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You are working on a rural ambulance service that staffs three units. There is one ALS unit, one BLS unit, and one on-call BLS unit. You are working on the BLS transfer car.

You were called to transport the recent physical assault victim that your other unit had picked up earlier today. It turns out that she has a fractured cervical vertebra and a left tibia and fibula fracture as well. She was to be transferred to higher level of care for further treatment and possible surgery.

Before you are able to load the transfer patient, dispatch calls for someone to respond to a stabbing. There is an awkward silence after the dispatched message as you wait for response from the BLS crew. They will be delayed for about five minutes as they are on the other side of town.

The ALS crew is currently out on a transfer and is not immediately available. You make the decision to respond to the emergency call and postpone the transport of the awaiting transfer patient. Your BLS unit will have to back you up.

The scene is approximately six blocks from the hospital. When you arrive on-scene there are four police cars with lights flashing and one of the officers comes to the window of your ambulance to say: “You better hurry, he's in really bad shape.”

A 45-year-old male is sitting at the bottom of a flight of stairs that lead into a basement suite. A police officer is standing beside the victim and another officer is standing inside the residence.

There is blood on the walls, door and steps where the victim is sitting. Your patient overview shows the alleged victim with no shirt holding his right lateral chest wall with both hands and a bunched up t-shirt. His skin is pale and caked with both wet and dried blood. He appears to be in moderate distress. His cheek was apparently cut open with the cut exposing some of the teeth on the right side of his mouth. A stab wound is visible to the left of his sternum and it is obvious even from a distance that his left chest is not moving with his rapid respirations. His left hand is also cut and oozing blood.

You are an EMT-A and your partner is an EMR.

-Quiz by Dale Bayliss and Ron Oswald.

 

Quiz 1: One of those days

Feb-March 2011

1. Police services are on-scene when you arrive. Therefore you do not have to worry about hazards.
2. The patient is able to talk in three to four word sentences and prefers to sit with his upper body leaning slightly forward. The patient is managing his own airway at this time. What other airway could you also consider for this patient when his LOC decreases?
3. How would you extricate this casualty from the stairwell where he is sitting?
4. Full spinal immobilization was omitted because:
5. You are in a bad environment with poor lighting and are also in a space too small to move or to provide much care. A quick visual inspection shows multiple stab wounds to the front and back of the thorax. What is your initial priority in examining this patient when this situation is not user-friendly in providing care?
6. Upon removal of the “bunched-up” t-shirt from the right lateral chest you find two stab wounds with air bubbling out of them. How would you treat these injuries?
7. An open pneumothorax allows air entry in and out of the chest cavity so there is never any possibility of a tension pnuemothorax in these patients.
8. The left chest is not moving and auscultation reveals absent breath sounds on the left side. Percussing the chest:
9. Differential diagnoses of the right chest include all of the following except a:
10. Traumatic chest injuries are sometimes referred to as the “deadly dozen.” The six “hidden” or “potentially life-threatening” injuries include all of the following except:
11. The “deadly dozen,” that are referred to as the lethal injuries include all of the following except:
12. The initial set of vital signs include: RR: 38; HR: 92; BP: 136/70; SPO2: 94; BGL: 5.0; Temp: 36.0; Skin: pale, cool, bloody. These vital signs:
13. This patient should be considered load and go. He should receive only interventions which are necessary to treat immediate life-threatening conditions. Due to short transport time it may even be possible to defer establishment of IV until arrival in the emergency department.
14. Your decision to provide oxygen by non-rebreather was guided by:
15. The blood observed on-scene does not represent significant blood loss unless an actual pool of blood is observed because the surfaces were non-porous. However, the blood “lost” in a unilateral hemothorax (in the adult patient) could be as much as:
After turning over patient care to the emergency department physician you and your partner transfer the other assault patient as originally intended. You have definitely earned your money tonight. The following questions pertain to the transport of the stabbing patient via ground ambulance to a trauma centre. You have an ALS crew of three that allows for two paramedics to provide patient care en route.
ALS – CCP QUESTIONS
16. The patient is sedated, intubated and on a ventilator. What diagnostic tool(s) have you lost because of these interventions?
17. The best sedation choices for this patient would be:
18. The patient has bilateral chest tubes. When applying suction to the Pleurovac the vacuum should be set at least __________ in order to create the proper negative suction to keep the lung inflated.
19. A chest tube should be clamped:
20. All of the following statements about Pleurovacs are true except:
21. This patient is also receiving whole blood. Blood transfusion reactions in this patient could be suspected if you observe any of the following except:
22. This patient rapidly progresses to a weak and thready pulse. The best interventions would be to:
23. This patient goes into a bradycardic PEA. The first medication that is required in this situation is:
24. This patient has no pulse when chest compressions are performed. The most likely circumstance that can cause this would be:
25. This patient's rhythm shows asystole immediately after two minutes of CPR. Would pacing be of much use in this case?