March 2017 Region VIII CE

March 2017 Region VIII CE

Respiratory Poisons

1. The upper airway can be more susceptible to ______and the lower airway is more susceptible to ______.
2. wheezing, stridor
3. traumatic injury, chemical process
4. chemical process, traumatic injury
5. penetrating injury, blunt injury

1. The lungs operate on ______pressure. Meaning air rushes in when the diaphragm contracts.
2. Neutral
3. Positive
4. Negative
5. Ambient

1. If multiple DNR / POLST forms are present and the patient is in cardiac arrest, EMS should:
2. Honor the one signed by the patient, in the event that there are forms signed by other individuals
3. Honor the form with the most recent date
4. Honor the form that is printed on colored paper, in the event there are multiple forms and some are black on white
5. Honor only the pink form, since that is the latest recommended color

1. Which of the following is a benefit of our natural respiratory mechanism?
2. Positive pressure in the thoracic cavity allows more blood to circulate helping to maintain normal blood pressure
3. Negative pressure in the thoracic cavity increases preload to the heart which helps maintain a normal blood pressure
4. Homeostasis is achieved through a neutral balance between our respirations and tidal volumes
5. Positive pressure increases overall PEEP helping to keep lungs inflated and alveoli open.

1. ______is the active ingredient found in bleach which reacts with ammonia, drain cleaners, and other acids.
2. Sodium hydrocholide
3. Muriatic acid
4. Hydrogen sulfide
5. Sodium hypochlorite

1. You are dispatched for the 44 year old male unconscious subject. Upon your arrival to the scene you are told by family there is an individual inside the house who was trying to dislodge a clog from the sink. “He put some chlorox bleach and some liquid drano down the drain. Please hurry!!” you are told. There is no one else in the home. Your first action to consider is:
2. Immediately enter the home and retrieve the individual as this is a load and go situation.
3. Enter the home with the family member so they can show you where the patient is located and exactly what was mixed together.
4. Don the proper protective equipment (Full PPE and self contained breathing apparatus) and consider the need for hazmat prior to entering the house
5. Call medical control to pronounce patient as this is not a survivable event

1. Pesticides can cause symptoms through an acute one time exposure, or may cause chronic symptoms through multiple exposures over time.
2. True
3. False

1. Isocyanates are found in which of the following products?
2. Paints used on automobiles
3. Foam padding in couches
4. Wood paneling
5. Spray on polyurethane products
6. All of the above

1. Which of the following is NOT a health concern associated with isocyanates?
2. They can cause birth defects
3. They are considered carcinogenic
4. High doses can have the same effect as nerve agents
5. Exposure can trigger bronchoconstriction and pulmonary edema

1. True/ False – In Illinois, an attending physician may authorize surrogate decision makers to make decisions for patients who lack decisional capacity, even if they are not authorized as a health care agent under Power of Attorney for Health Care.

1. Cyanide is 35 times more toxic than CO and is found in many substances naturally in our environment that our bodies can process. Why are large doses dangerous to the body?
2. Large doses cause bronchoconstriction and atelectasis that leads to hypoxic hypoxia
3. Large doses cause cerebral vasoconstriction leading to reduced cerebral perfusion pressures, seizures, and cellular death.
4. Large doses quickly overwhelm the hemoglobin causing histotoxic hypoxia which starves the heart and brain of oxygen.
5. Large doses causes protein malfunctions leading to fibrinolysis, blood clots, and ischemia.

1. Hypoxia that is caused by blood cell poisoning is also known as:
2. Stagnant hypoxia
3. Histotoxic hypoxia
4. Anemic hypoxia
5. Hypoxic hypoxia

1. You are called to an extended care facility for a patient who passed out following insertion of a central venous catheter. The patient is a 55 year old male who was having a subclavian double lumen catheter placed. He is conscious but disoriented, GCS 14, vitals BP 80/50, P 128, R 20. Which of the following IS CORRECT per SOP?
2. EMS can use the catheter for any IV fluid or medication, as long as someone on the crew is familiar with the device
3. EMS can regulate the rate of an IV bag (such as administering a fluid bolus) that is initiated by the RN or physician at the originating facility
4. EMS can use the CV catheter only for resuscitation medications, unless Medical Control approves
5. Under no conditions can EMS have anything to do with a venous catheter they did not insert

1. You respond to the structure fire with reports of victims in the building. As you arrive on scene you are advised that a victim is being brought out to you. Your patient is a 55 year old male who in unresponsive and breathing at a rate of 6 times per minute. You note soot inside his mouth and around the nares. You are suspect of cyanide poisoning. You begin ALS treatment and decide to treat with a Cyanokit. How will you dose this patient?
2. 5g over 15min (15ml/min) piggybacked into existing IV/IO line
3. 15g over 5 minutes (45ml/min) in IV/IO line dedicated for cyanokit
4. 5g over 15min (15ml/min) in IV/IO line dedicated for cyanokit
5. 15g over 5 minutes (45ml/min) piggybacked into existing IV/IO line.

1. In a confined space environment, which of the following atmospheric oxygen levels would most likely cause mental failure and unconsciousness?
2. 14-19%
3. 10-12%
4. 8-10%
5. 4-6%

1. You are called to a single family residence for a bed-bound elderly male patient reported to be unresponsive. The caller and only other person there is a neighbor who “was just asked to come over and sit with him for a few minutes” while a family member went to the store. The patient has a GCS of 3, is making agonal glottic movements but has no effective respirations, has no palpable pulse. The neighbor says he knows the patient did not want CPR but does not know the location of POLST or DNR paperwork. Which of the following is your correct action?
2. Begin resuscitation
3. Withhold resuscitative efforts until the family member returns to clarify
4. Withhold resuscitation based on the neighbors statement
5. Do CPR only and begin transport

1. You and your partner are dispatched to a construction site where an individual has fallen while entering a manhole. When you arrive on scene, the patient’s co-workers state “Hey guy, he got almost all the way down but then slipped off the ladder and fell the last 5 feet. He hasn’t moved since.” Your best course of action is to:
2. Send one person from the medic unit down into the hole to tend to the victim while another waits for help to arrive and gathers more information from co-workers
3. Both you and your partner enter the manhole since this is a traumatic injury due to a fall, treat the patient, and provide expeditious transport to a trauma center.
4. Call for additional resources, and do not enter the manhole unless you have the proper PPE and/or respiratory protection
5. Enter the manhole, but only after you have secured the rescuer to a proper harness and rope system

1. Which of the following best explains a cholinergic crisis?
2. A nerve gas agent over-stimulates the sympathetic nervous system causing a release of adrenaline. This in turn causes tachydysrhythmias, vasoconstriction, and cellular hypoxia
3. A nerve gas agent attaches itself to the hemoglobin in the bloodstream causing a reduction in the oxygen carrying capacity of the hemoglobin. This causes anemic hypoxia, apoptosis, and cerebral ischemia.
4. A nerve agent overstimluates the parasympathetic nervous system which causes an excess release of acetylcholine. This then causes bradycardia and GI disturbances.
5. A nerve agent blocks the production of acetylcholine causing the parasympathetic system to under-stimulate. This leads to ventricular rhythms, vomiting, miosis, and excessive salivation.

1. The Mark 1 kit is designed to be used as prophylaxis in the event of a nerve agent exposure or chemical attack. Providers can then respond to emergencies effectively.
2. True
3. False
4. The proper initial treatment for an individual who has been exposed to CN or CS gas is:
5. Fresh air and time
6. Immediate use of albuterol for respiratory distress
7. Gross decontamination with fresh water
8. NIPPV

1. Aging is referred to as:
2. The process of identifying if cyanide exposure patients will benefit from the use of medicinal interventions
3. The available window of treatment relating to 2pam for patients exposed to various toxic nerve agents.
4. Allowing the cyanokit to reconstitute for greater than 90 seconds to allow proper activation of medication prior to administration
5. Pesticides that have accumulated in the bloodstream over time leading to chronic neurologic disorders

1. Per SOP, which of the following IS NOT an indication for the use of atropine in the adult patient?
2. Symptomatic bradycardia
3. Asystole / PEA
4. Muscarinic / organophosphate poisoning
5. Nerve gas auto-injector

1. Which of the following is an appropriate capnometry reading of a normothermic, normotensive intubated patient?
2. 10-15mmHg
3. 25-30mmHg
4. 40-50mmHg
5. 35-45mmHg

1. Waveform capnography is an important tool in that:
2. It can identify large fluctuations in perfusion levels in intubated patients
3. It can direct proper ventilation rates of intubated patients
4. It can instantly confirm placement of an endotracheal tube
5. Help create better survivability and outcomes for our patients
6. All of the above

1. You are dispatched for the 19 year old male patient who was found unresponsive by bystanders. As you arrive on scene you note open bottles of paraquat in the patients vehicle he is laying next to. You take the proper scene precautions to ensure your own safety and begin to treat your patient. On initial assessment you note he has a GCS of 3, dilated pupils, heart rate of 42, blood pressure of 82/47, respiratory rate of 6. Your best course of action is:
2. ALS care including IV, EKG and intubation for airway protection. Atropine at 1mg IVP q 3 minutes to a total of 3mg
3. ALS care including IV, EKG and intubation for airway protection. Atropine at 2mg IVP q 3 minutes to a total of 6mg
4. ALS care including IV, EKG and non-rebreather with nasal airway. Atropine at 2mg IVP q 3 minutes with no dose limit
5. ALS care including IV, EKG and intubation for airway protection. Atropine at 2mg IVP q 3 minutes with no dose limit (SOP’s)