Case Study

EMS Quiz

While cleaning the ambulance, you and your partner are dispatched to a community 15 minutes away. A male patient, 57 years old, is complaining of shortness of breath. On arrival, you find the patient’s apartment to be poorly kept. The patient appears very anxious and is found sitting in a tripod position at the kitchen table. Several beer bottles and dirty ashtrays are noticed littering the table as you approach the patient. The patient is 125 kg. He has three word dyspnea as he responds to your questioning and denies any chest pain or discomfort. He states he has had a productive cough of purulent sputum for five years, especially in the mornings, and breathing problems for the last three months, especially with exertion. Since the patient woke this morning he denies exertion, although his shortness of breath is progressively worsening. The patient admits alcoholism and a long smoking history of one pack per day for 40 years. The patient indicates a past history of asthma and pneumonias, as your partner returns with a ventolin MDI. On assessment, your patient is alert and oriented, has a RR of 18 and shallow, HR of 110 and bounding, SpO2 of 86 per cent on room air, afebrile and a BP of 164/86. He has peripheral and central cyanosis, accessory muscle use in his neck, J.V.D, bilateral bronchial wheezes and crackles and R.U.Q. abdominal pain on palpation. Pedal edema is noted and clubbing of his fingers is present.

Vitals

Pulse	110 and bounding
Blood pressure	164/86
Respiration	18 and shallow, bilateral bronchial wheezes and crackles
Skin	peripheral and central cyanosis
SpO2	86 per cent on room air

BLS Questions

1.This patient is acutely suffering from:

2.This patient initially would most likely benefit from;

3.The patient’s ventolin works by:

4.Ventolin can be given for:

5.You notice 1000 psi in the D cylinder. This will safely last for how many minutes at 12 lpm.?

6.The correct dose of ventolin for this patient is:

7.A long history of smoking is usually associated with:

8.Which statement is most accurate?

9.Why is epinephrine typically not given to these patients?

10.C.O.P.D. can be caused by:

ALS Questions

11.Most people with C.O.P.D. have:

12.Pain in the U.R.Q. is likely due to:

13.Normal jugular vein distention is:

14.Blood analysis would most likely show:

15.With an SpO2 of 86 per cent the patient likely has a Po2 of:

16.Atrovent is used in the treatment of asthma because of it's:

17.Corticosteroids are:

18.Cor Pulmonale is:

19.Chronic Bronchitis is diagnosed by a patient having:

20.Severe C.O.P.D. is treated by titrating oxygen flow rate so that the arterial Po2 is:

Please keep in mind 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.

Submitted by Car/is Coulter and Donald Hunter. Both are studying Paramedicine III at Holland College, Charottetown P.E.I. To offer feedback on the quiz or for information on the Paramedicine Programs at Holland College, e-mail us at: sccoulter@ ccgw.cc.hollandc.pe.ca. ca

This Article is reprinted by permission from the Canadian Emergency News. It originally appeared in the December 1998 / January 1999 issue (volume 23, number 1).

Your comments are appreciated!

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

Your name:
Email address:

Any comments about the Case Study?

Chuck Chivers