Paramedic Quiz Chapter 20

Decreased melanin granules

Disturbances in fluid balance

Difficulty with thermoregulation

Susceptibility to bacterial invasion

The body's ability to effectively dissipate significant heat energy and the patient's general state of health

The presence of any underlying medical problems, the duration of exposure, and the temperature of the heat source.

The duration of exposure, the physical size of the patient, and the presence of concomitant traumatic injuries.

The temperature of the heat source of the heat source, amount of heat energy possessed by the object or substance and the duration of exposure

Once hot liquids come in contact with clothing, heat is rapidly dissipated

Scald burns often cover large surface areas because liquids spread quickly

Scald burns caused by grease or oil are typically limited to the epidermis

Scald burns are less commonly seen in pediatric patients that adult patients

Steam burns

Flame burns

Scald burns

Arc burns

A massive infection that occurs when microorganisms breach burned skin

Renal failure secondary to excess myoglobin production from burned muscle

Fluid loss across damaged skin and volume shifts within the rest of the body

Acute dehydration, and it commonly manifests within 30 minutes after the burn

The inhalation of superheated gases

Exposure to carbon monoxide or cyanide

The inhalation of hot particulate steam

Direct flame exposure to the oropharynx

Never rule out CO poisoning because of the absence of cherry red skin

The most common symptom of CO poisoning is chest pressure

CO results in systemic hypoxia by disintegrating red blood cells

Hyperbaric therapy is beneficial only if CO levels are above 40%

The type of liquid used to irrigate the burn

Whether the burn should be flushed

Whether toxicity is local or systemic

The antidote required to reverse the effects

Fireworks,air

Oven cleaner, water

Drain cleaner, air

Battery acid, water

Chlorine

Ammonium

Sulfur mustard

Hydrogen peroxide

Typically only experiences burns to the epidermal layer because calcium oxide is a weak chemical

Often does not experience a burn unless he or she is exposed to the cement for longer than 2 hours

May not notice a skin burn for hours because cement penetrates through clothing and reacts with sweat

Experiences immediate pain and inflammation to the area because of the calcium oxide in the cement

The red zone of coagulation necrosis

Simply caused by local inflammation

A charred area of full thickness burn

Characterized by cold, gray, dry tissue

Most commonly experience blast type injuries

Often have areas of burns that resemble a fine red rash

Typically experience intractable ventricular fibrillation

Experience full thickness burns that require debridement

Is caused by excess serum potassium levels

Occurs when damaged muscle produces myoglobin

Can be prevented with boluses of lactated ringers

Is the result of electricity passing through the kidneys

Experiences a direct hit while standing in a large open area

Is talking on a phone and a utility pole is truck by lighting

Is attempting to escape an oncoming thunderstorm by running

Receives a splash effect after lighting strikes a nearby object

Five minutes of CPR generally restores a pulse

Perform a compression to ventilate ratio of 15:2

His or her heart may resume beating spontaneously

The ECG usually shows an organized cardiac rythm

Have minimal penetrating energy

Easily pass through solid materials

Are able to travel much farther in air

Are not dangerous if they are ingested

Can be reversed if chemotherapy is administered within 24 hours

Occur over time and will not be apparent in the prehospital setting

Are a direct result of beta particles and are usually life threatening

Manifest with lethal cardiac dysrhythmias and sudden cardiac arrest

Generally extended into the dermal layer

May appear hours or days after exposure

Are typically confined to the epidermis

Are immediately apparent after exposure

Toxic gases are often present, even after the fire is out

The lead paramedic determines where you should stage

Most fabric materials release cyanide when they burn

You may need to provide rehabilitation for fire fighters

Hypothermia

Burn shock

Inhalation injury

Cyanide toxicity

May undergo necrosis within 24-48 hours after the burn

Surrounds the central part of the burn and is often inflamed

Is the area least affected by the burn and will likely recover

Is the central part of the burn and suffers the most damage

Partial thickness burns are usually extremely painful for the patient

They are difficult to distinguish from a superficial burn in the field

The majority of partial thickness burns are caused by an open flame

Is the central part of the burn and suffers the most damage

18

27

36

45

Obtain an accurate calculation of how severe the patient's burns are

Determine whether the patient should be transported via helicopter

Ascertain how much IV fluid the patient should receive during transport

Help the paramedic determine the most appropriate destination hospital

Require the paramedic to incise the burn to decompress it

May cause significant restriction of respiratory excursion

Are generally not significant unless the skin is unyielding

Necessitate immediate intubation and ventilatory support

Determining if the scene is safe to enter

Thoroughly decontaminating the patient

Quickly moving the patient to a safe area

Evaluating airway, breathing, and circulation

Infection

Hypovolemia

Hypothermia

Myoglobinemia

This increases the risk of intubating the right mainstream bronchus

Facial edema may cause tube dislodgement 2-3 days after the burn

Drugs given via the ET tube will not adequately disperse in the lungs

It may result in excessive volumes of air being delivered to the patient

Due to the risk of causing hemodynamic compromise,analgesia should be avoided in the field

One half of the usual dose of narcotic analgesics should be given in order to avoid drug toxicity

Benzodiazepines are preferred over narcotics because they are less likely to cause hypotension

Burns increase the metabolic rate, which may necessitate higher than normal doses of analgesia

Analgesia

High flow oxygen

Moist dressings

Sterile burn pads

Calcium chloride

Sodium bicarbonate

Magnesium sulfate

Viscous lidocaine gel

Occurs in any patient over the age of 45 years

Is located to the proximal aspect of an extrmity

Is rated as at least a 5 on a pain scale of 0-10

Involves more than 30% of the body surface area

Tetanus

Meningitis

A viral infection

A staph infection

Immediately gain access to the patien

Apply gloves, a gown and facial protection

Determine if air medical transport is available

Carefully assess the scene for safety hazards

Apply firm manual pressure to the hematoma to reduce internal bleeding

Place him in a sitting position and apply a chemical heat pack to his head

Apply an icepack to the hematoma and monitor his level of consciousness

Start an IV of normal saline and administer 2 mg of morphine for the pain

Apply supplemental oxygen and keep her warm

Elevate her extremity above the level of her heart

Apply a pressure dressing and start a large bore IV

Locate and apply digital pressure to the brachial artery

Apply and inflate the PASG, start two large bore IV lines with an isotonic crystalloid, and transport.

Give oxygen via non rebreathing mask, start a large bore IV of lactated ringers or normal saline, and transport

Administer high flow oxygen, transport immediately, and attempt other bleeding control methods en route

Perform endotracheal intubation, administer crystalloid fluids until his carotid pulse strengthens, and transport at once

Protect his spine, insert a nasal airway, assist ventilations with a BVM and 100% O2. keep him warm and elevate his legs, transport at once, and establish vascular access en route to a trauma center

Perform immediate endotracheal intubation, apply a cervical collar, establish two large bore IV lines and give a fluid bolus at the scene, apply warm blankets, and transport expeditiously to a trauma center

Apply high flow oxygen via nonrebreathing mask, apply blankets, elevate his lower extremities 12 inches, insert bilateral intraosseous catheters, deliver a 500mL fluid bolus, and begin transport to a trauma center

Insert an oral airway, hyperventilate him with a BVM at 24 breaths/min, keep him warm and elevate his legs, transport at once, and establish at least one large bore IV line of normal saline while en route to a trauma center

Administering high flow oxygen via nonrebreathing mask, monitoring his cardiac rhythm, starting a large bore IV and giving a 20 ml/kg crystalloid bolus, initiating transport and infusing dopamine at 10-20 mcg/kg/min while en route to the closest facility

Applying a CPAP device, monitoring his cardiac rhythm for dysrhythmias, establishing IV or IO access at the scene, administering a 500 mL crystalloid bolus, initiating transport, and administering atropine en route to prevent bradycardia

Hyperventilating him with a BVM device for 2-3 minutes, intubating his trachea, establishing vascular access, administering prophylactic amiodarone to prevent ventricular dysrhythmias, and transporting him while infusing crystalloid fluid boluses en route to the hospital

Assisting his ventilations, applying a cardiac monitor, intubating if necessary, auscultating his lungs, transporting at once, establishing vascular access en route, administering a 200 mL crystalloid bolus if his lungs are clear and considering a dopamine infusion

Apply high flow oxygen, attempt transcutaneous pacing to increase his heart rate, apply spinal motion restriction precautions, establish vascular access and administer a crystalloid bolus of 10-20 mL/kg, begin transport, and infuse dopamine at 2 mcg/kg/min en route

Consider immediate intubation to protect his airway, apply spinal motion restriction precautions, apply warm blankets, begin transport, establish IV or IO access en route, and administer up to 4 liters of normal saline or lactated Ringer's solution to increase his BP and improve perfusion

Assist ventilations as needed, apply spinal motion restriction precatutions, keep him warm, begin transport, establish vascular access en route, administer crystalloid boluses in 200 mL increments, consider atropine for his bradycardia, and infuse dopamine if his blood pressure is refractory to fluid boluses.

Provide ventilatory assistance with a BVM device, establish immediate vascular access and infuse normal saline wide open, apply spinal motion restrictions, administer 1 mg of atropine to increase his heart rate above 60 beats/min, begin transport, and perform transcutaneous pacing en route if he remains bradycardic

Cardiogenic,dopamine

Neurogenic,a beta blocker

Hypovolemic, saline boluses

Distributive, an antidysrhythmic

Apply downward manual traction below the venipuncture site to stabilize the vein in position.

Apply the constricting band to a distal location

Use a through the needle IV catheter in order to gain better control over the rolling vein

Place a chemical heat pack over the vein for 10 minutes in order to decrease movement of the vein

Gently manipulate the catheter and reassess the flow

Discontinue the IV and reestablish it in the other arm

Ensure that the constricting band has been removed

Use a pressure infuser device to improve the IV flow

An air embolus

An allergic reaction

Circulatory overload

A pyrogenic reaction

Extravasation due to an inappropriate angle of IO catheter insertion

Inadvertent entry of a large vein, causing infiltration

Fracture of the bone with leakage of bone marrow into the soft tissue

Acute osteomyelitis 2nd to inappropriate cleansing of the site

5.5

6.2

6.5

6.8

Contact your medical director at once

Ask the physician to repeat the order

Refuse to administer the ordered dose

Confirm the correct dose in your field guide

The patient may require another dose of the same drug

The dose was too low for the patient's clinical condition

The IV tubing was occluded proximal to the injection

You diluted the bolus by following it with a 20 mL saline flush

Anticholineric

Sympathomimetic

Sympatholytic

Parasympatholytic