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Chapters 09-11
Intermediate Emergency Care And Transportation Of The Sick And Injured-Chapters 9-11
144
Medical
Professional
02/15/2013
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Term
What structure is located in the posterior aspect of the nasal cavity?
 Definition
Nasopharynx
Term
The turbinates, which extend into the nasal passageway, function by:
 Definition
improving filtration, warming, and humidification of inhaled air.
Term
The opening to the trachea is guarded by a cartilaginous flap called the:
 Definition
epiglottis.
Term
Which of the following structures is NOT found in the upper airway?
 Definition
Bronchioles
Term
Which of the following structures is NOT found in the lower airway?
 Definition
Larynx
Term
The mandible, tongue, epiglottis, and thyroid cartilage attach to the:
 Definition
hyoid bone.
Term
Internally, the lower airway extends from the:
 Definition
glottis to the pulmonary capillary membrane.
Term
The lungs are covered with a thin, slippery outer lining called the:
 Definition
visceral pleura.
Term
Alveolar collapse is a condition known as:
 Definition
atelectasis.
Term
The amount of air that is inhaled or exhaled during a single respiratory cycle is called:
 Definition
tidal volume.
Term
Inhaled air that does not participate in pulmonary gas exchange is called:
 Definition
dead space air.
Term
Minute volume would increase if:
 Definition
respiratory rate was increased.
Term
The biphasic process of inspiration and expiration is called:
 Definition
ventilation.
Term
When the diaphragm and intercostal muscles contract:
 Definition
intrapulmonary pressure falls below atmospheric pressure.
Term
The exchange of oxygen and carbon dioxide occurs by a process of diffusion, in which:
 Definition
gas moves from an area of higher concentration to an area of lower concentration.
Term
The by-product of cellular respiration is:
 Definition
carbon dioxide.
Term
All of the following conditions would cause a decreased concentration of oxygen in the blood, EXCEPT:
 Definition
an increased respiratory rate.
Term
Chemoreceptors send messages to the brain to increase respirations when:
 Definition
arterial carbon dioxide levels increase.
Term
The hypoxic drive stimulates breathing when the:
 Definition
arterial oxygen level falls.
Term
The normal respiratory rate for an adult ranges from:
 Definition
12 – 20 breaths/min.
Term
If a person is anoxic, he or she has:
 Definition
a total absence of oxygen.
Term
You are assessing a semiconscious patient's respirations and note that they are 18 breaths/min. When further assessing the patient's breathing, which of the following signs would indicate inadequate breathing?
 Definition
Shallow movement of the chest
Term
If the brain is deprived of oxygen for 4 to 6 minutes:
 Definition
anoxic brain injury will occur.
Term
A male patient with a history of congestive heart failure complains of orthopnea. This means that:
 Definition
the severity of his respiratory difficulty varies with position.
Term
Which of the following patients is NOT breathing adequately?
 Definition
Confused, respirations of 20 breaths/min, shallow depth
Term
The measurement of hydrogen ions in a solution is called:
 Definition
pH.
Term
Cellular function deteriorates and death occurs when the pH:
 Definition
drops below 6.9 or rises above 7.8.
Term
The MOST rapidly acting compensatory mechanism that maintains pH is the:
 Definition
bicarbonate buffer system.
Term
An 18-year-old female is experiencing an anxiety attack and is breathing at a rate of 48 breaths/min. Which of the following acid-base derangements will occur if her condition is not promptly treated?
 Definition
↓ CO2 →↓H2CO3 → ↑pH
Term
All of the following would result in metabolic acidosis, EXCEPT:
 Definition
an overdose of antacids.
Term
Which of the following patients should be placed in the recovery position?
 Definition
A 33-year-old unconscious male without injury who has respirations of 22 breaths/min and good chest rise.
Term
You respond to a call for an unconscious person. Upon arriving at the scene, you find an unconscious young male lying in a prone position in his front yard. After taking BSI precautions, you should:
 Definition
roll the patient into a supine position, without twisting his body, and assess his airway.
Term
A patient is found unconscious and trauma has been ruled out. The MOST appropriate method for opening the patient's airway is the:
 Definition
head-tilt chin-lift maneuver.
Term
What do snoring respirations in an unconscious patient indicate?
 Definition
Partial occlusion of the posterior pharynx by the tongue
Term
Which of the following signs is MOST indicative of a severe airway obstruction?
 Definition
Inspiratory stridor
Term
After performing a series of chest compressions on an unconscious adult with a severe airway obstruction, you should:
 Definition
visualize the airway.
Term
While assessing an unconscious 30-year-old female's airway, you note that her respirations are rapid, shallow, and gurgling. What is your initial course of action?
 Definition
Suction her oropharynx.
Term
When suctioning the airway of a child, you should:
 Definition
suction for 10 seconds and reassess the child's airway.
Term
When opening the airway of a non-injured unconscious apneic patient, you should perform a head-tilt chin-lift maneuver and then:
 Definition
insert an oropharyngeal airway.
Term
Which of the following patients would benefit MOST from a nasopharyngeal airway?
 Definition
Semiconscious patient with a gag reflex
Term
An oxygen humidifier is MOST beneficial when a patient is:
 Definition
being given oxygen during a lengthy transport to the hospital.
Term
A semiconscious 40-year-old female is found to have regular respirations at a rate of 24 breaths/min with reduced tidal volume. Initial airway management for this patient should include:
 Definition
assisted ventilations with a BVM or pocket mask.
Term
The MOST efficient method for ventilating a patient is the:
 Definition
two-person BVM technique.
Term
You note decreasing airway compliance when you and your partner are ventilating an apneic patient with the two-person BVM technique. How will you manage this situation initially?
 Definition
Reassess the position of the patient's airway and readjust if needed.
Term
A 19-year-old male has sustained severe facial trauma after being assaulted by a rival gang. He is semiconscious, has rapid and shallow respirations, and oropharyngeal bleeding. After opening the airway with the jaw-thrust maneuver, you should
 Definition
suction the oropharynx and assist ventilations with a BVM.
Term
If a multilumen airway device is inserted into the trachea:
 Definition
it functions the same as an endotracheal tube.
Term
A stoma, located superior to the suprasternal notch, is the resultant orifice following a:
 Definition
tracheostomy.
Term
When ventilating a patient with a stoma and a tracheostomy tube, you should:
 Definition
attach the BVM device to the 15-mm adaptor on the tube.
Term
A 72-year-old male with a tracheal stoma requires ventilatory assistance. However, when you attempt to ventilate, you meet resistance. You should:
 Definition
suction the stoma and mouth.
Term
Stomas are commonly occluded with mucous and other secretions because:
 Definition
patients with stomas possess a less effective cough.
Term
After taking BSI precautions, which of the following MOST correctly describes the technique of suctioning through a stoma?
 Definition
Preoxygenate with a BVM and 100% oxygen, inject 3 mL of saline into the trachea, instruct the patient to exhale, insert the catheter, and suction while withdrawing the catheter.
Term
Internal respiration is BEST defined as the:
 Definition
exchange of oxygen and carbon dioxide at the cellular level.
Term
The majority of carbon dioxide is transported in the blood in the form of:
 Definition
bicarbonate ions.
Term
Carbon dioxide in the blood combines with water to form:
 Definition
carbonic acid.
Term
Carbonic acid is an ideal buffer because it:
 Definition
is a weak acid and can accept or donate hydrogen ions.
Term
A buffer is a compound that can:
 Definition
neutralize excess acids or bases to maintain pH.
Term
A 43-year-old female is unconscious following an overdose of heroin. Her respirations are slow and shallow. Which of the following conditions will she initially develop if not treated?
 Definition
Respiratory acidosis
Term
Which of the following equations represents metabolic acidosis?
 Definition
↑ H2CO3 → ↑ H+ + HCO3- → ↓ pH
Term
Unresponsive patients MOST often experience airway obstructions from:
 Definition
occlusion of the posterior pharynx by the tongue.
Term
Following insertion of an oropharyngeal airway, your patient begins to gag. You should:
 Definition
remove the airway following the curvature of the mouth.
Term
The endotracheal tube:
 Definition
protects the airway against aspiration.
Term
How does the straight blade provide a laryngoscopic view of the vocal cords?
 Definition
It directly lifts the epiglottis and exposes the vocal cords.
Term
You are preparing to intubate a 68-year-old male in cardiac arrest. Minimum BSI precautions for this procedure include:
 Definition
gloves and facial protection.
Term
Hyperoxygenation prior to performing endotracheal intubation serves to:
 Definition
delay desaturation and minimize resultant hypoxia.
Term
The three axes of the airway that must be in alignment to achieve a sniffing position are the:
 Definition
mouth, pharynx, and larynx.
Term
Poor neurologic outcomes following aggressive airway management are often the result of:
 Definition
intubation-induced hypoxia.
Term
The MOST serious complication associated with endotracheal intubation in the acute setting is:
 Definition
unrecognized esophageal placement.
Term
You are attempting to intubate a 300 pound patient; however, despite posterior cricoid pressure, you are unable to obtain a view of the vocal cords. You should:
 Definition
place padding under the patient's neck and shoulders.
Term
A major cause of failed intubation attempts is:
 Definition
losing visualization of the glottic opening.
Term
Following insertion of a straight blade into a patient's mouth, your view of the upper anatomy is obscured by the tongue. What has MOST likely happened?
 Definition
The blade was inserted in the midline of the patient's mouth.
Term
Following intubation, your partner auscultates the patient's lungs and epigastrium and reports that she hears gurgling over the stomach, and weak but equal breath sounds over all lung fields. You should:
 Definition
remove the tube and reoxygenate the patient.
Term
You have just inserted an ET tube into your patient and have removed the stylet. Your next step should be to:
 Definition
inflate the distal cuff of the tube with 5 to 10 mL of air.
Term
Primary confirmation of correct ET tube placement is obtained by:
 Definition
visualizing the ET tube pass between the vocal cords.
Term
The purpose of an end-tidal CO2 (ETCO2) detector is to:
 Definition
identify the presence of carbon dioxide in expired air.
Term
Following intubation, you hear breath sounds over the left hemithorax only. All of the following situations could cause this, EXCEPT:
 Definition
tube placement in the right mainstem bronchus.
Term
Which of the following actions would you NOT perform during the scene size-up?
 Definition
Assess a patient's breathing effort.
Term
While treating a critically injured 23-year-old male with a gunshot wound to the chest, the perpetrator who shot the patient returns to the scene. You should:
 Definition
leave the scene immediately and request help.
Term
Proper use of personal protective equipment (PPE) will:
 Definition
reduce your risk of an infectious exposure.
Term
You will MOST likely be able to determine whether the cause of your patient's problem is medical or trauma in origin, after you have:
 Definition
surveyed the scene and assessed the patient.
Term
Determining the mechanism of injury will contribute to your decision of whether you should:
 Definition
perform a rapid assessment or focused exam.
Term
When energy impacts a body structure it:
 Definition
translates into injury.
Term
When assessing a patient with a small-caliber gunshot wound, it is important to remember that:
 Definition
internal injury severity is often unrelated to the entrance and exit wounds.
Term
When performing an initial assessment of a patient, your goal is to:
 Definition
identify and treat immediate life-threatening injuries or conditions.
Term
When forming a general impression of your patient, you can determine the:
 Definition
presence of gross external bleeding.
Term
Your initial assessment of a 32-year-old male reveals that he is semiconscious and is breathing at a slow rate with shallow movement of the chest. You should:
 Definition
begin assisting his ventilations.
Term
A responsive 40-year-old male complains of chest pain. He is able to speak to you in complete sentences and has no obvious respiratory difficulty. From this information, you can conclude that:
 Definition
his airway is patent and his breathing is adequate.
Term
You are called to a grocery store where a clerk has found an unconscious female in one of the aisles. There were no witnesses to the event. You should immediately:
 Definition
stabilize her head and open her airway with the jaw-thrust maneuver.
Term
A 49-year-old male collapsed and is now unconscious. There is no evidence of trauma. Your initial assessment reveals that the patient is pulseless and apneic. You should:
 Definition
begin CPR and apply the AED as soon as it is available.
Term
Law enforcement requests your assistance at a local nightclub for a patient who has been assaulted. Upon arrival, an officer escorts you to the patient, a 21-year-old male, who is bleeding severely from a lacerated brachial artery. The patient is conscious and is screaming in pain. You should immediately:
 Definition
control the bleeding with direct pressure.
Term
Which of the following patients requires immediate transport following initial stabilization at the scene?
 Definition
Severe pain to the left lower quadrant of the abdomen
Term
A small truck slid off the road and struck a utility pole. The driver, a 40-year-old male, has only minor abrasions from the airbag. His 38-year-old wife was killed in the crash. After performing an initial assessment of the driver, you should:
 Definition
perform a rapid trauma assessment.
Term
On which of the following patients should you perform a rapid trauma assessment?
 Definition
A 38-year-old male who was wearing a helmet while involved in a motorcycle crash.
Term
Following the initial assessment, your actions prior to transport of a critically-injured patient should include:
 Definition
rapid trauma assessment, spinal immobilization, vital signs.
Term
You have completed the rapid trauma assessment of a critically-injured patient and have performed full spine immobilization. Once the patient is loaded into the ambulance, you should next:
 Definition
obtain baseline vital signs.
Term
Assessment of a patient's pelvis is MOST appropriately performed by:
 Definition
gently compressing it inward.
Term
Rales, rhonchi, and wheezing are examples of:
 Definition
adventitious breath sounds.
Term
When a section of the ribs has been fractured, the injured section falls during inspiration and bulges during expiration. This is called:
 Definition
paradoxical chest movement.
Term
A 50-year-old male has fallen from a significant height. He is conscious and alert, but is unable to feel or move both of his lower extremities. This is MOST likely the result of:
 Definition
injury to the spinal cord.
Term
You are transporting a critically-injured patient to a trauma center located 30 minutes away from the scene. At a minimum, how many times should you reassess the patient's vital signs during transport?
 Definition
6
Term
Which of the following questions would allow you to assess the “P” in the SAMPLE history?
 Definition
Has this ever happened to you before?
Term
The focused assessment of a patient is based primarily on the:
 Definition
patient's chief complaint.
Term
You are dispatched to an apartment complex, where a tenant was found unconscious by the landlord. There is no evidence of trauma. After completing the initial assessment and addressing immediate life-threats, you should:
 Definition
perform a rapid assessment.
Term
Following the initial assessment, the MOST appropriate order to proceed when treating a responsive medical patient is:
 Definition
history of present illness, SAMPLE history, focused physical exam, baseline vital signs.
Term
The focused history and physical examination of a responsive medical patient is guided by:
 Definition
the patient's reason for calling EMS.
Term
You are assessing a responsive patient who complains of abdominal pain. Which of the following questions would be MOST effective in determining the quality of the patient's pain?
 Definition
“What does the pain feel like?”
Term
A 70-year-old male tells you that he took three of his wife's nitroglycerin tablets for chest pain prior to calling EMS. This information is clinically important to you because it:
 Definition
may have an effect on the treatment you provide.
Term
A 66-year-old female is found unconscious in her front yard by a neighbor. You perform an initial assessment and begin the appropriate treatment. There are no bystanders or witnesses to the patient's event. You should:
 Definition
transport the patient without delay.
Term
When performing a rapid medical assessment on an unresponsive patient, you should follow the same approach as the:
 Definition
rapid trauma assessment.
Term
The need to perform a detailed physical exam on a patient is based on:
 Definition
the nature of illness or mechanism of injury.
Term
Which of the following statements regarding the detailed physical exam is correct?
 Definition
The detailed exam is usually performed en route to the hospital.
Term
When auscultating the breath sounds of a patient with respiratory distress, you hear a high-pitched whistling sound during expiration. This suggests:
 Definition
lower airway obstruction.
Term
A 30-year-old male presents with signs of shock. He is conscious but anxious, and is in no obvious respiratory distress. After applying oxygen, you attach a pulse oximeter, which reads 78%. This low oxygen saturation reading is MOST likely the result of:
 Definition
decreased perfusion.
Term
While assessing the abdomen of a 37-year-old female who experienced blunt abdominal trauma, you note the presence of bruising around the umbilicus. This finding suggests:
 Definition
blood in the peritoneal space.
Term
A 55-year-old male complains of severe pain to the right lower quadrant of his abdomen. During your assessment, you should first palpate the:
 Definition
left upper quadrant.
Term
When using the Cincinnati Stroke Scale to assess a patient with a possible stroke, you should:
 Definition
remain close to the patient in case he or she falls.
Term
During transport of a 34-year-old male with a possible femur fracture, you perform an ongoing assessment. This process begins with:
 Definition
reassessing his level of consciousness.
Term
You are approximately 10 minutes away from the hospital with a 59-year-old female with a possible myocardial infarction when she suddenly loses consciousness. You should:
 Definition
open her airway and assess for breathing.
Term
When performing an ongoing assessment on a 22-year-old male with hypoglycemia, you note that his mental status has improved and he is now verbally responsive. You should:
 Definition
reassess his vital signs.
Term
Unlike the detailed physical exam, the ongoing assessment is:
 Definition
performed on all patients during transport.
Term
How does an enhanced 9-1-1 system function?
 Definition
It displays the caller's information on the dispatcher's computer.
Term
Which of the following functions would an emergency medical dispatcher (EMperform?
 Definition
Instructing a caller how to perform CPR
Term
A concise and well-organized radio report to the hospital is MOST beneficial because it:
 Definition
allows the hospital to allocate the appropriate resources.
Term
Which of the following represents the MOST appropriate order to present patient information over the radio when communicating with the hospital?
 Definition
Age and sex, chief complaint, history of present illness, exam findings, care provided, estimated time of arrival
Term
When communicating with medical control via radio, you should:
 Definition
refrain from using special codes or signals.
Term
Which of the following information is generally NOT reported to the dispatcher during a call?
 Definition
The patient's clinical condition
Term
The transfer of patient care officially occurs when you:
 Definition
give an oral report to a nurse or physician.
Term
When assessing an anxious 55-year-old male with chest pain, you should:
 Definition
ask him how he prefers to be addressed.
Term
A 79-year-old female is complaining of shortness of breath. When you ask her when this episode began, she does not answer you. You should:
 Definition
speak clearly and repeat the question.
Term
A 68-year-old female with a history of Alzheimer's disease complains of acute abdominal pain. As you prepare to start an IV on her, she becomes verbally abusive. You should:
 Definition
remain patient and explain the procedure to her.
Term
You are dispatched to a residence for a 5-year-old child with fever. During your assessment, the child becomes irritable and starts crying. You should:
 Definition
encourage a parent or caregiver to hold the child.
Term
In addition to serving as legal documentation, which of the following is the MOST critical function of the patient care report (PCR)?
 Definition
It ensures continuity of patient care.
Term
When documenting your assessment of a patient with a headache, you should include pertinent negatives, which are:
 Definition
expected signs or symptoms that are not present.
Term
Which of the following statements regarding patient refusals is correct?
 Definition
You cannot legally mandate that a patient sign a refusal form.
Term
Which of the following situations requires reporting to the authorities?
 Definition
An adult who was bitten by a stray dog
Term
Any radio hardware that contains a transmitter and receiver and is located in a fixed location is called a:
 Definition
base station.
Term
The ability to communicate from a portable radio to a base station is MOST effectively enhanced by a:
 Definition
repeater.
Term
Pertinent information that is transmitted over the radio to the receiving hospital includes all of the following, EXCEPT the:
 Definition
name and address of the patient.
Term
After medical control has ordered you to administer 10 mg of valium to an actively seizing patient, you should:
 Definition
repeat the order, word for word.
Term
You are requesting an order to administer a medication to a critically ill patient from medical control when the radio system suddenly fails. You should:
 Definition
follow established protocols.
Term
You are giving your oral report to the attending physician in the emergency department. Which of the following information about the patient is usually NOT given at this point?
 Definition
The patient's physical address
Term
Your assessment of a 40-year-old male with an altered mental status (AMS) reveals the possible odor of alcohol on his breath. When documenting the events of the call, you should state that:
 Definition
an unusual odor was noted on the patient's breath.
Term
When documenting medical terminology on a patient care form, you should:
 Definition
only use standard medical abbreviations.
Term
A 66-year-old female's daughter called EMS because her mother was having chest pain. When you arrive, the patient states that she does not need EMS and will not go to the hospital. The patient is conscious, alert, and oriented and will not sign a refusal form. How should you manage this situation?
 Definition
Have the daughter sign the form verifying her mother's refusal.
Term
Which of the following is the MOST significant consequence of inappropriate documentation?
 Definition
Subsequent patient care that is inappropriate
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