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ED 242 889 CE 038 664

TITLE . EmergencyMedical Care. A Manual for the Paramedic in the Field--Workbook. INSTITUTION National Highway Traffic'Safety Administration (DOT), Washington, D. C. REPORT,NO DOT-HS-900-067 PUB DATE Jan 83 NOTE 51p.; For the related textbook, see CE 038 663. rlAILABLE FROMSuperintendent of Documents, U.S. Government Printing Office, Washington, DC 20402. PUB TYPE Guides Classroom Use Materials (For Learner) (051) Tests/Evaluation Instruments (160)

;DRS- PRICE MFOI/PC03 Plus Postage. DESCRIPTORS Accidents; Allergy; *Anatomy; ;_ Birth; Blood Circulation; Cardiovascular System; Case Studies;

Definitions; ;_ *Emergency Medical V Technicians; First Aid; *Guidelines. Heart Rate; Human Body; Injuries; *Job Skills; Job Training; Learning Modules; *Medical Services; Metabolism; Motor Reactions; Obstetrics; Patients; Pediatrics; Pharmacy; Physical Activity Level; *Physiology; Postsecondary Education; Rescue; Sensory-Deprivation; Telecommunications; Test Items; Toxicology; Workbooks, ABSTRACT This workbook is designed to accompany the text of the same name and to serve as an aid to both learning andreview during the course of study, The workbook consists of 15 module self-tests and vocabulary lists that follow the modules of the text. Tests consist of objective questions (multiple choice, fill-in-the-blank, short answers, and matching), case histories, and essay questions. Line drawings are used toillustrate questions. Both the questions and the vocabulary lists are taken from the textand from no other sources. Topics covered in the modules are the following: the emergency medical technician-paramedic, human systems and patient assessment, shock and fluid therapy, geneval pharmacology, , cardiovascular system, central nervous system, soft-tissue injuries,musculoskeletal system, medical emergencies, obstetric/gynecological emergencies, pediatrics, Management of emotional crises, extrication/rescue techniques,and telemetry and communications. (KC)

*********************************************************************** Reproductions supplied by EDRS are the best that can be made from the original document. **********************************************************4************ Emergency U.S. Cpartment Medical Care of Transportation Nationd Highway Traffitsawy Administration A _Manual for the U.S. DEPARTMENT OF EDUCATION__ N IONAL INSTITUTE OF EOUCATION ED ATIONAL RESOURCES INFORMATION Paramedic in the CENTER 1ERICI This document has been reproduced as received from the person or organization originating it. FieldWorkbook Minor changes have bean math to improve reproduction quality.

Points of Oew or opinions stated in this docu mont do not necessarily represent official NIE pasitirm or policy.

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2 Emergency U.S.Department of Transportation Medical Care National HigKfay Traffic safety Administration A Manual for the Paramedic in the FieldWorkbook

DOT HS 900 067 January 1983

For sale by the Superintendent of DoeUrTlenti, U.S. Govereth-eut Printing Ofifee.Washington. D.C. 20402 *3 INTRODUCTION

This workbook is designed to accompany .the text In using this workbook you should put down what Emergency Medical CareA Manual for Paramedics in you consider your own best responses. Subsequent the Field and to sere as an aid to both learning and discussions with the instructor will add to your. re- review during the course of study. Both the questions sponses and; in turn; your mastery of the learning and vocabulary lists are taken from the text and no objectives. other source. They are intended to cause you to reread, study, and think as you progress. CONTENTS

Module Page I The Emergency Medical Technician-Paramedic II Human Systems and Patient. Assessment 2 III Shock and Fluid Therapy 6 IV General Pharmacology 10 V Respiratory System 13 VI Cardiovascular S ,tern 19 VII Central Nervous System 26 VIII Soft Tissue Injuries 30 IX Musculoskeletal System 33 X Medical Emergencies 37 XI Obstetric/Gynecologic Emergencies 39 41 XII. Pediatrics XIII Management of the Emotional Crisis 43 XIV Extrication/Rescue Techniques 45 XV Telemetry and Communications 46 Module I The Emergency Medical Technician-Paramedic SELF-TEST

1. Li St MA major components of the emergency a. Good, Samaritan laws are promulgated by the medical Services system. Department of Transportation for the prbtec= 2. List five items of equipment usually carried by tion of emergency medical personnel. mobile intensive care vehicles in addition to the b: Goad Samaritan laws protect medial person= "Essential Equipment for Ambulances," promul- nel from legal action arising from emergency gated by the Committee on Trauma of the Ameri- treatment. can College of Surgeons. c. The concept of reasonable and prudent care, as 3. All of the following are necessary to prove negli- would be provided_ under similar circumstances gent care EXCEPT which one? by similarly trained personnel, is an important element in Good Samaritan laws. a. An injury occurred. d. Gciod Samaritan laws do NOT protect a pro- b. The person accused had a duty to act. vider from responsibility if he gives NEGLI- c. The person accused failed to act as another GENT care. prudent person with similar training would hays acted under similar circumstances. 5. Define the difference between informed consent and implied consent. d. The patient did not give implied consent. 6. List the five circumstances that define "abandon- e. Failure to act appropriately was the causeof ment." the injury. 7. List six important elements to a thorough and 4. Which one of the following statements regarding accurate medical record. Good Samaritan laws is FALSE?

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1 Module II Human Systems and Patient Assessment SELF-TEST

1. BaSed on the prefixes and suffixes learned inhis digestive tract, bronchi module, define the following words: voluntary a. hemiparesis (hemiparesis) = automaticity b. anesthesia (an + esthesia) 6. Match the falloWing terms with the phrases that c. arthritis (arthroitis) = relate to each: d. myalgia (myo+algia) = centesis) = 11. central nervous-system e. pericardiocentesis (peri +cardio b. peripheral nervous system 2. List four types of joints. c. autonomic nervous system 3. Match the following terms with the phrase that spinal cord describes each. thoracic and lumbar spine a: cervical spine taste buds b. thoracic spine brain c. lumbar spine d: sacrum motor nerves to skeletal muscle e: coccyx parasympathetic nerves articulates: with the pelvis medulla neck pain sensation receptors posterior articulation of the ribs 7. Number the following parts in the order in which tailbone blood travels fromthe venous system to the arte- lower back rial system. 4. Match the following terms with the phrase that pulmonary artery deScribeS each. left atrium a. humerus right ventricle b. femur pulmonary vein c. radius venae cavae (1. ulna e.tibia aorta f.fibula right atrium articulates with.the pelvis left ventricle forms the medial malleolus of the ankle pulmonary capillaries forms the distal part of the elbow joint 8. Match the following with the phrase that de- shinbone scribes each: on the thumb side of the forearm a. vein articulates with the scapula b. artery thick, muscular wall 5. Match the following with the phrase that de- carries blood away from the heart scribes each carries blood to the heart a. skeletal muscle b. smooth muscle high pressure vessel c: cardiac muscle pulse 2 9. Match the following *terms with the word or b. adrenal phrase that describes each c. pancreas a: oropharynx d. thyroid b. epiglottis e: parathyroid c. bronchus f.ovary d. trachea g. testes e. larynx female sex hormones f alveolus hormone regulating metabolic rate valve thatprotects the airway during swallowing epinephrine voicebox hormones regulating the other endocrine organs throat Male sex hormones . windpipe hormone regulating calcium air space where exchange of gases takes place insulin air tube in. the lung 13. What kind of information about the patient can be derived from observations of the environment in 10. Match the following systems with their compo- which he is found? nent organs: a. digestive system 14. A patientt chief complaint is abdominal pain. List b. urinary system 10 questions you might ask to learn more ahout c. male reproductive system the nature of the complaints d. female reproductive system 15. List three aspects of a patient's medItal history kidney that may be important in the field: uterus 16. List the components of the primary survey. liver 17: SYMPTOMS are complaints' that the patient re- ureter ports to you; and they form part of the history. testes SIGNS are things you observe in your physical duodenum examination. Classify each of the following as to whether it is a symptom or a sign: seminal vesicle bladder cyanciSfs, pancreas paipitations ovary dyspnea 11. List three factors that may delay gastric empty- ing. diaphoresis 12. Match the following endocrine glands with the nausea hormone each produces: dysconjugate gaze a. pituitary faintness 3 18. In each of the following questions, choose the h. suggests: correct anNwer. (1) The patient has ingested a toxic blue sub- a. you are examining a patientwith suspected stance head injury and notice a clear discharge from (2) The patient has been lying in bed for a the nose. What serious condition should this long time sign suggest to you? (3) The patient is anemic (4) The patient's blood is not sufficiently ox)7- (1) common cold genated. (2) hayfever with marked sinus congestion (3) skull fracture with CSF leakage 19. Match the following descriptions with the condi- (4) tions in which they are seen. b. You are examining a patient who has beenin an a. trachea deviates AWAY from the affectedside automobile accident and was thrown against b. trachea deviates TOWARD the affected side the steering wheel. He __is conscious bUt con- brOnchus obstructed fused. Which of the following should you do tension pneumothorax FIRST? hemothorax - (1)examine the abcromen for internal bleeding (2) look for hip fracture simple pneumothorax (3) palpate for fractured ribs 20. The knowing are groups of signs, each group (4) immobilize the spine suggestive of a certain condition: Match the (5) establiSh an airway group of signs with the condition it suggests. c. An ecchymosis over the mastoid,behind the a. labored ear, is called: distended jugular veins gallop heart rhythm (1) Cheyne-Stokes' sign rales (2) Battle's sign tachycardia (3) Kussmaul's sign b. tracheal deviation (4) Kernig's sign respiratory distress d. Whena mastoidal ecchymosis ispresent,it unequal breath sounds sugg subcutaneous emphysema (1) basi!ar skull fracture dysconjugate gaze (2) ruptured ear drum facial weakness (3) broken nose paralysis of the left side (4) pneumothorax garbled speech d. pinpoint pupils e. Flaringof the nostrils, tugging of the trachea, coma and intercostal_ muscle retractions are all irn- slow, portant signs of: e. unequal pupils (1) emotional, disturbance periodic respirations (2) coma coma (3) ruptured intraabdominal organ decerebrate posture (4) dyspnea. f.patient lying very still f. A distended 'jugular vein in a patient sitting at a rigid a0domen 45 degree angle signifies: absent bowel sounds tachycardia patient's extreme muscular develop- (1) the gtparalysis of both legs ment with_hypertrOphY Zif the jugular vein normal sensation in arms (2) back-tip of blood,behind the right heart; absent sensation in both legs secondary to right heart failure (3) excessive circulation after exertion heroin overdose (4) subcutaneous emphysema from a tension congestive heart failure pneumothorax stroke g. Pupils that arepinpoint may be caused by: injury to lumbar spine (1) fright peritonitis .dt (2) atropine-like drugs pneumothorax (3) narcotic drugs (4) a darkened room cerebral edema

4 21. In the cases that follow, you are given data on He was bleeding profusely from a scalp laceration. He two patients. The data are arranged in random had no significant childhood illnesses. Pulse was. 100 order. For each case, list: and regular? His mother called for an ambulance after a. the age and sex of the patient, he fell backwards, 'striking his head against a. metal b. the chief complaint cabinet. Four years old. He was- crying vigorously; c. history of present illness alert, and moving allextremities. Condition during d. any information about the past history transport was stable: Respirations were 20. Mother e. a description of the physical examination stated that the child never lost consciousness: There f. EKG Fqdings; if any was no evidonce of injury elsewhere than the scalp; g: treatment given in the field Sterile dressing was applied. h. condition of the patient during transport VOBUkARY CASE #1 Patient had a history of diabetei. Her BP was 180/ Check yourself on the following vocabulary words. If 100. She was taking digoxin and Lasix at home. She there are any meanings you do not know, refer to the appeared comfortable. Seventy-four years old. She had text or consult the glossary at the end of the book. never 'has chest pain before. Respirations were 20: She homeostasis femur ovary was sitting upright in bed, in moderate distress, The anterior fibula uterus pain radiated down the left arm and-into the neck. posterior tibia fallopian tube There was no pedal edema. She called for an ambu- ventral carpal vagina lance because of chest pain. Pulse was 110 and irregu- tarsal testes lar. 1 here was no known history of hypertension. A dorsal superior acetabulum seminal duct rhythm strip taken in the field showed atrial fibrilla- patella prostate tion., She was alert and fully oriented. Oxygen was inferior superficial sympatheti cervix administered at 6 liters per minute by nasal cannula. hormone There was no distension of the jugular veins: The proximal parasy hetic distal cerebrospinal fluidpituitary pain was scieeiing ifecharacter. There. was no dia- medulla thyroid phoresis: She was stable during transport: Lungs were medial lateral atrium adrenal clear; She denied ; dizziness; palpi ventricle chief complaint tat ions. craniad caudad pericardium supine lymph palpation prone plasma CASE #2 abduction pharynx inspection An air splint was applied to the left. leg. Pulse was adduction trachea decortication 100. The patient has. known metastatic lung cancer. flexion larynx decerebration 'Sixty-three years old. Patient was walking down the extension epiglottis cyanosis street when he slipped on some ice and fell to the --articulation bronchus pallor ground., Respirations were '18. He is known to have maxilla alveolus ecchymosis severe heartdisease, with two myocardial iiii-arctions ittattdible esophagus dysconjugate in the past,l-lis BP was 140/70. He called for an cranium stomach ambulance because of pain in__his leftleg. He was suture duodenum lying on the ground; in moderate distress: He zygoma jejunum Cheyne-Stokes remained stable during transport, without change in vertebra ileum breathing vitalsigns. He takes. nitroglycerin 'several times a cervical colon subcutaneous week. His left lower leg showed deformity: He stated thoracic pancreas emphysema he had no feeling in his left leg below the ankle. He lumbar liVer rales was alert and oriented: The} rest of the_physical exam- sacral gall bladder rhoncf-ii ination was negative; coccyx bile whe'zzes scapula anus clavicle rectum hemiplegia 22. Rewrite the following case inthe appropriate humerus kidney quadriVegia format. Feel free to change the wording so long radius ureter as you include all the data in your presentation. ulna paraplegia Module M Shock and FluidTherapy SELF-TEST

(crystalloid or Col= 1. List the compartmentS inwhich the total body 7. IntraVenbiiS fluids containing 6ontains 66 loid) molecules willin water is divided. Which compartment crease the volume in theintraysscular comport= percent of the total body Water? Meta. 2: Ions with positive charges are called , andions with nega- 8. Match the following electrolyteswith the state! tive ebtii-get are called ment that describes each 3. Match the followingchemical` symbols with a. Sodium names: b. potassium - a. Na+ c. chloriet b. K+ d. bicarbonate C. Ca++ e. calcium d. Mg++ buffer e. controls neuromuscular irritability HCOI principal osmotic force in theextracellu- magnesium sodium lar fluid potassium chloride follows sodium bicarbbnate calcium when elevated, may produce peaked 4. Match the'llescriptionwith the ion(S) it MS: ' waves on EKG a. monovalent 9. A pH of. 7:6ismore(acidoralkaline) b. bivalent than. a pH Of 7.1. Sbdium bicarbonate 10. The most rapidly acting ofthe mechanisms potassium volved in icid=base regulation isthe (rpnal, respi- system. calcium magnesium ratory, or biiffer)- concentration increases, 5: In the process of osmosis, waterwill move across When the hydrogen ion a semiPerineablemembrane from a solutionof the pH (increases ofdecreases) (lower or higher) partied= This shift is in an (acid oralkaline) late concentration to asolution of (loWer or direction. ------higher) particulate concen- 12. Supply the missing compound: tration. HiC0i with the definition_ 6. Match the following terms b. 114. H2CO3 that describet each: very-anXious; thin; 34- a: isotonic 13. You are called to attend a year -old woman'complaining of dizziness. You hypotonic deeply and very c; hypertonic note that she is breathing very concentration rapidly; You can a:skit-tie that: solutiOn having a solute than 16Wer thin that of the cells a: her CO2 is(higher Or lower) solution having a soluteconcentiQion normal. b. as a consequence, hercarbonic acid level is higher than that of the cells than solution having aSOlitteconcentration (higher or lower) equal to that of the cellS normal., 6 c. thus.herpHis(increasedordecreased) the percentage of the blood accounted for by red blood cells d. her acid-base problemiscalled the cluniping together of red cells by anti- 14. You have..been called to attend a 47-year-old male body diabetic whom you find slowly responsive to a protein that can unite with oxygen painful stimuli. His wife says they could not buy 17. Match the following blood preparations,..deriva- his insulin; and that he has not taken any for 2 tiVes, or substitutes with. the clinical situation(s) in days: You notice a.,fruity odor on ,his breath; and which each is most appropriatelS, used: he appears to be dehydrated: His vital signs are . BP 140/90; pulse 110; respirations4$ and regular: a. whole blood a: From the patient's history; you can determine vb. packed red blood cells that the patient's pH will be (higher or lower) c. plasma or plasma substitute d. crystalloid than normal: b. His indicates that he is com- Shock due to extensive burn§ pensating forhisacid-base abnormality by hemorrhagic shock (blowing brretaining) ' "severe dehydration his (oxygen or carbon chronic anemia dioxide) 18.List five possible cpmplicatiOns Of blood transfu- c. True False:You should put a sack over the patient's head. Justi- sion: fy your answer. 19: Match the following conditions with the characteristic of each: 15. You find a 10-year-old boy in coma from heroin overdoSe. He is breathing shallowly six times per a. dehydration minute. You cap -assume that. b. overhydration postural syncope a...his CO2 is (higher orlowe) O than normal. shrunken, furrowed tongue b. as a consequence, his carbonic acid is (higher edema or lower) than normal. poor skin turgor c. thushispHis(increasedord'ecreased) rales 20. Match the folloWing intravenous infusion solu- d. his acid-base derangement isocalled tionSWith the condition(S) in which they are most appropriately used: 16. Match the following terms with thestatement a.5. percent dextrose in water (D5W) that .describes each: b.normal saline or Ringer's lactate a. hematocrit c.plasmanate b. hemoglobin dehydration due to excessive.- urinary losses c. /platelet d. agglutination intravenous lifeline for patient in conges- a formed element of the blood that par- tive heart failure ticipates in clotting shock due to burns 12 severe hypotenSion due to massivediarrhea 29. List three advantages to the use ofMAST. the use of stopgap measure in hemorrhagicshock 30. List three relative contraindications to until blood beedines available MAST. 21. Match the folloWing clinical situationswith the 31. Select the statement thatdescribes the correct type of shock each may cause: order of deflating MAST: a. both legs first, then theabdominal segment a. cardiogenic shock leg at b. hypovolernic Shock b. the abdominal segment, followed by one c. neurogenic shock a time c. one leg at a timefollowed by th' abdominal reflex vasodilation in response to gastric segment distention d. one leg, followed by the abdominalsegment; massive hemorrhage followed by the other leg e. all segments at once o profuse sweating myocardial infarction 32. MAST is most suited to the treatmentof a. cardiogenic shoek b. hypovolemic shock polyuria c. neurogenic shock 22. Which of the following givesthe best indicatiOn of the adequacy of brain perfusion? a. urine output b. blood pressure c. state of consciousness Vocabulary d. equality of pupils . If from whatever cause, Check yourself on the following vocabulary terms: 23. Every patient in shock, there are any meanings you don'tknow, .refer to the should be given text or consult the glossary atthe end of the book. a. steroids total body water Rh fact& b. vaiopressors volume expander c. morphine intracellular fluid ektracellular fluid transfusion reaction d..oxygen air embolism electing a site interstitial fluid 24. List three sites to, be avoided when intravascular fluid dehydration fin' peripheral venipuncture. electrolyte overhydration 25. You have been ordered toadthinister a liter of ion edema normal saline over 4 hourS. Youradministration cation shock set delivers 10 drapS. permilliliter: Calculate the anion perfusion correct infusion rate in drops perminute. milliequivalent cardiogenic hypovolemic 26. Your order is to adMiniSter half aliter of Ringer's monovalent administration set bivalent neurogenic laFtate in half an hour. You# septic shock delivers 15 droPS per milliliter.Calculate the cor- osmosis minute. semipermeable Vasopressor rect infusion rate in drops per saline-_ of intravenous hypttonic 27. List four potential complications hypotonic aseptic therapy. isotonic antecubital 28. You have started an IV ofnormal saline in an crystalloid subelavian: elderly, dehydrated than; About 30minutes after colloid jugular initiation of the IV; he begins complainingof a thrombophlebitit backache and nausea You noticethat his teeth acid infiltrate are chattering and he isshivering. You should: alkali autotransfusion base iridompatibifity a. SlOW down the IV agglutination b. speed up the IV buffer erythrocyte thrombocyte c. discontinue the IV leukocyte d. leave the IV as it is andadminister steroids hemoglobin SELF-TEST (Module Ill)

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VEN1PUNCTURE SITES Module IV General Pharmacology SELF-TEST

1. Match the following generic names of drugswith 4. Match the following terms with theirrelated the proprietary name with which each is associat- characteristics: ed: a. parasympathetic system a. furoSemide b. sympathetic system b. norepinephrine mediated through nerves in the thoraco- c. diazepam lumbar regions d. naloxone e. Oxytocin acetylcholine Narcan slows the heart Lasix vagus Pitocin norepinephrine Levophed vegetative functions Valium epinephnne 2. Match the zfollowing drug terms Withthe state- blocked by atropine melt that describeS each: bronchodilation a.pill cholinergic b. capsule c. suppository adienergic d. solution 5. Match the following terms with theeffects associ- e. suspension ated with each: f.tincture a. alpha stimulation finely divided drug incorporatedina b. beta stimulation liquid, separates on standing increased heart rate cylindrical gelatin container enclosing a vasoconstriction dose of medication no effort on the heart dilute alcohol extract of a drug bronchodilation drug mixed in a firm base that melts at room temperature vasodilation drug shaped into balloroval,often 6. Match the following categories with the drugs to. coated to disguise taste which they apply: a. alpha stimulator liquid containing one or more chemical b. beta stimulator substances entirely disscilved c. beta blocker 3; Arrange in order the following routesof drug isoproterenol administration from that having the fastest rate of absorption to that having the slowest rateof ab- propranolol sorption. norepinephrine a. subcutaneous d. endotracheal phenylephrine b. oral e. intramuscular epinephrine c. intravenous 16 I0 -7-:--qoavert the following to decimal fractions: 16. What is the weight in kilograms of a 200 pound 640 54/i000 3/1 Goo 4518/100 man? 8. Worr-ccul the answers to the following arithmetic 17. You are instructed to administer 80 milligrams of problems involving fractions: furosemide; which is supplied in a concentration of 10 milligrams per milliliter. What volume of 1.5 x 23.42 = medication must you give to administer the cor- 0.5 X 0.254= rect dose? 6.25+2.5= 100 + 0.25 = 18: You are told to add 0.5 grams of lidocaine to 250 6.540.32 = milliliter of D5W. Lidocaine is supplied in a con- 11.513 +2.1=- centration of 50 milligrams per milliliter. How much lidocaine should you add to the IV bag? 9. Convert from milligrams to grams: What will be the resultant concentration of lido- 453 milligrams= caine in the bag,in milligrams per milliliter? 1240 milligrams= Assuming there are 60 drops in a milliliter, how 25 milligrams= many drops per minute would you have to admin7 10. Convert from grams to milligrams: ister to give the patient1 milliliter per minute? 5 grams= 19. A patient weighs 150 pounds. You are instnicted 31 grams= to give him am milligram of atropine per kilo- 0.6 grams= gram of his body weight. Atropine is supplied as 1 milligram per milliliter. What volume of atro- 11. Convert From milliliters to liters: pine should you administer? 3411 milliliters= 20. Match the following drugs with the indication ap- 500 milliliters= propriate to each: 65 milliliters= a.sodium bicarbonate 12. Convert from liters to milliliters: b.lidocaine 3 liters= c.morphine 0.75 liters= d.atropine 0.075 liters= e.epinephrine 13: A physician wishes to replace a liter of fluid lost f.calcium chloride by vomiting. Your bottles each contain 500 milli- to stimulate the heart in asystole or fine liters. How many bottles of fluid should the ventricular fibrillation patient receive? to treat 14. You are instructed to give a patient 0.020 grams to speed the heart rate by blocking-the of a medication that is dispensed in tablets of 5 vagus milligrams each. How many tablets should the - patient receive? torelieve pain 15. A patient has taken an overdose of medication; he to treat electromechanical dissociation has ingested 25 tablets of 10 milligrams each to suppress ectopic foci in the ventricle How many grams of medication has he taken?

16 Vocabulary Check yourself on the following vocabulary words. For any meaning you do not know, refer to the text or check the glossary at the backof the book. generic name acetylcholine trade name cholinergic extract atropine powder sympathetic pill norepinephnne capsule epinephnne tablet alpha effect suppository beta effect ointment receptor pulvule adrenergic solution isoproterenol Susfiension phenylephrine fluid extract blocker tincture propranalol spirits indication syrup contraindication apothecary system emulsion metric system milk . gram liniment milligram lotion milliliter ampule decimal vial sodium bicarbonate intravenous lidocaine intramuscular morphine sulfate sublingual calcium chloride subcutaneous metaraminol intracirdiac furosemide depressant diazepam stimulant naloxone physiologic action syrup of ipecac irritation activated chai zoal antagonism aminophylline cumulative action corticosteroid tolerance oxytocin synergism neurotransmitter potentiation catcholamines liter habituation untoward reaction idiosyncrasy hypersensitivity kilogram therapeutic action parasympathetic vagus

12 Module V Respiratory System SELF-TEST

1. Trace the course that inspired air travels from the a. If this individual decreases his tidal volume nose to the lungs, naming the structures it passes sighificantly, his arterial PCO2 will (increase or on the Way. decrease) This condi- 2. An endotracheal tube inserted too far will often tion is called ( or hyperventila- come to lie in the (left or right) tion) mainStem bronchus. b. If this individual becomesnervous_and begins 3. Gas exchange in the lungs takes place in the breathing very rapidly, hiS PCO2 WillAiricreaSe This con= , which areairspaces sur- or decreas) dition is called (hYpoventilation or hyperventi- rounded by tiny capillaries; lation) 4. Between the lung and the chest wall is a potential 9. A patient has an arterial PCO2 of 20 torn His space known as the tidal volume is normal. What can you assume 5. Desaturated blood from the right heart reaches about his respiratory rate? In the the lungs via the 10. &patient With polio is found to have an arterial lungs; these vessels subdivide into tiny which transport the blood to the alveoli for gas PCO2 of 55 tort. He is breathing 20 times per exchange. Oxygenated blood then returns to the minute. What is the probable cause of his blood gas abnortnality? left heart via the 11. A 54-year-old man is found in fulminant pulmo- 6. A 24-year-old male is found unconscious in his nary edema: He is 'sitting bolt upright in a chair, apartment. There are needle tracks on his arms, laboring to breathe; with frothy coming and his pupils are pinpoint. He is breathing shal- lowly approximately six times per minute. from his mouth: a. Would you expect his arterial POl to be higher A. What is the site of this patient's respiratory or lower than normal? Why? problem(CNS,muscles,airpassages,or lungs)? b. What might be done to improve his arterial b. Is the patient's minute volume greater or less than normal? 12. In normal individuals, the respiratory rate is _acti- vated principally by increases in (P02 or PCO2) c. Would you expect his arterial PCO2 tobe in- and decreases in (PO creased or decreased? and PCO2) , d. What changes would you expect in his arterial 13. List four signs of respiratory distress. pH? 14. Match the following terms with the statements 7. Patient A has a respiratory rate of 10 per minute that describe them: and a tidal volume of 300 milliliters. Patient B has a respiratory rate of 15 per minute and a tidal a. wheezing volume of 400 milliliters. Which patient has the b. greater minute volume? c. stridor d. rales 8. In a healthy young adult breathing room air, the e. rhonchi PO2 of arterial blood is approximately and the PCO2 approximtely fifie; moist sounds associated With fluid in the smaller airways

18. 13 a whisling sound; oftenassociated with respiratory distress. Vital signs are pulse 110, BP 150/90, and respirations 36. Rhonchi and § asthnia are heard on altscultation of thecheSt. rattling noises in the throat or bronchi, often caused by mucus a. What is this patient'sproblem? for him, a harsh; high-pitched soundheard on in- b. What is the FIRST ming you will do spiration with upper airwayobstructiOn aftermaking certainhe has anadequate produced by partial airway? a rumbling sound arise from upper airway obstruction c: What possible complications may your treatment, and hoW will youdeal with with the 15. Match the findings of chest percussion them? conditions in which they are likely to befound: . 21. You are called to help a 254eatz-old womanin\ a. dullness to percussion her home. When YOU arrive you findher sitting b: hyperresonance to percussion upright, labbring to breathe. She is toobreathless asthma to speak. On the kitchen table younotice a Medi- 160/80 and hemothorax (affected side) haler. Her pulse is 120 per minute, BP respirations 30 per minute and labored; side) tension pneumothorax (affected are heard in all lung fields. emphysema a. What is this patient'sproblem? pneumonia b. What steps will you take in treatingthis pa- 16. List four causes of upper airwayobstruction. tient? Which is the most common? 22. A 63-year-old woman calls. -for anambulance be- 17. You are dining in a restaurant on yournight Off cause of shortness of breath.She states that she and you notice a man at an adjacenttable doing a was awakened from sleep_ byshortness of breath strange pantomine. He looks to be in acutedis- and had to get up andwalk around. She is under tress, but is completely silent. His eyes are open treatment for hypertension and takesdigitalis and Wide and he lurches forward, then pusheshimself a diuretic medication. Onphysical exnmination she back from the table and begins to stagger.You- appears _apprehensive and isbreathing with dai- rush over to him and ask him what iswrong, and culty. Her pulse- is 120 per, minute; BP190/110 he does not reply. He slumps to thefloor at your and respirations 30 per minute: Onauscultation of feet. the chest, diffuse wheezing is heard: a. What do you thinkmay have happened to a. What is this patient's problem? him? b. How will you manage her? b. What is the FIRST step youwill take to try to 23. A 35-year-old man was drivingwhile intoxicated help him? When you arrive, ineffective, what do you and hiS Car_ struck a utility pole: c. If the first action is you find hiiti pinned bythe steering wheel; con- do next? scious, and laboring to breathe: Thereis no eVi= 18. On another night, you arecalled to this same denCe of facial trauma. His airway is patent.You restaurant to attend a patientin respiratory dis- extricate him on a long _and short spineboard.On tress. He hoargely tells you;"I knew I should not secondary survey you nnote that the-left anterior have eaten it, but I just can't resistshrimp." He chest wall bulges outward on expiration. throat" and complains further of a "lump in his a. What injury does this patienthave? you note that he iscovered with hives. AS you examine him, his respiratory distressincreases and b. What other injuries might be associated? his bteathing becomes stridorous. c. How will you managethis patient? a. What is happening? 24. A passenger in the same car asquestion #23 was is in b. How would you manage thispatient? thrown forward against the dashboard and respiratory distress. On examination, you note 19. List three factors thatcontribute to airway .ob- that his pulse is 120,' BP 80/50, andrespirations 36 struction in asthma. per minute; His trachea isdeviated to the right. 20. You are called to attend a56-year-old man whose Breath sounds are poorly heard on the left, and chief complaint is dyspnea. He statesthat he has a theleftchestishyperresonant to percussion. chronic , but over the past severaldays the There is subcutaneous emphysema onthe upper cough has gotten worse and the sputumhas . chest and about the neck. On physical turned from white to yellow-green. a. What has happened tothis patient? examination, he is a heavy-set man, with aflushed somewhat cyanotic complotion, and isin obvioud b. How will you manage this patient? 14 19 I 25. During a domestic fight, a 25-year-old man was (1) The 42-year-old man, who was found trapped stabbed in the anterior right chest. You find hiin in the den, trying to get out; severe respiratdry distress. His trachea deviates (2) His wife, who wat found unconscious in an to the left on inspiration, and the right chest is upstairs smoke-fillecWedroom; hyperresonant to percussion with absent breath (3) His 14-year-old som who was found conscious sounds. and alert, trying to drag his .mother out of the a. What type of injury has this patient sustained? bedroom; and (4) His12-year-old daughter, who was found b. After establishing an airway, what is the next leaning out the window of another bedroom. measure you must take? a. Which victim(s) is/are most apt to have respi- c. After you have taken all the appropriate steps ratory problems? Why? to treat this patient, he does well for about 10 minutes. Then he develops signs of increasing b. Which victim(s) should receive oxygen? respiratory distress. The right chest is found 30. A 55-year old woman has been confined to bed to be hyperresonant with decreased breath for several weeks following an operation. Her sounds. What do you think has happened, and family called for an ambUlance because she had' how will you :canage it? suddenly become extremely short of breath on .6. A constructicn worker was sending a load of getting up to go to the bathroom. On examina- bricks up to he third floor of a construction site tion,,, you find her anxious and tachyPneic. Her by a carrier-pulley apparatus when the rope broke pulse is 120, BP 100/60, and rf spirations 36 per and the briCks came down on top of him, injuring minute. The chest is clear to auscultation; his chest. When you uncover him, you notice that a. What is the pathophysiology behind this pa- his chest appears caved 111, and his face, neck, and tient's distress? upper chest are blue. His eyes are bulging out and b. How will you manage this problem ?' his lips are cyanotic. His pulse is 120 and thready. His BP is 60 palpable, and his respirations 28 and 31. A 32-year-old woman calls for an ambulance be- labored. cause of dizziness and dyspnea. She states that she has been very tired lately and today began to feel a. What is this-patient's syndrome called?- She also complains ofinfrilbnesi-arotifid -he-t b. Beside the obvious injuries to the chest, what lips; On physical examination, you observe'a thin, Other injuries may be associated, given the 'cir- anxious woman breathing very deeply 36 times cumstances of the accident? per minute. Pulse is 100 and BP is 130/85. Lung c. How will you manage this patient? fields are clear to auscultation. a. Why does this patient haVe numbness around 27. An 18-year-old boy is found floating in a swim- her lips? ming pool, face up. By-standers state that he had hived into a shallow part of the pool and did not b. How can you best assist this patient? come up for a long time. 32. List four safety precautions necessary in the han- a. What specialprecautionsarenecessaryin dling of oxygen cylinders. treating this near-drowning victim, given the 33. Describe the two maneuvers for establishing an circumstances of the accident? airway WITHOUT adjuncts. b. How would the pathophysiology of this pa- 34. - ;Which of the following devices can deliver the tient's lungs differ from that of a near-drown- highest oxygen concentration when used with the ing victim pulled from salt water? appropriate liter flow? 28. A 16-year-old boy is caught in an undertow while a.plastic face mask surfing. His friends drag him to shore, where You b. nasal cannula find him to be apneic. A pulse isstill present. c. nonrebr,eathing mask After severalminutes of ventilatinghim, he begins breathing spontaneously and regains con- 35. Under what circumstances should an oropharyn- sciousness; He say he feels a little shaky but is gearairway NOT be used? otherwise in good shape. How would you manage 36. What oxygen concentrations can he delivered. this patient from this point on? with a bag-valve-mask: 29. A 42-year-old man fell asleep while smoking in a. without oxygen supplementation? his den. The chair caughi fire and soon the house b. with oxygen supplementation at a flow of 12 was in flames. The firemen bring the occupants of liters per'rninute? the house outside to your unit; The victims in- c. with 12 liters per minute oxygen flow and an clude: added reservoir? 15 37. Why must any mask used to ventilate a patient be Vocabulary transparent? Check your.elf on the following vocabularywords; 38. Which of the fdllbWing methods of artificial ven- back to the tilation gives the highest tidal volumes? For any meanings you do not know, refer text or consult the glossary at theend of the book. a. bag7valve-mask b. pocket mask adjunct larynx c. mouth -to -mouth alveoli laryngoscopy d. bag - esophageal obturator airway angioneurotic edema laryegospasm laryngeal edeniA 39. What is the principal hazard of tracheal suction- ing? What can be done to minimize this hazard? atelectasis Magill forpepS bag-valve-mask minute volume Q. List four advantages of endotracheal intubation bronchus open pneumothorax over other adjunctive ornonadjunctive tech- bronchospasm_ niques in controlling the airway? canna paradoxical respirations 41. List, two hazards of endotrachealintubation. cricothyreotomy pharynx What methods do you use to prevent these? cricothyroid membrane pneumothorax 42. You have intubated a 53-Year-old man in cardiac cyanosis rates arrest. Your assistant reports that he cannot hear demand valve rhonchi breath sounds on either side of the cheSt. dyspnea shunt endobronchitil sucking chest wound a. What must you do first? endotracheal stridor b. What steps; in order, must you take tohelp epigolottis subcutaneous emphysema this patient?. esophageal obturator tachypnea airway tension prieumothorak 43. Whatisthe maximum time thatventilations should be interrupted for an intubation attempt? flail chest tidal volume hemothorax trachea 44. List three circumstances in which you should hypercarbia vital capacity NOT-use an esophageal airway. wheezeS 45. What steps must be taken before an esophageal airway is removed from an unconscious patient? IPPB

NN

2j

16 SELF-TEST (Module V)

Identify the parts by filling in blank spaces:

CROSS SECTION of PHARYNX 17 22 SELF:reST-1c:Wale V)

Fill in blank spaces with correct titles:

LOCATING THECRICOTHYROID MEMBRANE.,

18 24 Module VI Cardiovascular System SELF-TEST

4,

1. Arrange the following structures in the order in 5. A:patient has a stroke volume of 50 milliliters and which they are traversed by bloOd returning to a pulse of 100 per minute. What is his cardiac and through the heart from the peripheral tissues: output? pulmonary artery pulmonary vein left ventricle right ventricle 6. A patient has a tachycardia of 120 per minute. If right atrium left atrium his stroke volume is the same as it was at 80 per pulmonary capillaries versa cavae minute; will his cardiac output increase or de- tricuspid valve mitral valve crease? pulmonic valve aortic valve aorta 7. Increasing venous return to the normal heart `N shotild (increase or decrease) 2. Match the following with the structures in which cardiac output. they are carried: a. blood with low oxygen concentration `8, When a moderate blood loss occurs, the (sympa- b: blood with high oxygen concentration \-thetic or parasympathetic) aorta rievous system fires; stimulating the arteries to pulmonary vein ( dilate or constrict) to maintain blot:id pressure. renal vein right ventricle 9. A patient has had a spinal injury that damaged his pulmonary artery sympathetic nervous system; causing hit, peripher- al vessels to dilate. Assuming that his cardiac carotid artery output remained constant; what would happen to left atrium his blciod pressure? 3. Match the following terms with the statement that applies to each: 10. Arrange the follo*ing in the order in which they are Ordinarily tr.versed by an electrical impulse a. cardiac output in the process of cardiac depolarization. b. stroke volume c. contractility Bundle of His d. peripheral resistance AV node Piirkinje fibert the capacity to vary the speed and degree internodal pathways of contraction SA node amount of blood pumped out of the left right and left bundle branches ventricle per minute

the state of arteriolar vasoconstriction 11: Arrange in order the following pacemakers from . that with the fastest intrinsic rate of firing to the amount of blood pumped out of the ven- with the slowest tricle in a single beet AV node 4. Complete the equation: Purkinje system stroke volume x heart rate= SA node

24. 18. Match the fodowing types of syncopewith the 12. Match the following componentsof the EKG with the statement that is appropriate toeach: situation each describeS: a. vasovagal syncope a. P wave b. syncope of cardiac origin b. QRS complex c. postural syncope c. T Wave d. vagal syncope d. PR 'interval e. ST segment ...... patientwith heart block who hadsynco- f. RR interval pal episode while lying in bed repolarization of the ventricles Medical student who fainted whenhe saw beginning of atrial depolarization to the his first cadaver beginning of ventricular depolarization 53-year-old man who had syncopalepi: time between two successiveventricular Sode after violent coughing in for depolarizations soldier who fainted after standing illation for 3 hours in the hot sun depolarization of thi: atria end of ventricular depolarization to the 19. At 0200 hours; you are called- to.attend a man beginning of repolarization who "can't breathe." He states that fiefelt moder- ately well when he went -to bed,although he has &polarization of the ventricles been a little tired lately, but wasawakened &Om sleep shortly before he alined youby an inability 13. Match the followingmedications sometimes taken he could not lie still, conditions for which to breathe: He found that by cardiac patients with the but had to get up and walkaroundin order to:get they are usually prescribed any relief from his symptbillsYou find him minute and a.digitalis -4,-, tachypneici with a pulse of 120 per b.quinidine diffuse wheezes and rales;-in his chest.What is c:nitroglycerin wrong with this patient?What medications might d.diuretics be used in management? Whatprocedures should e.,propranolol you perform to assisthim? too faSt heart rate 20. A 63Eyear-old martfainted whilesitting in his den Chest pain watching -television: You find himawake but flOor. chronic PVCs Slightly confused on the inforMation would you want to heart failure a. What kind of, obtain in your 'history? hypertension, fluid retention' b. What things would you belooking for in your' physical examination? 14. Upon eliciting a history from apatient with chest c. How would you managethis patient? pain, you learn that he once had aserious adverse his.Porsche at 40 reaction to a medication the dentist used tonumb 21. A 28- year -old man was driving might ordi- miles per hour when Jie lostcontrol of the car his minth. What medication that you What possible narily use in the treatment ofcardiac patients and struck a utility pole head on. based on this injuries to his heart might he havesustained? For would be avoided in this patient; should you be espe- piece of historical information? What life=threatening injuries cially alert? (Two at least.) 15. Listfive riskfactors for the development of 22. You arecalled,`,to attend a36-year-old woman atherosclerotic disease. who had Siidden onset of severeheadache and vomiting. You find her confusedand combative . While you are 16. List five symptoms of acutemyocardial infarc- with a blood pressure of 210/150. examining her, she has a grandmal-seizure. What tion. is her problem, and how will you managethiS patient? 17. You are called to :attend a51-year-old man com- plaining of severe crushing chestpain, which has 23. Which -two drugs may beadminiStered by the been present for about 1 hour.He appears pale tracheobronchiairoute in cases of cardiac arrest if and anxious. His pulse is 40 perminute with_occa- an IV cannot be immediatelyinitiated? BP 100/60, sional premature ventricular beatS, acidosis, what is the respirations 26 per minute. Describe the stepsyou 24. In cardiac arrest, to reduce *bald take; in order; inmanaging this patient. correct doie of sodiumbicarbonate?

204 25 .25. If an adult has been in cardiac arrest for less than Vocabulary 2 minutes, the correct amount of joules for defi- brillation is Cheek yourself bit-th-F eI-f Wfcving vocabulary words. 26. If an adult has been_in cardiac arrest for an unde- For any meanings you don't know; refer to the text termined amount of time, What procedures must or check the glosary at the endof the book. be done before defibrillation is attempted? pericardium edema 27. Describe the steps, in order, for resuscitation of myocardium rales an adtilt diSCOVered to be in cardiacarrest for an coronary artery cyanoSiS undetermined amount of time. atrium tachypnea 28. What is the recommended maximum amountof ventricle syncope watts per second for adult defibrillation? pulmonary artery vasovagal pulmonary vein taitipOtiade 29. Describe the preferred paddle placement for defi- right heart hypertension brillation. left heart epistaxis 30. What -must be done immediately if no pulse is felt septum ectopic focus AFTER a defibrillation attempt is made? systole ischemia 31. List three media used 1:etween defibrillation pad- diaStdle artifact dles and skin. Which is most advantageous? aorta normal sinus rhythm vend cava sinus arrhythmia 32. How much pressure should beused to press the capillary inus arrest paddles into the skin? cardiac output sinus bradycardia 33. Match each drug with the condition that indicates stroke volume sinus tachycardia its use: contractility PVCs a. atropine parasympathetic PACs b. propranolol sympathetic PJCs supraventricular tachycardia; C. nitroglycerin vagus d. dopamine stimulator atrial fibrillation e. sodium bicarbonate blocker atrial flutter alpha first degree ANT:VOck , f:morphine g: digoxin beta second degree AV hIO'ck- h. isoproterenol automaticity Mohitz IlWerickebach) pacemaker Mobitz II . i.metaraminol ay/ block lidocaine sinoatrial node third degree j. cotnpete heart block k. furosemide atrioventricular node Bundle of HiS Ventricular tachycardia 1. calcium Chloride ventricular fibrillation m. epinephrine Purkinje fiber§ depolarization asystole cardiogenic shock repolarization electromechanical dissociatiOn third degree AV block refractbry periods congestive heart failure (CHF) ' frequent premature ventricular contrac- P WaVe : - 6pulmonary edema QRS complex basic life support tions . 4 T wave advancedjife support electromechanical dissociation ST segment defibrillation angina pectoris PR interval cardioversion . sinus bradycardia with hypotension isoelectric line motrepic RR interval chronotropic acidosis palpitations dromotropic intractable PAT arteriosclerosis idioventricular rhythm pain of AMI atherosclerosis tachydysrhythmia angina demand acer atrial and ventricular tachydysrhythmias necrosis transthaCtc pacer congestive. heart failure infarction acceler ted nodal rhythm pulmonary edema diaphoresis btiridlbranch block anorexia unwitnessed cardiac arrest

21 34.The remainder of the problems involve arrhythmia interpretation. For each of the rhythms pictured, systematically analyze the rhythm and answer the questions listed.

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Rhythm Rate P Waves QRS Complex

Diagnosis Treatment

b. ME MEEEEEEMEEEEEEEIUEEEIDTEMEEEIIEI IIMPILIMMINIMMMMEMMI'MTMLUIV WM= 1.1111MEMMIMMMMEIMMEMMW dLM...HEINT millEMMIP.M1.211.MMINIP2MMEIMMIMMILIMMIP21 NIMMMEAMMIMMIMMifflaumrAM.Liihillhivi EMEEEEMEMEEMMEEEEEE.MMEEEEMEMEMEMEEEEEEEEMEMMEEEE

Kly.CORP. ME mommmEEEEEM =ME EWE=

Rate

P WaVeS @RS C plex'

Diagnosis Treatment

27 22 e. 51-year-o1d man with hypotension and stupor I E..111. MEEENE1 4.' EMIENIEN" ' EN _; f;=-:: ME AMIE111 Wi : El . Pm WNW IIIII MilirAMINIZIMIA ' MEENE 1 Moririll 1111111PANIVAIEVEMINIWISPr_ PreErliMIVAIrtatialFA AlikligiraliiiIIIKIIIMIMEIHVIIIIMILvaillardWidilriiiirifillAiriffin ROLAAK! IIMIIIIMI.TM ;NEM .:111111111PAr- DAMNEMI Y0 =70i!mitm..m.Ainnommi 0 0E000 4 .41Ii 4_ ! . : - .:. -

Diagnosis Treatment

d. 48-year-o1d man found lying unconscious 5 minutes before youarrived III REM R11EXIMMEMEIELREEEEAMEIEEEFiEiiMiEIrNEiiEEEE:- 1I_.11_IjII amME EliMEE Ialljr...... 11111111111,11.MffiffilEIMEME -. ,-,-,- MEM 111111111110111111.1121M611111:. .;. MEE 111.1.111111 1 111111 NI Diagnosis Treatment

e. 62-year-old man with chest pain ,.. iti ....., ... ' " ''':::: 4 444+,'1;4ftht..±4 ... . 14 :-4 Eisaisaaaasa ;-, ' . I: Iti MEE= ! Etti-E MEMEmsaM1111 .-.rEtilEME,.-ENIERIMPAILMIE.E .1111IMENIIIIIPIAIIMIME i ItAINNIIIIIMEIEFIET-1.-_ _EMAINT,..ElialL. t RI ...... L911 . gliiiiiiMkii7 -'-rt'11-4 L._1_,:. . :::::..91ELIME=VIE -7.-- . EWA ''-'mmonorgim 1 .14mNim.4: 4 .-,. 7,44-4 _ ;;;ii-..; E

Diagnosis Treatment

23 f. 47-year-old man with I-hour of crushing chest pain EMENREEMEMEEEMME t ENVEMEENNENENEEN n .

_ ITIRI NEI I INlikILIMEEMEMEEN 1A5k4r4LAIA-ririal NIIMillEM NNW. EMMEN LIME WM WPM NISILIZZI kV, mIUUL1I IIIIEMENAMEEKE -1-. MENNE _ MENNEN EMI ME El TEENEINENEE E IMENEMEllHIfl.IflUUU onis

Diagnosis Treatment

g. 61-year-old woman with syncopalepisode

. . gram % 141

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1 ,... . M -:1:-E11_::: -ttlfffilitnarblingilffligliffli-11.:14 ;I:ii- Ri :T; liTiMi;::III , :. i.;;: ....iiiii.:":PICEL5j'Aritd=11.1:41knailsugma64111,4,AUMENIMMERIN.. alli ..,IN; , . : . i iiiiallfie -' PHYSIEnbNTROLCORP ::: .

Diagnosis Treatment

h: 54-year-old man found unconscious '4-1111 4-11,11-4-1- 111 1 :4- ITT' .4. I '-i'f':-.7,1:.:::-.:1-Ti lit;:::-: t.:: ..,,. : H-aalai-.--1aka*''::- 'Baia1i":." ...:1-rr: ;11'-'' . i ' --. I...... III:iiii inill ...... ::::11:1:M:44:4:244=11-.1MEE:::MEmilmanu._1 t, NM::_-',_ENNIKIIMPE :-:,t_i------:i---i-EIMEMEIMENE INNITEllig.1,14119110PW*--WMiiineWir4Blorri.,-igmarnwaro.ffignomovil---- a r . V 1 krANAL1-611-.'11LILINIDELALIag"Itg--111-kiliva.A.-IMENEM1104.1!N-E11

.:: ,-,...!.. ::-:: EIMMEM...ME. r- MEM . . _ll ----- 9 E N -.:, _ :-.::: --.--: :-: iido,Dio.caR_-:p_:-,._Emffig.mmi,::.::mamm.:-..,::. 1"o:-1:: : m....EN k

Diagnosis Treatment

29

24. SELF-TEST (Module VI)

Identify the parts of the heart indicated by the numbers:

1

7 2

4

5

THE HEART in CROSS SECTION

25 30 Module VII Central Nervous System SELF-TEST

1. .Match the following ENS structures with the 8. An 18- year -old boy is found floating face down in statement that describes the function of each: a swimming pool, after having dived into shallow water. Upon reaching him, you note that no bub- a. cerebrum c. medulla d. spinal cord bles are issuing from hiS nose or mouth, which b. cerebellum are under water. Describe your management of contains centers for , heart rate, this patient. fi and other vital functions 9. A patient involved in an automobile accident has contains long nerve tracts of the somatic no sensation to pinprick from the toes to the and sympathetic nervous systems clavicles. Where in the spine do you think the controls equilbnum and coordination injuryoccurred?What life-threatening complica- tion of the injury at, this level should you antici- mediates all higher, integrated functions, pate? such as thinking 'ttOr-WhiCh of the following patients should be immci= 2. List three important functions served by the bilized with a cervical collar and backboards? nerve tracts carried in the spinalArd. (There may be more than one correct answer.) 3. A patient has sustained trauma to his thoracic a. A man who fell froth a second-story scaffold; spine. You find him hypotensive and disonented he is moving all extremities spontaneously. to time and place. There is no evidence of head injury or of significant internal or external hemor- b. A woman With a steering Wheel injury to her rhage. How do you account for the signs and ch.st,_but she is complaining of numbness of symptoms? her left arm. 4. Describe the method§ for establishing an airway c. An elderly gentleman fell down a flight of in the comatose patient with suspected cervical steps and reports that he "fainted" at the top Spine injury. Of them. He has a fracture of his right hip; but otherwise he is moving all extremities: . 5. A patient was assaulted by, a gang of hoodlums d. A young man was found unconscious by the and found unconscious on the street. On prithary side of a road with tire marks across his abdo- survey; you note that he has multiple contusions men. He is still unconscious with no reaction about the head, but otherwise there are no other to pain stimulus: obvious signs of injury. His pulseis130 per minute, respirationi 30 per minute and shallow,_ e., An elderly lady who walks with a cane com- BP 70/40. List the possible injuries in order of plains of sudden onset of weakness and tingling seventy and state your management of theSe prob- in both legs. lems. 11. List six possible causes of coma. 6. List five measurements of vitalfunctions that 12. A patient is found unconscious in his home. There should be assessed periodically in the patient with are liquor bottles on the floor, and the patient's head trauma. breath smells of alcohol. Describe your manage- 7. You are called to attend a patient who was found ment of this patient. unconscious in an alley: He has a bruise on his 13. Your call is to a man having seizures. A woman forehead; but no other sign of injury. His skin is with him says that he is 26-years-Old, has a histo- cold and clammy; pulse 120; BP lam, respira- ry of seizures, and that she does not now if he tions 20 per minute: Describe in order the steps in took his medications, but that he did not have managing this patient; them With him. While you are examining the pa- 26 31 tient, he has two grand mal seizures, lasting 1 minute each with a 10 minute postictal period between them. How would you manage this pa- tient? 14: Your patient is a 67;year-old woman who "just stopped talking" as related by her daughter. The daughter also says that her mother's physician has prescribed several medications and shows you vials of hydrochlorathiazide and Aldomet. The patient at present is anxious and alert She is able to follow most commands, but she cannot move her right arm and leg. What is the pathophysiol- ogy of the patient's illness and what shall you do for her? Vocabulary Check yourself on the following vocabulary words: For any meanings you don'tknow; refer back to the text or consult the glossary!at the' -end of the book; cranium aura cerebrum tonic cerebellum clonic medulla status epilepticus sympathetic nervous system cerebrovascular accident autonomic nervous system transient ischemic attack parasympathetic nervous otorrhea system rhinorrhea doll's eyes cerebrospinal fluid extraocular motions paralysis Cheyne-Stokes breathing quadriplegia central neurogenic hemiplegia Ad hyperventilation paraplegia Battle's sign paresthesia raccoon sign motor aphasia postictal sensory aphasia idiopathic hemiparesis grand mal seizure Glasgow Coma Scale petit mal seizure, osteoporosis focal motor seizure decerebrate psychomotor seizure decorticate SELF-TEST (Module VII)

Identify the brain divisions by filling in blank spaces:

BRAIN DIVISIONS

28 SELF-TEST (Mckiule VII)

Fill in the blank spaces with names of parts and complete the title by filling in the type of injury (blank no; 4)

4. SPINAL CORD

29 Madule VIII Soft Tissue Injuries SELF-TEST

1. Pale, 6:Ad, Clammy Skin IS an indication ofperiph- 8: A 6-month-old child is brought out of a burning eral (vatodilatiOn or VasoctiiistaCiron) ...... house. The child has Second= _End thircklegree andis \sometimes burns over both legs and part of the left arm. She due to diSeharge of the (sympathetic or para- is crying feebly and hoarsely. You are 35 minutes sympathetic) nervous from the hospital. HOW *Mild you manage this system in- response to fallingcardiac output: patient? 2. Match the following terms with the statement 9. A woman has been splashed with some strong lye Whi-ch describes each , that She was using to clean out her kitchen sink drain. When you arrive, she is digging under the a.contusion sink for an antidote. On examination you note lye b.abrasion over her blouse and slacks: Howwould you c.laceration manage this patient? d.puncture e.avulsion 10. When you walk into the local drugstore, you notice a small child apparently "frozen" to the a stab from a pointed object electrically powek&l ice cream, storage box. The closed injury child is not moving and does not respond to your cut inflicted by a sharp instrument calls: List in order the steps you must take to the tearing loose of a flap of skin and release and treat her. tissue beneath 11. What is usually the MOST EFFECTIVE means superficial wound caused by rubbing or of controlling external hemorrhage? scraping 12. List two potential hazards associated with the use of a tourniquet to arrest bleeding in an extremity. 3. A 35-year-old man is found with an ice pickstick- mg- out of MS thigh. HiS Vitalsigns are stable; he 13. A 6-year-old child accidentally got ammonia in .., is alert. Describe the management of thispatient: his eye. How would you Manage this patient? 4. A 58-year-old Man received burns from hot water 14. A child was running with a stick in his hand and over the entire surfaces of both arms and the tripped, jamming the stick through his right entire anterior thorax. Estimate the percent of his cheek. It is still impaled in his cheek when you bodY inVolVed in the burn. Would this be consid- arrive. Describe the management of this case. ered a critical burn? How would you managethis 15. A 42-year-old man, a passenger in anautomobile patient? that struck an abutment; sustained a head injury 5. Your patient is a 75-year-old woman who backed when his head went through the windshield. At into an open fire and her nightgown caught lire. present he is conscious and alert,spitting out a Her burns covered the surfaces of both legs, her considerable amount of blood. On examination back, and her lower body to her ribs. She hasa you find his mandible swollen and.unstable. He history of chronic respiratory disease and had a says there are teeth missing. List inorder the stroke 2 years ago: Describe the treatment forthiS steps you would take in caring for thispatient. patient and list the precautions to betaken en 16. A 3-year-old child has stuffed a dried beanin her route to the hospital: left ear and two beans in her right nostril. Her 6: List four factors that qualify a burn ascritical. mother isfrantic and pleads for you to "do 7. List three factors that might lead you toantici- aomething:" You are 10 minutes frdin the hospi- tal; The child is becoming upset by herinother's- pate respiratory problems in the biitriedpatient. _

30 panic. HoW are you going to handle this predija- ment? 17. A 31-year=old woman was stabbed in the side of the neck and is bleeding profusely around the blade. Her pulse in 120 per minute; _BP 90/50, respirations 30 per minute. She is conscious: List in order the steps you would take. in treating this patient. 18. In the same room as the patient described in #17; there is another woman lying on the floor; con- scious; with her viscera protrdding through an abdominal wound: Vital signs are stable. How would you manage this patient?

Vocabulary

Test yourself on the following vocabulary words. For any meanings you do not know, refer to the text or check the glossary in the back of the book. hemeostasis tourniquet epidermis conjunctivae dermis scleraeH melanin iris sweat gland_ cornea sebaceous gland temperomandibular joint pallor mandible cyanosis maxilla ecchymosis hygroscopic hematoma epistaxis abrasion air embolism laceration subcutaneous emphysema puncture evisceration avulaion orbit impaled object zygomatic contusion ethmoid first degree burn sphenoid second degree burn foramen third degree burn formaina antidote

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...... ~ ...... I .. : ...... Module IX Musculoske etal System SELF-TEST

1. Match the following descriptive terms with the 6. A_ 36Pyear-old man fractured his radius in a fall bone(s) each describes: while ice skating at a local pond. You apply an a. long bone airsplint to the forearm and bring him to the b: short bone ambulance. It is a long drive to the hospital and c. flat bone after about 20 minutes, the patient begins com- d. irregular bone plaining of pain and tingling in his fingers of the injured. arm: Willa is the cause of th_e_painftnd clavicle , metatarsal tingling? What steps would you e- to re,tkmedy. -^

femur 1 rib the situation ?- vertebra humerus 7; For each of the injuries listed, select the appropri- 2. Match each of the following terms with the state- ate method of immobilization: ment which describes each: a; :rigid splint a. tendon b. air splint b. ligament c. pillow splint c. cartilage d. traction splint holds hones to bones e. sling and swathe supportingstructureof trachea,nasal antertsr shoulder dislocation septuni, outer ear forearm fracture holdS muscle to bone fem l fracture 3. List five signs and symptoms of fracture. fracture 4. Which ofthefollowinginjuriesshouldbe ankh fracture straightened under traction? (There may be more than one correct answer.) 8. Describe the advantages in the use of MAST for a. fracture of the femur fractures of the pelvis. b. fracture of the elbow t. dislocation of the wrist 9. You arrive_at_the scene Of an automobile accident d; fracture of the knee and you find a conscious, agitated 28-year-old e. dislocation of the shoulder male lying on the ground complaining of right 5. List the following in the order of priority of man- thigh pain. There is a- large. -blood stain over his anterior right thigh arrahis right femur appears 'to agement: be deformed. His bloom pressuris 80/60; and his a. fractured tibia pulse is 126; Describe the steps ou would take in

b. severe hemorrhage from the arm .managing this patient; c. evisceration d. obstructed airway e. angulated femoral fracture transverse fracture impacted fracture Vocabulary spiral fracture immobilization ligament alignment Test yourself on the following vocabulary words. For splint the text ,cartilage any meanings you don't know, refer back to fracture traction the book. .R. or consult the glossary at the end of sprain windlass sling diaphysis tendon dislocation swathe epiphysis crepitus strain marrow cavity simple fracture ecchymos's cravat .ompound fracture oblique fracture position of function periosteum MAST endosteum greenstick fracture comtoinuted fracture

34 SELF-TEST (Mcsiule IX)

Fill in the blank spaces with the name of the fractures:

3; 4

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110. 011111111101 iiiiii

I 011001110111111100111111111111 11 111noIInu111 10111111 1 1

OMMON TYPES of FRACTURES

40 SELF-TEST (Mule IX) Sr

Fill in the blank spaces with the names of the distal pulses:

5.

8;

DISTAL PULSES 41

36 Module X Medical Emergencies SELF-TEST

1. Match the following conditions to the signs and 7. Match the f011owing conditions with the signs and symptoms that help identify them: symptoms that help identify them: a. a. heat exhaustion b. hypoglycemic reaction b. heat stroke bizarre behavior muscle cramps cold, clammy skin coma polyuria bounding pulse weak, thready pulse salt depletion overdose of insulin hot skin excessive thirst pallor fruity odor on the breath w or normal temperature dry mucous membranes 8. Dead a tw mechanisms by which the body- de- incoordination fends itse ainst a drop in temperature. Kussmaul breathing 9. Explain in what ways your management of the hypothermic patient in cardiac arrest differs from 2. You are Called to take care Of a patient in coma. that of ftie normothermic patient in _cardiac arrest; He is unknown to the bystanders, but he wears a medical alert tag stating that he is a diabetic. Hit 10. A hiker who was stranded ti" a blizzard is found vital signs are normal. Skin is somewhat moist. with frostbite of both fept: Describe the steps you There is no evidence of head trauma, and his would use in management of this patient; airway is patent. Describe your management of 11; List three ways in which alcoholism differs from this patient. "social drinking:" 3. Name two cc nclitions other than insulin shock 12; List three pathological conditions to which alco- that may cause severe hypoglycemia. holies are especially prone. 4. You are called t3 see a 28-year-old than in severe 13. What clues "might' you look for in trying to deter- distress. He tells you that he was stung by a mine whether a patient has Sn alcohol problem? yellow jacket about 10 minutes earlier, and began 14. List four routes through which poisons may gain to itch on his arms and chest very soon thereafter. access to the body. Now he is acutely short of breath, and complains 15. What information must you obtain in taking a of tightness it his.chest. There is diffuse wheezing history from a patient who has ingested a poison? in both lung fields; 16. Induction of vomiting is contraindicated if the a. What is the pathophysiology of the patient's patient has ingested which three classes of poison? symptoms? 17. List three patient conditions that contraindicate b. How will you manage this patient? the induction of vomiting. 5. List five symptoms of anaphylactic shock. 18. Activated charcoal should be administered (be- _ 6. Describe two mechanisms by which the body gets fore, together with, or after) rid of excess` heat. syrup of ipecac.

37 19. If you are required to pass a nasogastric tube on a 29. A young man injured in a car-truck collision comatose patient; what preliminary stepshould complains of severe lower abdominal pain. He you take? tells you that he was on the way home from a' unknown beer party when the accident occurred. What 20. A 37year-old child has ingested an questions must you ask to determine the possible quantity of lighter fluid. Describe how you will cause of the abdominal pain? manage this patient? 21. Another child has swallowed Drano. Howwould 30. Name three organs that are found in the left you manage this patient? upper quadrant. 22. A chronic alcoholic, unable to get to .theliquor 31. Your call is to a 54-year-old man who has been store; .elected instead to satisfy his craving with a vomiting bright red blood for an 'hour. He is pint of antifreeze. What symptoms will he show weak and pale, BP 80/50; pulse 120; respirations and how will you manage hith? 28 and shallow. What pathological conditions can 23. .A 4-year-old child lnia eaten a very largequantity cause the massive hemorrhage; and how will you of apple seeds. He was found disoriented, sleepy, care for the patient? and gasping. What poisonous substance isin- volved, and hoW would you manage this prob- 32. Name five reactions to illness that are altered as a result of the patient being elderly. lem? 4. A housewife hal decided to winterize her home 33. Why is a history sometimes more difficult to by caulking all the cracks' around windows and obtain from elderly patients? doorS, and in her zeal, sealed off the flue; Howev- is heater; 34. Your patient is an 80-yeaf-Vid lady who is er, the flue was the vent for her space acute ,respiratory distress, with respirations at40 Yon are called by a neighbor when she observes of her bed, dwelling in what per minute. She is sitting on the edge the housewife stagger out of her leaning forward. Her neighbor said that she has . appeara to be a drunken state: What is the most had heart trouble for 15 Yeart and "takes apill likely cause of the housewife's problem; and how for her heart and a pill for her **Met." Whatis would you manage it? the most likely cause for her distress?What medi- 25. A backpacker found himself face to face with an cations do patients with her problem mostlikely &foot-long snake that made a peculiar rattling take? How can you help ease her distress? noise with its tail: The snake failed to give ground to the hiker; and the man was bitten onhis left _forearm. Fortunately; the rescue unit was nearby and got to the man in 10 minutes. Describe how Vocabulary you, as lead man on the unit; will take care ofthe patient; Check yourself on the following yocabulary words. 26. Your call is to a possible poisoning.When you ll'or any meanings you do not knoW, refer to the text arrive, you find that the patient is 3-years-oldand or check the glossary at the back ofthe book. hallucinations; An iscrying hysterically with hyperglycemia narcotic adultproduces_a sugar cube and reveals that LSD, hallucinogen The child hypoklYceriiiii was being used by the patient's parents. ketoacidOSiS lavage seems to trust the adult who is holding himand ethanol What should you do insulin seems to be, calming down. polyuria methanol now? polydipsia venom 27. The child neat door was foundfeverish and ta- polyphagia ingestant chypneic. She vomited spontaneously and some anaphylaxis speed pills were noted in her Vomitus. What might she urticaria blue devil have ingested, alid how will you treat her? vasdilation yellow jacket red devil 28. Your patient is a 21-year-oldmale who was found vasoconstriction Comatose by a friend. Thefriend, says that the hypothermia Mick6r male had a long history of drug ingestion,includ- hyperthermia coke ing opiates; uppers; downers, andhallucinogens. intoxication salicylate At present the patient is breathing_six times a withdrawal peritoneum minute; has a pulse rate of 110, and BP of110/80. psychological dependence quadrant What precaution must you _take if Narcanis or- habituation aneurysm epigastrium dered by thephysician?What procedures will tolerance you undertake to determine the natureof the ph ')isical dependence retroperitoneuni geriatric man's overd6Se? addiction 38 3 Module XI Obstetric/Gynecologic Emergencies SELF-TEST

I. Arrange the following structures in the order by a fetus that has died at less than 20 weeks which they are traversed by the unfertilized egg gestation and is retained in the .uterus for (ovum) in the course of a menstrual cycle: at least 2 months a.cervix an abortion induced for justifiable medical b.fallopian tube reasons c.uterus anabortioncharacterizedbyvaginal d.vagina bleeding; °uterine contractions; and cervi- e. ovary cal dilation 2. Match the following terms with the statement 5. A 23-year-old mother of two is having contrac- which describes each: tions 2 minutes apart and lasting 30 seconds. She' a. fetus complains of an urge to move her bowels. Do b. placenta you have time to transport her to the hospital, c. amniotic sac which is 15 minutes drive, or should you prepare d. umbilical cord for delivery at home? e. presenting part special organ of pregnancy; attached to 6. After aiding in the delivery of a healthy baby, the uterine .wall, that nourishes the baby you notice that blood is oozing from the umbilical cord despite your clamp. What do you do in this rope-like attachment through which the situation? infant receives nourishment membranous bag surrounding the baby 7. At 60 seconds, a newborn_ baby has blue extrem- ities but a pink trunk, a pulse of 90 per minute. It developing baby before it is born cries vigorously in response to stimulation and the part of the baby that comes out of the mg* actively. What is the APGAR score? How mother first will You treat the baby? 3. 'List at least three questions that you would ask in 8. What are the only two situations in which the eliciting a history from a woman with abdominal paramedic may place his or her hand in the moth- pain. er's vagin 4. Match the following terms with the statement which describes each: 9. You are called to attend a 2&year-old woman who is close to term and who complains of the a. spontaneous abortion sudden onset of severe, lower abdominal pain. b. therapeutic abortion She is pale and her skin is claniirty. Her pulse is c. threatened abortion 120 and BP 82/50. Her abdomen is board-like to d. inevitable abortion palpation; How would you manage this patient? e. incomplete abortion f;missed abortion 10. A 30-year-old woman in her 8th month of preg- uterus expels part of the fetus, but retains nancy calls for an ambulance because of severe some prodUcts of conception headache. On physiatil examinationi you note that her. brood pressure' is 180/120 and she has marked bleeding and cramps during pregnancy edema. What complications might you anticipate? an abortion occurring naturally Describi how you will manage this patient.

39 Vocabulaty

Check yourself on the following vocabularywords. If there are any meanings you don't know, referbaCk to the text or consult the glossary at theend of the book. ovary threatened abortion ovum inevitable abortion allopian tube incomplete abortion uterus missed abortion menstrual period preeclampsia cervix eclarnpsia vagina toxemia perineum APGAR score fetus prolapsed cord placenta limb presentation umbilical cord abruptio placenta amniotic sac placenta previa amniotic fluid PID crowning hysterectomy presenting part oophorectomy cephalic deliVeiy tubal pregnancy breech deliVerY Caesarean section labor amniocentesis abortion primipara spontaneous abortion multi pars therapeutic abortion gravid

40 Module XII Pediatrics SELF-TEST

1. Describe the age-related problems in management 8. A 6-year-old has been running a high fever for you might encounter in dealing with the 3-year- the past 36 hours. She says it hurts to swallow, old injured in an automobile accident. What sort and you notice that she is drooling. What poten- of fears will this child have? What can you do to tially life-threatening condition might this child.. calm the child? have, and how will you manage her? 2: You are called to care for an 18- month -old child 9. Compare croup and epiglottis in regard to the age who has aspirated a large piece of a toy construc- of the patient,causes,signs,mecfications, and tion set: When you arrive; she is conscious and treatment. struggling to breathe: Describe your management of this patient: 10: A 7-year-old child with a history of head trauma 1 year earlieris -having seizures: The mother 3: A 7-year-old boy is found in severe respiratory states that he had two seizures during the past distress by his parents: The child has no history of half hour, and you witness another seizure while similar episodes; but he has multiple allergies to you are there. How would you manage this pa- foods and pollens. When you arrive; he is sitting tient? If the child were experiencing seizures with upright, struggling to breathe. There are tight a high temperature, how would your treatment wheezes allover his chest. How would you differ? manage this patient? 11: List at least 10 signs of mental or physical injury 4. A 6-month7old child, who had been running a that indicate child abuse: low: grade fever for several days, is found by her parents coughing and wheezing audibly. On aus 12. Describe proper physical examination for a child cultation, you hear wheezes all over her chest. that you suspect has been abused. She is breathing about 40 times a minute. How would ,you manage this child? 13: Your call is to a 6-year-old boy who was injured when his parents' car collided with a truck: The 5. Compare asthma and bronchiolitis in regard to child is bleeding from a scalp laceration; and you age of the patient, signs, causes, medications, and notice an aMplated forearm and a bruised, swell- treatment. ing thigh: He will not allow you to touch his 6: Explain the rationale for using each of the follow- abdomen: His cries become weaker as you splint ing drugs and treatments in the management -of his arm and leg: What complications; must you asthmatic attacks: suspect from these injuries? How will you deal a: oxygen with this child and his medical problems? b. epinephrine, 14: For each of the folloWing, describe any differ- c. fluid therapy ences in the technique of resuscitationinthe d. IPPB infant with respect to the technique in the adult: 7. You are called about 3:00 a,m. to see a 2-year-old a. technique of establishing an airway child who seems to be barking in a most alarming b. technique of ventilation fashion. His bleary-eyed mother states that this is c. number of ventilations per minute the third night in a row that he has been like this d. ratio of ventilations to compressions although he seems to be all right during the day. e. technique of cardiac compression (include You find him laboring to breathe, with marked hand position) retractions of his intercostal and suprasternal re-/ f.number of cardiac compressions per minute gions. A shrill noise is present on his inspiration. g. defibrillation How will you manage this patient? h. drug administration 41 46 hyperresonance SIDS Vocabulary wheezes 'Status epilepticus stridor hematoma Test yourself on the following vocabulary words.For bronchodilator glottis thetext any meanings you don't know, refer back to bronchiolitis oropharynx or to the glossary at the end of the book. croup "sniffing" position aspiration hypercarbia epiglottitis febrile status asthmaticus hypoxemia larytigospasm laryngotracheobronchitis bronchoconstriction acidosis crib death

SELF - TEST. MOdule

. Identify the parts by filling in blank=spaces:

THE VOCAL CORDS

...... Module XIII Management of the Emotional Crisis SELF-TEST

1. Describe five common responses that patients 10. A 27-year-old man phones the rescue unit and may have to serious illness or injury. states that he is thinking of slashing his wrists. 2. Describe five types of reaction to mass casualty How would you handle this situation? and how you would deal with each. 11. List five risk factors for suicide. 3. List at le six guidelines you should observe in assessing l'Fip "disturbed patient. 12. A 19-year-old man is found unresponsive by his 4. Under what circumstances tray you take a patient parents. When you arrive on the scene, you find to the hospital against his will? two 100-tablet, empty, aspirin bottles by his side, 5. List six causes of_abnormal behavior other than together with a note stating that life is no longer mental illness; worth living. Describe how you manage this patient. 6. You are calledfto attend a 21-year-old woman having an "anxiety attack."You find her sur- 13. A woman calls you because her father has been rounded by a crowd of agitated people, all de- behaving strangely. He has told her that the FBI manding that you "do something." The patient is and CIA are trying to kill him, and that voices on pacing back and forth. Her pulse is 120, respira- the radio have warned him to be prepared for tions 40, and blood pressure 130/80. She com- danger. When you arrive he locks himself in his plains of dizziness and tingling around the mouth. room, declaring that you are agents of the FBI Describe how you would manage this situation. and are trying .to kill him. How would you deal 7. The daughter of a 60- year -old woman calls you with this patient? because her mother has been behaving strangely. She refuses to leave the house, but remains inside 14. You are called by a neighbor to see an elderly with all the blinds drawn. Further, she has locked woman who has bcome "out of touch." Accord- her, daughter outside and even taken the phone ing to the neighbor; the woman believes she is off the hook. You find that patient suspicious and still living in her former home town and thinks reluctant to talk with you. When you suggett she that World War, II is in progress. You find 'the should go to the hospital, she. declares, "I can't go patient pleasant but unable to furnish her married outside.Leave me alone." How would you name, the date, or her present address. Describe manage this situation? how you would manage this patient., 8. A woman calls you to deal with her 35-year-old 15. A woman, near hysteria, calls because she is husband, who is inside the house smashing the "afraid my husband might do something crazy." furniture; He became upset because he felt that On arrival, youZmd the caller outside the house his wife had been unfaithful to him; He wants no with her two chdren. She states that her hus- one to come near him; and"' states- that anyone band is inside with a shotgun and is threatening to trying to approach him "will be sorry." How kill all of them; How would you manage this would you handle this patient? situation? 9. You are summoned toattenda30-year-old woman who was found by her mother sobbing 16. A middle-aged man is found wandering aimlessly unconsolably; When you approach the patient,, in the middle of a busy intersection. He is wear- she states that she wants to be be left alone; ing three overcoats even though it is midsummer; saying "It's hopeless anyway. There's nothing When you address him, his speech is garblid: and anyone can do to help." How would you deal incomprehensible. How would. you manage this with this patient? patient? 43 Vocabulary

Check yourself on the following vocabulary words; Foi: any meanings you don't' know, refer back to the text or consult the glossary at the end ofthe book; depression conversion hysteria :---hostility ; crisis paranoia tallucination anxiety delusion phobia suicide disorganization homocide disorientation nondirective voluntary commitment facilitation involuntary commitment confrontation regression senility dependency neurosis apathy psychosis denial schizophrenia blind panic manic-depressive overreaction mania

44 Module XIV Extrication/Rescue Techniques SELF-TEST

I. True False It is assumed by the 6. The patient carries and lifts that the paramedic developers of this textbook that at the paramedic shotild be able to demonstrate and that can be training level the trainee will have already re- / used in emergency and nonemergency situations ceived training in extrication/rescue procedures are: (Select the correct answer.) -- and techniques as a requirement. for EMT or a. pack-strap carry and scat carry EMT-A certif:,lation. b. traction blanket lift and seat carry 2. true False The Department of c. traction blanket lift; seat carry; extremities Transportation has published a training curricu- carry, two-man lift; pack-strap carry; fireman's lum entitled "Crash Victirrtrtrcation Training carry; and fireman's drag Course." d; pack-strap carry; seat mini; two-man lift; and .3. True False The geographic area fireman's -cl-Fag where the paramedic serves does NOT_have to be e. fireman's carry; fireman's drag, extremities considered when deciding what 'type of training is . carry, and seat carry required for extrication /rescue work. f..firreman's carry, seat carry, and extremities carry. .4. True False The extent of train- ing for extrication/rescue service can only be de- 7. Devices used for trauspoiting the patient should termined at a local level. include: (Fill in-tlie blanks.) 5. Which of the following hazardous conditions a. chair stretcher should the paramedic recognize and manage as a b. stokes basket threat to the patient, the EMT, or bystanders? c (There may be more than one answer.) explosive materials radioactive materials traffic at the scene of an accident d fire downed electrical wires toxic materials 'unstablevehicle or structure; es; an automobile on a ledge.

6

50, 45 Module XV Telemetry andCommunidations SELF-TEST

highway-pay phone 1. What four points of information shouldthe public a. A motorist phones from a have to properly access the local EMSsystem? to report an accident. to ask for an 2.. List the sequence ofcommanications thatis nee= b. A panic-stficken mother calls essary to properly care for apatient requiring axnbulance to pick up her 5-year-old child who advanced life support fell off the swing. c. Avery excited middle=aged woman calls to 3. List four alternative communicationsnetworks say that her husband issitting in the living that may be used in a disastersituation. . room chair and she cannotawaken him. 4. List three causes of noise in a telemetry signal. d. A passer =by calls from a pay phoneand says \.5. List five bits of information a dispatcher must there is a drunk lying face down in frontof a obtain on a medical call. local tavern. report a semi 6. What information should4dispatcher obtain 0. A highway patrolman calls to and what action should he take in thefollowing hat jackknifed across the median ofthe high:- way, pinning two cars beneath it. cant?

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