exam Flashcards
What physiological changes could cause hypotension in a burned child?
- Increased capillary permeability from thermal injury
- Serum leakage through permeable capillaries into the burn area
- Decreased stroke volume due to decreased venous return
Factors which influence the severity, subsequent complications, and prognosis of the burn patient include:
- Involvement of hands, face, feet, or perineum
- Circumferential burns
- Concomitant/associated injury
Electrical burns from a high voltage source:
May produce life-threatening cardiac arrhythmias.
May initially reveal little damage.
May coagulate tissue along path of the current.
May produce closed fractures.
A 40 y/o man has sustained 2nd and 3rd degree burns to the anterior and posterior surfaces of both arms and one leg, as well as his entire back. Percentage of body area involved is:
54%
The majority of deaths during fires are related to:
smoke inhalation
In the pathology of thermal burns, which of the following statements are correct?
Release of myocardial depressant decreases cardiac output.
Vasodilation contributes to relative hypovolemia.
Hemolysis leading to anemia.
Increased capillary permeability leads to intravascular fluid loss.
Damage to tissue from a frostbite results from:
Rupture of cell walls as water forms ice crystals which expand.
Vasoconstriction of local blood vessels leading to ischemia and necrosis.
Which of the following statements on altitude sickness are true?
The incidence, severity, and duration is proportional to the rate and height of ascent.
Persistent hypoxia and resulting polycythemia may lead to a hematocrit above 60%.
A 3 y/o, 16 kg child has been abused, as he was placed in scalding a hot bath. Both his legs were completely affected with deep 2nd degree burns. Fluid therapy was initiated with a 20 gtt/ml solution set. What is the initial drip rate?
40 gtt/min
After 20 hours a total of 1.5 liter has been delivered to the above child. Making the appropriate adjustments what is the new drip rate?
35 gtt/min
Using the burn formula calculate the fluid replacement during the first hour for an 80 kg. patient who has 20% second and third degree burns covering his body.
400 ml.
After 8 hours your 80 kg. Patient with the 20% burns has received only 2000 ml. Your adjustment at this point to provide the appropriate infusion rate using a 10 gtt/ml solution set is:
45 gtt./min
Which of the following physiological responses is the most significant in heat stroke?
There is a disturbance in heat-regulating mechanisms.
In the profoundly hypothermic patient an acid-base imbalance develops, which is:
Metabolic acidosis with respiratory acidosis.
What is the primary danger of nitrogen narcosis?
Impaired judgment
High altitude illness is a result of which of the following principles at work?
Dalton’s law
One of the goals of taking prophylactic drugs during extreme altitude climbs is to prevent HAPE. A dangerous side effect of these drugs is:
Dehydration
What is the appropriate management of decompression sickness and arterial gas embolism:
Transport patient supine or Trendelenburg with patient in left lateral position
Air ambulance is recommended if patient requires hyperbaric therapy and the transport time can be reduced
Agitation, restlessness, confusion, syncope, and staggering gait represents a ______ saturation with carbon monoxide.
30%
Which law of physics states that the volume of gas is related inversely to its pressure at a constant temperature?
Boyle’s law
You are called to the scene of a diver who has a pressure disorder after a rapid ascent. Regardless of the type of pressure disorder, you should assess the patient for which condition?
Pneumothorax
Decompression sickness commonly occurs in divers who are diving below what level?
33 feet
A diving injury commonly called “the squeeze” occurs during which phase of diving?
Descent
You and your partner are treating a drowning patient who had a submersion time of 10 minutes. Your partner wants to perform the abdominal thrusts; you should:
Advise your partner that the Heimlich maneuver should not be used for drowning victims.
A reflex that occurs when a person dives into cold water in which his breathing is inhibited, his heart rate becomes bradycardic, and vasoconstriction occurs is known as the:
Mammalian diving reflex
The type of electricity supplied to homes is ________ current. Contact with this type of current may result in ________.
Alternating; muscle immobilization
Which of the following is TRUE of the heat generated when electricity flows through the body?
Dry skin offers more resistance to electricity, generating more heat
A victim of near-drowning is successfully rescued. He states he does not wish to go to hospital. Paramedics counsel the patient to seek follow up assessment because:
Pulmonary edema, if water was aspirated, may develop over time.
All drownings are characterized by:
Hypoxia, acidosis, and hypercapnia
A diver is in respiratory distress after an ascent. You palpate subcutaneous emphysema. She is probably suffering from:
Pulmonary over-pressurization syndrome
Which of the following are s/s associated with decompression sickness?
Stabbing pains in the limbs
Burning pain in the chest
Paresthesia and paralysis
Itching sensation in the skin
When confronted with a naked (or partially clothed) unconscious (or confused) patient with perforated eardrums and a fern-like burn pattern on his body, you should think:
Lightning “flashover” phenomenon
All of the following are signs of mild hypothermia EXCEPT:
Vasodilation.
Which of the following is a predisposing factor to hypothermia?
All of the above are predisposing factors.
Which diagnostic test is important to include in the assessment of patients with a heat-or cold-related emergency?
Electrocardiogram
Contact with strong alkalis results in burns involving ________ necrosis of the tissue.
Liquefaction
You are caring for a patient with 30 percent full and partial thickness burns. He is an 80 kg man. According to the Parkland formula, he should receive ________ liters of fluid over 24hours, with ________ liters infused in the first 8 hours.
9.6; 4.8
Which of the following accounts for the most severe thermal burns of the airway?
Inhalation of superheated steam
The first step for treating a patient who has been contaminated with dry lime is to:
Brush away as much of the powder as possible.
Your patient is a 15-year-old soccer player who was kicked in the calf by another player. She has a contusion on her calf, but the amount of pain she is experiencing seems out of proportion to the apparent injury. You note that although you can palpate a pedal pulse, there is swelling in the foot and ankle, and the skin is cool to the touch.You should suspect which of the following at this time?
Compartment syndrome
The tough, fibrous sheaths that bundle skeletal muscle are called:
Fascia
Which of the following concerning a compartment syndrome are true?
Capillary blood flow with the fascia is restricted
Pressure compresses and damages nerves
Pain results on passive extension
Pulse deficit is a late sign of compartment syndrome
Which of the following assessment findings would lead you to suspect that your patient’s hands are deeply frostbitten? They are:
White, wax-like, cold and firm to the touch.
Which of the following abdominal organs is the LEAST affected by the pressure wave associated with penetrating trauma?
Bowel
The criteria included in most basic tools for early detection of systemic inflammatory response syndrome (SIRS) are:
Heart rate, temperature, respiratory rate, and white blood cell count
Your patient is a 30-year-old woman with a stab wound to the neck. She is sitting up and appears very anxious and short of breath. Minimal external bleeding is noted, but there is bubbling from the wound. Which of the following should you suspect, based on the mechanism of injury and assessment findings?
Laceration of the trachea
Which of the following guidelines applies to the prehospital administration of IV fluids in the patient with hemorrhagic shock?
Administer isotonic crystalloid fluids only as necessary to maintain perfusion.
Your patient is a 31-year-old female complaining of dizziness and difficulty breathing after being stung by a bee. You note that she is extremely anxious, and your physical examination reveals a rapidly developing urticaria to her shoulders, neck, and face. Your partner has administered oxygen via a nonrebreather, initiated IV access, placed the patient on the cardiac monitor, and administered epinephrine SC and diphenhydramine IV. Despite this, you also note that her voice is quickly becoming more hoarse and she has developed expiratory wheezes in all lung fields. HR = 128, BP = 100/70, RR = 20, SaO2 = 99%. What should be your major concern at this point, and what is the most appropriate treatment?
Laryngeal edema leading to total airway occlusion; consider intubation
What is the mechanism of TXA?
Antifibrinolytic
Your patient is a 38-year-old man who was pinned beneath the frame of a vehicle when it slipped off the makeshift jacks he was using to elevate it. The patient’s brother thinks he may have been trapped for up to 20 minutes. The rescue unit is preparing to use airbags to lift the vehicle off the patient. Which of the following medications could you consider giving this patient?
Sodium bicarbonate
You have arrived on the scene of a woman who was shot. The scene has since been secured. Your patient is a 38-year-old woman with one gunshot wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and difficulty breathing. The fire department has applied oxygen by nonrebreather mask and placed an occlusive dressing over the entry wound before your arrival. As you continue your assessment, the patient’s level of consciousness decreases. She responds to verbal stimuli. Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side. The patient lacks a radial pulse, and her abdomen is non-guarded and non-tender. Which of the following best explains the presentation of this patient?
Hemothorax
For the above patient, which of the following should you do first?
Assist ventilations with a bag-valve-mask device.
Which of the following is a complication of positive-pressure ventilation in the patient with significant chest trauma?
Impaired venous return to the heart
The location of the neurovascular bundles containing the intercostal arteries is best described as the bundle that runs along the:
Lower rib margin of the associated rib.
The morbidity associated with simple pneumothorax is primarily due to which of the following?
Ventilation/perfusion mismatch
The location of the neurovascular bundles containing the intercostal arteries is best described as the bundle that runs along the:
Lower rib margin of the associated rib.
What method of controlling hemorrhage should be done as a last resort?
Tourniquet
You are treating a patient you suspect may be suffering from septic shock. You should consider fluid and pressor therapy to maintain a mean arterial pressure (MAP) of:
Above 60 mmHg.
Following exposure to an allergen in which IgE antibodies are released, mast cells degranulate, releasing:
Histamine.
Your partner experiences an itchy, red rash on her hands that stops at the wrists after using a new brand of glove your service purchased. Her skin is warm, dry, and nondiaphoretic; the rash is isolated to her hands; and her lung sounds are clear bilaterally. She has no other complaints. HR = 88, RR = 12, BP = 122/80. Of the following treatments, which is most appropriate?
Diphenhydramine IM
Your patient is a 43-year-old female with a history of peanut allergy. She is complaining of dizziness after eating a casserole that she later discovered contained peanuts. Your physical examination reveals warm, diaphoretic skin; a blotchy, red rash covering her chest and arms; and lung sounds that are clear and equal bilaterally. HR = 122, BP = 124/76, RR = 15 and regular, SaO2 = 97%. In addition to providing oxygen, appropriate treatment for this patient includes:
IV with normal saline, epinephrine 1:1000 IM, diphenhydramine IV
Shock, sepsis, and multiorgan dysfunction syndrome (MODS) share which of the following common denominators?
Cellular function
The ability of the body’s tissues to extract and use oxygen that is bound to hemoglobin is reflected by which of the following values?
SvO2
Which of the following statements regarding septic shock is true?
Much of the cardiac decompensation is reversible.
In response to fever, the patient’s metabolic needs will:
Increase
The criteria included in most basic tools for early detection of systemic inflammatory response syndrome (SIRS) are:
Heart rate, temperature, respiratory rate, and white blood cell count.
You have arrived on the scene of a woman who was shot at her residence. The scene has since been secured. Your patient is a 38-year-old woman with one gunshot wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and difficulty breathing. Fire has applied oxygen by nonrebreather mask and placed an occlusive dressing over the entry wound before your arrival. As you continue your assessment, the patient’s level of consciousness decreases. She responds to verbal stimuli. Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side. The patient lacks a radial pulse, and her abdomen is non-guarded and non-tender. Which of the following best explains the presentation of this patient?
Hemothorax
You are treating a patient you suspect may be suffering from septic shock. You should consider fluid and pressor therapy to maintain a mean arterial pressure (MAP) of:
above 60 mmHg.
Your patient is a 43-year-old female with a history of peanut allergy. She is complaining of dizziness after eating a casserole that she later discovered contained peanuts. Your physical examination reveals warm, diaphoretic skin; a blotchy, red rash covering her chest and arms; and lung sounds that are clear and equal bilaterally. HR = 122, BP = 124/76, RR = 15 and regular, SaO2= 97%. In addition to providing oxygen, appropriate treatment for this patient includes:
IV with crystalloid solution such as lactated Ringer’s or normal saline, epinephrine 1:1000 SC, diphenhydramine IV.
Which of the following is NOT an effect of hypothermia on trauma patients?
An increase in platelet function
Common signs and symptoms seen in tension pneumothorax include:
Dyspnea, diminished or absent breath sounds, and anxiety.
During the formation of the general impression of your trauma patient, what does the first “C” in C-A-B-C stand for?
Control bleeding
If bleeding is not adequately controlled with pressure, what should be done immediately?
Apply a tourniquet
What is the appropriate treatment regimen for a suspected tension pneumothorax?
Ventilation, needle decompression, IV fluids to manage hypotension
Where could serious bleeding take place in the abdomen, but not produce distension?
Retroperitoneal abdomen
Why do one-third of all patients with pelvic fractures have associated intra-abdominal injuries?
The very significant force required for damage
All the following are complications of hypothermia in the trauma patient EXCEPT:
Reduction in blood loss.
Sensitization in hypersensitivity reactions is best described as:
The repeated exposure to an allergen and consequent production of antibodies.
Which of the following statements concerning anaphylaxis are true?
A quicker onset of signs and symptoms, risks a more severe the reaction.
Laryngeal edema is a leading cause of death secondary to anaphylaxis.
During anaphylaxis degranulation of which WBCs predominate?
Basophiles
Which sign associated with an allergic reaction should concern a caregiver the most?
Wheezing
Your patient is a conscious and alert 22-year-old female who was stung by a hornet. She states that she has “allergies to bee stings” and has been told that she could die if stung. Your physical examination reveals a 1-cm-diameter, red, edematous area where she was stung on the left forearm. Her skin is warm and dry, and her lung sounds are clear and equal bilaterally. HR = 12 and regular, BP = 122/82, RR = 12 and regular, SaO2 = 98%. The most appropriate treatment for this patient would include:
IV as soon as possible with a crystalloid solution.
Diphenhydramine is administered in anaphylaxis because it:
Produces all of the above.
Your patient is a 31-year-old female complaining of dizziness and difficulty breathing after being stung by a bee. You note that she is extremely anxious, and your physical examination reveals a rapidly developing urticaria to her shoulders, neck, and face. Your partner has administered oxygen, initiated IV access, placed the patient on the cardiac monitor, and administered epinephrine SC and diphenhydramine IV. Despite this, you also note that her voice is quickly becoming more hoarse and she has developed expiratory wheezes in all lung fields. HR = 128, BP = 100/70, RR = 20, SaO2 = 99%. What should be your major concern at this point, and what is the most appropriate treatment?
Laryngeal edema leading to total airway occlusion; intubate
