Advanced EMT Practice Questions (Complete Solution) Answered

Advanced EMT Practice Questions (Complete Solution) Answered You arrive on scene to a patient with a large gash on his forearm spurting blood. Pressure is immediately applied with a gloved hand. He is pale with a weak, rapid pulse; RR = 30 bpm. During initial assessment & wound bandaging, the patient yells "get away". Your best course of action is, what? explain to the patient that you are almost finished bandaging his wound and you will leave him alone then If you continue to treat a patient who is refusing treatment, what can happen? - you can be charged with assault and or battery; - do your best to finish up the treatment, but if the patient continues to refuse, you must comply The patient is an 18 month old who is "acting strange". You find the child reclined in his mother's arms. "I don't know what's wrong with him," she says. "I came out of the bathroom & he started making odd sounds & had spit running out of his mouth." What is the first thing you should do? get a general impression of the child by visually assessing the quality of his respirations, his skin color, and his appearance When forming a general impression of a pediatric patient, what is the best tool to use? Pediatric Assessment Triangle (PAT); - work of breathing; - skin circulation; - appearance Why is the Pediatric Assessment Triangle (PAT) used? to form a rapid general impression of a child without making physical contact When assessing a patient's appearance, what should you look for? - muscle tone; - deformities and characteristics; - race; - body build When assessing a patient's work of breathing, what should you look for? signs of respiratory distress What signs of 'work of breathing' are evidence of respiratory difficulty? takipneah (tachypnea) or retractions of sternum and or intercostal muscles, especially with pediatric patients When assessing a patient's skin circulation, what should you look for? - pallor; - flush Pallor can be a sign of, what? poor circulation Would it be appropriate to administer Dextrose (D50) to a trauma patient with a history of hypoglycemia who hit his head on a concrete driveway after falling 8 feet off a ladder? yes, based on his medical history and mechanism of injury, and especially if he is found unresponsive, D50 is appropriate List the indications for administration of Dextrose 50% (D50). symptomatic hypoglycemia (BGL < 70 mg/dL), and: - altered LOC for unknown reasons; - unresponsiveness with no obtainable history; - cardiac arrest with P.E.A., a-systole, or history of diabetes What are contra-indications for administration of Dextrose 50% (D50)? - presence of increased intra-cranial pressure; - possible intra-cranial bleeding You and your partner answer the call for a 1 year old boy who was dropped on his head by his older brother. His mother said he hit his head on the edge of the coffee table on the way down. You would expect to find, what? - bruising and hematomas; - bleeding between the skull and the scalp; - swelling True or False: Head injuries are more prevalent in children. True, because their heads are larger in proportion to their bodies When assessing a child after they have suffered a head injury, you should check for, what? - bleeding; - swelling; - bruising; - hematomas A sunken, or depressed fontanelle in a young child is an indication of, what? dehydration Swelling that occurs after a head injury in a young child is an indication of, what? intra-cranial bleeding or pressure True or False: D5W is used for long term therapy? False, D5W has a short duration of action and is used for treatment of hypoglycemia If D5W is mixed with Dilantin, what can occur? - crystal-lization to form in the line, and or vein and cause serious injury to the patient; - make sure you understand the compatibility of all medications with the infusion solution True or False: D5W is contra-indicated as a fluid replacement in patients who are hypo-volemic. - True, D5W (5% dextrose in water) is basically sterile water; this fluid is normally used to replace free water in the hyper-natremic patient; - D5W contains only 170 k cal/L from dextrose, and is not sufficient to meet energy requirements True or False: D5W is used to dilute concentrated drugs for I.V. infusion. True Albuterol is classified as a, what? sym-patho-mimetic; meaning, it produces physiological effects characteristic of the sympathetic nervous system by promoting the stimulation of sympathetic nerves What is dependant lividity? blood settling at the lowest point in the body and visible through the skin True or False: A patient may show signs of blood pooling and skin dis-colorization after being in the same position for an extended period of time. True, and this can be an indication of death The most important treatment when caring for a patient with an irritant gas exposure is, what? ventilation; although oxygen is always important, you need to treat the under-lying problem Irritant gases are harmful to patients in, what manner? exposure restricts the lungs ability to ventilate; therefore, the need for ventilation is priority How many minutes of oxygen remain in a D-size cylinder, which has 1600 p.s.i., when the flow rate is set to 4 L/min? 56 (1600 - 200 x 0.16 / 4 Lpm = 56 minutes) What is the formula for calculating minutes of oxygen remaining? take the Gauge pressure (p.s.i.), minus the Safe Residual (200 for all size cylinders), then times the Cylinder Factor (0.16 for D-size cylinder), and divide by Flow Rate (L/min) The correct dosage for dextrose for a pediatric patient is, what? - for infants, 0.5 gm/kg 25% dextrose; - for patients over 1 year of age, 0.5 gm/kg 50% dextrose Provide an example of a patient who would be declared more viable to treat. a 5 year old apneeik (apneic) and pulseless patient who fell through the ice and was submerged for 10 minutes before being brought to the ambulance True or False: Drowning victims should be treated even if they have been submerged for a long time. True, the rule 'no patient should be pronounced dead, until warm and dead' applies True or False: Children, in particular, have a good chance of survival if they have been submerged in water for a long time. True, but only < 3 minutes, or < 10 minutes in cold water If a infant patient is found with rigor mortis, should you treat them? No; all muscles stiffen in rigor mortis and this process occurs between two and six hours following death Does a DNR negate the need to begin CPR on an elderly patient? Yes, regardless if the patient is or is not breathing, and is with or without a pulse, a valid DNR must be honored A 9 month old infant is found apneeik (apneic), pulseless, cool, blue, and stiff after a nap. What do you suspect. the patient is dead A 38 year old male has had both legs torn off from a railway incident. He has ag-onal respirations, and no palpable pulse. Is he a viable patient? this patient has suffered major trauma, and while all efforts will be given, the odds of surviving a traumatic arrest are very small You are called to the scene of a structure fire. Upon arrival you notice several people staggering down the block away from the fire with soot marks around their mouths. You should do, what? - call for additional ambulances; - continue to assess the scene; - confirm scene is safe; - triage, and; - treat those that are most in need You have an unconscious patient. What, do you do? - ABC's [airway, breathing, circulation]; - history taking; - rapid full body scan True or False: ABC's are part of the primary survey. True, followed by history taking, secondary assessment, and rapid full body scan Rapid full body scan is the first step in, which patient assessment? secondary Can the rapid full body scan be incorporated into the primary survey? Yes, it is a useful tool in order to determine any life threats Would it be necessary to start CPR in a patient, who is only unconscious? No, as they may be breathing with a pulse When are baseline vital signs completed on a patient? after the primary and secondary assessment When does the decision to transport a patient occur? before vital signs are taken Which of the following should you not use to aid in the insertion of an ET tube or Combi-Tube? a. petroleum jelly; b. water based lubricant; c. laryngoscope; d. cricoid pressure a. petroleum jelly; such as, Vaseline because it is a petroleum based lubricant What is D50? a solution of Dextrose in water, used for treating hypoglycemic emergencies and infused by I.V. You are transporting a 32 year old pregnant woman who is in the 32nd week. She is complaining of stomach pain and is pale. How would you transport her? a left lateral recumbent position is recommended in order to relieve potential pressure on the inferior vena cava You and your partner are in route to a 28 year old female with an apparent closed tibia fracture resulting from a rock rolling on her leg. It's reported that she's beginning to show shock signs. Your ambulance is at least 20 mins away from scene. On arrival, the best sequence of steps are, what? - scene safety; - PMS [pulse, motor, sensory assessment]; - splint the leg; - PMS [pulse, motor, sensory assessment] The PMS [pulse, motor, sensory assessment] tool is also known as, what? CSM [circulation, sensory, motor assessment] True or False: Making sure the scene is safe always comes first, before checking CSM or splinting. True Antidote [Mark 1 or NAAK], kits for exposure to nerve agents are now being carried on some E.M.S. units. What do these kits consist of? two auto injectors; - one filled with Atropine, and; - the other filled with 2-PAM chloride After exposure to nerve agents, Atropine helps with, what? to eliminate excessive cholinergic stimulation and resolve many of the SLUDGE symptoms of exposure SLUDGE stands for, what? - Salivation; - Lacrimation; - Urination; - Defecation; - Gastrointestinal Distress, and; - Emesis; - which are, symptoms resulting from or-gano-phosphate or carbamate antidote poisoning, or nerve agent exposure After exposure to nerve agents, 2-PAM chloride helps with, what? to eliminate the nerve agent from the body True or False: LMA's are less likely to cause soft tissue, vocal cord, or dental trauma than ET tubes? True, an LMA surrounds the opening of the larynx and should sit into the hypo-pharynx. When properly positioned, the LMA will sit right at the glottic opening. True or False: The LMA is an airtight device. False; in addition, the patient is susceptible to aspirating the contents of the stomach. Therefore, the LMA doesn't have widespread use in the pre-hospital setting. You are at a charity event, a man approaches you whom you recognize from a call earlier that week. He introduces himself as Dr. Stevens, the neighbor of "Tom" who had the AMI. "How did he end up doing when you got him to the ER?", he asks. Your best response, would be? - "I'm sorry, I can't discuss the call with you."; - you are not permitted to discuss the patient unless the person is directly related to the case; - the fact that he is a doctor, has no bearing on whether or not you can disclose the information What is the most significant downfall of using a cell phone to make a report to the hospital? topography, like mountains and buildings, may obstruct the signal and interfere with the transmission and reception You are first on scene to an MVA involving two cars. The crash scene is only blocking the south bound lane of traffic and cars from both directions are taking