EMS Quiz

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EMS Quiz

By Heather MacKenzie-Carey

Spring has sprung and you are enjoying the sun and the freedom of your job on an outdoor patio in the resort town where you work. You have spent the majority of the day drinking coffee, giving directions and answering questions about where the most wildlife can be found. It’s a hard life.

The radio startles you into reality as your dispatcher reports you have a call. It’s 16:00 hours as you weave your way through the tourist traffic. You are responding to a ‘difficulty breathing’ at the staff residence of a hotel.

Ten minutes later you arrive on scene and are met by a frantic female at the front doors of the residence. She directs you to the patient’s room and tells you her roommate arrived home early from her waitress shift. She appeared to be frantically searching for something and was saying something about an allergy. As you arrive at the patient’s room, you find an 18-year-old female sitting on the edge of the bed in obvious distress. From across the room you can hear her wheezing respirations. She is sitting forward gasping for air, obviously panicked. She notices your arrival but is concentrating on trying to breathe. She grasps your arm, points to her throat and says, “Can’t breathe”. She appears orientated but is able to speak in one word sentences only. Her airway is open but there are audible wheezing noises. Her pulses are fast, weak and irregular at the neck and wrist. Her skin, particularly at the neck and face is flushed and swelling is evident. On auscultation you find no air entry in the bases and wheezing throughout the apices. The rest of your assessment is unremarkable except for evidence of urticaria and edema throughout. The limited history available from the patient and friend is that the patient has allergies to peanuts, shellfish and certain pollens. She ate something at work, probably 15 to 20 minutes ago, that caused the sudden reaction. She came home for her Epi pen but was unable to find it. She also has a history of asthma but is on no medication at present.

Vitals

Pulse	120 & irregular
Blood pressure	92/60
Respiration	30 + wheezing and stridor noted
Skin	neck and face is flushed and swelling is evident
Pulse oximetry	88 per cent
E.C.G.

1.The best tentative diagnosis for this patient is:

2.At a B.L.S. Level this patient would be considered:

3.Your initial B.L.S. treatment should be:

4.This patient’s pulse oximeter reading indicates:

5.Common agents responsible for anaphylaxis include:

6.This patient’s wheezing respirations are caused by:

7.Urticaria is:

8.For this patient, proteins in nuts and shellfish would be considered:

9.This patient is experiencing:

10.Usually the most rapid anaphylactic reactions occur if the allergen is introduced by:

11.The chemical most predominant in the allergic response is:

12.Signs and symptoms of an allergic reaction include:

13. Cardiovascular symptoms of anaphylaxis include:

14. At an EMT-intermediate level, an I.V. should:

15. The patient’s Epi pen would deliver epinephrine via:

16. This patient’s E.C.G. tracing would be interpreted as:

17. This patient’s cardiac rhythm should be treated by:

18. IV. Therapy for this patient should be:

19. Pharmacological intervention that might be helpful for this patient would include:

20. The correct dose of epinephrine for this patient would be:

21. Diphenhydramine for this patient:

22. Epinephrine is helpful for anaphylaxis because it:

23. Vasopressors for this patient:

24. The airway for this patient would be best controlled by:

25. Your service could provide optimal patient care for this type of patient by:

References

Caroline, Nancy L., Emergency Care in the Streets Fifth Edition; Little, Brown and Company, Toronto: 1995

Grant, Harvey D. Et. Al.; Emergency Care Seventh Edition; Brady: New Jersey,1995

Jones, Shirley A. Ft. Al; Advanced Emergency Care for Paramedic Practice; J. B. Lippincott Company; Philadelphia: 1992.

Sheppard, F. W. J., Anaphylaxis: A Shocking Condition, Canadian Emergency News, Vol. 20, No. 2, pp. 31-35; Calgary:1997.

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 18 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 February — March 1997 issue (volume 20, number 2).

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Chuck Chivers

EMS Quiz

By Heather MacKenzie-Carey

Vitals

Your comments are appreciated!

Just complete this form. Click on Submit when ready to send.

Your name:

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Any comments about the Case Study?