You are working in the emergency department (ED) of a community hospital when the ambulance arrives with A.N., an $18$-year-old woman who was caught in a house fire. She was sleeping when the fire started and managed to make her way out of the house through thick smoke. The emergency medical system crew initiated humidified oxygen at $15 \mathrm{~L} / \mathrm{min}$ per nonrebreather mask and started a $16$-gauge IV with lactated Ringer's solution. On arrival to the ED, her vital signs are $100/66, 125, 34$, $\mathrm{SaO}_2 93 \%$. An additional $16$-gauge IV is inserted. She appears anxious and in pain.

$$\begin{aligned} &\text { Laboratory Test Values }\\ &\begin{array}{ll} \text { Hgb } & 20 \mathrm{~g} / \mathrm{dL} \\ \text { Hct } & 51 \% \\ \mathrm{~K} & 4.9 \mathrm{mEq} / \mathrm{dL} \\ \mathrm{Na} & 133 \mathrm{mEq} / \mathrm{dL} \\ \mathrm{Cl} & 100 \mathrm{mEq} / \mathrm{dL} \\ \text { Glu } & 159 \mathrm{mg} / \mathrm{dL} \\ \text { BUN } & 28 \mathrm{mg} / \mathrm{dL} \\ \text { Cre } & 1.0 \mathrm{mg} / \mathrm{dL} \end{array} \end{aligned}$$

Interpret A.N.'s laboratory results.

You are working in the emergency department (ED) of a community hospital when the ambulance arrives with A.N., a 28-year-old woman who was involved in a house fire. She was sleeping when the fire started and managed to make her way out of the house through thick smoke. The emergency medical system crew started $100 \%$ humidified oxygen at $15 \mathrm{~L} / \mathrm{min}$ per non-rebreather mask and started a 16-gauge IV with lactated Ringer's solution. On arrival in the $\mathrm{ED}$, her vital signs are 100/66, 125, 34, $\mathrm{SpO}_2 93 \%$. She is alert and oriented $\times 4$ and appears anxious and in pain.

Laboratory Test Values:

$$\begin{array}{ll}\mathrm{Hgb} & 20 \mathrm{~g} / \mathrm{dL}(200 \mathrm{~g} / \mathrm{L}) \\ \mathrm{Hct} & 51 \% \\ \mathrm{~K} & 4.9 \mathrm{mEq} / \mathrm{dL}(4.9 \mathrm{mmol} / \mathrm{L}) \\ \mathrm{Na} & 133 \mathrm{mEq} / \mathrm{dL}(133 \mathrm{mmol} / \mathrm{L}) \\ \mathrm{Cl} & 100 \mathrm{mEq} / \mathrm{dL}(100 \mathrm{mmol} / \mathrm{L}) \\ \text { Glucose } & 159 \mathrm{mg} / \mathrm{dL}(8.8 \mathrm{mmol} / \mathrm{L}) \\ \text { BUN } & 28 \mathrm{mg} / \mathrm{dL}(10.0 \mathrm{mmol} / \mathrm{L}) \\ \text { Creatinine } & 1.0 \mathrm{mg} / \mathrm{dL}(88.4 \mathrm{mcmol} / \mathrm{L})\end{array}$$

Interpret A.N.'s lab results.

You are working in the emergency department (ED) of a community hospital when the ambulance arrives with A.N., an $18$-year-old woman who was caught in a house fire. She was sleeping when the fire started and managed to make her way out of the house through thick smoke. The emergency medical system crew initiated humidified oxygen at $15 \mathrm{~L} / \mathrm{min}$ per nonrebreather mask and started a $16$-gauge IV with lactated Ringer's solution. On arrival to the ED, her vital signs are $100/66, 125, 34$, $\mathrm{SaO}_2 93 \%$. An additional $16$-gauge IV is inserted. She appears anxious and in pain.

Eighteen hours after the injury, the NAP reports these vital signs for A.N. and states that the urine output for the past hour was $20$ mL.

$$\begin{aligned} &\text { Vital Signs }\\ &\begin{array}{ll} \text { Blood pressure } & 90 / 50 \mathrm{~mm} \mathrm{Hg} \\ \text { Heart rate } & 110 \text { beats } / \mathrm{min} \\ \text { Respiratory rate } & 24 \text { breaths } / \mathrm{min} \end{array} \end{aligned}$$

What do you suspect is occurring, and why does this concern you?

You are working in the emergency department (ED) of a community hospital when the ambulance arrives with A.N., an $18$-year-old woman who was caught in a house fire. She was sleeping when the fire started and managed to make her way out of the house through thick smoke. The emergency medical system crew initiated humidified oxygen at $15 \mathrm{~L} / \mathrm{min}$ per nonrebreather mask and started a $16$-gauge IV with lactated Ringer's solution. On arrival to the ED, her vital signs are $100/66, 125, 34$, $\mathrm{SaO}_2 93 \%$. An additional $16$-gauge IV is inserted. She appears anxious and in pain.

Eighteen hours after the injury, the NAP reports these vital signs for A.N. and states that the urine output for the past hour was $20$ mL.

$$\begin{aligned} &\text { Vital Signs }\\ &\begin{array}{ll} \text { Blood pressure } & 90 / 50 \mathrm{~mm} \mathrm{Hg} \\ \text { Heart rate } & 110 \text { beats } / \mathrm{min} \\ \text { Respiratory rate } & 24 \text { breaths } / \mathrm{min} \end{array} \end{aligned}$$

What treatment do you anticipate?

Three-year-old C.E. is admitted to the emergency department (ED) fast track clinic. Her mother tells the nurse that C.E. has had a low-grade fever for 2 days and is complaining of ear pain and a sore throat. C.E.'s mother states that C.E.'s appetite has been "off;' but she has been drinking and using the bathroom as usual. As you get C.E. settled in the exam room, you suspect C.E may have otitis media (OM).
Place an arrow where you suspect fluid would be found.

J.R. is a $28$-year-old man who was doing home repairs. He fell from the top of a $6$-foot stepladder, striking his head on a large rock. He experienced a momentary loss of consciousness. By the time his neighbor got to him, he was conscious but bleeding profusely from a laceration over the right temporal area. The neighbor drove him to the emergency department of your hospital. As the nurse, you immediately apply a cervical collar, lay him on a stretcher, and take J.R. to a treatment room.

Differentiate between a primary and secondary head injury.

Ambulance response time. Geographical Analysis (Jan. 2010) presented a study of emergency medical service (EMS) ability to meet the demand for an ambulance. In one example, the researchers presented the following scenario. An ambulance station has one vehicle and two demand locations, $\mathrm{A}$ and $\mathrm{B}$. The probability that the ambulance can travel to a location in under 8 minutes is $.58$ for location $\mathrm{A}$ and $.42$ for location $\mathrm{B}$. The probability that the ambulance is busy at any point in time is $.3$. Find the probability that EMS can meet the demand for an ambulance at location B.

An accident victim who had not been wearing a seat belt received trauma to his forehead when he was thrown against the windshield. The physicians in the emergency room worried that his brain stem may have been driven inferiorly through the foramen magnum. To help assess this, they quickly took a standard X-ray film of his head and searched for the position of the pineal gland. How could anyone expect to find this tiny, boneless gland in a radiograph?

(Use Excel) Color coding is often used in manufacturing operations to display production status or to identify/prioritize materials. For example, suppose "green" status indicates that an assembly line is operating normally, "yellow" indicates it is down waiting on personnel for set up or repair, "blue" indicates it is down waiting on materials to be delivered, and "red" indicates an emergency condition. Management has set realistic goals whereby the assembly line should be operating normally 80% of the time, waiting on personnel 9% of the time, waiting on materials $9 \%$ of the time, and in an emergency condition 2% of the time. Based on $250$ recent status records, the status was green $185$ times, yellow $24$ times, blue $32$ times, and red $9$ times.

a. State the appropriate null and alternative hypotheses to test if the proportions of assembly line statuses differ from the goals set by management.

b. Calculate the value of the test statistic.

c. Use Excel's CHISQ.DIST.RT function to calculate the $p$-value.

d. Are management's goals being met at $\alpha=0.05$ ? Will your conclusion change at $\alpha=0.01$ ?

Study of why EMS workers leave the job. A study of fulltime emergency medical service (EMS) workers published in the Journal of Allied Health (Fall 2011) found that only about 3% leave their job in order to retire. (See Exercise $3.45$, p. 158.) Assume that the true proportion of all fulltime EMS workers who leave their job in order to retire is $p=.03$. In a random sample of 1,000 full-time EMS workers, let $\hat{p}$ represent the proportion who leave their job in order to retire. Compute $P(\hat{p}<.05)$. Interpret this result.

A driver makes an emergency stop and inadvertently locks up the brakes of the car, which skids to a stop on dry concrete. Consider the effect of heavy rain on this scenario. Using the values in Table 1, determine how much farther the car would skid (expressed as a percentage of the dry-weather skid) if the concrete were wet instead. What does this question imply about driving safely?

Table 1 Coeffi cients of Kinetic Friction for Rubber on Concrete

After a heavy meal rich with fried foods, Debby Collins, an overweight 45-year-old woman, was rushed to the emergency room with severe spasmodic pains in her epigastric region that radiated to the right side of her rib cage. She indicated that the attack came on suddenly, and her abdomen was found to be tender to the touch and somewhat rigid. What do you think is this patient's problem and why is her pain discontinuous (colicky)? What are the treatment options and what might happen if the problem is not resolved?

Consider a simple elevator design in which a 15,000 kg car A is connected to a 12,000 kg counterweight B. Suppose that a failure of the drive system occurs (the failure does not affect the rope connecting A and B) when the car is at rest and 50 m above its buffer, causing the elevator car to fall. Model the car and the counterweight as particles and the cord as massless and inextensible, and model the action of the emergency brakes using a Coulomb friction model with kinetic friction coefficient $\mu \mathrm{k}=0.5$ and a normal force equal to 35% of the car’s weight. Determine the speed with which the car impacts the buffer.

A vehicle is stuck on the railroad tracks as a 430,000 lb locomotive is approaching with a speed of 75 mph. As soon as the problem is detected, the locomotive’s emergency brakes are activated, locking the wheels and causing the locomotive to slide. If the coefficient of kinetic friction between the locomotive and the track is 0.45, what is the minimum distance d at which the brakes must be applied to avoid a collision? What would that distance be if instead of a locomotive, there was a $30 \times 106 lb$ train? Treat the locomotive and the train as particles, assume that the railroad tracks are rectilinear and horizontal, and note that only the locomotive’s brakes are applied.