It’s All About the ABC's
An unusual sound (not speech) coming from a patient's mouth most often indicates what?
The airway is not patent!
What concentration of oxygen is delivered by a bag-valve-mask device when it is not connected to supplemental oxygen?
20.9% (Platinum rounds down to 20%)
Which structure in the upper airway is most susceptible to spasm when irritated or affected by illness? Use the correct medical term.
Larynx
During normal perfusion, how is carbon dioxide transferred from the bloodstream into the lungs for exhalation?
Diffusion
After confirming a pulse in an unconscious patient, what is the next step in emergency treatment?
Open the airway! An unconscious patient does not have an open airway!
While removing a patient from the ambulance to move into the Emergency Department, you see that blood is back‐flowing up the patient’s IV line. The most likely reason that this is occurring is that:
The IV bag is too low.
Blood backs up the IV line when the bag is laid on the stretcher or is being carried to low and close to the patient. The solution cannot flow and maintain a consistent pressure when the bag is not above the heart. Gravity must be allowed to assist in the flow.
What treatment is used as a last resort for creating an airway?
Percutaneous cricothyrotomy
when listening to lung sounds of a patient with suspected pneumonia what would you expect to hear and where?
Rhonchi/crackles one sided
What airway structure is proportionally larger in a young child compared to an older child?
Epiglottis
What is the condition in the body when the pH is less than 7.35?
Acidosis.
Your patient is breathing shallowly and becoming unresponsive after a car crash. They still have a gag reflex, and transport to the trauma center will take a long time. (You do not have RSI available)What is the best way to manage their airway and breathing during transport?
Have an EMT ventilate with a BVM.
Using another responder to provide ventilatory assistance will keep the paramedic free to perform other interventions as needed.
When selecting an IV catheter and insertion site to deliver the greatest fluid volume to a patient, what factors should you choose?
A lower number gauge needle and a proximal vein.
For delivering high fluid volume, you will need a lower number gauge needle and a proximal vein. The higher the number needle, the smaller gauge it is. A distal vein would be smaller than a proximal vein.
What are the benefits of using CPAP or a BVM for a patient in severe respiratory distress secondary to emphysema?
Continuous Positive Airway Pressure helps to keep more alveoli open and keep more from collapsing. This type of ventilation can be very helpful in patients that are in acute respiratory distress.
After successfully performing endotracheal intubation, you begin to hear gurgling sounds coming from the tube a few minutes later. When suctioning the tube, what is the maximum amount of time you should spend suctioning?
Ten seconds is the amount of time you can be down in the ET tube and actively suctioning. Longer than that may reduce the oxygen saturation or cause cardiac arrhythmia.
You are calling in a radio report about a patient you are transporting to the hospital. You describe the patient’s wound as being posterior‐lateral in the thoracic area. Where is wound?
In the back of the chest on the side.
Daily Double
While treating a healthy 32-year-old female who is hyperventilating after a minor car crash with no injuries, how might her blood gas levels be affected?
↓ PCO₂ (hypocapnia)
↑ pH (alkalosis)
You are managing a patient in respiratory arrest who has a stoma (No tracheostomy adapter available). What is generally the most effective method for providing ventilation in this situation?
Ventilate using a child or infant soft mask over the stoma
You are treating a young man in acute asthma attack after exposure to cat dander. He is wheezing, breathing rapidly, and his color is worsening. What CLASS OF MEDICATION can paramedics administer to help relieve his symptoms?
Beta-adrenergic agonist
The area of the brain that controls breathing is the?
The medulla and pons contain the receptors that regulate respiration.
After transporting a patient from a motor vehicle crash and noticing that poor visibility at the intersection may have contributed to the collision, what responsibility do you have as a provider once the patient has been delivered to the hospital?"
Contact the public utility regarding this intersection.
It is your public health duty to call the public utility company about what you are seeing with this intersection. Paramedics are out in the community and witness this type of problem every day. Ask the public utility to take a look at the intersection to see how it could be made safer.
When a patient is in respiratory distress, what accessory muscles in the neck are commonly seen contracting?
Sternocleidomastoid.
After delivering a cardiac arrest patient to the emergency department, you hear that the initial blood gas report showed a PaCO₂ of 55 mmHg. What does this value suggest about the effectiveness of EMS ventilation during resuscitation?
patient was likely hypoventilated
While assessing an unconscious patient to determine the cause of their medical condition, what part of your interview might provide a crucial clue to the underlying problem?
Medical History
Daily Double
Why is it concerning when a patient with asthma is taking metoprolol and is now wheezing badly
The metoprolol may prevent them from responding to this treatment.
Lopressor (metoprolol) is a beta‐1 adrenergic blocker. It slows heart rate and reduces BP. During asthma when a patient has bronchospasm, they need to be given a drug that will cause bronchodilation. The metoprolol may prevent this from happening.
What term describes a medication’s effect when it increases the heart rate?
Positive chronotropic effects
What two underlying pathological change in the lungs is primarily responsible for the chronic hypoxia observed in patients with emphysema?
Emphysema is characterized by the loss of pulmonary capillary beds and the alveolus stretches and become more bulbous. There is decreased elastic recoil of the alveolus and the terminal bronchiole.
You are assessing a patient pulled from a house fire who has singed nasal hairs, hoarseness, and stridor. Which airway complication should you suspect as the most likely cause? Give the correct medical term
Laryngeal edema.
What's the name of the central receptor that senses a change in the level of PCO2 in the blood such as when a patient is in respiratory distress?
Primary chemoreceptor.
The primary chemoreceptor located in the brainstem is most sensitive to the changes in PCO2. All other receptors work secondary to this receptor.
Although BiPAP is not commonly available in most EMS systems, it can be used as an alternative to CPAP. What is one advantage of using BiPAP over CPAP?
BiPAP provides pressure on inhalation and on exhalation. Patients feel that this system is more like normal ventilation and is more comfortable than CPAP
A vial contains 20 mL of a medication with a total of 200 mg. If the order is for 50 mg, how many milliliters should you administer?
Vol = (20 ml X 50 mg)/200 mg = 1000/200 = 5.0 ml.
Volume to be administered = ((volume on hand) x (desired dose))/(dosage on hand).
When assessing a patient with COPD, what change in the blood occurs as a result of chronic hypoxia?
Polycythemia.
Chronic hypoxia stimulates the body to produce more RBCs so more cells can carry more oxygen. This over‐production of RBCs thickens the blood, congesting the circulatory system. This patient is more prone to hypertension and clotting.
A young, healthy pilot develops dizziness, sudden sharp chest pain, and difficulty breathing after completing a cross-country flight. Her pain worsens with inhalation. Based on this presentation, what condition should be your prognosis?
Pulmonary embolism.
A young woman with sickle cell anemia is experiencing severe, uncontrolled pain in the left upper quadrant of her abdomen. What condition related to her sickle cell disease might be causing this pain
Vessel obstruction in the spleen.
The sickle cells can obstruct blood vessels in the spleen. They may obstruct blood moving through the spleen or prevent blood from leaving the spleen.
What mechanism do the kidneys use to help regulate blood pressure?
Renin‐angiotensin‐aldosterone mechanism.
List 3 potential complications associated with endotracheal intubation?
Trauma to airway structures
Esophageal intubation
Right mainstem intubation
Hypoxia
Aspiration
Laryngeal or tracheal edema
Infection
Barotrauma
Dislodgement or accidental extubation
Increased intracranial pressure (ICP)
Vocal cord damage or paralysis
Whar would be the proper drip rate for a 20 mL/kg infusion for a 6-kg infant using a 10 gtts set over a 30-minute time frame?
(20ml/kg x 6 kg) x (10 gtts/ml) divided by (30 minutes) would equal 40 gtts/min.