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Chapter 15 - Shock and Resuscitation: Online Tests

Terms in this set (115)

What is an advantage of a load distributing band CPR device or vest CPR device??

A. It eliminates the need to ventilate the patient.
B. It allows for a 100% successful resuscitation rate.
C. It eliminates the need to incubate the patent or place any other advanced airway.
D. It improves coronary and cerebral blood flow in comparison to traditional CPR.
D. It improves coronary and cerebral blood flow in comparison to traditional CPR.

ALthough some reserch shows that the devices are better at providing cerebral and coronary perfusion than is traditional CPR, the available evidence still cannot support routine use of these devices.
If the heart has an electrical rhythm but the circulatory system has lost so much blood that there is nothing to pump, the patient is said to be in:
A. Ventricular tachycardia
B. Asystole
C. Pulseless electrical activity
D. Ventricular fibrillation
C. Pulseless electrical activity

In cases pulseless electrical activity (PEA), the heart has an organized rhythm, but either the heart muscle is to weakened that it falls to pump, the heart does not respond to the electrical activity, or the circulatory system has lost so much blood that there is nothing to pump. Defibrillation is not approprié in the rhythms.
The change in which body process is the primary reason that the patient will progress through the stages of shock and eventually die?
A. Increasing heart rate
B. Lack of adequate perfusion
C. Diminishing respirations
D. Decreasing alveolar ventilation
B. Lack of adequate perfusion

The primary change of the body that causes death in shock syndrome is a lack in organ perfusion. With a lack of perfusion, cells, tissues, and organs become ischemic and start failing. A drop in perfusion to the heart results in its failure, and a drop in perfusion to the lungs results in ongoing hypoxia and hypercapnia. An increasing heart rate is a compensatory mechanism initially, and the changes to respiratory and alveolar ventilation are the result of a failing pulmonary system, not the cause of the failing pulmonary system. Eventually, everyone dies when the heart rate stops, but the stopping of the heart is a consequence of the failing perfusion pressure.
You are caring for a patient who has overdosed on an unknown medication ans as a result is hypotensive. Which of the following causes of shock is LEAST likely to explain why the blood pressure is low?
A. Cardiogenic shock
B. Hypovolemic shock
C. Anaphylactic shock
D. Distributive shock
B. Hypovolemic shock

Th least likely explanation for the shock would be hypovolemic, as this type of shock is of them from blood loss due to hemorrhage. Cardiogenic shock could be the cause if the medication causes the heart to beat slower or more weakly, distributive shock could be a cause if the medication caused peripheral vasodilation,and anaphylactic shock could be the cause if the patient was allergic to the medication on which the patient overdosed.
How does the body prolong the effects of the sympathetic nervous system during shock?
A. By constantly providing nervous stimuli to the heart and adrenal glands.
B. By increasing the intravascular volume by creating more blood.
C. By promoting fluid réabsorption in the kidneys.
D. By releasing hormones from the adrenal glands.
D. By releasing hormones from the adrenal glands.

During the initial stages of shock syndrome, the sympathetic nervous system initially stimulates the heart and blood vessels to react through direct nerve stimulation to cause an immediate affect. To prolong this effect, the body also stimulates the adrenal medulla to release epinephrine and norepinephrine into the bloodstream. The release of the hormones is what causes the ongoing sustained effects of sympathetic nervous system. While the kidneys will reabsorb volume during shock, this is not he the mechanism by which the body propagates the sympathetic effects (it is actually an effect of it).
You are preparing to transport a post-arrest patient with return of spontaneous circulation (ROSC) to the hospital. The hospital to which you are transporting is a 15-minute drive due from your currently location. The closest ALS unit is 10 minutes away, coming toward you from the east. What should you do?
A. Initiate transport to the hospital.
B. Start transport to a hospital 30 minutes away but in the arms directions as the incoming ALS service.
C. Wait 5 more minutes to depart the scene, then tell the ALS service to expedite so that they can arch up with you.
D. Wait for the ALS service to arrive before transporting.
A. Initiate transport to the hospital

Although this decision is often driven by protocol, the EMT should realize that the overall goal and the last link in the "Chain of Survival" is getting the patient ALS care as a soon possible. In this situation ALS care would be at the hospital. The best option would be to start transport to the hospital that is 15 minutes away without ALS intercept. All other options will delay arrival of the patient at the ED.
Which of the following patients would benefit from defibrillation?
A. An unconscious, apneic patient who has a slow pulse.
B. An unconscious, pulseless, apneic patient who has an organized heart rhythm.
C. An unconscious, pulseless, apneic patient in asystole.
D. An unconscious, pulseless, apneic patient with a heart rhythm of ventricular tachycardia.
D. An unconscious, pulseless, apneic patient with h heart rhythm of ventricular tachycardia.

The AED would be the most beneficial for a patient in cardiac arrest who is unconscious, pulseless, apneic and in either ventricular tachycardia or ventricular fibrillation. The AED will not shock a patient who is in asystole or has a shallow pulse or any type of organized heart rhythm.
You are managing a patient who fell off a roof and impaled himself on a metal bar. You suspect that the patient has significant internal bleeding. What is your overall goal for managing this patient?
A. Initiating positive pressure ventilations.
B. Maintaining peripheral perfusion and rapid transport.
C. Providing full spinal immobilization on a backboard.
D. Applying oxygen to maintain the pulse ox > 94%.
B. Maintaining peripheral perfusion and rapid transport.

The overall goal during the management of shock is to improve oxygenation of the blood and ensure delivery of oxygen and glucose to the cells. The steps in doing this are immobilizing as appropriate to prevent further injury, ensuring adequate ventilations, and maintaining a pulse ox reading greater than 94 percent.
What is the phase of cardiac arrest in which the heart cells shift from aerobic to anaerobic metabolism?
A. Metabolic phase
B. Electrical phase
C. Circulatory phase
D. ROSC phase
C. Circulatory phase

The circulatory phase begins 4 minutes and lasts through 10 minutes after cardiac arrest. During this phase, the oxygen stores have been exhausted, and the myocardial cells shift from aerobic to anaerobic metabolism. the electrical phase begins immediately upon cardiac arrest and ends 4 minutes afterward. During this early and initial phase, the heart still has a good supply of oxygen and glucose; therefore aerobic metabolism is maintained with continued energy production for cell function and prevention of mass production of acid. The metabolic phase begins 10 minutes after cardiac arrest. At this point the heart is starved of oxygen and glucose and has a large amount of acid buildup. The tissues are very ischemic and may begin to die. The chances of survival drop dramatically during this phase. ROSC in an abbreviation for "return of spontaneous circulation".
Which of the blood pressures is MOST indicative of a patient who is still in the compensatory stage of shock?
A. 120/80 mmHg
B. 106/88 mmHg
C. 102/64 mmHg
D. 110/78 mmHg
B. 106/88 mmHg

The key finding for early shock is that the systolic pressure is still acceptable (above 90 systolic), but the pulse pressure is becoming more narrow. The patient with a blood pressure of 106/88 only has a pulse pressure of 18 mmHg whereas the rest of the patients have pulse pressures over 30 mmHg.
What is the BEST reason for the EMT to have extra batteries available for the AED on each shift?
A. Because it is mandated by federal law.
B. In case the medical director is on scene and wants to ensure that you are following protocol.
C. In case you have two patients at one scene.
D. In case the batteries in the machine fail.
D. In case the batteries in the machine fail.

Scheduled maintenance of the AED is crucial for ensuring that the machine functions properly. Follow your local protocols and the manufacturer's directions when maintained the AED. AED failure is most commonly attributed to improper maintenance, especially battery failure. Typically, if two arrested patients are on scene, you will have two ambulances and two AEDs. State law, not federal law, dictates equipment types.
The failure of what cellular metabolic activity in a shock state is essentially the start of the downward spiral that results in patient​ death?
A. Failure to produce adequate adenosine triphosphate​ (ATP).
B. Failure to produce adequate glucose levels.
C. Failure to produce an increase in hydrogen production.
D. Failure to produce an increase in carbon dioxide production.
A. Failure to produce adequate adenosine triphosphate​ (ATP).

Energy is needed to maintain the function of the cell's sodium/potassium pump. If the pump fails, the sodium is no longer removed from the cell in exchange for potassium. Potassium and lactic acid leave the cell and begin to collect in the interstitial fluid and blood. The sodium collects inside the cell and attracts water. The cell swells and eventually ruptures and dies. The acid release causes the failure of enzyme systems and the real ease of lysozymes. The lysozymes begin to attach the cell, leading to cell death and eventual organ death.
Which of the following answers MOST accurately describes the cardiovascular effect resulting from the release of epinephrine and norepinephrine?
A. Increased heart rate ad contractility.
B. Artériole constriction, increased heart rate, and increased contractility.
C. Increased contractility and bronchodilation.
D. Increased heart rate, bronchodilaation, and smooth muscle dilation of the bowel.
B. Arteriole constriction, increased heart rate, and increased contractility.

These two hormones increase peripheral vascular resistance by causing arteriole constriction and increasing heart rate and contractility (thereby increasing cardiac output). Collectively, this causes a rise in blood pressure during a shock state. Bronchodilation and dilation of the bowel are not cardiovascular effects.
What is the fourth link in the Chain of Survival of which the EMT should remain cognizant whenever treating a patient in cardiac arrest?
A. Summon ALS.
B. Contact medical control.
C. Transport the patient to the hospital.
D. Apply the AED, and allow it to analyse the heart rhythm.
A. Summon ALS.

With a patient in cardiac arrest,out of cardiac arrest, or even suspected of having been in cardiac arrest before your arrival, you should keep the American Heart Association's Chain of Survival in mind. The fourth link of that chain is effective advanced cardiac life support (ACLS). It would make sense tat an ALS provide may be able to provide other therapies uch as medications to prevent the patient from deteriorating back into arrest.
You arrive on scene for a traumatic cardiac arrest for a male patient who wrecked is motorcycle at a high rate of speed. You start resuscitation and attach the AED, which advises NO shock. Your partner has called medical direction and has given a brief report. The medical direction physician tells you to stop resuscitation. What should you do?
A. Continue resuscitation but transport to a different hospital.
B. Stop resuscitating the patient after another 10 minutes.
C. Stop resuscitation efforts.
D. Continue resuscitation anyways.
C. Stop resuscitation efforts.

If, after you have begun resuscitation, your medical direction physician has ordered you to stop, that is what you should do. Essentially, the physician realizes that patients with traumatic arrests rarely survive because of this injuries, and transporting a dead body is a risk to the EMS providers and the public. Additionally, id the medical director has given the order, which also means that the medical director has assumed the responsibility.
Not only should the EMT provide 30:2 ration compressions to ventilation's to an adult patient in cardiac arrest, the EMT should also:
A. Push hard and push fast.
B. Remain on scene with the arrested patient until ALS arrives.
C. Pause compressions for 30 seconds while assessing for a pulse.
D. Provide a large ventilation with each squeeze of the bag-valve-mask device.
A. Push hard and push fast.

The American Heart Association advocates """push hard and push fast" to provide effective chest compressions. Doing this helps to ensure that the compressions are delivered at a rate of at least 100/minute, which has bee shown to provide suitable blood flow to essential organs during cardiac arrest. Delivering large ventilation's using a bag-valve-mask device can be detrimental, as can delaying compressions for 30 seconds while assessing for a pulse. Finally, do not wait on scene with an arrested patient if arrival of ALS is delayed. Instead, consider allowing them to intercept with you en route to the hospital.
Why are biphasic AEDs sometimes preferred over monophasic​ AEDs?
A. The biphasic units come with two electrode pads rather than just one like most monophasic models.
B. Monophasic AEDs carry only enough power to deliver one​ shock, where biphasic units can shock up to nine times.
C. Biphasic AEDs are thought to cause less damage to the heart.
D. Biphasic AEDs tend to be considerably less expensive than their monophasic counterparts.
C. Biphasic AEDs are thought to cause less damage to the heart.

Some external defibrillators use the older monophasée waveform. Most now use the newer biphasic waveform. The monophasic AED delivers energy at 200, 300 and 360 joules. The biphasic delivers lower energy (typically less than or equal to 150-200 joules) pulses. Th lower energy delivered by the biphasic AED is thought to cause less heart cell damage yet is still more effective at terminating ventricular fibrillation.
What is the MOST important extra equipment that the EMT should carry with the AED?
A. Extra retaining clips.
B. Extra razors.
C. An extra protective case.
D. Extra pads and batteries.
D. Extra pads and batteries.

Scheduled maintenance of the AED is crucial for ensuring that the machine functions properly. Follow your local protocols and the manufacturer's directions when maintaining the AED. The AED, its batteries, and the system's self-check status indicator should be checked at the beginning of each shift. Extra, fully charged batteries should always be available.
Which of the following would be the LEAST likely to occur if there were a sudden drop in the perfusion to peripheral tissues to the body?
A. Diminished blood flow to body organs.
B. Decreased carbon dioxide elimination from the tissues.
C. Increased aerobic metabolism.
D. Elevation in anaerobic metabolism.
C. Increased aerobic metabolism.

If there were a sudden drop in the perfusion status of the body, it would result in poor blood flow to the body;s tissues and organs, it could cause decreased carbon dioxide elimination from the tissues from poor blood flow, and there would be an in crease in anaerobic metabolism from a lack of oxygen. The one thing that would be the least likely to occur would be increased aerobic metabolism, as this would require sufficient oxygen, which is lacking with poor perfusion.
Bringing a patient back from potential or apparent death is​ called:
A. Resuscitation
B. Defibrillation
C. Cardiac arrest
D. Sudden death
D. Resuscitation

The term "resuscitation" means bringing the patient back from potential or apparent death. The potential or apparent death may result from many different causes, including trauma and medical conditions. Resuscitation focuses on management of the airway, ventilation, and oxygenation, and restoring adequate circulation. Defibrillation is a care technique that may be used during resuscitation, and cardiac arrest and sudden death are both etiologies that would require resuscitation.
Which of the following things would NOT increase the strength or effectiveness of the Chain of Survival?
A. Strategically placed AEDs.
B. Community-trained CPR providers.
C. Immediate 911 activation.
D. Discourage community CPR until the EMTs arrive.
D. Discourage community CPR until EMTs arrive.

Not allowing community members to intervene on the patient's behalf during an arrest situation would have a negative outcome on the likelihood of survival because of the longer delays in the patent's receiving CPR or AED use. The other steps would enhance survival.
Of the following findings, which one is MOST likely to be present in North compensated shock and early decompensated shock?
A. Tachycardia
B. Hypotension
C. Altered mental status
D. Irregular breathing
A. Tachycardia

During a shock syndrome, the body responds by employing the sympathetic nervous system, chin will increase the heart rate, promote vasoconstriction, and release hormones to increase intravascular volume. The result is tachycardia, one of the earliest findings and consistent finding through shock stages. Irregular breathing occurs as the brain stem becomes ischemic during irreversible shock, and hypotension and altered mental status are more consistent with the decompensated and irreversible stages of shock.
To prevent a shift to anaerobic metabolism, the body needs to ensure adequate perfusion to the tissues of glucose as well as what other substance?
A. Carbon dioxide
B. White blood cells
C. Oxygen
D. Platelets
C. Oxygen

To prevent the development of anaerobic metabolism, the body needs not only have good perfusion to delver glucose to the cells and remove carbon dioxide and other wastes from the cells, but also to delivery adequate amounts of oxygen so that aerobic metabolism can occur. White blood cells are part of the immune system and do not play a role in adenosine triphosphate (ATP) development, nor do platelets.
You are treating a patient whom you suspect has a tension pneumothorax. The patient has no external hemorrhage of suspected internal hemorrhage, yet he is hypotensive. What type of shock is most likely causing the drop in blood pressure?
A. Obstructive shock
B. Hypovolemic shock
C. Cardiogenic shock
D. Distributive shock
A. Obstructive shock

Obstructive shock results from a condition that obstructs forward movement of blood flow. The volume is adequate, the heart is not damaged, and the vessels are of normal size with adequate resistance. However, and obstruction is not allowing the blood to move forward. For example, a large clot that obstructs blood flow in the lungs (pulmonary embolism) will prevent an adequate amount of blood from getting to the left atrium and, subsequently, the left ventricle. Two other. Conditions that are often associated with injury an can lead to obstructive shock are tentions pneumothorax and pericardial tamponnade.
What is the trigger that causes the body to initiate the compensatory mechanism that is seen in a shock state?
A. Elevation in the respiratory rate as detected by the phrenic nerve.
B. Decreased vessel tension detected by the baroreceptors.
C. Peripheral vasoconstriction as determined by the capillary beds.
D. Increased heart rate as determined by the brainstem.
B. Decreased vessel tension detected by the baroreceptors.

The baroreceptors are stretch-sensitive receptors that continuously measure the pressure inside the aorta and carotid arteries. When there is a reduction in blood volume or pump function or a massive vasodilation with a redistribution of blood volume away from the core circulation, the cardiac output decreases. This causes a decrease in pressure inside the aorta and carotid arteries, which results in a reduction in stretch or tension in the arterial walls. The baroreceptors sense the reduction in arterial wall tension and trigger compensatory mechanisms. The increase in the heart rate is part of the compensatory mechanism, not the cause of it, and the phrenic nerve innervantes the diaphragm; it does not sense its activity.
In what locations are cardiac pacemakers MOST often implanté that may interfere wit ARD pad placement?
A. Directly n front of the hear on the anterior chest.
B. In the upper right quadrant of the abdomen.
C. Beneath the clavicles.
D. In the upper left quadrant of the abdomen.
C. Beneath the clavicles.

Cardiac pacemakers are usually positioned beneath one of the clavicles. They form a visible lump and can be palpate. If you détecta pacemaker n a cardiac arrest patient, you can still use the AED. However, be sure not to place an adhesive pad directly over the pacemaker.
What is the underlying pathology that causes myocardial cell death in a patient who is in cardiac arrest?
A. Lack of oxygen and carbon dioxide.
B. Failure of the sodium/chloride pump.
C. Lack of sodium and potassium.
D. Lack of oxygen and glucose.
D. Lack of oxygen and glucose.

Time is a critical issue in cardiac arrest. As time passes, the heart continues to deteriorate from a lack of oxygen and glucose, and begins to undergo changes that lead to severe myocardial cell ischemia and eventually organ death. Unfortunately, the time is in minutes and begins immediately upon the onset of cardiac arrest.
Your patient has a blood pressure of 88/46, shallow reparations of 38/min, a het rate of 68/min, and a pulse ox reading of 96% on high-flow oxygen. Given these vital signs, what type of shock is this patient most likely experiencing?
A. Hypovolemic shock from blood loss.
B. Obstructive shock from thoracic injury.
C. Cardiogenic shock from heart attack.
D. Distributive shock from spinal chord injury.
D.. Distributive shock from spinal chord injury.

With a spinal chord injury, the blood vessels may dilate from a lack of sympathetic tone causing hypotension. Additionally, because of the lack of sympathetic tone, the heart rate will be in the slow to normal range and not tachycardia. Hypovolemic shock, obstructive shock and cardiogenic shock lol result in narrowing pulse pressure and tachycardia.
During transport tot. Eh hospital of a patient who was successfully réussites from cardiac arrest, which of the following should the EMT do?
A. Maintain a compression/ventilation ratio of 30:2
B. Leave the AED attached to the patient.
C. Do not transport the patient unless an ALS provider is int he ambulance with the EMT.
D. Provide ventilation at 20/minute.
B. Leave the AED attached to the patient.

Patients who have been brought out of ventricular fibrillation through use of the AED have a high likelihood of deteriorating back into that state. Monitor these patients closely, and leave the AED attached so that it is read to be used immediately, if needed. Ventilation 20/minute us to fast, and there is no need for compressions if the patient has a pulse. Finally, having ALS available is favorable, but if that will delay deliver of the patient to the hospital, transport should be initiated immediately.
Your patient has a history of gastric ulcers and GI bleeding. He is now tachycardic, hypotensive and tahypnic.. He admits to passing a lot of blood the past several days. What type of shock is this MOST likely to be?
A. Inadequate blood volume
B. Inadequate pump function
C. Inadequate oxygen levels
D. Inadequate vessel tone
A. Inadequate blood volume

Hypovolemic shock (low blood volume) is the most common form of shock. It can be due to blood loss of some other fluid; basically any condition or injury that decreases the blood content or the fluid portion of the blood. The most common cause of hypovolemic shock is hemorrhage. Cardiogenic shock results from a dysfunctional heart causing inadequate pumping action, distributive shock causes widespread vasodilation, and respiratory shock occurs when he body is unable to oxygenate the bloodstream,
The patient you are treating for trauma is no unresponsive with a dropping heart ate and unobtainable blood pressure. You also note that he is starting to bleed again from injuries that were already controlled and starting to clot. These indies are consistent with what stage of shock?
A. Irreversible
B. Progressive
C. Decompensatory
D. Compensatory
A. Irreversible

Irreversible shock is the stage in which, regardless of the interventions, the patient outcome is death. Cell, tissue and ouragan failure and damage are so pervasive and severe that no matter what the treatment , the shock cannot be reversed and organ death is inevitable. Microemboli begin to block capillaries throughout the body leading to lung failure, kidney failure, and other multi-system organ failure (MSOF). Clotting factors are used n the formation of microemboli in the blood. The body responds to the clot by releasing substances to attempt to break them up. Because the clotting factors were used up in the formation of the microemboli, the substances that the released to break down the clots are unopposed, and there is widespread uncontrollable bleeding from any wound that was previously clotted.
Upon arrival for a patient who was found unresponsive by​ neighbours, you note that the skin is cool with​ mottling, the smaller joints of the hands are​ stiff, and the jaw seems to be locked into position. There are no environmental extremes in the ambient environment. What should you infer from this​ presentation?
A. The patient is hyperthermic.
B. The patient has arthritis.
C. The patent has rigor.
D. The patient just went into arrest.
C. The patient has rigor.

Rigor is a condition in which the joints of the body start to stiffen from changes due to prolonged cardiac arrest. This is a finding that occurs hours after arrest, so this serves as a condition to not start resuscitation on the patient.
During management of a patient who is in shock, what abnormal metabolic process is the EMT attempting to prevent?
A. Hypokalemia
B. Hyponatremia
C. Aerobic metabolism
D. Anaerobic metabolism
D. Anaerobic metabolism

A lack f oxygen in the cell from a shock syndrome causes a shift from aerobic to anaerobic metabolism. Aerobic metabolism is the creation of ATP in the presence of oxygen. When there is a lack of available oxygen, anaerobic metabolism takes place, resulting in a drastically lower production of ATP and the creation of lactic acid as a by-product. This is the initiating event that causes cellular death and eventual organ failure and system failure. Both hyponatremia (low sodium levels) and hypokalemia (low potassium levels) are conditions, out abnormal metabolic processes.
Which type of shock would be associated with a condition in which the body tissues are unable to properly utilize the oxygen that is available to them in the bloodstream?
A. Anaphylactic
B. Cardiogenic
C. Metabolic
D. Distributive
C. Metabolic
Respiratory or metabolic shock is a type of shock that is described as a dysfunction in the ability for oxygen to diffuse into the blood, be carried by hemoglobin, off-loud at the cell, or be used effectively by the cell for metabolism. Certain poisons, such as cyanide, interfere with the cell's ability to use oxygen; the lord is carrying an adequate amount of oxygen, but the cyanide prevents the cell rom using it. Carbon monoxide poisoning interferes with the ability of hemoglobin to carry oxygen . Carbon monoxide binds much more readily to the hemoglobin molecule than oxygen does, thus preventing oxygen from binding. Carbon monoxide cannot be used by the cells, so a sever hypoxia state is created in the blood and in the cells.
Sudden cardiac arrest in the patient with a relatively low level of cardiac disease is generally attributed to:
A. Commotio cordis
B. Hypertrophic cardiomyopathy
C. Myocardial infarction
D. Disordered electrical conduction
D. Disordered electrical conduction
Cardiac arrest, the worst manifestation of cardiac compromise from an acute coronary event, occurs when the ventricles of the heart, for any of a variety of reasons, are not contracting or when the cardiac output is completely ineffective and no pulses can be felt. The normal electrical impulses are usually absent or disrupted, or the mechanical response to the electrical impulse does not occur. Instead of smooth, coordinated contractions, the heart shows a different type of activity, most commonly the uncoordinated twitching known as ventricular fibrillation. Pumping action ceases, and without oxygenated blood, the body's cells begin to die.
What two care interventions are MOST likely to contribute to the successful resuscitation of a patient who is in ventricular fibrillation?
A. CPR and defibrillation.
B. Airway maintenance and ventilators support.
C. Early ALS care ad endotracheal intubation.
D. Compressions and rapid transport.
A. CPR and defibrillation.
Research by the American Heart Association reinforces the necessity of early defibrillation in the management of sudden cardiac arrest due to ventricular fibrillation. However, high-quality CPR focusing on immediate compressions with minimal interruption was found to be even more important. Additional research has shown that high-quality chest compressions with minimal interruptions and early defibrillation are the best determinants of successful cardiac arrest management.
Which of the following scenarios would be MOST unsafe for the EMT who is about to deliver a shock with an AED?
A. The patient has an implanted defibrillator.
B. The patient is lying on a metal surface.
C. The patient is lying outside in the yard.
D. The patient is lying on a hotel room floor.
B. The patient is lying on a metal floor.
When you are using an AED, you are operating a device that delivers an electrical shock. That shock can save the life of a cardiac arrest patient, but in can injure others who come into contact with it. Such shocks are unlikely to be lethal, but they should be avoided. Metal is a good conductor of electricity. Be careful with patients who are in contact with metal flooring, catwalks, stretchers, and other items with metal components. Before you administer a shock, either remove the patient from this surface or ensure no one else is directly in contact with metal that is touching the patient.
You are caring for an 8-year-old male patient who was thrown from a car during a collision. The child has a blood pressure of 90/systolic, a heart rate of 98/min, and restoration of 20/min. How would you characterize the patient's shock state?
A. The child is hypotensive.
B. The child's blood pressure is acceptable.
C. The child is in irreversible shock.
D. The child is tachycardic.
B. The child's blood pressure is acceptable.
Normal vital sign findings vary with age for paediatric patients. For children you're than 10 years of age, a systolic blood pressure of 70 mmHg plus two times the age in years is a lower limit of normal (70 + (8 x 2) = 86 mmHg). A systolic blood pressure ses than the lower limit would be considered hypotensive. Hypotension is a late finding in prédicatrice patients and often leads to cardiac arrest. In this patient the blood pressure is above the minimally acceptable value that would represent hypotension.
What is an important difference between the paediatric Chain of Survival and the adult Chain of Survival?
A. Post-arrest care
B. Rapid trapdoors to the hospital
C. Bystander CPR
D. Prevention of arrest
...
During the initial stages of shock, the skin becomes pale and the heart increases. These findings are due to what hormone(s)?
A. Epinephrine and glucagon
B. Norepinephrine, epinephrine and glycogen
C. Epinephrine and norepinephrine
D. Norepinephrine
C. Epinephrine and norepinephrine
After two cardiac arrests, a large home improvement center has purchased a fully automated AED. You have been asked to provide education on its use. During an instructional session, a student asks you what will happen when the AED indicates that a shock is indicated. Your response should be:
A. The AED will prompt you to recheck the pulse.
B. The AED will automatically shock the patient.
C. You will need to reanalyze the hearth rhythm.
D. You will need to press the shock button.
B. The AED will automatically shock the patient.

Fully automated AEDs are designed to do everything themselves, all the user must to is apply the pads and stay clear of the patient when the shock is being delivered.
You arrive on the scene of an unconscious middle-aged male patient. On assessment, you find that the patient is in cardiac arrest. The witness him fall and called for help. She did NOT initiale chest compressions. What should you do NEXT?
A. Immediately apply te AED and shock the patient.
B. Compress the chest 1,5 to 2 inches for two minutes.
C. Give the patient two full breaths and then begin chest compressions.
D. Begin chest compressions at the rate of at least 100 per minute.
D. Begin chest compressions at the rate of 100 per minute.

Early chest compressions will assist with perfusion.
You have just applied the AED to a female patient in cardiac arrest and the machine is ready to analyze the heart rhythm. Which of the following instructions is appropriate at this time?
A. Continue CPR until we see if a shock is advised.
B. Stop CPR and clear the patient.
C Stop chest compressions but continue ventilation.
D. Stop CPR but continue to check for a pulse.
B. Stop CPR and clear the patient.

All EMS personnel should clear the patient to ensure minimal disruption and accurate AED analysis.
It is critical tat the EMT never apply the AED to a person who is not in cardiac arrest because an accidental shock could.
A. Produce full thickness burns and lead to a deadly infection.
B. Cause the beating heart to go into cardiac arrest.
C. Cause the patient to lose his eyesight.
D. Cause the patient extreme pain.
B. Cause the beating heart to go into cardiac arrest.

Just as an AED can assist in defibrillating a ventricular fibrillation, it can also cause fibrillation if not required.
A 28-year-old male was cutting limbs from a tree when he lost his footing and fell proximately 20 feet. He is unresponsive and breathing shallowly at 28 times per minute. His radial pulse is weak and threads, and his sin si cool to the touch. Emergency Medical Responders (EMRs) have placed him on a nonrebreather face mask and are holding manual in-line cervical spine stabilization. His respirations are snoring. asked on these assessment innings, which of the following instructions would you provide?
A. Do not cover him with a blanket because that will cause his blood vessels to dilate and drop his BP.
B. Let's take off the oxygen mask and start positive pressure ventilation to assist his breathing.
C. Let's go ahead and elevate his legs 8 to 12 inches. So more blood gets to his vital organs.
D. He has snoring respirations, so let' go ahead and open the airway with the head-tilt, chin-lift.
B. Let's take off the oxygen mask and start positive pressure ventilation to assist his breathing.
The AED should never be applied to a patient who is NOT in cardiac arrest because some patients in:
A. Ventricular fibrillation may have a pulse.
B. Ventricular fibrillation may be conscious and alert.
C. Asystole may still have a pulse
D. Ventricular tachycardia may have a pulse.
D. Ventricular tachycardia may have a pulse.

Only if the patient is pulseless, unconscious with no signs of life should an AED be applied.
What is the overall goal for the EMT in managing a shock patient?
A. Keep the pulse ox reading greater than 94%.
B. Provide adequate ventilations.
C. Keep the heart rate less than 100/min.
D. Maintain adequate perfusion to the core and peripheral tissues.
D. Maintain adequate perfusion to the core and peripheral tissues.
You have arrived at a residence for a 66-year- old female who is in cardiac arrest. In the leaving room, you find Emergency Medical Responders performing CPR on the patient. They quickly repeat that they found the patient in cardiac arrest and have been doing CPR for 5 minutes. Which one of the following statements should you make at this time?
A. Let's continue CPR for another 2 minutes, and then I will put the ARD on.
B. Let's stop CPR so I can put the electrodes of the AED on her chest.
C. Let's continue CPR while I talk to the family to see if they want us to continue.
D. Let's stop CPR so I can check the airway, breathing and circulation.
D. Let's stop CPR so I can check the airway, breathing and circulation.
An unrestrained 37-year-old female is in cardiac after striking a tree head-on at a high rate of speed. Assessment reveals her to have suffered massive blunt trauma to the chest and abdomen. The patient is quickly extricated from the vehicle and placed on long board for immobilization. It is estimated that the patient has been in cardiac arrest for approximately 10 minutes, during which CPR was not performed. At this time, the EMT would:
A. Perform CPR and contact medical direction for permission to use the AED.
B. Apply electrodes to te patient's chest and follow the AED's instructions.
C. Administer CPR for 2 minutes prior to applying the AED.
D. Withhold CPR and perform a focused trauma assessment.
A. Perform CPR and contact medical direction for permission to use the AED.
You have been dispatched to a residence for a Mae patient with a cardiac arrest history who is complaining of chest pain. On scene you find a 52-year-old male patient sitting in a chair. He is alert and oriented and states that his chest pain eels like te last time he had a heart attack. He also states that in the hospital his heart stopped and they had to shock him twice before it restarted. He is breathing adequately and has a strong radial pulse. Which one of the following would be appropriate in the care of this patient?
A. Provide positive pressure ventilation with high-concentration oxygen.
B. Apply the AED to the patient but do not turn it on.
C. Obtain the heart rate, respiratory rate and blood pressure.
D. Open the airway using the head-tilt, chin-lift manoeuvre.
C. Obtain the heart rate, respiratory rate and blood pressure.
You are treating a patient with severe chest pain and believe she is in cardiogenic shock. As such, which of the following is most appropriate?
A. Application of the AED.
B. Supplemental oxygen.
C. Rapid transport with the patient supine.
D. Administration of nitroglycerin.
B. Supplemental oxygen.
In which of the following interventions may the EMT participate with ALS providers for a patient who has a return of spontaneous circulation?
A. Hyperbaric therapy
B. High-frequency ventilation
C. Therapeutic hypothermia
D. Facilitated oxygen
C. Therapeutic hypothermia
You have been assigned to a football game to provide standby coverage. While taking a break, you decide to walk to a nearby concession stand for a soft drink. On the way you come across a group of people standing around a. Male patient who collapsed and is on the ground. Your assessment reveals him to be unresponsive, not breathing, and pulseless. A bystander states that the patient collapsed less than a minute earlier. An AED is located less than a minute from your location. The nearest EMT is 5 minutes from your location. Which one of the following should you do immediately?
A. Call for assistance and start CPR.
B. Take a manual in-line stabilization.
C. Run to retrieve the nearby AED.
D. Start CPR and wait for the AED.
C. Run t retrieve the nearby AED.
Which one of the following statements best indicates an understanding of the prehospital role in caring for the patient in shock?
A. Because shock is a life-threatening condition, it is important that the EMT identify the exact cause so the proper care can be given.
B. Since shock is best treated in the hospital, the EMT should proved e care to maintain perfusion to the vital organs and transport.
C. If shock is in the compensatory stage, it is not yet life-threatening and the EMT can take his time in assessing and treating.
D. The job of the EMT s to recognize that a person is in shock and get them to the hospital so treatment can be started.
B. Since shock is best treated in the hospital, the EMT should proved e care to maintain perfusion to the vital organs and transport.
As you approach a patient you observe a 1-inch circle of dark blood on his chest. He appears. Confused, pale and diaphoretic. Which one of the following should you so first?
A. Assess his airway.
B. Treat for sock.
C. Apply oxygen.
D. Cut his shirt.
A. Assess his airway.
While using the AED to treat a patient in cardiac arrest, your partner informs you that he can feel a carotid pulse. Which one of the following should you do immediately?
A. Insert an oropharyngeal airway.
B. Obtain a blood pressure.
C. Reanalyze the patient's heart rhythm.
D. Assess the patient's breathing.
D. Assess the patient's breathing.
The AED has just been applied to a female cardiac arrest patient. After analyzing the heart thythm, it provides a "No Shock Advised" message. The EMT should immediately:
A. Check the electrodes for proper placement.
B. Check the patient for a pulse and blood pressure.
C. Resume cardiopulmonary resuscitation.
D. Reanalyze the patient's heart rhythm.
C. Resume cardiopulmonary resuscitation.
Which type of shock results from cardiac insufficiency, that is, the inability of the heart to pump an adequate amount of blood?
A. Circulatory
B. Distributive
C. Cardiogenic
D. Obstructive
C. Cardiogenic
The patient has been in cardiac arrest for 15 minutes now, and you are still 10 minutes away from the hospital. ALS intercept did not occur due to all being assigned to another call. During transport, the AED analyzed the patient and gave a "No Shock Advised" message. What should the EMT do?
A. Resume compressions
B. Contact medical direction to ask if a defibrillatory shock can be administered anyway.
C. Decrease the oxygen flow-rate in case the patient is becoming hyperoxic.
D. Attempt defibrillation anyway to "start" the heart.
A. Resume compressions.
A "No Shock Advised" message is provided by the AED. The EMT understands that this could mean:
A. The patient has regained a pulse.
B. CPR is no longer needed.
C. The patient is in ventricular fibrillation.
D. The electrodes may be loose.
A. The patient has regained a pulse.
When assessing the patient whom you suspect has hypoperfusion, the early effects of norepinephrine can be seen as:
A. Tachycardia
B. Increased urine output
C. Pale, cool skin
D. Pupillary constriction
C. Pale, cool skin
You have been called to a public pool for an unresponsive patient. On arrival you find lifeguards performing CPR with a pocket mask and oxygen on a 67-year-old male. They report that the patient was in the water and was seen clutching his chest seconds before going unresponsive. He was immediately pulled from the water and CPR was intitulâtes. They estimate that CPR has been performed for 5 minutes. Assessment shows the man to be unresponsive, apneic, and pulseless. Which one of the following is your first response?
A. Stop CPR and let's apply the AED.
B. We need to quickly dry him from head to toe before applying the AED.
C. Let's start ventilation with a bag-valve mask and oxygen.
D. Let's take a towel and dry off his chest.
D. Let's take a towel and dry off his chest.
When managing the patient whom you suspect is in shock, why is it important NOT to hyperventilate this patient?
A. It will increase the blood pressure too dramatically.
B. It will promote increased bleeding into the nervous tissue.
C. It makes the blood alkaloid and reduces off-loading of oxygen from the hemoglobin.
D. It will increase the body temperature.
C. It makes the blood alkaloid and reduces off-loading of oxygen from the hemoglobin.
Which one of the following mechanisms have been found to cause distributive shock in a patient?
A. Blood infection
B. Pulmonary embolism
C. Cardiac valve failure
D. Blood loss
A. Blood infection
What structures within the cell, after becoming released as a result of failure of the sodium/potassium pump, start to auto digest the cell?
A. Lysozymes
B. ATP
C. Carbon dioxide
D. Sodium molecules
A. Lysozymes
A 7-year-old boy choked on a grape at school. By the time the obstruction was removed, assessment revealed him to be in cardiac arrest. When you arrive, teachers are performing CPR. The school nurse informs you that CPR has been in progress for 6 minutes. You have an AED, but do not have pédiatrie conversion device that reduces the energy of defibrillation from that of an adult to that of a child. Which one of the following should you do immediately?
A. Instruct the teachers to continue CPR for 2 additional minutes before applying the AED.
B. Perform 5 abdominal thrusts then 1 minute of CPR before using the AED.
C. Place the electrodes on the boy's chest an follow the AED's prompts.
D. Continue CPR and transfer the boy to the stretch for immediate transport.
C. Place the electrodes on the boy's chest an follow the AED's prompts.
You have applied the AED's electrodes to an obese male patient in cardiac arrest. When you press the analyze button, the AED gives you the "check electrode" message. In looking at the patient, which one of the following would most likely be responsible for this message?
A. Hairy chest
B. History of asthma
C. AED pads placed too far to the left
D. Obese chest and abdomen
A. Hairy chest
If the body's class exist too long with insufficient oxygen during a shock syndrome, what metabolic process will start to prevail?
A. Hypoxia drive
B. Hypercapnic drive
C. Anaerobic metabolism
D. Aerobic metabolism
C. Anaerobic metabolism
Your unresponsive trauma patient has a rapidly dropping blood pressure. This indicates the​ patient:
A.. Is compensating adequately.
B. Has internal bleeding.
C. Will not survive his injuries.
D. Is in a state of decompensation.
D. Is in a state of décompensation.
A driver was ejected from his vehicle in a rollover-type collision. Assessment findings reveal the patient to be unresponsive with bruising to the abdominal and pelvic areas along with an open femur fracture. The patient has an open airway and is breathing 32 times per minute. His skin is cool and clammy and the radial pulses weak. Manual in-line spinal stabilization is being maintained. The EMT's next intervention would be to:
A. Examine the fracture site.
B. Apply a cervicale collar.
C. Obtain blood pressure.
D. Assist respirations
D. Assist respirations
A confused and anxious patient fell 20 feet from a ladder. Which one of the following signs would suggest that the patient is in shock?
A. Deformity to the left arm.
B. Constricted pupils.
C. Heart rate of 110.
D. Contusion to his head
C. Heart rate of 110
The major categories of shock include:
A. Burn, hypovolemic, distributive and hypoxic.
B. Hypoglycemic, obstructive, distributive and hypovolemic.
C. Hypovolemic, cardiogenic, obstructive and distributive.
D. Hemorrhagic, distributive, hypoxic and obstructive.
C. Hypovolemic, cardiogenic, obstructive and distributive.
Which one of the following statements about the heart rhythm of ventricular fibrillation is true?
A. Ventricular fibrillation occurs when the heart rate is so slow and weak that a pulse cannot be felt.
B. The most effective treatment for converting ventricular fibrillation to a healthy heart rhythm is CPR.
C. The AED is designed to identify ventricular fibrillation and give a "No Shock Advised" message when it is present.
D. When a patient's heart is in ventricular fibrillation, it is unable to pump blood throughout the body.
D. When a patient's heart is in ventricular fibrillation, it is unable to pump blood throughout the body.
Your patient has fallen from a horse Ana's suffered a high cervical injury. This has resulted in a loss of sympathetic nervous ton, and the patient is becoming hypotensive. What is the underlying mechanism that is causing this?
A. The heart rate will start to increase, but the massive vasodilation still results in blood pressure loss.
B. Lack of autonomic tone causes bradycardia and vasoconstriction, which decreases blood pressure.
C. The lack of sympathetic tone causes the heart to slow and the vessels to dilate; both of these will drop blood pressure.
D. With a spinal cord injury, the patient cannot breathe, which causes hypoxia and a drop in the heart rate and systemic vascular resistance.
C. The lack of sympathetic tone causes the heart to slow and the vessels to dilate; both of these will drop blood pressure.
With no sympathetic tone, the parasympathetic system will have a large effect on the body, which causes a drop in the heart rate and peripheral vasodilation. Together, these can effectively put the patient into a hypotensive state.
While you are caring for a patient with a heart attack, the patient is becoming tachycardic and hypotensive. Your partner asks you why this might be happening. What would be a logical explanation?
A. The use of oxygen causes vasodilation, which will drop the blood pressure and cause the heart rate to increase.
B. The patient's stroke volume is probably diminished.
C. The patient's lungs are no longer able to oxygenate the blood because of alveolar damage.
D. The patient is suffering from massive vasodilation secondary to the heart attack.
B. The patient's stroke volume is probably diminished.
The heart is the pump that is responsible for generating the force necessary to move the blood throughout the body. If the pump fails, regardless of the blood volume, the delivery of oxygen and glucose to cells will be decreased. Pump function failure may result from an injury to the heart that reduces its ability to generate contractions strong enough to push the blood forward throughout the body. For example, a heart attack (myocardial infarction) deadens a portion of the heart muscle. Like any other muscle, a portion that is dead doesn't contribute to the force of contraction. If the heart attack has affected a large enough area of heart muscle, the pump will fail and lead to a shock state.
During the management of a patient in shock, which of the following patients will continue to compensate well on their own until they reach a point of compensatory exhaustion - they rapidly deteriorate?
A. Elderly
B. Paediatric
C. Female
D. Male
B. Paediatric
Elderly persons and newborns de not compensate well for sock and therefore have a tendency to deteriorate rapidly. Children and young adults compensate very well, often exhibiting only minor signs and symptoms for a long period of time and ten decompensating suddenly.
Which of the following findings generally indicates that the patient has transitioned from compensated shock to decompensated shock?
A. Tachypnea
B. Pale skin
C. Tachycardia
D. Hypotension
D. Hypotension
Although all the findings could be present in decompensated. Shock, the specific finding that often delineates when that has occurred us systolic hypotension. Tachycardia, tachypnea and ale skin are present in compensated shock as well, bu hypotension is not.
During which phase of cardiac arrest does the development of overwhelming acidosis from anaerobic metabolism start?
A. Metabolic phase
B. Circulatory phase
C. Terminal phase
D. Electrical phase
B. Circulatory phase
The circulatory phase begins at 4 minutes and lasts through 10 minutes after the cardiac arrest. During this phase, the oxygen stores have been exhausted, and the myocardial cells shift from aerobic to anaerobic metabolism. This results in very little energy production for cell function in addition to the production of acid. The myocardial cells are becoming scheming and are in need of oxygen and glucose. Because of the lack of oxygen and glucose, the her is not prepared for defibrillation and is not prone to restarting.
You are on the scene of a patient who severed his left leg distal to the knee in an industrial accident. When you arrive, the bleeding is still severe. What should you do with this hemorrhage during the initial phases of shock management on scene?
A. Place the patent on a backboard and initiate transport. Provide treatment to the bleeding leg while en route to the hospital.
B. Apply direct pressure and a tourniquet if necessary.
C. Summon ALS and wait on scene until they arrive to control the bleeding.
D. Initiate an IV to replace lost fluid.
B. Apply direct pressure and a tourniquet if necessary.
The immediate goal for a major bleed while on scene is to stop it from occurring. First, attempt to stop the bleeding as quickly as possible, using direct pressure. If direct pressure is not effective, proceed to application of a tourniquet. Consider hemostatic agents to control hemorrhage if permitted by your local protocol.
What does the current research indicate about the use of mechanical piston and load-distributing band CPR devices versus traditional CPR?
A. Evidence suggests that these devices should be used in EMS systems that have only two EMTs on cardiac arrest calls.
B. Available evidence does not support the routine use of these devices.
C. Evidence suggests that these devices should be used only on elderly patients.
D. Evidence indicates that these devices should be used only on paediatric patients.
B. Available evidence does not support the routine use of these devices.
Although some research shows that the devices are better at providing cerebral and coronary perfusion that is traditional CPR, the available evidence still cannot support routine use of these devices.
You have a patient in cardiac arrest with an unknown down time. What should be one of the initial interventions by the EMS crew?
A. Initiate PPV with a BVM.
B. Administration of medications by an ALS provider.
C. Two minutes of CPR while the AED is being readied.
D. Placement of and advanced airway.
C. Two minutes of CPR while the AED is being readied.
If a patient goes into cardiac arrest in front of you, you should apply the AED allow it to assess the patient to determine whether a shock is indicated. However, if the patient has been down for several minutes (or has been down for an unknown period of time) before your arrival, provide two minutes of CPR before use of AED so the heart can be better perfused before application of the AED. An advanced airway or administration of medications by an ALS provider should be done only after high-quality CPR has been initiated and the AED has been applied and used as appropriate.
In what stage of hemorrhagic shock might the EMT notice only subtle vital sign changes of tachycardia and narrowing pulse pressure?
A. Decompensated
B. Irreversible
C. Late
D. Compensated
D. Compensated
Compensated shock is the stage that has the fewest changes to the vital signs. This is because the body is able to compensate for the lost volume. If the etiology of shock is reversed in this stage, such as by stopping the hemorrhage, the compensatory mechanisms will continue to maintain the blood pressure and perfusion and will eventually begin to signal the body to decrease its response as the pressure is restored. The blood pressure may appear to be relatively normal in compensated shock. However, you might also note a narrow pulse pressure. In decompensated and irreversible shock (sometimes called late sock), the body is unable to maintain normalcy due to the volume loss, and there is often decreasing slope to the systolic blood pressure.
You are treating a patient who has an implantable cardioverter defibrillator (ICD) and is in cardiac arrest. How should the treatment for this patient proceed?
A. Do not place the AED pads over the implanted ICD.
B. Do not use the AED.
C. Do not check for a pulse in case the ICD defibrillates the patient while you are touching them.
D. Use of the AED is permitted but do not initiate CPR.
A. Do not place the AED pads over the implanted ICD.
Treatment for the unresponsive patient with an implantable cardioverter defibrillator (ICD) is the same as that for any other unresponsive cardiac patient. However, when applying the AED's adhesive pads, do not place them directly over the implanted ICD because the device has an insulated backing that will deflect the shock.
A patient is in cardiac arrest, and the AED provided one shock, which was followed by the return of a pulse. The EMT should recognize that the heart was in what rhythm?
A. Asystole
B. Ventricular asystole
C. Ventricular fibrillation
D. Ventricular block
C. Ventricular fibrillation
When the patient is initially in cardiac arrest, two common rhythms that may be present that require defibrillation by the AED are ventricular fibrillation and ventricular tachycardia without a pulse. Asystole is the absence of all electrical activity, and ventricular asystole is the absence of any ventricular contraction. Ventricular block is a fictitious term. The point is that the AED will shock only a rhythm that is either ventricular fibrillation or ventricular tachycardia.
During the body's attempt to compensate during hypoperfusion, there is usually an increase in the heart rate for what reason?
A. To increase cardiac output.
B. To improve coronary artery perfusion.
C. To increase systemic vascular resistance.
D. To compensate for the peripheral vasodilation.
A. To increase cardiac output.
During the initial stages of a shock syndrome, the sympathetic nervous system stimulates the adrenal medulla to release epinephrine and norepinephrine into the bloodstream. The primary effects of these hormones are an increase in heart rate and contractility as well as vasoconstriction in an attempt to increase the blood pressure and perfusion. The increase in the heart rate increases the cardiac ouvrit to improve the blood pressure.
When does AED application ad defibrillation have the BEST benefit?
A. As soon after the onset of arrest as possible.
B. After 2 to 3 minutes of the heart being in ventricular fibrillation.
C. After 3 to 5 minutes of CPR has been performed.
D. Any time after the 10 minute mark of cardiac arrest with ongoing CPR.
A. As soon after the onset of arrest as possible.
Defibrillation - but more important, early an rapid defibrillation (shock within minutes) - in another component in determining survival of cardiac arrest. Survival rates of patients in sudden cardiac arrest due to ventricular fibrillation decrease with every minute defibrillation is delayed.
The AED is designed to d'ovidé a shock to the patient with what underlying cardiac rhythm?
A. Pulseless electrical activity
B. Asystole
C. Ventricular fibrillation
D. Atrial fibrillation
C. Ventricular fibrillation
AEDs should be applied to patients who you suspect are unresponsive and do not have a pulse. The AED is designed to assess for ventricular fibrillation or ventricular tachycardia and then recommend that the operator administer a shock or not. A patient in asystole, any PEA rhythm, or atrial fibrillation will not prompt the AED to recommend a countershock.
You are managing an ROSC patient. While transitioning the patient to the ambulance, your partner dropped and broke the pulse oximeter. During transport, how much oxygen should you provide?
A. 10 lpm
B. 8 lpm
C. 15 lpm
D. 12 lpm
C. 15 lpm
After return of spontaneous circulation (ROSC), check the patient's airway, and provide oxygen at 15 lpm by nonrebreather mask if the patient has signs of hypoxia or displeasure, or the pulse ox reading is unavailable. If the patient's breathing is adequate, use a nonrebreather. If the patient's breathing is inadequate, provide positive pressure ventilation.
What should the EMT do in preparing to apply the AED to a patient in cardiac arrest who was found in a filled bathtub?
A. Apply the electrodes without removing the patient from the water.
B. Place the electrodes on the patient's arms or legs if they are dry.
C. Apply the electrodes, but do not turn on the AED.
D. Remove the patient from the water.
D. Remove the patient from the water.
You are transporting a patient in cardiac arrest. The AED is being used and a shock ans been advices. Prior to administering the shock what should you do?
A. Withhold all shocks because metal will conduct the shock into the ambulance.
B. Stop the ambulance and have all rescuers exit prior to shocking with the AED.
C. Move the patient from the metal stretcher to a nonmetal surface.
D. Ensure that no rescuer is touching the stretcher.
D. Ensure that no rescuer is touching the stretcher.
You get a call for cardiac arrest. Upon your arrival you find out the family did CPR for about 3 minutes before the pulse retuned and the patient awoke. The patient is now conscious and has a chief complaint of heart palpitations and displeasure. She has a very fast pulse and feels dizzy. What should you do?
A. Administer one shock and start chest compressions.
B. Anguleuse the rhythm with the AED.
C. Administer oxygen and call ALS.
D. Lay her down in Trendelenburg position.
C. Administer oxygen and call ALS.
What statement regarding care for the adult patient in cardiac arrest is NOT true?
A. The sternum should be compressed about 2.5 inches with each compression.
B. It is important to always check for a pulse immediately after the AED has delivered a shock.
C. When using an AED the machine should be turned on before applying the electrodes.
D. If two EMTs are performing CPR, a ration of 20 compressions to 2 ventilations can be used.
B. It is important to always check for a pulse immediately after the AED has delivered a shock.
You have been called for a 57-year-old female who is choking on a large pill. Upon arrival you find the patient collapsed and unresponsive on the floor with the family by her side attempting to remove the obstruction. After ou quickly verify the airways is still concluded and confirmation the pulse is still present, you should immediately?
A. Open the airway and attempt ventilation.
B. Start chest compressions.
C. Perform five abdominal thrusts.
D. Apply the AED and hit eh "analyze" button.
B. Start chest compressions.
A patient has fallen down a flight of stairs and has suffered a scalp laceration with minimal venous bleeding. You find him to be redress and confused. The airways is open, and he adequately breathing 22 times per minute. He has a radial pulse of 92 beats per minute and is moderate in strength. Emergency Medical Responders are maintaining manual in-line spinal stabilization. Your next priority action would be to:
A. Immobilize the patient with a cervical collar and long spine board.
B. Check the blood pressure and assess for injuries causing blood loss.
C. Insert an oral airway and start positive pressure ventilation with oxygen.
D. Apply oxygen at 15 litres per minute via nonrebreather face mask.
D. Apply oxygen at 15 litres per minute via nonrebreather face mask.
You are assessing a patient that as a heart rate of 110/min, a blood pressure of 108/88, and respiration of about 14/min. If this patient also has lost blood from a traumatic event, what stage of shock would this be categorized as?
A. Compensated
B. Progressive
C. Decompensated
D. Irreversible
A. Compensated
You are treating a patient who is hypotensive and unresponsive. The ALS partner with whom you are working with states that the patient is having a massive heart attack according tot he 12-lead ECG findings. Why might this cause a hypotensive patient?
A. Inadequate oxygen levels
B. Inadequate blood volume
C. Inadequate pump function
D. Inadequate vessel tone
C. Inadequate pump function
After you apply the AED to a cardiac arrest patient, it delivered a shock. Immediately after the shock the EMT should do what?
A. Check the patient for a pulse and reanalyze the rhythm f no pulse is present.
B. Check the patient for a pulse and start CPR if no pulse can be located.
C. Provide 2 minutes of CPR and the check the patient for a pulse.
D. Provide 5 cycles if single-rescuer CPR with a ratio of 15 compressions to 2 ventilations.
C. Provide 2 minutes of CPR and the check the patient for a pulse.
Which one of the following statements about the AED and its use in the treatment of cardiac arrest is true?
A. The AED is advantageous in that it will determine if a patient is in cardiac arrest and whether or not to shock.
B. To use and AED, the EMT must be able to identify some of the basic cardiac arrest rhythms so that he or sh cant tell the AED to shock or not shock the patient.
C. AEDs have simplified the treatment of cardiac arrest to the point where the EMT does not have to be worried about inappropriately shocking a patient.
D. Research has shown that the first shock delivered by an AED is often faster than the first shock delivered by a manual defibrillator.
D. Research has shown that the first shock delivered by an AED is often faster than the first shock delivered by a manual defibrillator.
What assessment parameter is the EMT interpreting if the patient's pulse pressure is determined to be narrowing?
A. Heart rate
B. Blood pressure
C. Pulse oximeter
D. Respiratory rate
B. Blood pressure
The EMT knows that the cause underlying distributive shock is:
A. Loss of blood volume
B. Damaged hear with poor contractility
C. Poor fluide intake
D. Dilation of the blood vessels
D. Dilation of the blood vessels
What is one reason the EMT should summon ALS to the scene of a cardiac arrest patient who experienced return of spontaneous circulation (ROSC)?
A. Only ALS providers can adequately ventilate a patient once an advanced airway is in place.
B. State law requires ALS on every cardiac arrest.
C. The ALS interventions may prevent arrest from recurring.
D. After one shock by the EMT, Bay additional shocks myst be performed by the ALS provider.
C. The ALS interventions may prevent arrest from recurring.
If a patient is found to be hypotensive after a stabbing to the thigh, what is the most likely cause of shock?
A. Respiratory shock
B. Obstructive shock
C. Cardiogenic shock
D. Hypovolemic shock
D. Hypovolemic shock
Your service has a new AED. During the in-service on the new device, the instructor informs you that it i a semi-automated AED and uses a biphasic wave form, as opposed to the monophasic form used by the previous AED. As a knowledgeable EMT you should recognize that:
A. The new AED will defibrillate with higher amounts of electrical energy.
B. The EMT will not need to press the "shock" button to shock the patient.
C. Less energy but more shocks will be needed to treat the cardiac arrest.
D. The new AED will defibrillate with lower amounts of electrical energy.
D. The new AED will defibrillate with lower amounts of electrical energy.
What is the relationship between the AED use and the conversion of ventricular fibrillation?
A. The higher the energy level that is used to shock, the lower the conversion rate.
B. The earlier the shock is applied, the higher the conversion rate.
C. The lower the energy level that is used to shock, the higher the conversion rate.
D. The later the clock is applied, the higher the conversion rate
B. The earlier the shock is applied, the higher the conversion rate.
Which one of the following statements made by a patient's family member would cause the EM to suspect that a patient is suffering from hypovolemic shock?
A. He got up this morning and was having a hard time breathing.
B. He cannot stop throwing up.
C. He has been taking an antibiotic for a chest cold.
D. He has had a rash for the past 3 days.
B. He cannot stop throwing up.
The EMT understands that when paramedics administer IV fluids as treatment for hemorrhagic shock, the fluids will:
A. Enable the lungs to better oxygenate the blood.
B. Stabilize the shock by restoring needed electrolytes.
C. Do nothing to enable the blood to carry more oxygen to the cells.
D. Reverse the shock by increasing the blood pressure.
C. Do nothing to enable the blood to carry more oxygen to the cells.
The EMT would recognize which of the following as the most probable case of cardiogenic shock?
A. Systemic infection
B. Severe vomiting and diarrhea
C. Myocardial infarction
D. Gastrointestinal bleed
C. Myocardial infarction
Which one of the following actions performed by the EMT indicates appropriate care with the AED when treating a patient in cardiac arrest?
A. He places the AED pads two inches away from the transdermal medication patch on the patient's chest.
B. He places, then quickly removes, a set of electrodes in an attempt to remove hair from the patent's chest.
C. He applies one electrode over top of the power source for a pacemaker located on the patient's chest.
D. He intentionally withholds a shock on a patient in cardiac arrest who has an implantable defibrillator.
B. He places, then quickly removes, a set of electrodes in an attempt to remove hair from the patent's chest.
When should the EMT transport the cardiac arrest patient?
A. After one shock has been delivered and the patient remains in cardiac arrest.
B. Before delivering the first shock when a "Shock Advised" message is received.
C. After three "No Shock Advised" messages are received.
D. Immediately upon determining that the patient is in cardiac arrest.
C. After three "No Shock Advised" messages are received.
During what phase of cardiac arrest is successful resuscitation the LEAST likely, owing to widespread death of heart tissue?
A. Circulatory phase
B. Metabolic phase
C. Terminal phase
D. Electrical phase
B. Metabolic phase
Which one of the following unresponsive patients would the EMT recognize as in cardiac arrest?
A. Male paten with a heart rate of 16 bpm and agonal breathing.
B. Male with an absent radial pulse but breathing 10 times per minute.
C. Female who is not breathing and has a heart rate of 24 bpm.
D. Female who has an occasional gasp fro breath but no palpable carotid pulse.
D. Female who has an occasional gasp fro breath but no palpable carotid pulse.
Because of a shortage of paramedics at your ambulance service, it has been announced that there will be AEDs placed on every ambulance for use by EMT crews. Which of the following statements indicates an understanding of how this will effect the EMTs?
A. EMTs will have to learn to interpret ECG tracings.
B. EMTs will now be a let o shock all patients in cardiac arrest.
C. The AED will let us know whether or not to shock the patient.
D. Cardiopulmonary resuscitation will no longer be needed.
C. The AED will let us know whether or not to shock the patient.
You have been called for an elderly male patient who has suddenly collapsed. On scene you find an 82-year-old man lying on a garage floor. Assessment reveals him to be unresponsive and not breathing. Which of the following should you de immediately?
A. Determine the "down time".
B. Check for a carotid pulse.
C. Apply the AED.
D. Start CPR.
B. Check for a carotid pulse.
You are transporting a 5-year-old male who went into cardiac arrest at home. After 2 shocks and CPR, he regained a pulse, but remains unresponsive and in respiratory arrest. During transport, your reassessment reveals the absence of a carotid pulse. Which of the following should you do first?
A. Reapply the AED and analyze the heart rhythm.
B. Stop the ambulance and analyze the heart rhythm with the AED.
C. Start CPR and continue emergency transport.
D. Provide 5 cycles of CPR prior to using the AED.
B. Stop the ambulance and analyze the heart rhythm with the AED.
You believe that a young male patient, who has been shot in the lower abdomen is bleeding internally and s in the early stages of shock. Which item indicates the appropriate prehospital care of this patient?
A. Oxygen therapy and warm packs to the abdomen.
B. "Shock" positon and administration of oxygen.
C. Oxygen therapy an rapid transport to the hospital.
D. Semi-Fowler's position and direct pressure over the injury site.
C. Oxygen therapy and rapid transport to the hospital.
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