Correction Notice For February/March 2016 (Vol. 39, No. 2) Paramedic Self-Assessment Quiz

Due to a production error, the answer key that was printed in the magazine for the February/March issue was incorrect. All of the rationale for question 1 was deleted, as well as part of the rationale for question 2. This caused the answers to be renumbered and were therefore they didn’t correspond correctly with the questions.

The online edition of the quiz was not affected and is correct.

Answers with Rationale

1.    A.  Environmental hazards (weather) are the easiest to rule out but we must find ways to assess for all the possible hazards. Some of them can be very elusive.

2.    B. The National Institute of Occupational Safety and Health defines the N95 mask as having at least 95% efficacy against non-oil particulate aerosols greater than 0.3 microns in size. Most Fire Departments should be able to detect harmful gases like CO or H2S. Severe respiratory infections, such as SARS, can be deadly. Respiratory infections can be devastating to EMS workers and front line workers. We should be always vigilant, as SARS or some similar infection will return someday, possibly worse than before.

3.    D. Request lots of help and work with what you can get. You can always turn resources away, but, as it stands now, this could be an MCI for your small service. Also remember you may need rescuers available for the rescuers in case of exposure or incidents; sometimes rescuers need to be rescued themselves.

4.    B. This is the best answer. This would be acceptable. As long as the chest is rising and you are around 8- 10 per minute or one every 6 seconds you’re close enough for a starting rate.

5.    A. Per the standard calculation 2+2+2. You’re in trouble it’s easy to see. ALS and intubation are the gold standard of care. BLS care includes supporting spontaneous ventilations with a bag valve mask.

6.    A. A hypo-perfused state can be the result of either breathing problems or circulation problems. If the causes are not treated the condition will continue to worsen.

7.    C. Decreased mentation reduced our ability to protect our airway.

8.    D. is correct. Dr. Peter Brindley is such an excellent facilitator of team work and I’ve seen him in action many times in critical care cases and in teaching ATLS courses and also been part of his ICU teams in ER. Please review the complete reference and you will never be let down on how good a team can work and how a team might also fail if not lead properly. (1)

9.    B. is correct. Dr. Brindley says this many times to his mentors and younger learners. It’s a good take home point. (1)

10.    C. is correct. This is a very good analogy of what can go wrong in a difficult case and how it’s prevented as well. (1)

11.    B.is correct. Any IV is a good IV but an 18 to a 20 would be lifesaving.

12.    B. is correct. IV boluses are the initial care in this case and don’t be shy with fluid resuscitation.

13.    A. is correct. As long as its only to a normal range I’d be more than happy but if it drops very low its actuality a very bad sign of cardiorespiratory or imminent arrest is just ahead.

14.    B. is correct. (6) Also as above a very skilled team can prevent an arrest with the right interventions on many occasions.

15.    D. is correct.  Although it’s a newer concept in kids this patient is basically an adult in many ways.

16.    D. is correct. Crackles are common with pneumonia as well as with atelectasis and left sided heart failure.

17.    C. is correct. This is mandatory. Never assume your safe without taking the standard precautions.

18.    A. is correct. Treat the patient and never just the monitor or the numbers.

19.    C. is correct. We must be aware of the condition and learn what interventions are helpful in the early stages to prevent a poor outcome.

20.    B. is correct. All indications are a mixed respiratory and cardiovascular collapse. If one system fails then the other system is affected also.

21.    C. is correct. It is looking more and more difficult. With significant practice, careful preparation and a bougie or gum elastic introducer the outcomes should be favorable. (4)(8)

22.    A. is correct. We all are likely not as good as we can be in all skills and when it comes to a difficult airway we need to be the best we can be 24/7.

23.    D. is correct. The article “High-Flow Oxygen Administration by Nasal Cannula for Adult and Perinatal Patients”from by Jeffery J Ward shows that it’s a good start in many patients until a better solution is available. (10)

24.     A. is correct. You need to maintain an adequate BP or a MAP in the acceptable range. All are acceptable but A. is 1st and then trial of one pressor and be ready to add a 2nd or 3rd pressor as required. The attached reference is an amazing article on Septic Shock, Medication therapy and is very helpful on many issues. Note the Dosing range in septic shock is a wide range in Levophed: 0.01 to 3.3 mcg/kg/min. (9)

25.    A. is correct. Medications can have positive and/or negative effects.

26.    C. is correct. Transport decisions can be just as critical as ALS interventions. An appropriate antibiotic is what is required, in addition to careful management of both airway and shock.

27.    C. is correct. This is one of the harder cases you will see and very challenging to ventilate carefully and adequately. Chest rise is our simplest clinical indicator of ventilatory volume in the field. We must learn to assess chest rise without hyperinflation to limit the possibility of volutrauma/barotrauma which could cause pneumothorax.

28.    A. is correct. This is the best first intervention in this case.

29.    C. is correct. Needle decompression to the most likely side 1st and then be prepared to decompress bilaterally, especially if you have no pulse and your patient is dying in front of you, and very difficult to ventilate. A tension should actually be treated before a CXR and its not healthy for the patient to find it on a CT as it’s the worst place to insert a chest tube and perform a resuscitation which we sadly see several times in our career.

30.    D. is correct. You have tried everything. The outcomes are terrible in this case at this point. A quick Fast Ultrasound of the heart and if the heart has no active motion your efforts are most likely futile in all cases now.