Paramedic Quiz Chapter 18-19

When caring for a patient with a soft-tissue injury to the face, the main concern should be airway compromise. This is because injuries to the face can potentially obstruct the airway, making it difficult for the patient to breathe. It is crucial to ensure that the airway remains open and unobstructed to prevent respiratory distress or failure.

The skin performs various functions such as protecting the underlying tissue from injury, sensing changes in the external environment, and assisting in the regulation of body temperature. However, providing the immune response for the body is not a function of the skin. The immune response is primarily carried out by the immune system, which includes organs like the lymph nodes, spleen, and thymus, as well as specialized cells like white blood cells. The skin acts as a physical barrier against pathogens, but it does not play a direct role in immune response.

Gangrene is the correct answer because it refers to the necrosis of tissue caused by an anaerobic, toxin-producing bacterium. This condition occurs when the blood supply to a certain area is cut off, leading to tissue death. The anaerobic bacteria release toxins that further damage the surrounding tissue. Gangrene can be categorized into dry gangrene, where the tissue becomes dry and shrinks, or wet gangrene, where the tissue becomes swollen and infected. If left untreated, gangrene can spread and lead to serious complications, including sepsis and amputation.

The correct answer is how the wound is managed. This is because the way a wound is managed, such as cleaning and dressing it properly, plays a crucial role in preventing or reducing the risk of infection. Proper wound management includes cleaning the wound, applying appropriate dressings, and ensuring that it is protected from further contamination. If a wound is not managed properly, bacteria and other pathogens can enter the wound, leading to infection. Therefore, the way the wound is managed is a key factor in determining whether contamination from an open wound will result in an infection.

The seriousness of a gunshot wound is determined by the type of tissue through which the projectile passes. This means that if the bullet passes through vital organs or major blood vessels, the injury will be more severe. The type of tissue, such as muscle or skin, also plays a role in how well it can tolerate temporary cavitation, which is the formation and collapse of a temporary cavity around the bullet's path. Therefore, understanding the type of tissue involved is crucial in assessing the seriousness of a gunshot wound.

In a patient with compensated shock, the body is actively trying to maintain blood pressure and perfusion to vital organs. Anxiety or agitation can be observed as a result of the body's response to the decreased blood flow and oxygenation. This can be attributed to the release of stress hormones, such as adrenaline, which can cause feelings of restlessness and unease. Therefore, anxiety or agitation is a likely sign that may be observed in a patient with compensated shock.

When the body's compensatory mechanisms fail to maintain perfusion, it can lead to hypotension (low blood pressure), low cardiac output (inadequate blood flow from the heart), and decreased coronary perfusion (reduced blood flow to the heart muscle). However, it does not result in an increase in preload. Preload refers to the amount of blood filling the heart before it contracts, and it is not affected by the failure of compensatory mechanisms.

A bedridden patient is at the highest risk for a pressure injury because they are immobile and spend prolonged periods in one position, which can lead to pressure ulcers. The constant pressure on specific areas of the body, such as the back, hips, and heels, can cause tissue damage and the development of pressure injuries. Obese patients, hypertensive patients, and patients with diabetes may also be at risk for pressure injuries, but being bedridden significantly increases the risk due to the lack of movement and pressure relief.

The seriousness of a laceration depends on its depth and the structures that have been damaged. This means that the severity of a laceration is determined by how deep the cut is and what important structures, such as nerves or blood vessels, have been affected. A shallow laceration may not be as serious as a deep one that has damaged vital structures. Therefore, assessing the depth and potential damage to structures is crucial in determining the seriousness of a laceration.

A laceration that lies perpendicular to the skin's tension lines often remains open, heals more slowly, and is more likely to result in abnormal scar formation. This is because when a laceration is perpendicular to the skin's tension lines, it creates more tension on the wound edges, making it difficult for the wound to close naturally. As a result, the wound may remain open and take longer to heal. Additionally, the increased tension can lead to abnormal scar formation, such as hypertrophic scars or keloids.

Exit wounds occur when the projectile's energy is not entirely dissipated along its trajectory through the body. This means that the projectile still has enough energy to create an exit wound as it exits the body. Compared to entrance wounds, exit wounds are generally much smaller and typically have regular edges. Despite fragmentation of the projectile, there is usually only one exit wound for each round that is fired. With low-velocity gunshot wounds, the exit wound is not always a mirror image of the entrance wound.

Exogenous hypovolemic shock refers to a condition where there is a significant loss of blood or fluid volume from outside the body. Among the given options, external bleeding is the most common cause of this type of shock. External bleeding can occur due to various reasons such as trauma, injuries, or surgical complications. When there is excessive bleeding, it leads to a rapid decrease in blood volume, causing hypovolemic shock. This condition can be life-threatening if not promptly treated.

Compartment syndrome is a condition characterized by increased pressure within a closed anatomical compartment, leading to compromised blood flow and tissue damage. It is more likely to occur with closed injuries, such as fractures or crush injuries, where there is limited space for swelling and increased pressure within the compartment. Open injuries, on the other hand, allow for decompression and release of pressure. Therefore, the statement that compartment syndrome is more likely to occur with closed injuries is the most correct.

Plavix is the correct answer because it is an antiplatelet medication that inhibits the formation of blood clots. This interference with the normal clotting process can lead to impaired hemostasis, which is the body's ability to stop bleeding. Paxil is an antidepressant, Procrit is used to treat anemia, and Tylenol is a pain reliever, none of which are known to interfere with hemostasis.

In cases of impaled objects, the general rule is to not remove the object unless it is obstructing the airway and preventing breathing or causing profuse bleeding. However, in a cardiac arrest patient, the priority is to perform cardiopulmonary resuscitation (CPR) and restore circulation. In this scenario, the impaled ice pick in the center of the back may be compressing the heart or major blood vessels, hindering the chances of successful resuscitation. Therefore, removing the impaled object becomes necessary in order to effectively perform CPR and increase the chances of survival.

When muscles are crushed beyond repair, tissue necrosis develops. This leads to the release of harmful products, such as myoglobin, into the bloodstream. This condition is called rhabdomyolysis.

Physical injury to the skin triggers mast cells to degranulate and synthesize special chemical mediators, which causes the injured area to become warm and red. Mast cells release substances like histamine, which dilates blood vessels and increases blood flow to the injured area, leading to redness and warmth. This is part of the body's inflammatory response to injury, aimed at promoting healing and fighting off potential infections.

A soft-tissue injury can cause bleeding, which can lead to hemorrhage. Hemorrhage refers to excessive bleeding, which can be life-threatening if not controlled. Immediate treatment is necessary to stop the bleeding and prevent further complications. Nerve damage, infection, and disfigurement are also potential risks associated with soft-tissue injuries, but hemorrhage poses the most immediate and significant threat to the patient's well-being.

An altered mental status is the most reliable indicator that a patient is no longer able to compensate for shock. This is because the brain is highly sensitive to changes in blood flow and oxygenation, and any disruption in these factors can lead to impaired brain function. Therefore, if a patient's mental status is altered, it suggests that the brain is not receiving enough oxygen and nutrients, indicating that the body's compensatory mechanisms for shock are failing.

The initial assessment of a shock patient begins by forming a general impression. This involves quickly assessing the overall condition of the patient, including their level of consciousness, breathing, and circulation. By forming a general impression, healthcare providers can quickly identify any immediate life-threatening issues and prioritize interventions accordingly. This step is crucial in identifying and managing shock, as it allows for prompt recognition and initiation of appropriate treatment.

Diphendydramine is the correct answer because it is an antihistamine medication that blocks the effects of histamine, which is one of the main chemical mediators released during anaphylactic shock. By inhibiting histamine, diphendydramine helps to reduce the symptoms of anaphylaxis and prevent the release of further chemical mediators, providing relief to the patient. Epinephrine, ipratropium, and albuterol are not specifically indicated for inhibiting the release of chemical mediators in anaphylactic shock.

During the process of wound healing, hemostasis temporarily stops bleeding via vasoconstriction and platelet aggregation. Vasoconstriction narrows the blood vessels, reducing blood flow to the injured area. Platelet aggregation refers to the clumping together of platelets to form a plug, which helps to seal the wound and prevent further bleeding. This temporary halt in bleeding allows for the formation of a blood clot and the subsequent healing of the wound.

When a patient is in shock with respiratory distress, positioning them in a semi-sitting position can help improve their breathing. This position allows for better expansion of the lungs and can help alleviate the feeling of breathlessness. Additionally, elevating the head and upper body can help to improve blood flow and circulation, which is important in managing shock. This position also allows for easier access to the airway and can facilitate the administration of oxygen or other necessary interventions.

Prolonged efforts to stabilize the patient in the field are not recommended for the prehospital treatment of cardiogenic shock. Cardiogenic shock is a life-threatening condition where the heart is unable to pump enough blood to meet the body's needs. Immediate medical intervention is crucial in this situation. The statement suggests that spending too much time trying to stabilize the patient in the field is not recommended, indicating that prompt transfer to a medical facility for further treatment is necessary.

Applying direct pressure to a bleeding wound allows platelets to seal the vascular walls. When pressure is applied, it compresses the blood vessels and reduces the flow of blood. This compression causes the platelets to adhere to the damaged area and form a plug, which helps in sealing the wound and preventing further bleeding.

A decreased pulse rate upon standing would not be expected in a patient with significant dehydration. Dehydration leads to a decrease in blood volume, which in turn causes the heart to pump faster in order to compensate for the decreased volume. Therefore, a decreased pulse rate upon standing would be unexpected in a dehydrated patient.

A crushing or tearing amputation can result in excessive blood loss due to hemorrhage if the paramedic does not intervene rapidly. This is because the severe vascular and soft tissue damage that accompanies the amputation can cause significant bleeding. Applying a proximal tourniquet and retrieving any detached body parts can help control the bleeding and prevent further blood loss. However, the blood vessels may still retain their ability to constrict to some extent, which can help reduce the amount of blood loss compared to what would be expected. Nevertheless, prompt intervention by a paramedic is crucial to prevent excessive blood loss and manage the situation effectively.

Splinting an open soft-tissue injury to an extremity is necessary because motion of the extremity may disrupt the blood clotting process. When an injury occurs, the body initiates a clotting process to stop bleeding and promote healing. Any movement of the extremity can disturb the formation of a stable blood clot, leading to prolonged bleeding and delayed healing. Splinting helps immobilize the injured area, preventing further damage and allowing the blood clotting process to proceed undisturbed.

After controlling the bleeding from a grossly contaminated open wound to the leg, the next step should be to irrigate the wound with sterile water and apply a sterile dressing. This is important to remove any remaining contaminants or debris from the wound, reducing the risk of infection. Irrigation helps to flush out bacteria and foreign bodies, while a sterile dressing provides a clean environment for wound healing. Applying a pressure bandage and elevating the extremity can be done after the wound has been cleaned and dressed. Administering 100% O2 and picking out foreign bodies with hemostats are not necessary steps in this situation.

During the neovascularization phase of the wound healing process, new blood vessels form as the body attempts to bring oxygen and nutrients to the injured tissue. This is essential for the healing process as it provides the necessary resources for tissue regeneration and repair. The formation of new blood vessels, also known as angiogenesis, is triggered by various factors, including the release of growth factors and cytokines. These new blood vessels help to restore blood flow to the injured area and promote the delivery of essential nutrients and oxygen, aiding in the healing process.

The given correct answer explains that anaphylaxis occurs when a person reacts violently to a substance to which they have been sensitized. This means that the person has previously been exposed to the allergen and their immune system has developed a hypersensitivity or allergic reaction to it. When they are exposed to the allergen again, their immune system overreacts and releases chemicals that cause symptoms such as urticaria (hives) and rhinorrhea (runny nose). This violent reaction can be life-threatening and requires immediate medical attention.

Corticosteroids are known to have anti-inflammatory effects and can suppress the immune system. This can lead to a delay in the healing process of wounds as the body's natural healing response is compromised. Therefore, a patient taking corticosteroids would most likely experience a delay in the healing of a wound.

In the case of a patient who is entrapped by a crushing object, it is crucial to make every effort to treat the patient before removing the crushing object. This is because removing the object without proper treatment can lead to a rapid release of toxins and metabolic waste products into the bloodstream, causing a systemic inflammatory response and potentially leading to organ failure. By providing immediate treatment, such as administering fluids, pain relief, and stabilizing any life-threatening conditions, the patient's overall condition can be improved before attempting to remove the crushing object.

Collagen is a fibrous protein that provides the skin with high resistance to breakage under mechanical stress. It is responsible for maintaining the skin's strength and elasticity, making it less prone to damage. Collagen helps to support and structure the skin, keeping it firm and preventing it from tearing or breaking easily.

Cardiogenic shock is a condition characterized by inadequate blood flow and oxygen delivery to the body's organs due to the heart's inability to pump effectively. Decompensated congestive heart failure refers to a worsening of the symptoms and signs of congestive heart failure, where the heart is unable to meet the body's demands. This can lead to cardiogenic shock as the heart's pumping function becomes severely compromised. In this scenario, the heart's inability to pump blood effectively is the most likely cause for the development of cardiogenic shock.

During the secondary phase of blast injury, flying shrapnel may cause penetrating injuries. This means that when an explosion occurs, fragments of debris or shrapnel can be propelled at high velocities, causing them to penetrate the body. These penetrating injuries can range from superficial wounds to more severe injuries, depending on the size and speed of the shrapnel. It is important to consider this aspect of blast injuries as it can significantly impact the severity and treatment required for the patient.

The correct answer is increased microvascular permeability and capillary leakage. In severe sepsis, the body's response to infection causes inflammation and leads to increased permeability of blood vessels. This increased permeability allows fluid and proteins to leak out of the blood vessels and into the surrounding tissues, resulting in hypovolemia (low blood volume). This can lead to decreased blood flow to vital organs and contribute to the development of septic shock.

The correct answer is following BSI precautions. BSI stands for Body Substance Isolation, which involves taking necessary precautions to protect oneself and others from potential exposure to infectious materials. In the context of caring for a patient with profound shock, following BSI precautions would include wearing personal protective equipment such as gloves, mask, and gown, to prevent the spread of any pathogens or contaminants. This is an important initial step before providing any further care or treatment to the patient.

Sebum is the correct answer because it is an oily substance that is produced in the dermis and helps to keep the skin supple. It acts as a natural moisturizer and lubricant, preventing the skin from becoming dry and cracked. Sebum also helps to protect the skin from external factors such as bacteria and pollutants, maintaining its overall health and elasticity.

The swelling that occurs in conjunction with a contusion is caused by the leakage of fluid into spaces between the cells. When a contusion occurs, blood vessels may be damaged, leading to the release of fluid into the surrounding tissues. This fluid leakage causes swelling as it accumulates in the interstitial spaces between the cells.

Neurogenic shock is a condition caused by damage to the spinal cord, resulting in a disruption of the autonomic nervous system. One of the characteristic signs of neurogenic shock is an absence of sweating, also known as anhidrosis. This occurs because the damaged spinal cord affects the sympathetic nervous system, which is responsible for regulating sweating. Therefore, individuals experiencing neurogenic shock may not be able to sweat, leading to an absence of sweating as a distinguishing feature of this condition.

The correct answer is "the postcapillary sphincters remain constricted". In shock, the body's blood vessels constrict in an attempt to maintain blood pressure and redirect blood flow to vital organs. The postcapillary sphincters are small muscles located at the junction between the capillaries and veins. When these sphincters remain constricted, it prevents blood from flowing out of the capillaries and back into the veins. As a result, fluid begins to accumulate in the capillaries, leading to engorgement and swelling.

During multiple organ dysfunction syndrome (MODS), there is a marked decrease in cardiac ejection fraction, which means that the heart is not able to pump blood effectively. This can lead to inadequate blood flow to various organs, causing their dysfunction. Noncardiogenic pulmonary edema also occurs in MODS, where fluid accumulates in the lungs without a primary cardiac cause. Decreased surfactant production by the alveoli can also occur, leading to impaired lung function. However, increased lactate metabolism by the liver does not occur in MODS. In fact, lactate levels may be elevated in MODS due to impaired liver function and inadequate lactate clearance.

Bleeding from a closed wound is limited because the skin is unbroken. When the skin is intact, it acts as a barrier to prevent excessive bleeding. Unlike an open wound where blood can freely flow out, a closed wound restricts the blood loss due to the containment provided by the unbroken skin.

Wet dressings provide a moist environment which promotes the growth of pathogens. In the field, where sterile conditions are difficult to maintain, the risk of contamination and infection is higher. Therefore, the use of wet dressings in the field is limited to avoid the potential growth of pathogens and subsequent infections.

When noncolloid solutions are used in the treatment of shock, it is recommended to give 2-3 times the volume of blood lost. This is because noncolloid solutions do not stay in the vascular compartment for a long duration and may quickly diffuse out of the intravascular space. Giving 2-3 times the volume of blood lost helps to compensate for this rapid diffusion and ensures an adequate amount of fluid reaches the cells for tissue perfusion and oxygen delivery.

An acidic condition in the blood inhibits hemoglobin in the red blood cells from binding with and carrying oxygen. This means that the oxygen-carrying capacity of the blood is reduced, leading to a decrease in the amount of oxygen available to the body's tissues and organs. This can result in various physiological effects, such as vasoconstriction and constriction of the postcapillary sphincters, which can impair blood flow. Additionally, the respiratory system function is immediately depressed, leading to severe hypoxemia, which is a low level of oxygen in the blood.

During compensated shock, the body tries to maintain perfusion to vital organs by initiating compensatory mechanisms. One of these mechanisms is an increase in respiratory rate and depth, which leads to hyperventilation. This hyperventilation causes a decrease in carbon dioxide levels in the blood, resulting in respiratory alkalosis. This compensatory response helps offset the metabolic acidosis that occurs during shock. Therefore, an increase in respiratory rate and depth creates a compensatory respiratory alkalosis to offset metabolic acidosis during compensated shock.

A weak radial pulse in a patient with shock indicates vascular dilation and decreased blood flow. In shock, the body tries to compensate for low blood pressure by dilating blood vessels in order to increase blood flow to vital organs. However, this can lead to decreased blood flow to peripheral areas such as the radial artery, resulting in a weak pulse. Additionally, the dilation of blood vessels can cause a drop in blood pressure, further contributing to the weak pulse.

Most open wounds should be sutured or otherwise closed no longer than 10 hours. This is because after this time period, the risk of infection and complications increases significantly. Closing the wound within 10 hours helps to prevent bacteria from entering the wound and promotes faster healing.