7 - Shock / BLS Resuscitation / Medical Overview

Question 1

Adequate perfusion performs two vital tasks, what are these tasks?

Answer 1

Maintain normal organ function through pushing fluids through the body

Transport CO2 out of the body

Question 2

List two devices that can be used to improve CPR.

Answer 2

(ITD) - Impedence Threshold Device

(LBD) - Load Distributing Band

Question 3

While assessing an unconscious patient, list two ways to determine the patient’s medical history?

Answer 3

Checking for medical alert bracelets or identification with relevant information

Interview family or bystanders present at the scene

Question 4

What three conditions may result in obstructive shock?

Answer 4

Cardiac Tamponade - leak in pericardial sack that compresses heart

Tension pneumothorax - air enters pleural space and cannot escape, collapses lung

Pulmonary embolism - blockage in pulmonary artery, obstructs blood flow to lungs or to the heart

Question 5

What is afterload?

High afterload is often that heart failure develops in patients with what medical condition?

Answer 5

Amount of blood left in the arteries that the heart works against during systolic phase.

Hypertension

Aortic Stenosis

Question 6

You are treating a 4-year-old patient who is unresponsive and breathing at a rate of 8 breaths/minute. There is cyanosis present in the face, with the heart rate of 46. What is the MOST effective treatment for this patient?

Answer 6

Alert ALS, maintain clear open airway, provide O2 with BVM, monitor vitals, rapid transport to pediatric hospital

Question 7

The most common endocrine emergencies are from complications of what chronic disease?

Answer 7

Diabetes

Question 8

How does septic shock occur? Briefly explain how sepsis causes shock.

Answer 8

Toxins damage the vessel walls and begin to leak. Plasma loss through injured vessel walls, results in shock

(Pneumonia , UTI )

Question 9

List two types of medical, neurological emergencies

Answer 9

Stroke
Seizure
Cerebral aneurysm

Question 10

Which bacterium is believed to be transmitted from patient to patient via unwashed hands of health care providers?

Answer 10

MRSA

Question 11

While reassessing a 53-year-old, you notice the patient has deteriorated into cardiogenic shock and during your assessment, you auscultate crackles bilaterally. What is this finding called? Explain what is causing this finding.

Answer 11

Rales aka crackles, caused by pulmonary edema

Pulmonary edema , caused by CHF progressing which leads to cardiogenic shock also pulmonary edema (crackles bilaterally).

Question 12

What two organs typically become hypoperfused first when a patient goes into shock?

Answer 12

Skin

Kidneys

Gastrointestinal tract

Question 13

When would it be appropriate to perform a focused exam, instead of a head-to-toe exam, on a patient suffering from a traumatic injury?

Answer 13

During the secondary assessment

Question 14

What two complications of anaphylaxis are life-threatening for patients?

Answer 14

Respiratory Arrest

Cardiac Arrest

Question 15

A 45-year old patient presents with agitation, a HR of 110, BP of 114/80 and cool, pale skin signs. What stage of shock is this patient exhibiting?

Answer 15

Compensated Shock

Question 16

A 13-year old is complaining of a fever, headache and a stiff neck. Your secondary assessment reveals red blotches in the skin. You should suspect this patient is suffering from what condition? You should take what immediate action?

Answer 16

Meningitis

Put on N95 respirator

Place surgical mask on patient

Rapid transport to hospital with an infectious disease department

Question 17

What is usually the first measurable sign that a patient has progressed into decompensated shock?

Answer 17

Falling blood pressure (systolic of 90 mmHg or lower with adults)

Question 18

All strains of influenza are transmitted by:

Answer 18

Direct contact with nasal secretions and aerosolized droplets

Question 19

List two characteristic signs of neurogenic shock that are not found in other forms of shock.

Answer 19

Normal to low HR despite hypotension

No sweating below injury

(538)

Question 20

What is the action of epinephrine as it relates to anaphylactic shock?

Answer 20

Bronchodilation - relaxes muscles for better airflow

Vasoconstriction - vessels constrict, increased blood flow

Question 21

Explain why a patient suffering from neurogenic shock does not present with the characteristic pale, cool skin.

Answer 21

The brain and spine are not able to send signals to the body below the level of trauma.

This is the only type of shock that presents without characteristic pale, cool skin, because the peripheral vasoconstriction cannot be triggered through the autonomic nervous system.

Question 22

While treating a patient for neurogenic shock, your primary assessment should be focused on:

Answer 22

Circulation

Question 23

What are the three basic causes of shock?

Answer 23

Pump failure (heart)
Poor vessel function (pipes)
Low blood volume (fluid)

• Perfusion Triangle

(533)

Question 24

A 32-year-old patient presents with an altered mental status. His RR is 28, HR is 114, BP is 108/82 and SPO2 is 93% and pale, cool, clammy skin. What stage of shock is this patient exhibiting?

Answer 24

Compensated shock

S/S: AMS, pale, cool, clammy skin, change in BP

Question 25

List all of the types of shock that would result from the pump failing.

Answer 25

Cardiogenic shock
Obstructive shock ,
Cardiac tamponade,
Tension pneumothorax,
Pulmonary embolism

(534-7)

Question 26

List two kinds of urologic emergencies.

Answer 26

Kidney stones, UTI

Question 27

You are assessing an altered patient with pale skin. This skin is most commonly an indication of:

Answer 27

Poor circulation or loss of fluid

Question 28

What two factors have a direct impact on cardiac output?

Answer 28

Heart rate: Number of times your heart beats in one minute

Stroke volume: volume of blood pumped out of the heart’s left ventricle during each systolic cardiac contraction

Equation: SV * HR = Cardiac Output

Question 29

Which of the four types of shock are classified as distributive shock?

Answer 29

Septic shock
Neurogenic shock
Anaphylactic shock Psychogenic shock

(537)

Question 30

List two situations where CPR should not be initiated.

(Do not write patient with pulse)

Answer 30

If the scene is not safe

If the patient has obvious signs of death. (i.e Rigor mortis , dependent lividity)

DNR order or no-CPR order

(584)

Question 31

List two situations that would require an EMT to perform a detailed exam, instead of a focused exam, on a patient who has a medical emergency?

Answer 31

If there is suspected trauma. Based off of their chief complaint.

Question 32

You are treating a patient who was struck in the chest with a metal pipe. His RR is 28, HR 94, BP 104/82, and SpO2 is 90%. Upon reassessment you notice JVD and the patient now has a RR 32, HR 98, BP 92/86 and SpO2 is 90%. What is your working diagnosis for this patient?

Answer 32

Cardiac tamponade

Question 33

How is pertussis transmitted? What age group is mostly affected by pertussis?

Answer 33

Pertussis is airborne mostly affecting children age 6 and younger

Question 34

You are treating a patient who you suspect may have an infectious disease. How should the assessment of this patient be approached?

Answer 34

Assess them as any other patient

Question 35

Briefly explain how septic shock results in hypoperfusion.

Answer 35

Plasma leaks from vessels, a buildup of fluid in the alveoli resulting in hypo-perfusion

Question 36

MRSA is believed to be transferred by what means?

Answer 36

Through direct contact with healthcare providers

Question 37

Regardless of the type of shock, what treatments should be initiated in patients suffering from hypoperfusion?

Answer 37

SOBER- (supine, oxygen, blanket, external bleeding, rapid transport)

Question 38

After delivering a shock to a pulseless patient you notice that the patient now has agonal breathing at 4 breaths/minute. The patient now has a weak radial pulse, which translates to a systolic BP of what reading? Outline your treatment for this patient?

Answer 38

Systolic BP 40

Continue CPR & assisted ventilations

Question 39

List three diseases an EMT may be at risk of contracting while on duty.

Answer 39

Influenza, hepatitis, HIV, meningitis