Workbook Questions Section 1

Question 1

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

Answer 1

a) 4-6 breaths/min

Question 2

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

Answer 2

d) Aura, Tonic, Clonic, Postictal

Question 3

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

Answer 3

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

Question 4

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

Answer 4

b) 1-4 L/min

Question 5

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

Answer 5

a) Acute Asthma

Question 6

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

Answer 6

a) An inability to process sensory information

Question 7

What are the FOUR lobes of the brain

Answer 7

1. Frontal
2. Parietal
3. Temporal
4. Occipital

Question 8

Outline one (1) cause for each letter for an unconscious patient using the acronym AEIOUTIPS:

Answer 8

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

Question 9

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

Answer 9

b) Antigens cause the release of antibodies which attach to mast cells and release histamine

Question 10

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

Answer 10

d) a sudden loss of consciousness that occurs and is commonly caused by a drop in blood pressure and/or reduced heart rate

Question 11

The endocrine gland that regulates blood glucose levels is the:

a) Adrenal gland
b) Thyroid gland
c) Pancreas
d) Hypothalamus

Answer 11

c) Pancreas

Question 12

A COPD patient target oxygen saturations are:

a) 94-98%
b) 92-96%
c) 90-94%
d) 88-92%

Answer 12

d) 88-92%

Question 13

A patient suffering dyspnoea, sharp pin point chest pain, tachycardia and a history of recent long distance travel may indicate which condition?

Answer 13

Pulmonary Embolism

Question 14

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’?

Answer 14

79 - On scene/arrive
80 - Depart Scene
81 - At Hospital
82 - All Clear

Question 15

You are attending an adult patient with an audible stridor. What does a stridor indicate in a patient?

Answer 15

Upper airway compromise/obstruction

Question 16

What is intrinsic and extrinsic asthma, and how may this be triggered in a patient?

Answer 16

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

Question 17

What level of asthma is associated with <90% oxygen saturation on room air, cyanosis and poor respiratory effort?

Answer 17

Life-Threatening asthma has symptoms of:

• Reduced consciousness or collapse
• Exhaustion
• Cyanosis
• Oxygen saturation <90%
• Poor respiratory effort, soft/absent breath sounds

Question 18

What are two additional factors in an asthmatic patient that suggest the need for immediate transport and consideration of time criticality?

Answer 18

• 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.

Question 19

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:

Answer 19

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.

Question 20

Explain a CO2 retainer and why this may impact treatment in the pre-hospital environment:

Answer 20

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%.

Question 21

Explain the three (3) manoeuvres performed when administering a triple airway manoeuvre:

Answer 21

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.

Question 22

List the anatomical landmarks for measurement of the following equipment:

a) Oropharyngeal Airway –
b) Nasopharyngeal Airway -
c) Flexible Suction Catheter

Answer 22

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.

Question 23

List the contraindications for the administration of a nasopharyngeal airway:

Answer 23

• Significant nasal or mid-facial trauma.

- Epistaxis

Question 24

You are attending a patient who is suspected of having an opiate overdose. What would be your findings be for:

Pupils
Respiratory Rate

Answer 24

Constricted pupils

Respiratory depression

Question 25

As Stroke / Cerebro-vascular accident CPG, which hospitals have an acute stroke centre?

Answer 25

• Sir Charles Gardener Hospital
• Fiona Stanley Hospital
• Royal Perth Hospital
• St. John of god - Midland
• Joondalup Health Campus

Question 26

What is the Rapid Arterial Occlusion Evaluation (RACE) score required for a patient to be transported to the Neuroendovascular Unit under priority 1 conditions?

Answer 26

FAST+ and RACE >5

Question 27

What is the maximum score you can receive on the RACE score for stroke assessment? Differentiate between the Perth metro hospitals based on patients

Answer 27

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

Question 28

What is the difference between a TIA and a CVA? Describe the causes, pathophysiology, assessment and management.

Answer 28

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.

Question 29

Explain the differences in the two main types of stroke:

Answer 29

Iscaemic stroke (85%)
Haemorrhagic stroke (15%)

Question 30

What are the FOUR primary lobes of the brain

Answer 30

Frontal
Occipital
Parietal
Temporal

Question 31

What are the blood glucose readings you would expect for a patient with:

a) Normal range:
b) Hypoglycaemia:
c) Hyperglycaemia:

Answer 31

a) : 4-8mmol
b) : <4mmol
c) : >16mmol

Question 32

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?

Answer 32

Hyperglycaemia

Question 33

An acute onset of swelling of the tongue, difficulty breathing, gastrointestinal discomfort and hypotension are signs of:

Answer 33

Anaphylaxis

Question 34

Define hypoxia

Answer 34

A lower-than-normal concentration of oxygen in arterial blood,

Question 35

Which toxic gas can be found in motor vehicle fumes?

Describe the signs and symptoms of this poisoning

Answer 35

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.

Question 36

Which two hormones are responsible for regulation of blood glucose levels and which organ are they secreted from?

Answer 36

Glucagon and Insulin are released from the pancreas

Question 37

What are the differences between type 1 diabetes and type 2 diabetes?

Answer 37

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

Question 38

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.

Answer 38

• Adrenaline 500mcg IM

- Salbutamol 5g nebulised

Question 39

What are the indications for Glucagon as per Glucagon CPG?

Answer 39

• 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

Question 40

You are attending a patient who requires Midazolam. Complete the following:
Presentation:

A water-soluble ________________ that has anxiolytic, ____________ and ______________ characteristics

Answer 40

Presentation:
15mg/3mL vial

Description:
A water-soluable BENZODIAZEPINE that has anxiolytic, SEDATIVE and ANTICONVULSIVE characteristics.

Question 41

Midazolam indications and contraindications

Answer 41

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.

Question 42

Explain why Naloxone is used in opioid overdose

Answer 42

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.

Question 43

Describe the presentation, indications and contraindications of Ipratropium Bromide

Answer 43

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

Question 44

What could be a potential complication of administering Glucose Oral Gel to a patient with a severely altered conscious state?

Answer 44

Airway obstruction

Question 45

What is a pheochromocytoma?

Answer 45

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.