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EMS Quiz

By Heather MacKenzie-Carey

Itis 5:00 a.m. on a cold fall morning. You are dispatched to an acreage house approximately 20 minutes out of town for an unknown problem, possibly an assault. Police are responding as well.

You arrive on scene shortly behind the police who assure you there is no obvious danger to yourself. A large dog is barking ferociously and he lunges at you, but is heavily chained even as.

The police officers direct you into the house and tell you the patient and his wife are in the bedroom with another officer. They report the patient appears to have a laceration to his stomach.

You find a 32-year-old male patient weighing approximately 90 kg lying in bed, propped up with pillows and leaning on his wife for support. He is fully clothed and there is some dried blood present on his shirt and on the bed sheets. He appears to be intermittently mumbling and conversing with his wife. He seems labouring to breathe. She looks at you anxiously as you enter the room. When you ask the patient what happened he looks at you in confusion and his wife relays the history. She reports they were arguing earlier in the evening and he left the house to go drinking in town. At approximately 2:00 a.m. his buddies drove him home and helped him into the house. She noticed blood on his clothes and asked what happened. He and his friends said they were at a local bar when a fight broke out. They were not involved and decided to leave. As they were leaving someone lunged against the patient shoving him into the side of his truck. He felt sudden pain but it was not until he got into the truck and looked at his shirt that he realized he had been stabbed. He assured his wife it was only a small laceration and he would get it looked at in the morning after he had sobered up. She helped him into bed where he fell asleep still in his clothes. His wife awoke at approximately 4:30 to the sound of her husband struggling to breathe. She found him slow to respond and confused. She panicked over his colour and overall appearance and phoned for an ambulance.

On assessment you find him awake, slow to respond and confused to present events but orientated to person, place and time. There is a smell of alcohol to his breath and clothes and he states he was drinking heavily. He says he is having difficulty breathing at present. Pulses are weak, fast and slightly irregular at both the carotid and radial. His breathing appears laboured. No J.V.D or tracheal deviation is noted. Auscultation reveals absent lung sounds in the right base. Dullness to percussion is heard. Palpation of the chest reveals no pain or deformity, nothing is noted on observation. There is a three inch laceration to the right upper quadrant of the abdomen. There is no bleeding at present but it does bleed minimally when you palpate around the area. He is guarding significantly and winches when you palpate. There are no other signs of trauma to the head, neck, chest, abdomen or extremities. He will squeeze your hands with his and is able to move his legs on command. There are no obvious gross sensory or motor deficits. His pupils are equal and reactive to light, no bruising, deformity or pain to palpation of the head is noted. He denies any fist fight or Injuries other than the stab wound. No one saw the weapon used. The patient’s wife states he has no pertinent medical history and is on no medications. Although he drinks alcohol she denies any other recreational drug use.

Vitals

Pulse	120 slightly irregular
Blood pressure	100/60
Respiration	30 laboured, absent right base
Oxygen saturation	93 per cent
Blood Glucose	9 mmol/L
E.C.G.

The patient reports an ambulance is not necessary as he will drive himself to the hospital after he sleeps and showers.

1. You should:

2. Before you move this patient you should:

3. This patient likely has a:

4. It is quite possible this patient also has a:

5. This patient should be transported:

6. This patient should receive:

7. The laceration should be treated by:

8. The patient’s confusion likely caused by:

9. In assessing this patient’s chest you should look for:

10. The normal respiratory rate for an adult is:

11. Unequal breath sounds are a sign of inadequate breathing.

12. The trauma this patient received would be characterized as:

13. This patient would have a Glasgow Coma Score of:

14. The primary presenting symptoms for patients with a hemothorax is initially:

15. A hemothorax is an accumulation of blood in the:

16. The ECG interpretation is

17. The ectopics should be:

18. An intravenous for this patient:

19. Indications to decompress a tension pneumothorax include:

20. Sites for decompression of a tension pneumothorax include:

21. Complications of chest decompression include:

22. Distended neck veins present in a chest injury patient indicate:

23. Tracheal deviation is often the first sign of a tension pneumothorax.

24. The anxiety and confusion experienced in a patient with a massive hemothorax is produced by:

25. Ways to protect yourself legally should this patient refuse treatment and transport include:

References

Campbell, John Emory Dr., Basic Trauma Life Support for Paramedics and Advanced EMS Providers, Third Edition; American College of Physicians, Brady 1995

Canadian Red Cross, First Responder, Mosby: 1997

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

Paramedic Field Care, A Complaint Based Approach, American College of Physicians, Mosby Lifeline 1996

Stoy, WALT A. and the Center for Emergency Medicine, Mosby EMT-Basic Textbook; Mosby Lifeline: 1996

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 October / November 1997 issue (volume 20, number ).

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EMS Quiz

By Heather MacKenzie-Carey

Vitals

1. You should: A. Allow this patient to cancel your treatment and transport B. Get the patient’s wife to drive him to the hospital C. Convince the patient to accept treatment and transport D. Have the patient arrested under the Mental Health Act

2. Before you move this patient you should: A. Splint his chest B. Check his back C. Restrain his arms D. None of the above

3. This patient likely has a: A. Myocardial contusion B. Hemothorax C. Pulmonary embolis D. Flail chest

4. It is quite possible this patient also has a: A. Lacerated liver B. Lacerated spleen C. Lacerated pancreas D. Lacerated left kidney

5. This patient should be transported: A. With full spinal immobilization B. Supine C. Trendelenburg D. High Fowlers

6. This patient should receive: A. No oxygen until he agrees to transport B. Oxygen via nasal cannula C. Oxygen and ventilation D. High flow oxygen via an non-rebreather mask

7. The laceration should be treated by: A. An occlusive dressing sealed on 3 sides B. A pressure dressing C. A sterile dressing taped in place D. Applying a wet compress

8. The patient’s confusion likely caused by: A. Hypoxia B. Alcohol C. Intercranial pressure D. A and B E. All of the above

9. In assessing this patient’s chest you should look for: A. Accessory muscle use B. Paradoxical breathing C. Subcutaneous emphysema D. All of the above E. A and B only

10. The normal respiratory rate for an adult is: A. 25-50 B. 15-30 C. 12-20 D. 8-12

11. Unequal breath sounds are a sign of inadequate breathing. A. True B. False

12. The trauma this patient received would be characterized as: A. Blunt B. Penetrating C. Medium energy D. High energy

13. This patient would have a Glasgow Coma Score of: A. 15 B. 14 C. 13 D. 12

14. The primary presenting symptoms for patients with a hemothorax is initially: A. Difficulty breathing B. Shock C. Anxiety D. None of the above

15. A hemothorax is an accumulation of blood in the: A. Lung B. Pleural space C. Thorax D. Mediastinum