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AEMT/Paramedic 1
Homework: Medical Emergencies Case Studies
Revised 28Dec2015 (GG)
Name:________________________________________Date:________________________________________
INSTRUCTIONS:
THIS IS A RESEARCH PAPER!
Review the following case studies and answer all questions relating to each. You may
use your textbook to research the answers, but you must also use Internet sources
obtained through Google.com. When you use information gained from ANY
source, you must cite your source following the question. Example: eMedicine
Online, (copy and paste URL of the source used.) Example: Caroline, Emergency
Care in the Streets, 6th ed., p. xxx. Use of your textbook alone will not result in an
acceptable paper. Do not quote from any source without enclosing the quoted portion
in quotation marks and citing the source. To do otherwise is plagiarism.
Your answers are expected to be comprehensive. Short answers will not be accepted.
You must discuss in detail the reasons for your answers. If, for example, you are asked
“what body systems are involved, “ it is not sufficient to simply say, “respiratory,
endocrine, and nervous.” You must explain WHY you have determined that these
systems are involved and HOW they are involved.
Demonstrate your critical thinking skills as fully as possible. There may or may not be
“right” answers to all questions. Look for plausible answers, and explain your reasons.
Justify your answers with WHAT, WHY, AND HOW explanations.
The more complete your discussion is, the better your grade will be. You will have an
opportunity to revise your paper before a final grade is issued. Feel free to contact me
for advice and help at any time.
Enter your answers below each question. When finished, email your instructor with
your paper as an attachment.
SCENARIO #1
Your patient is a 13-year-old male, Joe, with difficulty breathing. You find him lying
prone in bed. He appears pale and looks like he is sleeping. His chest is barely moving.
He is breathing shallow breaths at a rate of 26 per minute.
When you address him there is no response. When you touch him and attempt to wake
him, he cries and does not open his eyes. He does not answer your questions, and he
does not obey your commands.
His skin appears to be pale, dry, and hot to the touch. His radial pulse is 166 beats per
minute and regular. His blood pressure is 112/78. His blood glucose is 84, and his
temperature is 103.6 F. (39.8 C.).
History of the present illness:
Joe’s mother is present and advises that she had called his pediatrician, who had said
to bring him to her office. When she tried to wake him up, he became agitated, “shook
all over and turned blue.” She immediately called 911.
She further advises that he has had a “cold” for several days, and it seems to be the
“worst cold he has ever had.” Three days ago he began having severe headaches and
yesterday could not get out of bed because it made his headache worse. He has also
had some nausea and vomited several times yesterday. Today he “wasn’t making
sense” so she made an appointment with the doctor. She says he has had a fever for
the last several days.
Past Medical History:
He has had frequent upper respiratory infections over the last few years. The last one
prior to this one was about 6 months previous.
Allergies:
No known allergies.
Medications:
He has no prescription medications. His mother says she has been giving him Tylenol
and aspirin for fever over the last 3 days. His last dose of Tylenol was “a few hours ago,
and his last dose of aspirin was early last night.”
Last Oral Intake:
Water with the Tylenol several hours ago.
Physical Exam:
Head, eyes, ears, nose, and throat (HEENT):
Joe appears to be a well-nourished child of his stated age of 13 years. He weighs 112
pounds (according to his mother). Examination of his scalp and skull reveals no
abnormalities nor signs of trauma. There is no Battle’s sign nor Raccoon’s eyes. Eyelids
appear normal and equally closed. Eyes are very sensitive to light, he becomes agitated
when you attempt to check his pupils for response to light, and he withdraws, crying.
Ears are clean and there is no discharge. Facial symmetry is intact and without signs of
trauma. Nose is stable and without discharge. He does not cooperate when you ask
him to open his mouth so you can look. His neck is tense, with nuchal rigidity, but
without signs of trauma, and he complains of pain when you attempt to move it.
Jugular veins appear normal and trachea is midline. There is palpable
lymphadenopathy in the posterior cervical lymph nodes and also in the submandibular nodes. There is a petechial rash extending from his chin down to his
abdomen.
Chest:
There are no signs of trauma to his chest, and no surgical scars. The chest is nontender on palpation. There is equal rise and fall with respirations. Breath sounds are
somewhat diminished but clear and equal bilaterally. Breathing appears to be shallow
but non-labored. Pulse oxymetry is 99% on room air. There are no rales, rhonchi,
wheezes or audible rubs. Heart sounds are S1 and S2, without murmurs. There is a
petechial rash on his chest and in several places on his arms.
Abdomen:
The abdomen is soft, non-tender, non-distended, and non-guarded, and there are no
surgical scars. There are no Cullen’s nor Grey-Turner’s signs. There is a petechial rash.
Pelvis:
The pelvis is intact and pain free on palpation. Upper and lower extremities:
There are no signs of trauma, there are good distal pulses, movement, and sensation in
all extremities. Capillary refill is < 2 seconds in hands and feet. Skin is hot and dry.
Back:
The back is free of scars and a petechial rash is noted on the torso. The back is
otherwise unremarkable.
QUESTIONS:
1.
What is Joe’s chief complaint?
2.
In the history of his present illness:
3.
a.
What parts are most significant and why?
b.
What parts are not significant, if any, and why?
In his past medical history:
a.
b.
history?
4.
What parts are most significant and why?
What questions would you ask to further develop his past medical
a. what is meant by “lymphadenopathy?”
b. what is the significance of your findings concerning his lymph nodes?
5.
a. what is meant by a “petechial rash?”
b. what is its significance in this case?
6. What is the medical significance of severe sensitivity to light in this case and what
clues does it offer to his condition?
7. What is the significance of “nuchal rigidity” in this case and what clues does it offer
to his condition?
8. What is the most probable cause of Joe’s condition, and why?
9. How would you rate Joe’s condition in terms of life threat? Explain fully.
10. What level hospital would be the most appropriate destination for Joe, and why?
11. How would you treat Joe?
SCENARIO #2
You are called for a 3-year-old male who has had a seizure.
Arriving at a residence, you are shown into the bathroom by an anxious father to find
the mother of Darin attending to him. He is sitting in the bathtub and she is sponging
him with water. He is awake and crying vigorously. Upon seeing you and your partner,
he immediately focuses on you and cries even more vigorously. He is obviously not
happy.
He appears to be his stated age, is well nourished, and of normal height and weight for
a 3-year old. He is moving all extremities. His skin appears flushed, and he feels hot to
the touch even though he is wet from his mother’s sponging efforts.
Brachial pulse is 160, respirations are difficult to count since he is crying vigorously,
and you elect not to take a blood pressure under the circumstances.
Mother relates that Darin has had an upper respiratory infection with a runny nose for
the last two days. Earlier today he began to run a fever of 101º F. Currently his
temperature is 103º F. taken by your tympanic thermometer.
Mother further says that she went to check on him and found him shaking all over.
This lasted for about 30 seconds, and then he became quiet and lethargic. At this time
she asked her husband to call 911. She then began attempts to cool him by sponging
him with water. He slowly “came around” and began to cry. She says he has been in
good health previously. He has no known allergies. She had given him 1 tsp of Tylenol
liquid about an hour ago.
Physical Examination.
HEENT:
Head is normocephalic and without obvious trauma. Fontanelles are fully closed.
Pupils are round, equal, and react to light. Ears appear normal, without redness or
discharge. There are no signs of cyanosis. There is obvious thick mucus in his nose.
Neck is supple and non-tender. Darin moves his neck spontaneously.
Chest:
Respirations are difficult to hear because of crying, but there is equal chest rise and fall
with respirations. Heart sounds are impossible to hear because of crying. There are no
surgical scars. There is no pain elicited on palpation. Pulse oxymeter reads 99% on
room air.
Abdomen:
Soft, non-tender, non-guarded, and non-distended. No surgical scars.
Upper and lower extremities: Capillary refill < 2 seconds in both feet and hands.
Patient moves all extremities spontaneously.
Back:
Unremarkable.
QUESTIONS:
1.What are the most significant points in Darin’s history of this illness? Explain each
point in detail.
2.
What is Darin’s chief complaint?
3.
Since you are unable to count Darin’s respirations or hear breath sounds or heart
sounds, how would you describe his respiratory system’s status at this time? Explain.
4.
Should you attempt to lower Darin’s temperature?
a. explain why or why not.
b. how would you go about lowering his temperature if you chose to do it?
9.
How would you treat Darin?
10. Compare Darin’s condition to Joe’s. Which is more serious?
11. What is Reye’s syndrome and what medication should be avoided that is linked to
it?
SCENARIO # 3
Your patient is Debbie, a 30-year-old female complaining of dizziness and syncope. She
is lying on a couch in her living room. She is awake and appears very pale. She is able
to answer your questions appropriately and cooperate with your assessment. Her
airway appears open and clear. She is breathing rapidly and is short of breath after
talking. Skin is hot and dry. There are bright red areas of peeling skin on the palms of
her hands and extremities.
Vital signs:
Radial pulse at 136 and regular. Respirations 28, shallow, and labored. BP 92/54.
Pulse oxymeter 94% on room air. Blood glucose is 150 mg/dL. Tympanic membrane
temperature is 101.8º F.
History of present illness:
Came down with the “flu” about a week ago. Describes it as the worst case of “flu” she
has ever had. She complains of a very sore throat and headache. She also describes
extreme muscle aches, fever, chills, nausea/vomiting, and diarrhea for the last three
days.
Past medical history:
No significant past medical history. Has been generally healthy. Does not smoke.
Allergies:
Erythromycin
Medications:
No prescription medications. Has taken Advil and Alka-Seltzer Plus Cold Medicine for
the last several days without relief.
Physical exam:
HEENT:
Normocephalic with no signs of trauma. Conjunctiva are red; pupils are round, equal,
and respond to light directly and by accommodation. Ears are red but there is no
discharge. Skin is red. Tongue is extremely red, with a “strawberry” appearance.
Oropharynx is erythematous and swollen.
Cervical lymph nodes and sub-mandibular nodes are swollen and palpable. Neck is
supple, non-tender, and able to move freely. Jugular veins are non- distended. Trachea
is midline.
Chest:
No surgical scars; chest rises and falls symmetrically with breathing; Breath sounds
are diminished bilaterally with rales and wheezes in both bases. There is no evident
consolidation. Heart sounds are S1 and S2, without murmurs. Orthostatic vital sign
test is positive, with radial pulse disappearing when sitting up, patient felt dizzy and
faint and nauseous. BP dropped to 80/48. Carotid pulse felt at 150 regular, and weak.
There are red blotches and peeling skin on the chest. 12-lead ECG reveals sinus
tachycardia without ectopic beats or ST changes.
Abdomen:
Soft, non-tender, non-distended, and non-guarded. No surgical scars. Peeling skin
noted.
Lower and upper extremities:
Distal pulses in feet absent. Capillary refill 6 seconds in feet. Radial pulse absent when
sitting up, weak when lying supine. Some skin peeling noted in palms of hands.
Capillary refill 5 seconds.
Back:
Unremarkable. Breath sounds reveal rales and wheezes in lower lobes.
QUESTIONS:
1.
What is Debbie’s chief complaint?
2.
What is most significant about her current medical history?
3.
What is the most significant finding from your physical exam?
4.
What immediate treatment actions, if any, should you take? Explain fully,
including your goals for treatment and how your interventions will accomplish those
goals.
5.
What is the relationship between Debbie’s pulse and BP with sitting up?
6.
Are there any immediate life-threats to Debbie?.
7. What level hospital is most appropriate for Debbie?.
8. Discuss SIRS. Does Debbie fit the SIRS criteria? Note: Google SIRS for quick
references and answers to this question.
Scenario #4
The patient is a 14-year-old female who has been sick with pneumonia for about a week.
The pneumonia responded to a course of antibiotics, which was completed about 3 days
ago. The patient then began complaining of a headache, abdominal pain, nausea, and
vomiting which worsened over the last 2 days. The patient responds to questions with a
weak voice. Her skin is dry, pale, and cool. Her respirations are deep and rapid, and her
breath smells like rotten apples. Vital signs are BP 94/60; P 136 and weak; R 32, deep
and regular. The patient has not taken any other medications since completing her
antibiotic therapy.
1. From what endocrine disease is this patient suffering?
2. What is the respiratory pattern called?
3. Would you expect this patient’s blood sugar to be too high or too low? Why?
4. Would her blood pH be increased or decreased? Why?5.
5. From what acid-base imbalance is the patient suffering?
6. Describe your prehospital management of this patient.
Scenario #5
At 0400 hrs, you are called to see “a child who can’t breathe.” You arrive at an
apartment about 5 minutes from your station where two very anxious parents awake you.
They tell you that their 11 year-old son, who has a history of severe asthma, developed an
attack the previous morning and “has just gotten worse and worse.” He has been using
his metered-dose inhaler without apparent benefit. You find a very sick-looking child,
sitting upright in bed, struggling to breathe. He is extremely agitated and restless and
does not want to sit still for your examination. There are suprasternal and intercostal
retractions on inhalation. The patient’s skin is pale and dry. The mucous membranes are
also dry. Pulse is 130, weak, and regular. Respirations are 30, shallow, and regular.
Auscultation of the chest reveals a few faint wheezes throughout the lung fields. The
chest is hyperresonant to percussion.
1. An asthma attack involves a two-phase reaction. Describe the two phases and what
happens during each. Hint: Google “two-phase asthma reaction
2. Discuss the triggers that can set off an asthma attack.
3. Discuss responses to nebulized beta-2 agonists in both the early phase and the late
phase.
4. Why should oxygen given to patients suffering asthma attacks be humidified?
5. If this patient does not respond to nebulized beta-2 drugs, what other drug does an AEMT
have that could be administered to this patient?
6. Discuss the importance of giving fluids to a patient having a prolonged asthma attack.
i These scenarios are based in part upon Mosby’s Paramedic Review Manual by Dalton and Walker.