of the jugular veins and decreased or
muffled heart sounds on cardiac auscultation)
-Narrowing pulse pressure
-Muffled heart sounds
-Jugular vein distention
-Clinical signs: Distended neck veins, Cyanosis, Catecholamine effects, Pallor,
tachycardia, diaphoresis
Insulin shock - Answers - -Not a true shock
-Also called hypoglycemic shock due to low blood glucose levels
-Common cause is when a patient injects insulin, but does not eat in time
-Can affect non-diabetics
-Patients have their own glucometers (normal BGL = 70-110 mg/dL, BGL below 40
mg/dL will show LOW on glucometer, BGL above 500 mg/dL will show HIGH on
glucometer)
-Can look similar to shock
-Symptoms = pale, cool, diaphoretic, altered mental state, confused, unconscious,
seizures
-If the patient is able to swallow = oral glucose, juice with added sugar, patient MUST
eat afterwards
-If the patient cannot swallow = immediate transport, needs IV glucose
, Neurogenic shock - Answers - -Anything that stimulates parasympathetic activity or
inhibits sympathetic activity of smooth vascular muscles can cause neurogenic shock
-Results in widespread and massive vasodilation
-Spinal cord injury above T6
-Spinal anesthesia
-Vasomotor center depression
-May take hours to appear
-Different than typical shock
-Symptoms = skin warm and dry, bradycardia, poikilothermia, unable to control body
temperature
Septic shock - Answers - -Distributive type of shock
-Caused by severe infection that becomes systemic
-Very common in the ICU setting
-Patients often febrile (have fever)
-Antibiotics are needed to treat the infection
-More gradual onset, starting with SIRS (lots of inflammation)
Beck's triad for cardiac tamponade - Answers - Muffled heart sounds, distended neck
veins (JVD), hypotension
Know the signs and symptoms of Basilar Skull Fracture - Answers - -Signs = Raccoon
eyes, battle signs, positive HALO test, injury (trauma) to the side of the head
-Symptoms = pain, head injury, headache
Know how to use an OPA and NPA - Answers - -Oropharyngeal airway (OPA): used in
patients with NO gag reflex
-Displaces the tongue and opens the airway
-Insert with the tip pointing to the top of the head then rotate 180 degrees
-Measure from edge of mouth to angle of jaw
-Nasopharyngeal airway (NPA): can be used in patients WITH a gag reflex
-Displaces the tongue and opens the airway
-Use surgical lube to help with insertion
-RIGHT nare is typically the largest
-Use a twisting motion as you insert
-Tip of nose to tip of earlobe
Signs of inadequate breathing - Answers - -If they are breathing then they have a pulse
-Signs = cyanosis, accessory muscle usage
grunting, see-saw respirations, nasal flaring, tripoding
Know the indications for each oxygen delivery device (BVM, NRBM, NC, Venturi) -
Answers - -Bag valve mask (BVM) = do not use with Boots (beards, obesity, older,
toothless, snores, or stridor), typically unconscious patients
