Download Quiz - CDH EMS

March 2017 Region VIII CE
Respiratory Poisons
1. The upper airway can be more susceptible to _____________ and the lower airway is more
susceptible to ______________.
a. wheezing, stridor
b. traumatic injury, chemical process
c. chemical process, traumatic injury
d. penetrating injury, blunt injury
2. The lungs operate on ______________ pressure. Meaning air rushes in when the diaphragm
contracts.
a. Neutral
b. Positive
c. Negative
d. Ambient
3. If multiple DNR / POLST forms are present and the patient is in cardiac arrest, EMS
should:
a. Honor the one signed by the patient, in the event that there are forms signed by
other individuals
b. Honor the form with the most recent date
c. Honor the form that is printed on colored paper, in the event there are multiple
forms and some are black on white
d. Honor only the pink form, since that is the latest recommended color
4. Which of the following is a benefit of our natural respiratory mechanism?
a. Positive pressure in the thoracic cavity allows more blood to circulate helping
to maintain normal blood pressure
b. Negative pressure in the thoracic cavity increases preload to the heart which
helps maintain a normal blood pressure
c. Homeostasis is achieved through a neutral balance between our respirations
and tidal volumes
d. Positive pressure increases overall PEEP helping to keep lungs inflated and
alveoli open.
5. ___________________________ is the active ingredient found in bleach which reacts with
ammonia, drain cleaners, and other acids.
a. Sodium hydrocholide
b. Muriatic acid
c. Hydrogen sulfide
d. Sodium hypochlorite
6. You are dispatched for the 44 year old male unconscious subject. Upon your arrival to
the scene you are told by family there is an individual inside the house who was trying
to dislodge a clog from the sink. “He put some chlorox bleach and some liquid drano
down the drain. Please hurry!!” you are told. There is no one else in the home. Your
first action to consider is:
a. Immediately enter the home and retrieve the individual as this is a load and go
situation.
b. Enter the home with the family member so they can show you where the
patient is located and exactly what was mixed together.
c. Don the proper protective equipment (Full PPE and self contained breathing
apparatus) and consider the need for hazmat prior to entering the house
d. Call medical control to pronounce patient as this is not a survivable event
7. Pesticides can cause symptoms through an acute one time exposure, or may cause
chronic symptoms through multiple exposures over time.
a. True
b. False
8. Isocyanates are found in which of the following products?
a. Paints used on automobiles
b. Foam padding in couches
c. Wood paneling
d. Spray on polyurethane products
e. All of the above
9. Which of the following is NOT a health concern associated with isocyanates?
a. They can cause birth defects
b. They are considered carcinogenic
c. High doses can have the same effect as nerve agents
d. Exposure can trigger bronchoconstriction and pulmonary edema
10. True / False – In Illinois, an attending physician may authorize surrogate decision
makers to make decisions for patients who lack decisional capacity, even if they are
not authorized as a health care agent under Power of Attorney for Health Care.
11. Cyanide is 35 times more toxic than CO and is found in many substances naturally in
our environment that our bodies can process. Why are large doses dangerous to the
body?
a. Large doses cause bronchoconstriction and atelectasis that leads to hypoxic
hypoxia
b. Large doses cause cerebral vasoconstriction leading to reduced cerebral
perfusion pressures, seizures, and cellular death.
c. Large doses quickly overwhelm the hemoglobin causing histotoxic hypoxia
which starves the heart and brain of oxygen.
d. Large doses causes protein malfunctions leading to fibrinolysis, blood clots, and
ischemia.
12. Hypoxia that is caused by blood cell poisoning is also known as:
a. Stagnant hypoxia
b. Histotoxic hypoxia
c. Anemic hypoxia
d. Hypoxic hypoxia
13. You are called to an extended care facility for a patient who passed out following
insertion of a central venous catheter. The patient is a 55 year old male who was
having a subclavian double lumen catheter placed. He is conscious but disoriented,
GCS 14, vitals BP 80/50, P 128, R 20. Which of the following IS CORRECT per SOP?
a. EMS can use the catheter for any IV fluid or medication, as long as someone on
the crew is familiar with the device
b. EMS can regulate the rate of an IV bag (such as administering a fluid bolus) that
is initiated by the RN or physician at the originating facility
c. EMS can use the CV catheter only for resuscitation medications, unless Medical
Control approves
d. Under no conditions can EMS have anything to do with a venous catheter they
did not insert
14. You respond to the structure fire with reports of victims in the building. As you arrive
on scene you are advised that a victim is being brought out to you. Your patient is a 55
year old male who in unresponsive and breathing at a rate of 6 times per minute. You
note soot inside his mouth and around the nares. You are suspect of cyanide
poisoning. You begin ALS treatment and decide to treat with a Cyanokit. How will you
dose this patient?
a. 5g over 15min (15ml/min) piggybacked into existing IV/IO line
b. 15g over 5 minutes (45ml/min) in IV/IO line dedicated for cyanokit
c. 5g over 15min (15ml/min) in IV/IO line dedicated for cyanokit
d. 15g over 5 minutes (45ml/min) piggybacked into existing IV/IO line.
15. In a confined space environment, which of the following atmospheric oxygen levels
would most likely cause mental failure and unconsciousness?
a. 14-19%
b. 10-12%
c. 8-10%
d. 4-6%
16. You are called to a single family residence for a bed-bound elderly male patient
reported to be unresponsive. The caller and only other person there is a neighbor who
“was just asked to come over and sit with him for a few minutes” while a family
member went to the store. The patient has a GCS of 3, is making agonal glottic
movements but has no effective respirations, has no palpable pulse. The neighbor says
he knows the patient did not want CPR but does not know the location of POLST or
DNR paperwork. Which of the following is your correct action?
a. Begin resuscitation
b. Withhold resuscitative efforts until the family member returns to clarify
c. Withhold resuscitation based on the neighbors statement
d. Do CPR only and begin transport
17. You and your partner are dispatched to a construction site where an individual has
fallen while entering a manhole. When you arrive on scene, the patient’s co-workers
state “Hey guy, he got almost all the way down but then slipped off the ladder and fell
the last 5 feet. He hasn’t moved since.” Your best course of action is to:
a. Send one person from the medic unit down into the hole to tend to the victim
while another waits for help to arrive and gathers more information from coworkers
b. Both you and your partner enter the manhole since this is a traumatic injury
due to a fall, treat the patient, and provide expeditious transport to a trauma
center.
c. Call for additional resources, and do not enter the manhole unless you have the
proper PPE and/or respiratory protection
d. Enter the manhole, but only after you have secured the rescuer to a proper
harness and rope system
18. Which of the following best explains a cholinergic crisis?
a. A nerve gas agent over-stimulates the sympathetic nervous system causing a
release of adrenaline. This in turn causes tachydysrhythmias, vasoconstriction,
and cellular hypoxia
b. A nerve gas agent attaches itself to the hemoglobin in the bloodstream causing a
reduction in the oxygen carrying capacity of the hemoglobin. This causes
anemic hypoxia, apoptosis, and cerebral ischemia.
c. A nerve agent overstimluates the parasympathetic nervous system which
causes an excess release of acetylcholine. This then causes bradycardia and GI
disturbances.
d. A nerve agent blocks the production of acetylcholine causing the
parasympathetic system to under-stimulate. This leads to ventricular rhythms,
vomiting, miosis, and excessive salivation.
19. The Mark 1 kit is designed to be used as prophylaxis in the event of a nerve agent
exposure or chemical attack. Providers can then respond to emergencies effectively.
a. True
b. False
20. The proper initial treatment for an individual who has been exposed to CN or CS gas
is:
a. Fresh air and time
b. Immediate use of albuterol for respiratory distress
c. Gross decontamination with fresh water
d. NIPPV
21. Aging is referred to as:
a. The process of identifying if cyanide exposure patients will benefit from the use
of medicinal interventions
b. The available window of treatment relating to 2pam for patients exposed to
various toxic nerve agents.
c. Allowing the cyanokit to reconstitute for greater than 90 seconds to allow
proper activation of medication prior to administration
d. Pesticides that have accumulated in the bloodstream over time leading to
chronic neurologic disorders
22. Per SOP, which of the following IS NOT an indication for the use of atropine in the adult
patient?
a. Symptomatic bradycardia
b. Asystole / PEA
c. Muscarinic / organophosphate poisoning
d. Nerve gas auto-injector
23. Which of the following is an appropriate capnometry reading of a normothermic,
normotensive intubated patient?
a. 10-15mmHg
b. 25-30mmHg
c. 40-50mmHg
d. 35-45mmHg
24. Waveform capnography is an important tool in that:
a. It can identify large fluctuations in perfusion levels in intubated patients
b. It can direct proper ventilation rates of intubated patients
c. It can instantly confirm placement of an endotracheal tube
d. Help create better survivability and outcomes for our patients
e. All of the above
25. You are dispatched for the 19 year old male patient who was found unresponsive by
bystanders. As you arrive on scene you note open bottles of paraquat in the patients
vehicle he is laying next to. You take the proper scene precautions to ensure your own
safety and begin to treat your patient. On initial assessment you note he has a GCS of 3,
dilated pupils, heart rate of 42, blood pressure of 82/47, respiratory rate of 6. Your
best course of action is:
a. ALS care including IV, EKG and intubation for airway protection. Atropine at
1mg IVP q 3 minutes to a total of 3mg
b. ALS care including IV, EKG and intubation for airway protection. Atropine at
2mg IVP q 3 minutes to a total of 6mg
c. ALS care including IV, EKG and non-rebreather with nasal airway. Atropine at
2mg IVP q 3 minutes with no dose limit
d. ALS care including IV, EKG and intubation for airway protection. Atropine at
2mg IVP q 3 minutes with no dose limit (SOP’s)