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EMS Quiz

By Heather MacKenzie-Carey

It is 7:00 a.m. You have just stepped into the shower and applied the shampoo when through the splash of water you hear your pager going off. After stubbing your toe on the shower door and throwing on a now wet and extremely uncomfortable uniform, you discover you are to respond to the senior citizens apartment complex for an elderly female who is “not responding”.

The caretaker, who states the patient's husband phoned his daughter when he awoke and found his wife still in bed, not responding, meets you at the outside apartment doors. The patient’s daughter then phoned 9-1-1 and the caretaker. The caretaker saw you circling the building a few times looking for the number and came down to wave you in. At the apartment you are met by an elderly gentleman who directs you towards the bedroom. He informs you he awoke this morning and found his wife seemingly awake but unable to move or communicate. He appears very concerned and anxious.

Your patient is a 77-year-old female found supine in bed. Her eyes are open and she looks at you as you enter the room but does not speak or turn her head. Your primary survey reveals gurgling respirations but she is breathing at a good depth and rate. Her carotid and radial pulses are present but slightly irregular. There is no J.V.D. Lung sounds are clear and present throughout. There are no signs of trauma to her head, chest, abdomen or extremities. The abdomen is non-rigid, non-tender and non-distended. No incontinence is noted and no edema is found. In response to your commands you find her handgrips are weak but present on the right side and absent on the left. Plantar flexion extension is present but weak on the right side and absent on the left. You observe drool around the mouth and obvious left-sided facial drooping. Your note the pupils are unequal.

The patient’s husband reports his wife was feeling fine last evening. She usually gets up before him and has a light breakfast. It appears she got up this morning, had toast and some tea and then returned to bed. To return to bed is unusual for her. When he awoke that morning he found her as she now appears. He immediately phoned his daughter. She felt an ambulance should be called. He did not know the number and requested she do it for him. An hour has now passed since he first found his wife in her present condition.

He reports his wife has a history of high blood pressure and glaucoma. He reports no other medical problems. Her blood pressure is well controlled with medication. He brings you her pill bottle. The label indicates: Aldomet 250mg P.O.t.i.d. He believes she is also on another medication, which he calls a water pill but he is unable to find it. The patient’s husband claims she takes her medications regularly. She has no known allergies.

Vitals

Pulse	100 slightly irregular
Blood pressure	200/130
Respiration	18 gurgling respirations
Skin	warm, pale, dry
Pupil Response	R@5 mm & sluggish,
Pupil Response	L@ 3 responds appropriately
Chemstrip	l4mmol/L
E.C.G.

Basic Level Questions

1.This patient’s tentative diagnosis is:

2.This patient’s Glasgow Coma Score is:

3.This patient’s level of consciousness should be described as:

4.This patient’s unequal pupils indicate:

5.In a B.L.S. system this patient would be considered a stay and stabilize patient.

6.The use of oxygen for this patient:

7.Airway maneuvers for this patient should include:

8.For transport, this patient should be positioned:

9. Your history taking of this patient should:

10.The label on the patient’s pill bottle indicates the medication should be taken in a dosage of:

11.The area of the brain most likely damaged in this patient is the:

12.Most cerebrovascular accidents develop slowly, over a period of 24 hours or more.

13.Predisposing factors to stroke include:

14.T.l.A.’s are:

15.Hypertension is considered a consistent blood pressure in an adult:

Advanced Level Questions

16.The E.C.G. interpretation is:

17.IV. access should be secured for the purpose of:

18.This patient’s ectopics should be:

19.The I.V. solution of choice would be:

20.This patient’s blood pressure:

21.Nifedipine:

22.Sodium Nitroprusside:

23. Anti-hypertensive vasodilators include:

24. This patient’s medication, Aldomet, is indicated for:

25.This type of call could be handled smoother if:

References

Bledsoe, Bryan E., Clayden and Papa; Prehospital Emergency Pharmacology Fourth

Edition. Brady New Jersey: 1996.

Beck, Richard K. Pharmacology for Prehospital Emergency Care:F. A. Davis Company Philadelphia: 1992.

Drugs Second Edition Nurse’s Reference Library, Springhouse Corporation, Pennsylvania: 1984.

Karren, Keith J. and Brent Q. Hafen; First Responder A Skills Approach Third Edition; Morton Publishing Company, Colorado: 1990.

Jones, Shirley et. al., Advanced Emergency Care For Paramedic Practice. Lippincott

Company Philadelphia: 1992.

The answers to these questions are industry standards and may not necessarily be correct according to your local protocol.If there is any discrepancy between these answers and local protocol, please follow the protocol from your area as set out by your Medical Director.

Heather MacKenzie-Carey is a paramedic with over 15 years of EMS experience in Nova Scotia and Alberta.She has a Bachelor of Science Degree in Health Education from Dalhousie University, a diploma in Paramedicime from Northern Alberta Institute of Technology, and a certificate of Social Work from the University of Waterloo.Heather is an instructor for the Paramedic Program at Southern Alberta Institute of Technology.She can be reached at geomac@cadvision.com or www.turningpointgroup.com.

This Article is reprinted by permission from the author (Heather MacKenzie-Carey) and the Canadian Emergency News.It originally appeared in the June — July 1996 (volume 19, number 3).

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