Workbook Questions Section 1 Flashcards
The correct rate to ventilate a patient suffering an asthmatic respiratory arrest is:
a) 4-6 breaths/min
b) 6-8 breaths/min
c) 8-10 breaths/min
d) 10-12 breaths/min
a) 4-6 breaths/min
A generalised seizure will typically occur in which order of phases:
a) Tonic, Clonic, Aura, Postictal
b) Aura, Clonic, Tonic, Postictal
c) Clonic, Tonic, Postictal, Aura
d) Aura, Tonic, Clonic, Postictal
d) Aura, Tonic, Clonic, Postictal
When applying the Pressure Immobilising Technique (PIT) to a patient’s lower limb after a snake bite, the correct procedure is:
a) Apply the bandage by starting at the upper limb and extend downward covering as much of the limb as possible
b) Apply the bandage by covering the bite site first, then a second bandage starting at the toes and covering as much of the limb as possible
c) Wash the bite site and apply a bandage from the toes up
d) Elevate the patient’s leg before applying a bandage starting at the toes and extend bandage upwards covering as much of the limb as possible
b) Apply the bandage by covering the bite site first, then a second bandage starting at the toes and covering as much of the limb as possible
The correct flow when administering nasal prong oxygen is:
a) 0-2 L/min
b) 1-4 L/min
c) 2-6 L/min
d) 6-10 L/min
b) 1-4 L/min
Which condition is characterised by hyper-reactive airways and inflammation leading to episodic, reversible bronchoconstriction in response to a variety of stimuli?
a) Acute Asthma
b) Emphysema
c) Chronic Bronchitis
d) Airway obstruction
a) Acute Asthma
Agnosia is:
a) An inability to process sensory information
b) An inability to speak or find the correct words
c) An inability to make eye contact with another person
d) An inability to walk in response to a brain injury
a) An inability to process sensory information
What are the FOUR lobes of the brain
- Frontal
- Parietal
- Temporal
- Occipital
Outline one (1) cause for each letter for an unconscious patient using the acronym AEIOUTIPS:
A: Alcohol and/or abuse of substances
E: Environmental, Epilepsy, Electrolytes, Encephalopathy, Endocrine disease
I: Infection
O: Overdose, Oxygen deficiency
U: Underdose, Uraemia
T: Trauma, Tumor
I: Insulin
P: Psychogenic, Poisons
S: Stroke, Shock
In relation to an allergic reaction, which of these statements is true about antibodies?
a) Antibodies cause the release of antigens in response to mast cell and histamine production.
b) Antigens cause the release of antibodies which attach to mast cells and release histamine
c) Histamine neutralises antibodies to minimise the inflammatory response.
d) Antibodies neutralise histamine to minimise the inflammatory response in response to an antigen
b) Antigens cause the release of antibodies which attach to mast cells and release histamine
A syncope is:
a) a loss of consciousness after an impact to a patient’s head
b) a gradual loss of consciousness that occurs without resolve and intervention
c) a sudden loss of consciousness that occurs without resolve and intervention
d) a sudden loss of consciousness that occurs and is commonly caused by a drop in blood pressure and/or reduced heart rate
d) a sudden loss of consciousness that occurs and is commonly caused by a drop in blood pressure and/or reduced heart rate
The endocrine gland that regulates blood glucose levels is the:
a) Adrenal gland
b) Thyroid gland
c) Pancreas
d) Hypothalamus
c) Pancreas
A COPD patient target oxygen saturations are:
a) 94-98%
b) 92-96%
c) 90-94%
d) 88-92%
d) 88-92%
A patient suffering dyspnoea, sharp pin point chest pain, tachycardia and a history of recent long distance travel may indicate which condition?
Pulmonary Embolism
What does the following number sequence tell Comms when you announce them over the radio or acknowledge via pressing the buttons on the AMBICAD – ‘79’ ‘80’ ‘81’ ‘82’?
79 - On scene/arrive
80 - Depart Scene
81 - At Hospital
82 - All Clear
You are attending an adult patient with an audible stridor. What does a stridor indicate in a patient?
Upper airway compromise/obstruction
What is intrinsic and extrinsic asthma, and how may this be triggered in a patient?
Intrinsic: Intrinsic asthma is initiated by diverse non-immune mechanisms.
Trigger: medications (common: aspirin, beta blockers), weather conditions, exercise, infections, stress
Extrinsic: Extrinsic asthma is a type 1 hypersensitivity reaction induced by an extrinsic allergen. IgE-mediated activation of mucosal mast cells results in the release of primary mediators (histamine, eosinophilic and neutrophillic chemotactic factors) and secondary mediators including leukotrienes, prostaglandin D2, platelet-activating factor and cytokines.
Trigger: dust, pollen, mold, pets
What level of asthma is associated with <90% oxygen saturation on room air, cyanosis and poor respiratory effort?
Life-Threatening asthma has symptoms of:
- Reduced consciousness or collapse
- Exhaustion
- Cyanosis
- Oxygen saturation <90%
- Poor respiratory effort, soft/absent breath sounds
What are two additional factors in an asthmatic patient that suggest the need for immediate transport and consideration of time criticality?
- Prior ICU admission
- Prior intubation
- > 3 ED visits in past year
- > 2 hospital admissions in past year
- > 1 bronchodilator canister used in past month
- Use of bronchodilators > every 4 hours
- Chronic use of steroids
- Progressive symptoms in spite of aggressive treatment.
- Patient unable to speak in sentences.
Chronic Obstructive Pulmonary Disease is characterised by chronic obstruction of lung flow. List the two (2) types of COPD and state if these conditions can or cannot be fully reversed:
COPD is primarily affected by chronic Emphysema and chronic Bronchitis
The effects of COPD are often well established and irreversible by the time a diagnosis is made however it can usually be managed effectively in most patients providing they modify their lifestyle and adhere to their prescribed medications.
Explain a CO2 retainer and why this may impact treatment in the pre-hospital environment:
only a small number of patients with COPD can become desensitised to abnormally high levels of carbon dioxide found in the bloodstream caused by poor lung function. Where this occurs, low oxygen levels, rather than high carbon dioxide levels, become the stimulus to breathe.
In COPD patients with low oxygen saturations it is important to still provide supplemental oxygen aiming for saturations of 88-92%.
Explain the three (3) manoeuvres performed when administering a triple airway manoeuvre:
Head Tilt: Use both hands on side of head to tilt head backwards.
Jaw Thrust: Place manual pressure at the angle of the mandible (jaw); lift the jaw anteriorly. This will lift the tongue and minimise obstruction to the airway.
Open Mouth: Utilise both thumb tips to push the chin forwards to open the mouth and visualise the oropharynx.
List the anatomical landmarks for measurement of the following equipment:
a) Oropharyngeal Airway –
b) Nasopharyngeal Airway -
c) Flexible Suction Catheter
OPA:
centre of the lips to the angle of the mandible
NPA:
corner of the nose to the end of the earlobe
Catheter:
Measure maximum length of the catheter to be inserted into the patient’s mouth by measuring the distance from the corner of the nostril of the patient to the earlobe. Hold the catheter with thumb and index finger at the length measured.
List the contraindications for the administration of a nasopharyngeal airway:
- Significant nasal or mid-facial trauma.
- Epistaxis
You are attending a patient who is suspected of having an opiate overdose. What would be your findings be for:
Pupils
Respiratory Rate
Constricted pupils
Respiratory depression
As Stroke / Cerebro-vascular accident CPG, which hospitals have an acute stroke centre?
- Sir Charles Gardener Hospital
- Fiona Stanley Hospital
- Royal Perth Hospital
- St. John of god - Midland
- Joondalup Health Campus
What is the Rapid Arterial Occlusion Evaluation (RACE) score required for a patient to be transported to the Neuroendovascular Unit under priority 1 conditions?
FAST+ and RACE >5
What is the maximum score you can receive on the RACE score for stroke assessment? Differentiate between the Perth metro hospitals based on patients
Maximum score is 9/11
Sir charles Gardener Hospital:
- Monday - Sunday, 24hrs a day
Fiona Stanley Hospital:
- Monday - Friday 08:00 - 16:00
- Arrival to ED must be within prescribed times
What is the difference between a TIA and a CVA? Describe the causes, pathophysiology, assessment and management.
CVA and TIA both occur when the blood supply to the brain is interrupted. The difference occurs in the definition of the timing; a stroke produces symptoms that last for at least 24 hours, whereas symptoms produced by a TIA are trasient (less than 24 hours), usually resolving fully within 30 minutes.
Explain the differences in the two main types of stroke:
Iscaemic stroke (85%) Haemorrhagic stroke (15%)
What are the FOUR primary lobes of the brain
Frontal
Occipital
Parietal
Temporal
What are the blood glucose readings you would expect for a patient with:
a) Normal range:
b) Hypoglycaemia:
c) Hyperglycaemia:
a) : 4-8mmol
b) : <4mmol
c) : >16mmol
You are responding to a patient who has kussmal respirations, acetone breath, polyuria, altered conscious state, nausea and vomiting. What condition would you expect this patient to be suffering?
Hyperglycaemia
An acute onset of swelling of the tongue, difficulty breathing, gastrointestinal discomfort and hypotension are signs of:
Anaphylaxis
Define hypoxia
A lower-than-normal concentration of oxygen in arterial blood,
Which toxic gas can be found in motor vehicle fumes?
Describe the signs and symptoms of this poisoning
Carbon Monoxide
- The cherry pink skin colour is rare, and usually after death.
Note: Carbon monoxide binds to haemoglobins, displacing oxygen molecules. Pulse oximeters reads the percent of haemoglobin bound but not necessarily by oxygen; SpO2 is likely to be inaccurate in case of carbon monoxide poisoning.
Which two hormones are responsible for regulation of blood glucose levels and which organ are they secreted from?
Glucagon and Insulin are released from the pancreas
What are the differences between type 1 diabetes and type 2 diabetes?
Type 1:
- an auto immune condition in which the immune system is activated to destroy the cells in the pancreas which produce insulin (beta cells)
- not linked to lifestyle factors, represents around 10% of all cases of diabetes.
Type 2:
- Insulin becomes increasingly ineffective at managing BGL. As a result of insulin resistance, the pancreas responds by producing greater and greater amounts of insulin.
- As insulin overproduction occurs over a long period of time, the insulin producing cells in the pancreas wear themselves out
Which medication regime would you consider using for a patient with the following signs and symptoms?
- Speaking in single words, fighting to breathe, RR >20, silent chest with some expiratory wheezing, GCS 12
- Speaking in short sentances, RR >20, loud expiratory wheeze with mild inspiratory wheeze, GCS 15.
- Adrenaline 500mcg IM
- Salbutamol 5g nebulised
What are the indications for Glucagon as per Glucagon CPG?
- Demonstrated hypoglycaemia where oral glucose cannot be administerred and IV access cannot be obtained in a safe and timely manner
- Altered Conscious State in a known diabetic or of otherwise unknown cause where BGL is below 4mmol/L
You are attending a patient who requires Midazolam. Complete the following:
Presentation:
A water-soluble ________________ that has anxiolytic, ____________ and ______________ characteristics
Presentation:
15mg/3mL vial
Description:
A water-soluable BENZODIAZEPINE that has anxiolytic, SEDATIVE and ANTICONVULSIVE characteristics.
Midazolam indications and contraindications
Indications:
- Prolonged seizure activity - generalised seizure lasting >5 mins or recurrent/status elepticus
- Focal seizure activity >5 min and associated GCS <12
- Disturbed and/or abnormal behaviour that poses a threat to others or themselves.
Explain why Naloxone is used in opioid overdose
Naloxone is a pure opiod antagonist that exerts its effect by competitive inhibition at the opioid receptor sites. It prevents or reverses the effects of opioids, including respiratory depression, sedation and hypotension. In the absence of opioids it exhibits essentially no pharmacological activity.
Describe the presentation, indications and contraindications of Ipratropium Bromide
Presentation:
- An anticholinergic bronchodilator. It inhibits the vagal reflexes that mediate bronchospasm
Indications:
- Severe to life threatening asthma or COPD in ADULTS
- Severe to life threatening asthma in PAEDIATRICS
Contraindications:
- Hypersensitivity
What could be a potential complication of administering Glucose Oral Gel to a patient with a severely altered conscious state?
Airway obstruction
What is a pheochromocytoma?
A pheochromocytoma is a rare, usually noncancerous (benign) tumor that develops in an adrenal gland. You have two adrenal glands —one located at the top of each kidney. Usually, a pheochromocytoma develops in only one adrenal gland. But tumors can develop in both.
Glucagon for Injection is contraindicated in patients with pheochromocytoma because glucagon may stimulate the release of catecholamines from the tumor, which may result in a sudden and marked increase in blood pressure.
