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EMS Quiz

By Heather MacKenzie-Carey

It is 09:00 hrs. on your second day shift of this tour.It is a rainy but warm day in the late summer.You have finished checking your unit, have had a leisurely cup of coffee with your partner and you’re just considering cleaning the station floor when you are saved by the emergency phone.

Dispatch reports they have received a 9-1-1 call from a distraught mother.She believes her two-year-old has taken an unidentified number of vitamins and aspirin.Dispatch they could hear the child crying in the background.The mother hung up before they were able to get any more information or give pre-arrival instructions.

You arrive on scene at a private residence in an affluent area of town.Transport times from the residence are approximately 15 minutes to the children’s hospital and five minutes to the nearest hospital.You notice no hazards such as animals, debris or bystanders as you approach.As you reach the front door you can hear a child crying.

A frantic 25-year-old female holding a crying toddler opens the door for you and directs you to into the living room.The mother reports she arrived home from a tennis match and left her two-year-old playing near her while she took a shower.When she got out of the shower she found the two-year-old sitting on the floor in her bedroom surrounded by vitamins and aspirin bottles.Several pills were lying on the floor and he was holding a handful which she grabbed.She immediately phoned 9-1-1.The mother is unsure how many pills were in the containers or if the child actually swallowed any.The pills are not in the original bottles.When the mother asked the child if he ate any he shook his head vigorously.

The patient is a two-year-old male weighting approximately 25 pounds.He appears alert and continues to cry, although he is relaxing somewhat as his mother calms.You see no pills inside his mouth.Primary and secondary surveys are unremarkable.His mother reports no pertinent medical history, no allergies and he is not on any medications.She reports he had not vomited or spit up anything that she is aware of and she has not given him anything to eat or drink since or before the incident.He had a normal breakfast of cereal and milk at 08:00 hrs.

Vitals

Pulse	112 regular
Pulse Oximeter (O₂ Saturation)	100 %
Blood pressure	86/40
Respiration	28, non-laboured.
Skin	warm, pink dry

1.The incident would be considered a poisoning.

2.In this case you can safely say assume he has not taken any pills due to:

3.You should transport this patient to the:

4.Ingested poisons may particularly affect the:

5.Most poisonings in children are related to:

6. When liquid toxins are encountered on the skin, the site should be irrigated:

7.An important part of history taking when dealing with ingestion poisonings is:

8.This toddlers vital signs indicate:

9.This toddler weighs 25 pounds or kilograms.

10.This type of injury might be prevented by:

11.The child’s oxygen saturation level indicates:

12.Insect and snake bites are examples of poisonings.

13.In assessing this child you should start at the:

14.As part of your history taking you should:

15.An ECG reading on this patient:

16.Activated charcoal may be useful in this incident because it:

17.The usual amount of activated charcoal for infants and children is:

18.Before administering the activated charcoal you should:

19.Contraindications for using activated charcoal include:

20.Syrup if ipecac for this patient:

21.The antidote for organophosphate poisoning is:

22.Activated charcoal is of the drug classification:

23.Syrup if ipecac is of the drug classification:

24.The usual adult dose for activated charcoal is:

25.Your service could work towards eliminating these type of incidents by:

References:

Bledsoe, Bryan E., Clayden and Papa: Prehospital Emergency Pharmacology Fourth Edition: Brady 1996.

Eichelberger, Martin R., et al.: Pediatric Emergencies: Brady 1992

Mack, Daniel: EMT-B Certification Preparation and Review Second Edition: Mosby Lifeline 1996.

Shade, Bruce et al. Mosby’s EMT-Intermediate Textbook: Mosby Lifeline 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 August / September 1997 issue (volume 20, number 4).

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