So You Want To Be A Paramedic? Quiz

Answer: Heart failure

The patient who has been prescribed furosemide probably has heart failure. They are required to take their medications on a daily basis. There is often a problem with compliance in patients who have been prescribed furosemide as it deals with the symptoms of heart failure, but does not reverse (fix, cure) the cause.
I've lost count of the number of patients I've had with Pulmonary Oedema (PO) who call in the early hours of the morning, and the reason they are ill is because they have stopped taking their medication. They often state that they stopped taking their medication as they felt better, therefore, they did not need to take it anymore.
I'm constantly educating these patients that before they stop taking any medications they have been prescribed, it is important that they discuss it with their doctors.

Answer: Respiratory distress

Patients in the tripod position are sitting upright, leaning slightly forward, supporting themselves with the arms locked in position. Often this patient is sitting on a chair, with the hands between the legs, or leaning over a table.

Be wary of the patient who is reclining - either the level of respiratory distress being experienced is not as severe as first thought, or the patient is extremely distressed and is now too exhausted to support themselves anymore. If you are concerned it may be the latter, then this patient requires urgent assistance and intervention, as respiratory arrest may be imminent.

Answer: True

Anaphylaxis is a severe, life-threatening allergic reaction and requires prompt diagnosis and treatment by the paramedics.

Other signs and symptoms include a warm, tingling feeling in the face, chest and hands; hives; flushed or bright red skin; tightness in the chest, noisy and/or laboured breathing; hoarse voice or difficulty speaking; tachycardia (increased heart rate); hypotension (low blood pressure); increased anxiety and restlessness; lightheadedness; headache; nausea and/or vomiting; loss of bowel control; itchy/watery eyes; general weakness or discomfort.

The preferred treatment is adrenaline - known to my American counterparts as epinephrine. Many people now have adrenaline (epinephrine) auto-injectors for them to use if they begin having an anaphylactic reaction.

Answer: Increase in oxygen supply to the brain

The amount of carbon dioxide in our bodies is what triggers respiration - not the level of oxygen.

When people hyperventilate, they "blow off" the carbon dioxide, which increases the circulating oxygen in the blood. When this reaches the brain, the excessive amount of oxygen causes the blood vessels in the brain to constrict excessively, thereby reducing the blood (and oxygen) supply to the brain. This in turn causes dizziness, light-headedness, and in some cases can cause the person to faint. Carpo-pedal spasm, which is also often associated with hyperventilation, is cramping of the muscles caused by a decrease in the amount of calcium in the body.

As a paramedic, it is important that you do not withold oxygen administration from any patient you suspect is hyperventilating. At first glance, patients with asthma, pulmonary embolus, myocardial infarction and other life-threatening conditions may present in a similar way to hyperventilation. It is important to rule other conditions rather than assume the patient is hyperventilating.

Answer: False

Respiratory distress may be caused by either medical illnesses or traumatic injuries.

If a patient complains of a sudden onset of breathing difficulties, it is important that you inspect the chest for signs of trauma. Tell-tale bruising or other physical signs may lead you to the discovery of trauma that that could be life-threatening.

Answer: Ecchymosis

Ecchymosis is the word we use to describe the black-and-blue discolouration of bruising.

The discolouration occurs because blood leaks out of the vessels when the tissues are damaged. Red blood cells carry oxygen, and as they become deoxygenated they change colour. This explains the difference in colour between arterial blood and venous blood, and also explains why bruises change colour over time.

Answer: Open

Open wounds are wounds in which the skin is broken. An avulsion is a wound in which there is either a loose flap of skin with tissue attached to the flap that has been torn loose from the underlying structures, or, there is a piece of skin with associated tissue completely pulled off.

Other open wounds are abrasions, lacerations, punctures, and amputations. Beware of the patient you suspect of having a crush injury as their external bleeding may not be immediately obvious.

Answer: Apex (top)

Since air will be the lightest 'object' inside the chest, a patient sitting upright will have the air move to the apices (apex, top) of the lungs, and a decrease in breath sounds will be noticed here first.

Answer: Octonary

Some scales of blast injury classification have moved from 3 phases to 5 phases. They are Primary, Secondary, Tertiary, Quarternary, and Quinary.

Primary injuries occur when the pressure wave of the blast reaches the body.

Secondary injuries occur when the fragments of items (either the fragments of the device, or fragments of other items around the device) hit the body.

Tertiary injuries occur when the victim is thrown to the ground or hit with large objects (not fragments - eg, a pillar, or the floor above). Being crushed by a collapsing building is considered a tertiary injury.

Quarternary injuries are caused by exposure to heat or fumes caused by the blast.

Quinary injuries are a result of contaminants in the device that cause infection - this can include fragments containing human parts (in the case of suicide bombers), or sharp items dipped in sewage that are meant to cause infection if they can't cause immediate death.

Answer: Skull

It's important that if we see this pattern on a windscreen, we are aware of the potential damage to the cervical spine as well as the skull.
When the windscreen is impacted by the skull, the skull stops moving, but the rest of the body continues. This places exceptional force upon the cervical spine, which may fracture as a result of the stress placed upon it.