Which of the following signs is LEAST suggestive of a diabetic emergency?
A: Combativeness
B: Bradycardia
C: Tachycardia
D: Fruity breath odor
You selected A; The correct answer is B;
Reason:
Bradycardia is not commonly associated with either hyperglycemia or hypoglycemia. Tachycardia and combativeness can occur in patients with hyperglycemia or hypoglycemia. A fruity breath odor is noted exclusively in patients with diabetic ketoacidosis (diabetic coma, hyperglycemic crisis).
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Your patient is a 75-year-old female who, according to her son, tripped on a throw rug and fell. The patient is conscious and alert, is sitting on the couch, and has a hematoma to her forehead. When you ask her what happened, her son interjects by saying, “I already told you, she tripped and fell.” As you further question her, you find that she is hesitant to answer your questions and keeps looking at her son. You should:
A: interview the patient and her son separately if possible.
B: ask the patient if someone hurt her intentionally.
C: tell the son that you suspect his mother has been abused.
D: notify law enforcement and have the son removed.
You selected A; This is correct!
Reason:
There are several indicators that suggest this patient’s injury was intentionally inflicted: the son’s interjection, her hesitance to answer your questions, and the fact that she keeps looking at her son. If possible, interview the patient and her son separately; doing say may reveal inconsistencies regarding the event, which would further increase your index of suspicion for abuse. You must not, however, accuse her son of abuse or insinuate such. If you are wrong, you could be liable for slander. At present, the son is not verbally or physically abusive; however, if he becomes abusive, you should notify law enforcement at once. Remember, you are legally obligated to report any suspicions of abuse or neglect to the emergency department physician. You should make every effort to convince the patient to consent to treatment and transport.
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A middle-aged man was found floating facedown in a small pond. When you arrive at the scene, bystanders are present, but nobody has removed him from the water because they thought he was dead. After reaching the victim, you should:
A: move him to a supine position by rotating the entire upper half of his body as a single unit.
B: stabilize his head as you remove it from the water and open his airway by tilting his head back.
C: grab him by his clothing, remove him from the pond, and assess for breathing and a pulse.
D: float a buoyant backboard under him, remove him from the pond, and begin rescue breathing.
You selected A; This is correct!
Reason:
After safely reaching a drowning victim, you should first turn him to a supine position by rotating the entire upper half of the body as a single unit; protect the cervical spine as you do this because a spinal injury cannot be ruled out. Open the patient’s airway, without manipulating the neck, and begin rescue breathing while still in the water. Float a buoyant backboard under the patient, secure him to it, and remove him from the water. After removing the victim from the water, assess for a pulse. If the victim is pulseless, begin CPR, dry him off, and apply the AED as soon as possible.
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Which of the following is the MOST significant finding in a patient with a severe headache?
A: Pain in both legs
B: Abdominal tenderness
C: Chest discomfort
D: Unilateral weakness
You selected A; The correct answer is D;
Reason:
Unilateral weakness (weakness on one side of the body) is a clinically significant finding in a patient with a headache because it could indicate a stroke (ischemic or hemorrhagic). Abdominal, chest, and leg pain are not common complaints associated with a headache, although they should be noted and investigated if they are present.
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When insulin levels in the blood remain high:
A: a fruity odor can be detected on the patient’s breath.
B: the patient urinates excessively and becomes dehydrated.
C: glucose is rapidly taken out of the blood to fuel the cells.
D: the cells starve for glucose and begin to metabolize fat.
You selected A; The correct answer is C;
Reason:
Insulin is a hormone that promotes the cellular uptake of glucose from the bloodstream. If insulin levels remain high, such as when a diabetic inadvertently takes too much insulin, glucose is rapidly taken out of the blood to fuel the cells. This leads to low circulating blood glucose levels (hypoglycemia) and a condition called insulin shock. By contrast, if insulin levels are too low, such as when a diabetic forgets to take his or her insulin, glucose cannot enter the cells and pools in the bloodstream (hyperglycemia). In the absence of glucose, the cells begin to metabolize fat, which produces ketoacids (diabetic ketoacidosis [DKA]). The respiratory system attempts to eliminate ketoacids from the blood with an increased rate and depth of breathing that is accompanied by a fruity or acetone breath odor (Kussmaul respirations). Hyperglycemia causes the patient to eliminate excess water from the body through urination (diuresis), resulting in dehydration.
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Which of the following statements regarding lightning-related injuries is correct?
A: Because of the high electrical energy associated with lightning, full-thickness burns are a common finding.
B: The majority of patients who are struck by lightning die, even if CPR is provided immediately.
C: Multiple fractures, including those of the cervical spine, are the most common cause of lightning-related deaths.
D: The cardiovascular and nervous systems are most commonly injured during a lightning strike.
You selected A; The correct answer is D;
Reason:
The cardiovascular and nervous systems are most commonly injured during a lightning strike; therefore, respiratory or cardiac arrest is the most common cause of lightning-related deaths, especially if CPR is delayed. A lightning strike typically induces asystole (cardiac standstill); however, this spontaneously resolves in some people or can be reversed with early, high-quality CPR. The energy associated with lightning is composed of direct current (DC) of up to 200,000 amperes and a potential of 100 million volts or more; however, the duration of a lightning strike is short. Therefore, skin burns are usually superficial; full-thickness (third-degree) burns are rare. Lightning causes massive contraction of all the body’s muscles, potentially resulting in long bone and spinal fractures. Although this can clearly increase morbidity, it is not the most common cause of lightning-related deaths.
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Approximately 5 minutes after being stung by a bee, a 21-year-old male develops hives and begins experiencing difficulty breathing. When you arrive at the scene, you note that his level of consciousness is decreased, his breathing is labored, and wheezing can be heard without a stethoscope. The patient has a bee sting kit, but has not used it. You should:
A: provide positive-pressure ventilations, initiate rapid transport, and coordinate a rendezvous with a paramedic unit so they can administer the epinephrine from his bee sting kit.
B: give him high-flow oxygen via a nonrebreathing mask, cover him with a blanket and elevate his legs, and assist him in swallowing the antihistamine tablets that are in his bee sting kit.
C: administer high-flow oxygen via a nonrebreathing mask, apply a chemical cold pack to the sting, transport at once, and be prepared to administer the epinephrine from his bee sting kit.
D: assist his ventilations with a bag-mask device, administer epinephrine from his bee sting kit after receiving approval from medical control, and prepare for immediate transport.
You selected A; The correct answer is D;
Reason:
The patient is in anaphylactic shock and needs epinephrine immediately. Epinephrine is given to patients with anaphylactic shock because it constricts the blood vessels and dilates the bronchioles, thus improving perfusion and breathing. Begin assisting his ventilations with a bag-mask device; his breathing is inadequate (eg, decreased LOC, wheezing, labored breathing). After receiving permission from medical control, give the epinephrine from his bee sting kit (AnaKit) via intramuscular injection and transport at once. Some EMS protocols may not require you to contact medical control before giving epinephrine to a patient whose condition is critical. Ordinarily, you would instruct the patient to chew and swallow the antihistamine tablets after giving epinephrine. However, the patient’s level of consciousness contraindicates placing anything in his mouth.
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Which of the following actions should be carried out during the primary assessment of an unresponsive patient?
A: Assessing the skin
B: Obtaining a blood pressure
C: Auscultating the lungs
D: Palpating the cranium
You selected A; This is correct!
Reason:
Components of the primary assessment for both responsive and unresponsive patients include assessing and managing the airway and assessing and managing circulation, which includes controlling any major bleeding; assessing the rate, regularity, and quality of the pulse; and assessing the color, condition, and temperature of the skin.
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A 34-year-old female complains of persistent fever, fatigue, and night sweats. During your assessment, you note that she has purple blotches on her arms and legs. She MOST likely has:
A: chickenpox.
B: viral hepatitis.
C: HIV/AIDS.
D: tuberculosis.
You selected A; The correct answer is C;
Reason:
Signs of human immunodeficiency virus (HIV) infection include persistent fever, weight loss, fatigue, a cough, and night sweats. The presence of purple skin blotches (malignant lesions called Kaposi’s sarcoma) is consistent with acquired immune deficiency syndrome (AIDS), also known as late stage HIV infection. Patients with tuberculosis (TB) also present with fever, fatigue, weight loss, a cough, and night sweats; however, skin lesions are not common. Hepatitis is characterized by right upper quadrant abdominal pain, fever, nausea and vomiting, and a yellow tint to the skin and sclera (jaundice). Chickenpox is unlikely; the associated rash is characterized by pustules that crust over, not purple blotches.
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A 42-year-old male presents with fever, a severe headache, and a stiff neck. He is conscious, but confused. His wife tells you that he does not have any medical problems and does not take any medications. You should be MOST suspicious for:
A: influenza.
B: tuberculosis.
C: acute stroke.
D: meningitis.
You selected A; The correct answer is D;
Reason:
Meningitis is an inflammation of the protective coverings of the brain and spinal cord (meninges). Common signs and symptoms of meningitis include fever, headache, neck stiffness (nuchal rigidity), and vomiting. An altered mental status is common in severe cases. Meningococcal meningitis, caused by a bacterium, is the most contagious and potentially fatal type of meningitis. The patient’s signs and symptoms are not consistent with acute stroke, tuberculosis (TB), or influenza (the flu). Although fever is common with both TB and the flu, neither causes neck stiffness. Acute stroke may be associated with a headache, especially a hemorrhagic stroke; however, stroke patients typically do not have a fever.
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Which of the following is the MOST significant finding in a patient experiencing an allergic reaction?
A: Hoarseness
B: Widespread rash.
C: Headache
D: Abdominal cramps.
You selected A; This is correct!
Reason:
A rash (urticaria), headache, abdominal cramps, and hoarseness are all signs of an allergic reaction. However, the presence of hoarseness is the most significant finding because it indicates upper airway swelling. Other significant findings include swelling of the face, neck, or tongue; wheezing and/or stridor; difficulty breathing; tachycardia; and hypotension. Death due to a severe allergic reaction (anaphylaxis) is caused by vascular collapse (caused by massive vasodilation) and respiratory failure (caused by upper and/or lower airway swelling).
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A 32-year-old man who was stung by a bee has diffuse hives, facial swelling, and difficulty breathing. When he breathes, you hear audible stridor. What does this indicate?
A: Narrowing of the two mainstem bronchi
B: Narrowing of the bronchioles in the lungs
C: Swelling of the upper airway structures
D: Swelling of the lower airway structures
You selected A; The correct answer is C;
Reason:
This patient is experiencing a severe allergic reaction (anaphylaxis). Stridor, which is a high-pitched sound heard on inhalation, indicates swelling of the structures and tissues of the upper airway. If not promptly treated, the patient's airway may close completely, resulting in respiratory arrest. Narrowing of the bronchioles in the lungs causes wheezing, a whistling sound that may be heard during inhalation, exhalation, or both.
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A 73-year-old male presents with confusion; cool, pale, clammy skin; absent radial pulses; and a blood pressure of 70/40 mm Hg. The patient's wife tells you that he has had abdominal pain for a week and began vomiting a coffee-ground substance yesterday. His past medical history includes hypertension and gastric ulcer disease. Your MOST immediate concern should be that:
A: he is in shock and requires prompt transport.
B: he is bleeding from his gastrointestinal tract.
C: his blood glucose level is probably too high.
D: his condition requires surgery within 2 hours.
You selected A; This is correct!
Reason:
The patient is likely bleeding from his gastrointestinal (GI) tract. Although this is a serious condition, it is not a condition you can treat; internal bleeding cannot be controlled in the field. You can, however, treat his signs and symptoms of shock by administering high-flow oxygen and keeping him warm by covering him with a blanket. Therefore, this should be your most immediate concern. Furthermore, the patient requires prompt transport to the hospital where he can receive definitive care, which may or may not involve surgery. It is highly unlikely that his blood glucose level is too high; he does not have a history of diabetes.
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You are called to the residence of a 39-year-old male with flu-like symptoms. The patient tells you that he has been feeling ill for the last 2 days. He has a fever, headache, and diarrhea, and asks that you take him to the hospital. His blood pressure is 120/60 mm Hg, his pulse is 110 beats/min, and his respirations are 16 breaths/min. You should:
A: advise him that he can drive himself to his family physician.
B: ask him if he has a history of HIV infection or hepatitis.
C: request an ALS ambulance to the scene to start an IV line.