Northwest Community EMS System Continuing Education Class Credit Questions for April 2014 Summer Emergencies

Transcription

1 Northwest Community EMS System Continuing Education Class Credit Questions for April 2014 Summer Emergencies Name (PRINT): Date submitted: Affiliation: Rating: [ ] Complete [ ] Incomplete The answers are found in the April 2014 class handout, supplemental materials, and/or NWC EMSS SOPs. All are available on the website at 1. What is the goal of histamine release by the body in allergic reaction? (Class Handout) 2. List one sign or symptom of allergic reaction for 6 body systems involved in allergic reaction (not counting the immune system). (Class Handout) Airway/resp: Cardiovascular Cutaneous: GI: Mucus membranes: Neuro: 3. What are 2 pertinent questions/hx would it be important to ask/inquire about, specific to medication hx in the pt w/ allergic reaction? (Class Handout) 4. Name 2 factors that increase the risk of the pt developing anaphylaxis. (Class Handout) 5. What respiratory assessment finding warrants consideration of DAI? (Class Handout) 6. A patient w/ allergic reaction S&S has severe ventilatory compromise & rapidly developing lingual, facial and neck edema. ETI was unsuccessful. List 3 options for management of airway/oxygenation/ventilation? (Class Handout)

2 NWC EMSS CE Class Credit Questions for Diabetes November 2013 Page 2 7. Complete the following table (Handout, SOP) Action Epinephrine 1:10,000 Epinephrine 1:1000 Adult dose, route Peds dose, route Major / common side effects Why is it useful in allergic rxn? 8. EMS is called to a local park for a 5 y/o child w/ a bee sting. As you approach, you see an anxious-looking child sitting on a bench. His breathing appears mod. difficult, and he coughs frequently. As you get closer, you hear wheezing. Skin is flushed and warm. VS: 102/78, HR 132, RR 28, SpO2 94%. What level of allergic reaction is this pt presenting with? Defend your answer by citing the assessment findings that guided your choice. (SOP) 9. What is EMS first intervention? Provide dose in mg, ml volume, and route if you are giving a medication. (SOP) 10. At what point should this pt be transported? (SOP) 11. What is the next medication this pt should receive? Provide dose in mg, ml volume, and route. (SOP) Refer to this scenario to answer questions EMS is called to the county immunization clinic for a child having an allergic reaction. Upon arrival, you are told the pt received his 2nd MMR vaccine approx. 10 min. ago, and developed a rash shortly thereafter. The nurse states the child was given 20 mg Benadryl as soon as the rash appeared, and EMS was called. The pt is a 4 y/o child with red, raised rash over her entire body. She appears lethargic, and does not react when you enter the room. She has mod-severe resp distress and rapid breathing, with audible stridor & retractions. Skin is cool and moist, and peripheral pulses are fast and barely palpable. Pt s wt is 35# (16 kg). VS: 68/palp, apical pulse 144, RR 32 & labored, SpO2 91% on 3L NC O What level of allergic reaction is this pt experiencing? (SOP) 13. Upon what assessment findings did you base your answer? List at least 2. (SOP) 2

3 NWC EMSS CE Class Credit Questions for Diabetes November 2013 Page What intervention would be appropriate for airway management at this time? (SOP) 15. How will you treat this pt s hypotension? Be specific w/ med or fluid, dose or volume, route. (SOP) How many times can this be repeated? 16. What is the first medication this pt should receive? Specify dose, concentration, volume, & route for this pt. (SOP) 17. What is the next med? Specify dose, volume, & route for this pt. (SOP) 18. When should transport begin? (SOP) Refer to this scenario to answer questions EMS is called to a local restaurant for a woman choking. You find an anxious-appearing woman in the bathroom. She is itching a red, raised, blotchy rash that appears to cover her entire body. She tells you she is allergic to nuts, and that her throat feels like it is closing. She has significant periorbital edema. Med list found in her wallet: Claritin, lexapro. VS: 106/58, HR 116, RR 22, SpO2 95%. Mild wheezing can be heard w/ auscultation. Pt wt: 140 lb. 19. What severity level is this pt s allergic reaction? (SOP) 20. Upon what assessment findings did you base your answer on? (SOP) List at least What is the first medication EMS should administer? Specify concentration, dose, volume, route. (SOP) 22. What is the desired effect of this drug (what will it fix?)? (SOP) Please refer to the following scenario when answering questions Following the above interventions, the pt s respirations are now mod-severely labored, w/ retractions and stridor. Lung sounds are nearly absent. Mental status has deteriorated. VS: 84/56, HR 136, RR 30, SpO2 91%. Capnography waveform is sharkfin, ETCO2 is According to SOP, how might this pt s airway be best managed? (SOP) 24. With regards to IV fluids, in what amount should they be administered, to accomplish what goal? (SOP) In spite of the above interventions, the pt s HR falls quickly to IVR, 40 s, and she becomes pulseless. Compressions/ventilations w/ resqpod commence. 3

4 NWC EMSS CE Class Credit Questions for Diabetes November 2013 Page List the next two interventions. Be specific w/ regards to concentration, dose, route, time/frequency. (SOP) 26. According to NWC EMSS SOP, what is the guideline w/ regards to CPR in cardiac arrest related to anaphylactic shock? (SOP p. 11) Refer to the following scenario, and to the grid on p in your packet, to answer the following questions. EMS is called for a 32 y/o man w/ severe muscle cramping, headache, nausea and trouble swallowing. The pt is in obvious discomfort, c/o cramping all over his body, including his back, abd, and legs. He is very anxious. He was working in the barn about 1 ½ hrs ago, taking a tractor out of storage, when he began to feel nauseous. His symptoms have gotten progressively worse since then. Exam: Pt is alert. Airway patent. No resp distress. Lungs clear. Radial pulses rapid & weak. Face diaphoretic, otherwise, skin warm & dry. VS: 168/98, HR 120, ECG ST, RR 26. SpO2 96%, ECO2 32, pain 8/10. PMH: none; no allergies, no meds. Pt also notes a painful area on his hand, where he thought he may have gotten stung while working. He shows you 2 red marks on one of his fingers. 27. Consult the chart/grid on p Considering the above information, what do you suspect is responsible for this pt s symptoms? (Handout) 28. List 3 possible EMS interventions for this pt. (Handout) 29. Describe the following, comparing the brown recluse bite and that of the black widow. (Handout) Pain Bite appearance Brown Recluse Spider Black Widow Spider Effects: systemic or local? S&S Refer to the following scenario to answer questions EMS finds a 70 y/o unconscious female in her apartment two days after a blistering heat wave began. She has no fans or air conditioning and the heat in her room is suffocating. Her PMH is unknown. Physical exam: HEENT: Unresponsive to verbal, but responds purposefully to painful stimuli. Lungs: Clear. CV: ECG: ST with PVCs. GI: Soft, no guarding, masses. Skin: Hot, flushed and dry. VS: BP: 84/50, P: 112, R: 32, SpO2 93% T: 106 tympanic. 30. What is your paramedic impression? (SOP, Handout) 4

5 NWC EMSS CE Class Credit Questions for Diabetes November 2013 Page What neurologic symptom/complication might EMS need to treat, if it occurred? (SOP) 32. How should this pt be positioned? (SOP) 33. Describe interventions for the pt w/ heat stroke, whose SBP < 90: (SOP) Positioning: IV fluids: 34. How should cooling of this pt be accomplished? (SOP) 35. List at least 5 meds or substances that put patients at higher risk for heat-related illness. (SOP) Read the case study (PCR) on pages of the class handout. Refer to the NWC EMSS Near-Drowning SOP on p 27 to answer the following questions. 34. Did this pt meet criteria for resuscitation? Why or why not? (SOP) 35. Did this pt need to be immobilized? Why or why not? (SOP) 36. Was this pt a candidate for CPAP? Why or why not? (SOP) 36. What should be done initially for a patient who is unresponsive, has a pulse, but whose ventilations are ineffective? (SOP) 37. Was it appropriate to place an advanced airway for this pt? Support your answer by citing what criteria or conditions this pt presented w/, that warranted or did not warrant advanced airway. (SOP) 38. What event is common following submersion (especially if ventilations and or compressions are needed), and what precaution should be taken? (SOP) 39. How is the approach to resuscitation of the apneic, pulseless patient who has been submerged different from the approach to the pt in arrest who has not been submerged? (Hint: priority actions) (SOP) 40. Explain your answer to question 39, with regards to the cause of the submersion pt s arrest. (SOP) 5