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EMS Quiz

By Heather MacKenzie-Carey

You are pumped and ready to go when the first call of the night shift comes in. You are anticipating a busy Saturday night. It has been a hot dry week in mid-July and hundreds of city dwellers have flocked to your small lakeside town. All the campgrounds are full and the parties are already in full swing at 1900 hrs. You toss aside the remains of your chocolate dip cone and begin responding to one of the campgrounds for an unknown problem. Police will be responding with you.

The police report no hazards are present and direct you to a campsite where you find a 30-year-old female anxiously awaiting your arrival. She reports her husband appears confused and ill inside their tent trailer. You find an 80 kg, 35-year-old male lying supine on the bed. There is a bucket beside him and he appears to be leaning over it retching. There is some emesis in the bucket but no signs of blood. He does not seem to understand who you are or where he is. He is awake but orientated to person only. His skin is hot, flushed and dry. He is breathing at a good depth but a rapid rate. Pulses are present at the neck and at the wrist but are fast and regular. The radial pulse appears weaker than the carotid. Lungs sounds are present and equal bilaterally with no adventitious sounds. His abdomen is non-distended and non-rigid but appears tender to palpation. There are no signsof trauma. Motor functioning and sensation appear intact. He appears to have sunburn on his face, chest and extremities. His wife reports they have been group camping for the past week. They have been “playing hard”—water skiing, jet skiing, playing baseball and other sports. He has been drinking in the evenings but has not hadany alcohol today. For the past two days he has been complaining of stomach and leg cramps, diarrhea and some nausea. Tonight he appeared to suddenly get a lot worse. He started vomiting and complaining of shortness of breath. He has been alert and orientated but weak. Thirty minutes ago his wife had been preparing to take him to the local emergency department when he started vomiting, appeared to get dramatically weaker and suddenly appeared confused and disoriented. Friends called for the ambulance. She reports no pertinent past medical history, no allergies and no medications. She does report he has been taking Tylenol for the headache and cramps for the past two days. She believes he last took two Tylenol at 1600 hrs.

His vitals are:

Pulse	124 regular
Pulse Oximetry	99 per cent
Blood pressure	100/50
Respiration	30 shallow
Temperature	Axilla— 39.7 C
Chemstrip	8 mmol
E.C.G.

1.Your tentative diagnosis for this patient should be:

2.Your first treatment step should be:

3.You should treat this patient by:

4.The condition of heat cramps is more serious than generalized hyperthermia.

5.The patient with heat exhaustion or mild hyperthermia is likely to present with symptoms of:

6.Transport for this patient should be:

7.The temperature regulation control center is located in the:

8.The body maintains temperature in a hot environment by:

9.Heat cramps are usuallydue to:

10. Heat illness results from:

11. The body’s thermo regulating system is no longer effective in conditions of:

12.Factors contributing tothis patient’s condition include:

13. Patients with severe hyperthermia or heat stroke may have:

14.An intravenous for this patient should be:

15. This patient should receive:

16.The rhythm for E.C.G. # 1 is:

17.This rhythm should be treated by:

18.If the body temperature of the patient is not quickly lowered he may:

19. En route your patient begins to seize. The monitor reveals: E.C.G. # 2. This rhythm is:

20.The seizures should be treated by:

21. The seizures have stopped. You reassess your patient and find he does not have a carotid pulse. The monitor reveals\ E.C.G. #3. You should:

22. Intubation for this patient is now:

23. First line cardiac drugs administered to this patient should be:

24. Vasopressors, like dopamine, might be helpful for this patient.

25. Your service could act proactively to prevent such calls by:

References

Bledsoe, Porter andShade:ParamedicEmergencyCare.Brady, New Jersey, 1991.

Sanders, Mick J.:Mosby’s Paramedic.MosbyLifeline, Toronto, 1994.

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

1995.

E.C.G.#3Bledsoe, Porter andShade:ParamedicEmergencyCareSecond Edition. Brady,New Jersey, 1994.

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

Heather MacKenzie-Carey is a paramedic who has 15 years of EMS experience in Nova Scotia and Alberta. She is currently teaching in the Paramedic Program at the Southern Alberta Institute of Technology. She has a Bachelor of Science degree in Health Education from Dalhousie University in Nova Scotia and a certificate in Social Work from the University of Waterloo.She can be reached at geomac@cadvision.com or www.turningpointgroup.com.

Canadian Emergency News and the author of this quiz grant permission for readers to copy it for personal and departmental educational purposes. All other reproduction and republication without written consent is prohibited.

This Article is reprinted by permission from the author (Heather MacKenzie-Carey) and the Canadian Emergency News. It originally appeared in the June / July 1997 issue (volume 20, number 3).

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