Paramedics Special Patient Populations Questions and Answers — Questions and Answers
Question 1: You are immobilizing a 28-year-old female who is 34 weeks pregnant following a motor vehicle collision. She is secured to a long spine board. To prevent supine hypotensive syndrome, which of the following is the most appropriate action?
- Elevate the foot of the board by 15-30 degrees.
- Place the patient in a left lateral recumbent position on the board.
- Manually displace the uterus to the patient's left side. (Correct answer)
- Administer a 500 mL fluid bolus prior to transport.
Correct answer: Manually displace the uterus to the patient's left side.
In a pregnant patient beyond 20 weeks gestation, the weight of the gravid uterus can compress the inferior vena cava and aorta when the patient is supine, reducing venous return and cardiac output. While maintaining spinal immobilization, the most appropriate intervention is to manually displace the uterus to the left, relieving this compression.
Question 2: An 82-year-old female presents with acute onset of confusion, generalized weakness, and shortness of breath. She denies any chest pain. Her medical history includes hypertension and diabetes. Which condition should the paramedic maintain the highest index of suspicion for?
- Hypoglycemia
- Sepsis
- Acute Myocardial Infarction (Correct answer)
- Pulmonary Embolism
Correct answer: Acute Myocardial Infarction
Elderly patients, especially women and those with diabetes, frequently present with atypical symptoms of Acute Myocardial Infarction (AMI). Classic chest pain may be absent, and they may instead present with symptoms like weakness, confusion, syncope, shortness of breath, or nausea.
Question 3: You are dispatched to a 58-year-old male with end-stage renal disease who missed his last two dialysis appointments. He is lethargic and complains of palpitations. The cardiac monitor displays tall, peaked T-waves and a widened QRS complex. These findings are most indicative of which life-threatening electrolyte imbalance?
- Hypocalcemia
- Hyperkalemia (Correct answer)
- Hyponatremia
- Hypermagnesemia
Correct answer: Hyperkalemia
Patients with end-stage renal disease who miss dialysis are at high risk for hyperkalemia, as the kidneys are unable to excrete potassium. Classic EKG findings of severe hyperkalemia include tall, peaked T-waves, prolongation of the PR interval, widening of the QRS complex, and potentially a sine wave pattern, which can precede cardiac arrest.
Question 4: A 3-year-old child presents with a gradual onset of a low-grade fever, hoarseness, and a distinctive 'seal-bark' cough. You note inspiratory stridor that worsens when he becomes agitated. The child appears non-toxic and is playful between coughing episodes. This presentation is most characteristic of:
- Epiglottitis
- Laryngotracheobronchitis (Croup) (Correct answer)
- Bacterial Tracheitis
- Foreign Body Airway Obstruction
Correct answer: Laryngotracheobronchitis (Croup)
The classic presentation of laryngotracheobronchitis (croup) includes a prodrome of upper respiratory symptoms, a low-grade fever, a barking cough, and inspiratory stridor. This contrasts with epiglottitis, which typically has a more rapid onset, high fever, drooling, and a toxic appearance.
Question 5: When preparing for the intubation of a morbidly obese patient, what is the optimal positioning technique to facilitate airway alignment and improve the laryngeal view?
- Placing the patient in a reverse Trendelenburg position.
- Using a towel roll under the occiput to create a sniffing position.
- Placing the patient fully supine to flatten out soft tissues.
- Creating a 'ramped' position to align the external auditory meatus with the sternal notch. (Correct answer)
Correct answer: Creating a 'ramped' position to align the external auditory meatus with the sternal notch.
In morbidly obese patients, the standard sniffing position is often insufficient. A 'ramped' or Head-Elevated Laryngoscopy Position (HELP) is superior. This involves elevating the patient's head, shoulders, and upper back until their external auditory meatus is on the same horizontal plane as their sternal notch, which aligns the oral, pharyngeal, and laryngeal axes for better visualization.
Question 6: You are treating a 9-year-old with a tracheostomy who is in respiratory distress. Your attempts to pass a suction catheter are met with resistance, and ventilations via the tracheostomy tube produce no chest rise. Which of the following is the most appropriate immediate action?
- Attempt to ventilate the patient via the mouth and nose while sealing the stoma.
- Perform a needle cricothyrotomy superior to the stoma.
- Remove the tracheostomy tube and attempt to ventilate the stoma directly. (Correct answer)
- Administer a nebulized bronchodilator through the tracheostomy tube.
Correct answer: Remove the tracheostomy tube and attempt to ventilate the stoma directly.
An inability to pass a suction catheter or ventilate through a tracheostomy tube indicates a complete obstruction, likely from a mucus plug. The immediate, life-saving intervention is to remove the obstructed tube, assess the stoma, and attempt to ventilate directly through the stoma, often with a pediatric BVM mask.
Paramedics Special Patient Populations Questions and Answers
You are immobilizing a 28-year-old female who is 34 weeks pregnant following a motor vehicle collision.
She is secured to a long spine board.
To prevent supine hypotensive syndrome, which of the following is the most appropriate action?