Shock and Awe
An EMT evaluates a trauma patient who is restless and confused. The patient’s pulse is 124/min, respirations are 30/min, skin is cool and pale, but blood pressure remains 110/70 mmHg.
The EMT recognizes that the patient is experiencing this early phase of shock.
What is compensated shock?
You arrive at a motor vehicle collision and immediately run toward the vehicle to begin patient care. You notice the vehicle is leaking fuel and there are downed power lines nearby.
What critical EMS mistake did you make, and what should have happened first?
What is failing to ensure scene safety before patient contact; the EMT should assess hazards, establish a safe approach, and request additional resources if needed?
An EMT arrives for a patient complaining of abdominal pain. The patient states the pain is located in the epigastric region and radiates to the right upper quadrant.
Where is the patient describing pain?
What is pain in the upper middle abdomen that extends toward the upper right portion of the abdomen?
You are assigned as the first arriving EMT at a highway pileup involving multiple vehicles. Several injured patients are walking around, while others remain trapped inside vehicles.
What is your first priority upon arrival?
What is ensuring scene safety, establishing incident command, and requesting additional resources?
A patient experiencing an asthma exacerbation is wheezing loudly, using accessory muscles, and struggling to breathe. The patient uses a prescribed albuterol inhaler.
What is the primary action of albuterol that improves breathing?
What is bronchodilation caused by stimulation of beta-2 receptors in the lungs?
A 70-year-old patient complains of crushing chest pain and difficulty breathing. Assessment reveals crackles in both lungs, pale skin, a weak pulse, and signs of inadequate circulation.
What type of shock should the EMT suspect?
What is cardiogenic shock caused by heart pump failure?
An EMT arrives at a residence for a patient with chest pain. The EMT immediately places the patient on oxygen and gives aspirin without completing a patient assessment.
What mistake did the EMT make?
What is treating before performing an adequate assessment and failing to identify possible contraindications?
A patient complains of dyspnea, orthopnea, and increasing fatigue. The EMT documents that the patient is experiencing difficulty breathing, especially when lying flat.
What do the terms dyspnea and orthopnea mean?
What are difficulty breathing and difficulty breathing while lying flat?
You arrive at a bus crash with 40 patients. A patient is unconscious, breathing 8 times/min, has a weak radial pulse, and does not respond to verbal commands.
Using START triage, what category should this patient receive and why?
What is RED (Immediate) because the patient has inadequate respirations and altered mental status but may survive with immediate intervention?
A 35-year-old patient is stung by a bee and develops wheezing, facial swelling, hives, and a blood pressure of 70/40 mmHg. The EMT administers epinephrine.
What are the three major effects of epinephrine that help treat anaphylaxis?
What are vasoconstriction, increased heart rate/contractility, and bronchodilation?
DOUBLE JEOPARDY
A patient is found after a house fire. They are confused, breathing rapidly, have a weak pulse, and their skin is cool and clammy. Their blood pressure has dropped from 118/76 to 86/50 during your assessment.
The EMT should recognize this as:
What is decompensated shock?
An EMT arrives at a scene and notices their partner forgot to bring the stretcher inside. The EMT decides not to mention it because they do not want to embarrass their partner.
What EMS principle is being violated?
What is failure to maintain a culture of safety and accountability?
A patient’s chart states: “The patient is experiencing hemiparesis following a CVA.”
What does this diagnosis mean?
What is weakness affecting one side of the body following a stroke?
You are treating patients at an MCI caused by a chemical spill. Several patients are coughing and complaining of eye irritation. Some responders begin treating patients before entering the scene.
What major MCI principle is being violated?
What is failure to establish a safe zone and perform appropriate decontamination before treatment?
A 48-year-old diabetic patient is confused and diaphoretic. A blood glucose reading shows 34 mg/dL. The patient is unable to swallow and has a decreased level of consciousness.
Why should the EMT not administer oral glucose?
What is because the patient cannot protect their airway and may aspirate the medication?
A patient has a blood pressure of 84/50, heart rate of 48, warm dry skin, and altered mental status after falling from a ladder. The patient has no external bleeding.
What shock condition should you suspect, and what vital sign finding makes it different from most other shock states?
What is neurogenic shock, and the presence of bradycardia despite severe hypotension?
During a cardiac arrest, an EMT begins chest compressions but stops frequently to check for a pulse because they are unsure if the patient has improved.
What error is being made?
What is interrupting high-quality CPR and reducing coronary and cerebral perfusion?
A 59-year-old patient with a history of heart disease complains of orthopnea, paroxysmal nocturnal dyspnea, and increased fatigue. The EMT suspects worsening congestive heart failure.
What do these terms describe?
What are difficulty breathing while lying flat and sudden episodes of nighttime shortness of breath?
During an MCI, the Incident Commander asks why ambulance crews are transporting patients before a complete patient tracking system is established.
What ICS function is being compromised?
What is accountability and resource management?
A 45-year-old patient is found unconscious with slow respirations after suspected opioid use. Naloxone is administered, and the patient suddenly becomes awake, agitated, and combative.
What explains this patient’s behavior after receiving naloxone?
What is rapid reversal of opioid effects causing acute withdrawal symptoms?
A patient is involved in a motor vehicle crash and has signs of shock. His blood pressure is 96/62 mmHg, pulse is 124/min, and respirations are 28/min. His skin is cool and sweaty.
Which finding indicates the body is attempting to compensate for shock?
What is an increased heart rate to maintain cardiac output?
An EMT completes a patient care report but later realizes they documented the wrong medication dose. The EMT uses correction fluid to cover the mistake and rewrites the information.
What legal documentation error occurred?
What is altering a medical record instead of making a proper correction according to documentation policy?
A patient involved in a motor vehicle collision has a decreased level of consciousness. The EMT documents anisocoria and suspects increased intracranial pressure.
What does the term anisocoria describe?
What are unequal pupil sizes?
You are performing START triage on a patient after a building collapse. The patient has:
What triage category should this patient receive?
What is RED (Immediate)?
A 44-year-old patient is found unconscious with suspected opioid overdose. Respirations are 4/min and shallow. The EMT administers naloxone, and the patient’s respirations increase to 16/min.
Why must the EMT continue monitoring this patient even after improvement?
What is because naloxone may wear off before the opioid, causing respiratory depression to return?