Medic General Review I

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The correct answer is "anticipating a lengthy for backup units to arrive, so move this patient to the best of your ability." This statement contradicts the general rules for lifting and moving an obese patient. The other options provide valid guidelines for safe patient handling, such as positioning the load close to the body, using the large muscles of the legs for lifting, and taking one's time to maintain a wide base of support.

Based on the patient's symptoms and assessment findings, it can be inferred that the patient is most likely suffering from congestive heart failure. The patient's shortness of breath, crackles in the posterior bases of the lungs, and low pulse oximeter reading of 88% indicate fluid accumulation in the lungs. The elevated blood pressure, rapid pulse, and increased respiratory rate also suggest a cardiac cause. These signs and symptoms are consistent with congestive heart failure, a condition in which the heart is unable to pump blood effectively, leading to fluid retention and congestion in the lungs.

In geriatric patients, the bones tend to be weaker and more brittle due to age-related factors such as osteoporosis. As a result, they are more prone to fractures and require less force to break a bone compared to younger individuals. Therefore, the statement "Less force is required than in other patients" is true.

In addition to living wills and Do Not Resuscitate orders, durable power of attorney for health care is another type of advanced directive. This document appoints a trusted individual to make medical decisions on behalf of the patient if they become unable to do so themselves. This person, known as the healthcare proxy or agent, has the authority to make healthcare decisions based on the patient's wishes and values.

Before providing rescue breathing to an unresponsive victim, it is important to check for breathing. This can be done by looking, listening, and feeling airflow through the victim's nose or mouth. This step helps determine if the victim is breathing or not, and whether rescue breathing is necessary. Opening the airway, shaking and shouting to stimulate the patient to breathe, and establishing unresponsiveness are also important steps in assessing the victim's condition, but they do not specifically address checking for breathing.

Based on the given information, the victim's symptoms and injuries suggest a pneumothorax. A pneumothorax occurs when air enters the pleural space, causing a collapse of the lung. The victim's shallow and rapid breathing, along with the presence of contusions and diminished respirations on the right side, indicate that there may be air trapped in the pleural space. This can be caused by trauma to the chest, such as the multiple hits with a pool stick mentioned by the victim. Therefore, a pneumothorax is the most likely explanation for the victim's symptoms.

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The correct answer is "low PaO2." In patients with COPD, the hypoxic drive to breathe is primarily regulated by low levels of arterial oxygen (PaO2). Increasing the oxygen flow may lead to higher PaO2 levels, which can suppress the hypoxic drive and result in decreased respiratory effort. This is a concern because patients with COPD rely on this hypoxic drive to maintain their respiratory function. Therefore, it is important to carefully monitor oxygen levels and adjust the flow rate accordingly to prevent the elimination of the hypoxic drive.

Walking in fast-moving water can be dangerous as the force of the water can easily knock a person off balance. Walking in water that is ankle-deep may still be manageable, but as the water level rises to knee-deep, it becomes increasingly difficult to maintain stability. At waist-deep, the force of the water can easily sweep a person off their feet, making it unsafe to walk. Therefore, knee-deep water is generally considered the maximum safe depth for walking in fast-moving water.

Dopamine administration can lead to increased myocardial oxygen demand. Dopamine acts as a vasopressor and increases the heart rate and contractility, which in turn increases the workload on the heart. This increased workload requires more oxygen, leading to increased myocardial oxygen demand.

Succinylcholine is contraindicated in patients with crush injuries due to the risk of hyperkalemia. Crush injuries can lead to muscle damage and release of potassium into the bloodstream. Succinylcholine, a muscle relaxant, can further increase potassium levels, potentially leading to life-threatening hyperkalemia. This can cause cardiac arrhythmias and other complications. Therefore, succinylcholine should be avoided in these patients to prevent the exacerbation of hyperkalemia.

Obtaining a 12-lead ECG for patients with chest pain is important because it can provide valuable information about their heart's electrical activity. However, it is crucial to consider that changes indicating a heart attack may not immediately appear on the ECG. In some cases, it may take hours for these changes to become evident. Therefore, relying solely on the initial ECG results may lead to a false sense of security, as an unremarkable ECG does not completely rule out the possibility of an acute myocardial infarction (MI). Additional clinical evaluation and monitoring are necessary to make an accurate diagnosis and guide appropriate treatment.

The presence of jugular venous distention while sitting at a 45-degree angle indicates right heart compromise. This is because jugular venous distention is a sign of increased central venous pressure, which can occur when the right side of the heart is not functioning properly. It can be caused by conditions such as right-sided heart failure or pulmonary hypertension. This finding is clinically significant and requires further evaluation and management.

Stabilizing the machinery is the correct first action in this scenario. By stabilizing the machinery, we ensure that it is safe to approach the patient and provide care without further endangering their life or causing additional injuries. Once the machinery is stable, we can then proceed to control the bleeding, perform a rapid trauma assessment, and establish IV access. However, the immediate priority is to ensure the safety of the patient and the responders by stabilizing the machinery.

The signs and symptoms of a pregnant patient with preeclampsia include elevated blood pressure (BP), visual disturbance, headache, and edema. Preeclampsia is a condition that affects pregnant women and is characterized by high blood pressure and damage to organs such as the liver and kidneys. Visual disturbances, such as blurred vision or seeing spots, are common symptoms of preeclampsia. Headaches are also common, often described as severe and persistent. Edema, or swelling, is another common symptom, usually seen in the hands, feet, and face. Therefore, the answer "elevated BP, visual disturbance, headache, edema" is the correct choice for signs and symptoms of preeclampsia in a pregnant patient.

The correct answer is medical practice act. A medical practice act is a legislation that governs the practice of medicine and outlines the scope of practice for physicians and other healthcare professionals. It may include regulations regarding the delegation of authority to perform medical acts by paramedics or other healthcare providers. Licensure refers to the process of obtaining a license to practice medicine, while medical direction refers to the supervision and guidance provided by a physician to other healthcare professionals. Standard of care refers to the expected level of care provided by healthcare professionals in a given situation.

The priority of care in this situation is to provide careful fluid resuscitation. The patient's low blood pressure and signs of trauma indicate that she may be experiencing hypovolemic shock, which is a life-threatening condition caused by severe blood or fluid loss. Fluid resuscitation involves administering intravenous fluids to restore blood volume and improve perfusion to vital organs. This intervention is crucial in stabilizing the patient's condition and preventing further deterioration.

Based on the given information, the patient is alert and oriented, with warm, dry, pink skin. However, she is complaining of a headache and upper back pain. Her vital signs show a low blood pressure (90/62) and pulse rate (60). These signs and symptoms are consistent with neurogenic shock, which occurs due to a disruption in the autonomic nervous system's ability to regulate blood vessel tone. This can happen as a result of a spinal cord injury or other trauma. Therefore, neurogenic shock would be the initial impression in this case.

The presence of rebound tenderness in a patient with acute right lower quadrant pain suggests peritoneal irritation. Rebound tenderness refers to the pain experienced by the patient when pressure is released from the abdomen after palpation. It indicates inflammation or irritation of the peritoneum, the lining of the abdominal cavity. While guarding is the involuntary tensing of the abdominal muscles to protect the inflamed area, rupture refers to the tearing or bursting of an organ, and strangulation refers to the compression or obstruction of blood flow to a tissue or organ.

Poor muscle tone is an assessment finding that would indicate a pediatric patient is progressing from respiratory distress to respiratory failure. This is because poor muscle tone is a sign of respiratory muscle fatigue, which occurs when the muscles responsible for breathing are unable to maintain adequate ventilation. As the patient's respiratory distress worsens, their muscles become weaker and less able to effectively move air in and out of the lungs, leading to respiratory failure.

Intubation and positive pressure ventilation is the most definitive treatment for a patient with a flail chest injury. Flail chest occurs when multiple adjacent ribs are fractured in two or more places, causing a segment of the chest wall to become unstable. This can lead to paradoxical chest wall movement and impaired ventilation. Intubation allows for control of the airway and positive pressure ventilation helps to stabilize the chest wall and improve oxygenation. Other options such as positioning, stabilization with a sandbag, or needle decompression may provide temporary relief or support, but they do not address the underlying issue of impaired ventilation caused by the flail chest.

Endotracheal intubation is a procedure in which a tube is inserted into the trachea to assist with breathing. Complications from this procedure can include trauma to the teeth, esophageal intubation, and laryngospasm. However, gastric distension is not a complication of endotracheal intubation. Gastric distension refers to the abnormal accumulation of air or fluid in the stomach, which can cause discomfort and potential complications. Since it is not directly related to the procedure of intubation, it is not considered a complication.

Medical direction refers to the legislation that governs the practice of medicine and may prescribe a physician's ability to delegate authority to perform medical acts by the paramedic. This means that a physician has the authority to direct and supervise the actions of a paramedic in the performance of medical acts. This ensures that the paramedic is acting within the scope of their training and under the guidance of a licensed physician.

The correct answer is 1.5-2.0 mg/kg. This is the appropriate dosage range for administering succinylcholine during rapid sequence intubation. Rapid sequence intubation is a procedure used to secure the airway in emergency situations, and succinylcholine is a neuromuscular blocking agent commonly used for this purpose. The dosage is based on the patient's weight, with the recommended range being 1.5-2.0 mg/kg. This dosage ensures adequate muscle relaxation for intubation and minimizes the risk of complications.