An adult patient is in cardiac arrest. Which of the following is not a general guideline indicating the need for transport if ALS is not available?
A. If six to nine shocks have been delivered, transport is required.
B. If an automated external defibrillator (AED) gives three consecutive “no shock advised” messages, transport is required.
C. All cardiac arrest patients require immediate transport.
D. If the patient regains a pulse, transport is required.
Explanation:
Local protocols should always be followed. However, general guidelines for transport of a cardiac patient during resuscitation/defibrillation efforts include the following:
• if the return of spontaneous circulation (ROSC) occurs
• if six to nine shocks have been delivered and the patient remains in cardiac arrest
• if the AED gives three consecutive “no shock advised” messages that are separated by five cycles (two minutes) of CPR
Patients who do not regain a pulse on the scene typically do not survive; it is imperative to attempt CPR/defibrillation early to improve outcomes.
A 14 year old male complains of lower abdominal pain. His blood pressure is 120/80 mm Hg, his pulse is 130 beats per minute, his respirations are 28 breaths per minute, and his temperature is 104.8°F (40.4°C). The pain is located in the right lower quadrant. The patient has recent contacts with gastroenteritis.
Which of the following is the most appropriate treatment?
A. Do not transport, as gastroenteritis is not life threatening
B. Recommend acetaminophen for fever and reassess in 15 minutes
C. Recommend acetaminophen for fever and ask the parents to follow up with the patient's pediatrician
D. Administer oxygen and transport
Explanation:
Despite the likelihood of gastroenteritis, this patient's symptoms also suggest appendicitis. In addition to right lower abdominal pain and fevers, nausea/vomiting, anorexia, chills, and rebound tenderness are
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common. The patient also may have a ruptured appendix, which requires surgical intervention. Therefore, transport is vital.
Which of the following is the comparison of vital signs to previous values?
A. Index of suspicion
B. Reassessment
C. Trending
D. Triage
Explanation:
Trending is the comparison of previous and current vital signs. It is done to determine whether the patient's condition is unchanged, declining, or improving.
An index of suspicion is the awareness that unseen life threatening injuries or illnesses may exist.
Triage is the process of establishing treatment and transportation priorities according to severity of injury and medical need.
Reassessment is repeating the steps of the patient assessment at regular intervals to identify and treat changes in their condition. Reassessments are commonly performed every five minutes for unstable patients and every 15 minutes for stable patients.
During the initial assessment of a semiconscious patient’s airway, snoring respirations are heard. What do these respirations indicate?
A. Mucus or secretions in the larger airway
B. Constricted bronchi
C. Fluid in the upper airway
D. A partially obstructed airway
Explanation:
Snoring is an indication that the upper airway is partially obstructed. Fluid or secretion in the upper airway will manifest as gurgling, which requires suctioning. If the bronchi are constricted, wheezing will be heard. This commonly occurs in asthmatic patients and those with chronic obstructive pulmonary disease. Crackles (formerly known as rales) are the sounds of air trying to pass through fluid in the alveoli; they occur in congestive heart failure or pulmonary edema.
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A responsive adult patient complaining of shortness of breath could benefit from oxygen delivered via a non rebreather mask, but they are unable to tolerate a mask on their face. What is the most appropriate next step?
A. Use a nasal cannula with supplemental oxygen flowing at 15 liters per minute
B. Avoid providing oxygen altogether
C. A simple oxygen mask at 15 liters per minute held 4 inches away from the patient's face.
D. Use a nasal cannula with supplemental oxygen flowing at six liters per minute
Explanation:
A nasal cannula has limited use in the prehospital setting; a non rebreather mask is preferred. However, if a patient is unable to tolerate a non rebreather mask, a nasal cannula is a suitable alternative. The maximum flow rate for a nasal cannula is 6 liters per minute. It is inappropriate to avoid providing oxygen to a patient who may benefit from it. A simple oxygen mask held 4 inches away from the face would not be an effective oxygen delivery method for this patient.
There are no indications that this patient requires artificial ventilation (for inadequate breathing) or a nasopharyngeal airway (for an inability to maintain the airway spontaneously).
What is the correct procedure for removing oral secretions from the oropharynx of a conscious patient without visible foreign bodies and with no suspected C spine injury?
A. Log roll the patient to their side and clear the mouth carefully with a gloved finger
B. Insert an oropharyngeal airway to ensure a patent airway
C. Continuously ventilate the patient to ensure appropriate oxygenation
D. Turn the patient's head to the side, open the mouth, insert the catheter, and suction in a circular motion during withdrawal
The correct procedure, including the steps listed above, is to assemble the unit properly, ensure a vacuum of more than 300 mmHg, turn the patient's head to the side (if no C spine injury is suspected), open the mouth using a cross finger or tongue jaw lift, insert the catheter only as far as can be visualized (in a conscious patient), and apply suction in a circular motion during withdrawal. Prolonged suctioning can actually obstruct an airway, and can also cause vagal stimulation, which may cause further hypoxia or bradycardia. It is recommended to limit suction attempts for patients of all ages to 10 seconds. Some textbooks may reflect 15 seconds, but the current recommended practice is 10 seconds. An oropharyngeal airway is contraindicated in a conscious patient or a patient with an intact gag reflex. Log rolling should be completed for patients in whom solid objects (e.g., foreign objects, teeth, food) are visible, and the objects are unable to be suctioned. Continuous ventilation is not appropriate if a patent airway is not evident, as this may lead to aspiration. Visit us athttps://www.certschief.com/nremt-emt/
A 66 year old male complains of right upper quadrant pain and general malaise. He has a yellowish tint to his skin and scler
a. Which of the following is the most likely cause of his complaints and findings?
A. Pneumonia
B. Pancreatitis
C. Chronic renal failure
D. Hepatitis
Explanation:
Hepatitis (inflammation of the liver) or liver insult/injury will most commonly cause right upper quadrant pain and jaundice (yellowing of the skin and sclera). Liver insult may be caused by gallstones/gallbladder insult, viral hepatitis, or drug or alcohol use.
Chronic renal failure can cause lethargy, nausea, headaches, cramps, and extremity edema if untreated. It can progress to seizures or coma in later stages.
Pancreatitis, which may also be caused by gallstones, is an inflammation of the pancreas. Other causes include alcohol abuse and other diseases. Common signs and symptoms include upper left quadrant pain, nausea, vomiting, abdominal distension, and tenderness.
Pneumonia typically involves a cough, fevers, and dyspnea and occasionally causes pain that radiates to the upper abdomen.
A 10 year old girl has a cut on her face. Which of the following is not an appropriate way to interact with this patient?
A. Give the child simple, appropriate choices
B. Bargain with the child if necessary to complete the assessment
C. Talk to the child, not just the parent/caregiver, while taking their medical history
D. Ask questions to direct the conversation
Explanation:
Use a developmental approach to making the assessment of children. When the patient is a school aged child (6 12 years old), learn their name and use it while interacting with them. Speak directly to the child and then include the caregiver. Be careful not to offer too much information at once. Anticipate the child's questions and fears and discuss them immediately. Explain in simple terms what is wrong and how it will affect them. Explain procedures immediately before doing them. Thank the child for cooperating.
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Let the child be involved in their care. Children in this age group are afraid of being out of control. Never lie to a child, telling them that something will not hurt or that you are almost finished if it is not true. Ask older children (like this 10 year old) if they would like their caregiver to be present. Provide privacy. Do not negotiate unless the child really has a choice. For example, ask if they want the IV line in their right or left hand but do not ask if it is okay to start an IV line if this step is necessary.
Which of the following adventitious lung sounds are associated with lower airway problems?
Select the 3 answer options which are correct.
A. Wheezing
B. Stridor
C. Rales
D. Rhonchi
Explanation:
Wheezing is associated with bronchospasm. Rales are associated with fluid in the alveoli, and rhonchi are associated with mucus in the bronchi.
Stridor indicates an upper airway obstruction.
A 65 year old female fell and hurt her ankle. The ankle has an obvious deformity. After splinting the ankle, which of the following is appropriate to assess?
A. Cardiovascular and neurological function of all limbs
B. Cardiovascular and neurological function of the affected limb
C. Sensation, proximal to the injury
D. Pulse, proximal to the injury
Explanation:
Any extremity that requires splinting (e.g., due to being painful, swollen, or deformed) requires an assessment of cardiovascular and neurological function before and after the application of a splint. This is accomplished via distal pulses and motor and sensory function, respectively.
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