med emergency

Imagine you and your classmate Grace are on a ride-along when you’re called to help a woman with chest discomfort. She’s alert and tells you she’s already taken three nitroglycerin tablets but still feels the same. To see if the nitroglycerin is working, you and Grace brainstorm what to check. Which of the following would NOT help you determine if the nitroglycerin is effective?

• ask if the nitroglycerin tablets are in the original container

• look for signs of irritation or inflammation under the tongue

• check the expiration date on the medication

• ask if the nitroglycerin gave her a headache

Answer explanation

Nitroglycerin tablets must be protected from light. This is why they are in a brown glass bottle. Nitroglycerin may also cause a headache. If the patient reports a headache it may be an indication that the medication was effective. Expired medications may not be as potent or effective.

Nitroglycerin will not cause inflammation or irritation in most cases during short-term use. This will not help determine whether the medication was effective.

Imagine Daniel and Grace are learning about heart rhythms. Daniel asks, "What do you call a pulseless condition where the heart's electrical impulses are so disorganized that the heart muscle cannot contract normally?" (a)  

• Atrial fibrillation

• Premature ventricular contractions

• Ventricular tachycardia

• Ventricular fibrillation

Answer explanation

Ventricular fibrillation is a chaotic, disorganized rhythm that does not cause compression of the heart's chambers. Ventricular tachycardia is a rapid but organized heart rate which prevents the ventricles from filling enough between beats to allow for the blood flow to meet the demands of the body. Premature ventricular contractions are when the ventricles beat before they should in the normal cycle of a complete heart beat. Atrial fibrillation is when the atria beat in a disorganized fashion but a pulse is still present.

Nora, a female patient, tells you she has a heart condition and hasn't been feeling well for three or four days. She complains of chest discomfort. Which of the following clues would most make you think her symptoms are not related to her heart? (a)  

• Fever and chills

• Pain in the jaw

• Irregular pulse

• Pain when taking a deep breath

Answer explanation

Fever and chills most likely indicate an infectious process like pneumonia. This is the strongest indication that the problem is not cardiac in nature. While a slight elevation in temperature may be seen in a cardiac event, fever and chills indicate a significant infection. The 3 - 4 day duration of the symptoms also matches an illness like pneumonia. Pain when taking a deep breath may happen in cardiac-related conditions. The jaw is one place cardiac pain may radiate. An irregular pulse may also indicate a cardiac problem.

Noah and Emma are studying for their emergency medicine exam. Noah asks, "Hey Emma, can you remember the two main side effects we always see with nitroglycerin?"

(a)  

Answer explanation

The common side effects with the administration of sublingual nitroglycerin are hypotension, headache, and pulse rate changes (usually an increase).

During a science class, Michael, Luna, and Avery are discussing what happens to the body during hypoxia. Which of the following would they expect to see as a result?

• wheezing

• decreased resp. rate

• constricted pupils

• increased pulse rate

Answer explanation

As a result of hypoxia the pulse and respiratory rate will increase. Decreased respirations may cause hypoxia but are not a common result of hypoxia. Mild hypoxia will not have a significant change in pupil size although profound hypoxia may cause pupil dilation.

Abigail, a first responder, rushes to the scene and reports her assessment: the patient is incontinent, confused, and has lacerations on her tongue. Sophia and Ava are trying to guess what these findings could mean. Can you help them figure it out? These findings are consistent with:

• Hyperglycemia

• A reaction to a bee sting

• A seizure

• Myocardial infarction

Answer explanation

All of these assessments are commonly found in patients who have suffered a generalized tonic-clonic (grand mal) seizure.

Abigail, William, and Lily are discussing heart health. Who can correctly explain what acute coronary syndrome is?

• A heart attack

• Fluid build-up causing malfunction of the heart and lungs

• Damage to the ventricular wall that reduces coronary perfusion.

• A group of conditions brought on by reduced blood flow to the heart

Answer explanation

Acute coronary syndrome is a term for a group of conditions that are caused by reduced blood flow to the heart. These conditions include myocardial infarction (heart attack) and unstable angina.

Charlotte and Aiden are paramedics called to help an oriented male patient who suddenly started having chest pain while relaxing at home. The pain radiates to his shoulder and jaw. His pulse is 56/minute and regular, respirations are 18, BP is 158/98, and oxygen saturation is 97%. In reference to oxygenation, what should they do next?

• Administer oxygen via cannula at 2 lpm.

• Do not administer oxygen.

• Administer oxygen via NRB at 12 lpm.

• Administer oxygen via venturi mask at 40-50%.

Answer explanation

This patient has a saturation greater than 94% and is oriented. The question does not specify any signs of additional distress such as poor color or respiratory distress. He would not receive oxygen.

Imagine you’re at the city park with your friends Evelyn and Arjun when suddenly Arjun gets stung by a bee! He starts showing signs such as altered mental status, respiratory distress, hives, swelling of the face, hoarseness, and pale, clammy skin. As you check his vital signs, what do you expect to find?

• increased heart rate and decreased blood pressure

• decreased heart rate and decreased blood pressure

• increased heart rate and increased blood pressure

• decreased heart rate and increased blood pressure

Answer explanation

The response to a severe allergic reaction includes the signs and symptoms of shock. You will find an increased pulse rate and as the anaphylactic reaction worsens, the blood pressure will decrease.

Insulin is produced in the (a)   .

• Pancreas
• Liver
• Spleen
• Gallbladder

Answer explanation

Insulin is produced in the islets of Langerhans in the pancreas.