Paramedic Final

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For which of the following patients is nasotracheal intubation absolutely contraindicated?
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For which of the following patients is nasotracheal intubation absolutely contraindicated?
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You are called for a young man choking. Upon arrival you find very scared parents trying to dislodge a piece of hot dog from their 10 year old child's airway by administering back blows and abdominal thrusts, The child is limp. As you take over you discover the child is able to move a minimal amount of air. You should:
continue with back blow and abdominal thrusts until item becomes dislodged or obstruction becomes complete
You have just intubated an adult patient. You believe you have been successful. You are listening for sounds in the epigastric area and hear nothing. What would you do?
attach an ETCO2 monitoring device
What changes in blood gases occur when a patient is hyperventilating?
decreased CO2; increased PaO2
First responders are applying unusually long ventilations with an oxygen resuscitator to an apneic adult female. They are also not pausing between breaths. What negative effects can this increased pressure create?
increased pulmonary elasticity??
Percutaneous transtracheal ventilation
needle cricothyrotomy
You are treating a cardiac arrest patient who you have successfully resuscitated. The patient is still unconscious, apneic, and he is endotracheally intubated. The patient suddenly becomes cyanotic and his SpO2 decreases from 98% to 82%. His heart rate decreases from 110 to 40. What caused these sudden changes?
dislodged endotracheal tube
What is the primary danger to the infant during a precipitous delivery?
cerebral trauma
You are treating a 26 year old male victim of an assault. The patient was struck in the chest and abdomen with a baseball bat.
Vital Signs: P- 110, R- 6 with sonorous respirations.
The patient is place on high flow O2. While attempting an oral airway the patient gags. The oral airway is removed. How are you attempting to secure his airway next?
Place a nasopharyngeal airway and ventilate with a bag valve mask
What effects does morphine sulfate have on the venous system?
increases venous pooling, resulting in reduced preload and after load
You are treating a 48 year old female with chest pain. On scene you administer oxygen, aspirin, and two nitro tablets. En route to the hospital your patient states her pain decreases to a 1 on a scale of 0-10. To provide the best care, you should...continue high flow oxygen and repeat vitals, consider 12 lead EKG if pain persistsA 52 yom is compelling of constant, severe pain and pressure in his chest, which he says started about 4 hours ago. The patient has bilateral rales, and his skin is cool to the touch. Vital signs are: BP- 72/52, P- 124, R-28. No JVD or Edema in lower extremities. What condition is most likely responsible for his signs and symptoms.Myocardial infarction with cariogenic shockWhich of the following patients has the best cerebral oxygenation?45 yom, disoriented, BP 140/80, skin warm and dryWhat term best describes the ability of cardiac cells to spontaneously depolarize without being stimulated by a nerve?AutomaticityA 72 yom with a history of atherosclerosis complains of a sudden onset of sharp pain in his right leg and foot which has grown worse over the past 2 hours. Objective data includes an anxious patient with vital signs: BP- 124/60, P-70, R-18. He has a pale, waxy, cool right leg. No pedal pulses are present in the right foot. The left leg is normal. What is the patients probable diagnosis?Acute arterial occlusionWhat is atherosclerosis?The gradual blockage of an artery due to cholesterol and hardened depositsWhich of the following is the underlying cause of the pain associated with a sickle cell crisis?Tissue ischemiaWhich of the following best describes the term syncope?sudden temporary loss of consciousnessThe correct dose of naloxone for a 6lb 8oz neonate suffering respiratory depression secondary to in utero exposure to narcotics is0.3mgYour patient is a 22 yof without a medical history. She was sitting at her office desk where she had an acute onset of dyspnea and pleuritic type chest pain. Presently she is awake but agitated. Upon exam you find she is pale, cool, and diaphoretic. Vital signs are: BP- 92/40, P-142, R-36 and shallow but clear bilaterally. Only medications are Tylenol and a BC pill. What conditions would you suspect?Pulmonary EmbolismWhich of the following best describes the term syncope?sudden temporary loss of consciousnessWhich vessel provides blood supply to the SA and AV nodes in most patients?right coronary arteryImpulses that originate in both the atria and ventricles simultaneously, meeting somewhere in the heart, create a strange appearing complex. What is that complex known as?fusion beatMost common causes of premature atrial contractions?stimulants such as caffeine or tobaccoYour 66 yom patient is experiencing crushing chest pain, and has a BP of 80/64. Your monitor shows him to be in VTACH at a rate of 176. How would you treat this patient?synchronized cardioversion at 100JA 20 yom presents to you complaining of diffuse chest pain that increases with deep inhalation but decreases when he leans forward. His 12 lead EKG shows changes in all leads. He recently had a viral infection. From this information, what is his most probable diagnosis?pericarditisWhat does Starling's Law state?The strength of a contraction of a muscle fiber is proportional to how far it is stretchedWhich of the following scenarios may best describe a patient experiencing an acute mi79 yof gets in an argument with her sister. She begins feeling substernal pressure that is unrelieved by rest and nitro.An elderly female is found unresponsive by a neighbor. Your crew has initiate CPR. The cardiac monitor show VFib How would you treat this patient?continue CPR, then prepare to defibrillate at 360JWhat is the electrical axis of the heart?average of all depolarizations of the heartUnder which conditions does a Type II AV block have a very serious prognosis?AV dissociation exists????What are the primary causes of symptoms in patients experiencing tachydysrhythmias?decreased ventricular filling and stroke volumeYour patient is a 58 yom with a history of alcoholism and and cirrhosis of the liver. The patient is vomiting copious amounts of blood. Which is most likely the cause?esophageal varicesCorrect bolus amount for a 44 lb child in hemorrhagic shock?400 mlYou are treating a 80 yom who complains of headache, blurred vision, and left sided weakness. He has a history of heart problems and takes digoxin. Which of these is the most likely cause of his symptoms?embolic stroke caused by afibYou are caring for a patient with a heart rate of 50. He is alert and oriented. His BP is 126/72 and he denies chest pain or respiratory distress. How would you initially treat this patient?gather a complete history and physical assessmentWhich is the ion responsible for determining the resting membrane potential of a cardiac cell?potassiumA 55 yom complains of sudden onset of acute shortness of breath. He denies chest pain and is alert and oriented but anxious. Skin is pale (with cyanosis), cool, and diaphoretic. BP 230/110, P 110, R 28. No JVD. Crackles are heard bilaterally. He has a hx of heart attack 5 years ago. The patient is most likely suffering from? Besides increasing oxygen levels, what is the next step for this patient? What medication and dosage would you use?left sided heart failure decrease preload nitroglycerin 0.4Sally, a 72 yof, called EMS because of severe lower back pain that will not go away. She states that she has arthritis, but this is much worse. She has a hx of hypertension and takes medication for it. She is extremely pale and diaphoretic. BP- 90 by palpation, P- 104, R-24. After oxygen, how would you initially treat. What condition is most likely affecting the patient.rapid transport to the ED Abdominal Aortic AneurysmYour patient is a 26 yo female Who has ingested 150 amitriptyline tablets. She responds to painful stimuli and has intact gag reflex, has a BP of 88/50, P 130, R 16. What medications would you consider using to treat this patient?Sodium bicarbonate26 yo female ingested 150 amitryptaline tablets what would be your best thing to watch for changes?Cardiac monitoringWhich of the following statements conserning elderly emergency medical care of the elderly is tru?Alcohol and drug use may be a cause if amsWhich of the following statements concerning seizures is true?The post-ictal phase preceded the seizure in absence (petit mal) seizuresYour Patient is a 41 year old female who is 3 days postoperative, recovering from an abdominal hysterectomy. She smokes and is about 40 pounds overweight. She is taking hormone replacement therapy, an antidepressant, and an antibiotic. She has a sudden onset of sharp left-sides chest pain With dyspnea and near syncope. She is not responsive only two painful stimulus, her school skin is cool and diaphoretic, and she is cyanotic. BP 90/50, P 122 weak but regular, Are 36. Which of the following is most likely the cause of her presentation?Massive Pulmonary Embolism17 yo m ingested 20 diazepam tablets, unresponsive to all stimuli and has snoring respiration's at 6 per min. What is the best treatment?Insert a NPA and BVMWhich of the following does not need to be proven by the plaintiff with a malpractice case against a medic?A duty to act22 yo female vetinary student, ingested tick killer and is presenting with SLUDGE what med does she need?Atropine70 yo male in a bar fell off a stool, responds to verbal has slurred speech and has flank pain and head pain. How would you treat this Pt?Oxygen, IV 0.9% sodium chlorideThe correct placement for a needle throacostomy would beThe second intercostal space, over the third rib, midclavicular line.What is the most common cause of pulmonary embolism?deep leg vein thrombosisYou are treating a 6 yo who weighs 40lbs. He is unresponsive with a weak pulse, delayed capillary refill. His vital signs are BP 60/0, P240, R6. EKG shows a narrow complex tachycardia at a rate of 250. What is your initial treatment?Synchronous at 20 joulesWhat is the most common cause of death in children over the age of 1 year?TraumaWhich of the following has the greatest potential to prevent pediatric deaths?Car seats, seat belts, and seat belt positioning boostersWhen assessing the mental status of an 8 month old child, which of the following is expected behavior in a patient with a normal mental state?Recognizes familiar caretakersWhich of the following is the most common concern to the adolescent trauma patient?Parental reprimandWhich of the following is the recommended location for assessment of the pulse in an unresponsive 6 month old child?Brachial arteryWhen responding to the scene of an injured 5yo child, child abuse should be expected in which of the following circumstances?Injury pattern does not match the history of the mechanism of injuryA 5yo boy who awoke with a sore throat and fever is found sitting at the kitchen table. He appears quite ill and is leaning forward with his head in his hands. His voice is muffled and he is drooling. What illness do you suspect the child is suffering from?EpiglottitisHow can you reduce gastric distention during ventilation?The patient is ventilated slow with large volumes of oxygenWhich of the following pulse rates would be cause for concern in an 18 month old child?Options: 90,100,120,150 Answer: 150?Which of the following is true concerning pediatric febrile seizures?Febrile seizures are more likely to occur when the temp raises rapidlyWhich isn't the correct location for placement of an IO needle in a pediatric patient?Proximal tibiaYou are treating a pregnant woman in her third trimester. She is suffering from a headache. Her vitals, BP 220/108, P 80, R18. She tells you her ankles are more swollen than normal. What illness is most likely causing her signs and symptoms?Preeclampsia23 yo female is complaining of diffuse Lower abdominal pain, unusual vaginal discharge, and a low-grade fever. Her symptoms began 2 days ago, toward the end of her period, which was otherwise normal. What is the most likely explanation for her symptoms?PIDOxytocin is indicated for the management of which of the following conditions?Postpartum hemorrhageYou are assisting with a normal cephalon delivery. The infants head has been delivered. To assist with the delivery of the upper shoulder you should?Assist the infants head downwardWhat stage of labor begins with cervical dilation and ends with delivery of the infant?SecondYour Pt is G3P2Ab0. 38 weeks began having contractions 2.5 hours ago. Contractions are 2.5 mins apart and regular. The patient states that her water has not yet broken. In considering that the bag of water has not yet ruptured, which of the following is true?The infant may be delivered without the bag of water breakingWhich of the following is the recommended technique of stimulating a distressed newborn?Running the infants back vigorously with a dry towelYou are assisting delivery of a full-term infant. As the bag of water breaks, you notice that it is thick and greenish like pea soup. At delivery, the infant is apneic, blue limp and a HR of 80. what should you do?Assist ventilations with BVMWhich of the following would NOT be appropriate in the emergency management of an inverted uterus?Applying traction to the umbilical cord to separate the placentaA 31 yo G3 P1 AB1 is in labor at term at home. She's been in labor for 24 hr without dilation. The midwife called for an ambulance. Upon arrival Pt is having strong contractions 2min apart. As you prepare to transport the mother complains of sudden tearing abdominal pain and becomes pale diaphoretic and agitated. Upon palpating the abdomen you feel the outline of the fetus. You should suspectUterine ruptureUpon examining a 27 yo in labor at 32 weeks gestation you notice that the umbilical cord is prolapsed. Which of the following would you NOT do?Immediately clamp cord in 2 places and cut betweenWhen the monitor is configured to display lead II, what is the polarity of each lead?Left leg is positive right arm negativeWhat is the earliest gestational age at which a fetus may survive if born early?26You have been called to a fitness club where a 28 year old female experienced a sudden onset of lower right quadrant abdominal pain while running in a treadmill. She states she had a normal period 3 weeks ago. Assessment reveals that she is pale and wet with RLQ abdominal pain and tenderness to palpating. Vitals are BP 88/64 P 116. Which of the following conditions is LEAST likely to be causing the patients signs/symptoms?PID40 yo female who has been sexually assaulted. She is conscious but has multiple injuries. In addition to management of the patients injuries and attention to her psychological needs which of the following is appropriate?Place each article of clothing removed in a separate paper bag5yo was awakened with severe respiratory distress. She has a seal bark cough, fever, and finds it hard to swallow. What do you suspect?CroupYou are treating a 4 year old who is lethargic. Her vitals are BP 50/0, P 50, R 8. After the airway has been secured how would you treat her next?Perform CPRYou are caring for a 4 yo who took four tablets of her mothers elavil. Her vitals are BP 60/palp, P 140, R 6 and she is lethargic. What intervention would you perform first?BVM with O2Which of the following are early signs of dehydration in an infant?Dry mucus membranesIn what zone do EMS units at the scene of a hazardous materials, tactical or other dangerous situation operate?ColdWhat type of radio system uses transmissions and reception that occur on two frequencies?DuplexWhat is the function of the medical practice act?Provide state legislation that governs the practice of medicine within that stateThe term "ethics" is best described asMoral, rather than legal, standard of behaviorThe process by which an agency or association grants recognition to an individual who has met certain predetermined qualifications specified by that agency is calledCertificationWhich of the following is least likely to result in an accusation of negligence?Poor Pt outcomeThe statement, "the Pt states that she has had chills and a fever for 24 hours," belongs in which part of a narrative using SOAP format?SubjectiveThe majority of deaths associated with confined space incidents occur in which of the following groups?Individuals attempting a rescueGovernment agency that regulates radio communications is the:FCCThere are 5 plane crash survivors that are ready for transportation to the hospital. Who will notify hospitals and coordinate Pt allocation to those facilities?Transportation officerAt an mci rescuers have just pulled a patient out of the rubble. They report that he is not breathing. When they reposition the patients head to spontaneous breathing begins at 22 per min. His pulse is strong at a rate of 100 and he is now moaning and disoriented. What triage priority would you give this patient?RedWhich of the following variables poses the MOST risk to X-ray techs?Their proximity to the X-ray device? ???How should you approach a helicopter that has just landed to pick up your Pt?Toward the pilots, front of the craftYour Pt is a 40 yo male who has been depressed since his wife left him. He is currently threatening suicide. What would be best for you to ask or say to this patient?Have you given any thought to how you might kill yourself?The medical command physician orders 20mg of lasix IVP for your patient who is short of breath. After receiving the order, what should you do first?Repeat the order back to the physician to confirmYou have just finished a run. You are completing a run report and discover an error as you are writing. What should you do?Draw a line through the error, initial itWhich of the following is the best example of a subjective and possibly libelous statement?"The Pt was drunk and disorderly"You have arrived at the scene of a MVC. The Pt head is flexed forward, and she does not appear to be breathing. What is your immediate concern?Safety of the rescuersYou and your partner respond to a full arrest. During the arrest, you are unable to defib the Pt because it won't charge. Later the Pt dies, and the family learns that you forgot to replace the defib battery that morning according to routine procedures. What can the family sue you for?NegligenceYou have been called to check and alert and oriented diabetic patient who is sweating. He refuses treatment, but you forcibly proceed to give him an injection of glucagon. What legal charge will be most applicable?Committing batteryWhat is a radio "PL" (private line) tone?Allows 2 ambulances to talk to each other privatelyYou are at the scene of a riot. The IC has assigned you to the task of triage. Which of the following patients can wait the longest for transportation?34 yo bear amputation of a leg R18; strong radial; mental status: AlertYour partner Colleen, is assisting you with a premature delivery. Colleen is wearing gloves but no gown or face/eye protection. During the delivery amniotic fluid squirts up onto colleens face. After the shift ends, Colleen tells you she is embarrassed about getting amniotic fluid in her mouth and is not planning on reporting the incident. What should you do?Strongly encourage her to report the exposureYou are on scene of a mci you are expecting 40 Pt from a building collapse. A patient walks up to you and shows you a 3in laceration on his forearm. What triage priority would you give this patient?GreenYour ambulance has malfunctioned? En route to a non emergency call at a clinic. It stalled and will not restart. What is you best action to take next?Request another unit to respondA police officer at the scene of a traffic stop has requested that you medically clear the driver who was arrested for driving erratically. The other claims he's a diabetic. Refusing transport. The officer asks what his BGL was, what will you answer the officer?Apologize to the officer and explain that you can not divulge that informationYou respond to the local pool where a maintenance worker just spilled chlorine. You are the first to arrive. The lifeguards are treating your patient with oxygen and fresh air. What is your first course of action?Stop and do not approachWhat do apparently mild electrical burns and hydrofluric acid burns have in common?They can be worse than initially expectedWhat does neurogenic shock due to spinal injury create?Decreased cardiac outputYou are treating a 24 year old male who slipped and fell on an icy sidewalk. You are considering transporting this Pt in a sitting position. You should apply c-spine precautions if the patientIs unable to communicateHow do you calculate cardiac output?Heart rate multiplied by stroke volumeYou observe marked shortness of breath, JVD, tachycardia, and hypotension on a trauma Pt. What could this indicateTension pneumothoraxWhen calculating kinetic energy, the most important variable relating to total kinetic energy is?VelocityA dermatome can be described asAn area of the skin inner ages by a specific spinal nerveWhich of the following interventions should be performed on the scene (before loading a critical trauma patient into the ambulance)Decompress a tension pneumoAPGAR scores should be obtained at which of the following intervals?At 1 min after complete delivery and 5 mins afterThe intercostal artery, vein, and nerve are foundAlong the bottom of the ribYou are treating a 20 yo male who was an unrestrained driver of a vehicle that hit a pole at 65mph. He is unconscious but has a good airway and clear bilateral breath sounds. He has JVD and a large bruise on his chest, but there is no crepitus or instability to his chest. Vitals BP 70/60 P 120 R 24. What is the most likely cause of his condition?Pericardial tamponadeCompartment syndrome is best defined asTissue pressure rising above perfusion pressure, resulting in ischemia to the muscleYou are dispatched to the scene of a bar fight. Patient 25 yo male, suffered a laceration to the left lateral neck from a broken bottle. In addressing the injury, you shouldApply an occlusive dressingGCS QUESTION 24 yo woman laying in sidewalk after trailer caught on fire. Coughing up black tinged sputum and complains of difficulty breathing. Her breathing is stridorous but both lungs clear. She's awake and able to answer verbally but is hoarse. She moves on command, oriented to person place and time. What's her GCS?15A 24 year old woman is found lying on the sidewalk after jumping out of her trailer home bedroom during a fire. She has second degree burns to her face and head, and third degree burns to both her arms. What percent of her body is burned?18%Dispatched to the scene of a fight. 17 yo male complaining of left upper quadrant pain. He was hit with a bat in the "stomach" one time. On visual inspection you not redness at the left anterior costal margin. Palpating of the same region reviews the presence of slight crepitus. Based on these findings, you would expect damage to which abdominal organ?SpleenWhat complaint would suggest a traumatic injury to the spleen?"My left shoulder hurts"Injury into the spleen is life threatening. If the structure is severely injured, the greatest concern is which of the following?Rapid and significant blood lossWhen attempting to give the most fluid in the least amount of time through an IV line it is best to use a:14g, 4 inch IV cathYou are treating a patient and find that a carotid pulse60-80mmhgWhich of the following patients require immediate transport to the nearest appropriate medical facility as opposed to intervention by prehospital personnel?An unresponsive 30yo unrestrained passenger involved in a serious head on MVCShock might be defined asWhat is the preferred method for assessing a patient for spinal tenderness?Palpate over the spinal processesA 45 yo woman is found unconscious at the scene of a MVC. Her vitals are bp are BP 80/40, P 130, and R 30. Which of the following is most likely causing her condition?Bleeding into the chest or abdomenOn palpating you observe that your patient is complaining of point tender pain in the RUQ. These findings would be consistent with injury to theLiverYou are treating a 59 yom who is complaining of 7/10 chest pain. BP- 130/80, P- 130, R-18. ECG reveals sinus tach with occasional PVC's what drug should you administer?aspirin??Of the following, which item is acceptable and and productive to ask a 14 year old female in the presence of her parents?History of childhood illnessWhich of the following is LEAST likely to cause crackles?Asthma