2 - Medical, Legal and Ethical Issues / Blood Pressure

Question 1

How does standard of care differ from scope of practice?

Answer 1

Standard of Care: The manner in which you must act or behave as an EMT

Scope of Practice: Outlines the care you are legally able to provide for the patient. (98)

Question 2

List three complications that cause a decrease in blood pressure.

Answer 2

Loss of blood or its fluid components

Loss of vascular tone and sufficient arterial constriction to maintain the necessary even without any actual fluid or blood loss

A cardiac pumping problem (388)

Question 3

List three findings that would indicate presumptive signs of death.

Answer 3

Unresponsive to stimuli - No deep tendon or corneal reflexes

Lack of carotid pulse or heartbeat - Absence of pupillary reactivity

Absence of chest rise and fall - Profound cyanosis

No systolic blood pressure - Lowered/decreased body temperature
(95)

Question 4

You arrive on scene to find a patient lying motionless on the ground. What legal provision allows you to assess and treat this patient?

Answer 4

Implied consent (88)

Question 5

What does a blood pressure measure?

Answer 5

The pressure that the blood exerts against the walls of the arteries as it passes through them (410)

Question 6

To prove that an EMT was negligent in providing care there must be:

Answer 6

Duty to act
Breach of duty
Damages
Causation
(101)

Question 7

Police have requested a medical evaluation for a person in custody. You arrive on scene to find a 33-year-old patient who is handcuffed and sitting in the back of the police vehicle. The patient has several bruises on their arms and a small laceration on the forehead. Your assessment reveals the patient is alert and oriented but is refusing any care. How should you proceed with your assessment/treatment of this patient?

Answer 7

Assess the patient for mental status using AEIOU-TIPS. If mental status is ok and treatment is still refused, inform the patient of risks of refusal. If still refusing you must respect the patient’s right to refuse. Document everything in a report (PCR).

Question 8

What are two of the body’s compensatory mechanisms for a drop in blood pressure?

Answer 8

Increased heart rate
Constriction of the arteries (388)

Question 9

While treating a combative 24-year old, your EMT partner is being verbally abusive toward the patient and threatens to punch them if they don’t cooperate. Is this behavior unethical or illegal, if so what laws or ethical codes may have been violated?

Answer 9

It is both unethical and illegal. Ethically it is a breach of professional ethics and threatening the patient with the use of force. Legally this would be considered assault. (102)

Question 10

The diastolic pressure measures:

Answer 10

The residual pressure that remains in the arteries during the relaxing phase of the heart cycle. (388)

Question 11

List two reasons to avoid taking a blood pressure on one of a patient’s arms.

Answer 11

Intravenous site, catheter, or fistula
Injury to the arm
Mastectomy on that side (389)

Question 12

You are dispatched to a scene by a passerby who dialed 9-1-1. Witnesses saw a 15-year-old fall off a skateboard. The patient was not wearing a helmet, has a bruise on the forehead and can’t move their left arm. The patient says, “you can’t touch me and I’m not going to the hospital.”How should you proceed with the management of this emergency scene?

Answer 12

Attempt to contact parents, if you are not able to contact the parent, they can be treated and transported to the hospital under involuntary consent since the patient is a minor and cannot reject treatment.

If the patient is at school, a school official can act in loco parentis, and give legal permission or consent to treat the minor. (88-89)

Question 13

What purpose does HIPAA serve?

Answer 13

To strengthen laws relating to protection of patient privacy and safeguard patients confidentiality (91-92)

(Health Insurance Portability and Accountability Act)

Question 14

You ask a patient if you can check his blood pressure and he extends his arm towards you. What type of consent is being displayed.

Answer 14

Expressed consent (88)

Question 15

You are dispatched to a residence for a patient who is experiencing difficulty breathing. While you are assessing the patient, a family member shows you the patient’s DNR order. The patient is unconscious and showing signs of slow and shallow respirations. How should you proceed with your assessment and/or treatment?

Answer 15

DNR does not mean “do not treat,” even in the presence of a DNR Order. You are still obligated to provide supportive measures (oxygen, pain relief, and comfort) to a patient who is not in cardiac arrest. (94)

Question 16

You’ve been dispatched to a bus stop where you are assessing a mentally challenged adult patient who cannot tell you where they are. There is no caregiver present. The patient appears to be calm but is refusing any care. What is the most effective way to manage this situation? What legal provisions allow you to assess and treat this patient without their consent?

Answer 16

Involuntary consent

The patient is mentally challenged and treatment should continue. If the patient is defiant, police assistance may be necessary. (88)

Question 17

A blood pressure (BP) cuff that is too large may result in reading that is:

Answer 17

Falsely low readings (390)

Question 18

Walmart security guards have requested medical attention for a person they have in custody. You arrive on scene to find a 42 year old patient who is handcuffed and sitting in the back off of the store. The patient has several bruises on her arm and a small laceration on her left leg. Your assessment reveals that she refuses any care. How should you proceed with your assessment / treatment of this patient?

Answer 18

Encourage treatment up to 3 times if permitted

Explain the benefits of getting treatment

Explain potential risk if they do not get treated

Remind them to call 911 if the condition gets worse or they change their mind

Tell them to see a personal physician ASAP

Call medical control

Fill out PCR and refusal of treatment documentation

Try to have a witness there when filling out forms (90)

Question 19

You are assessing a patient who decides that she wants to refuse care. List the three primary requirements that are necessary for someone to refuse medical treatment:

Answer 19

An adult who is conscious, alert, and appears to have decision making capacity have the right to refuse treatment at anytime, even though this person may be ill or injured. (90)

Question 20

The EMT uses what type of consent to treat a patient who is unable to follow simple commands?

Answer 20

Implied consent (88)

Question 21

Determination of negligence is based on what factors?

Answer 21

Duty to act, Breach of Duty, Damages, and Causation (101)

Question 22

A patient is yelling obscenities and threatening violence if you touch him. You begin yelling back and threaten to forcefully drag the patient into the ambulance if he doesn’t comply. Is your behavior illegal or unethical? Have any laws been broken in this exchange? If the answer is yes, list them.

Answer 22

It is both unethical and illegal. Ethically it is a breach of professional ethics and threatening the patient with the use of force. Legally this would be considered assault. (102)

Question 23

You are assessing a mentally challenged adult patient who cannot tell you where they are. There is no caregiver present. The patient appears to be calm but is refusing any care. What legal provision allows you to assess and treat this patient?

Answer 23

Involuntary consent (88)