Emergency Exam3

1. You are called to the home of an elderly woman who states that she is dizzy and having difficulty breathing and that her chest feels "tight." She also has severe abdominal cramps. As you assess her, you find out that she was fine until after shestarted cleaning in the garage yesterday, but she says that she did not do any heavy lifting. As you examine her leg, you notice a light pink rash and what appear to be two small puncture wounds. These signs and symptoms indicate the bite of a: A: fire ant. B: pit viper. C: black widow spider. D: brown recluse spider.

2. A 10-year-old girl was stung several times by a swarm of bees. The areas where she was stung are red and swollen, and several stingers are embedded in her arms, legs, and face. The patient is crying and complains of severe pain in the area surrounding each sting. The parents state that she has no known allergy to bee stings. The patient has a rapid pulse. The most appropriate course of action would be to: A: squeeze the stingers and remove the venom. B: apply warm compresses to the areas and give oxygen. C: scrape off the stingers with the edge of a card, wash the areas, and apply cold packs. D: use tweezers to remove the stingers and then apply warm compresses to the areas.

3. Approximately 3 days after removing a tick from his upper leg, a 35-year-old man presents with a local rash that resembles that of a "bulls-eye." His blood pressure is 108/78 mm Hg, his heart rate is 100 beats/min and regular, and his respirations are 22 breaths/min with adequate air exchange. Which of the following do you suspect? A: Rocky mountain spotted fever B: A rheumatoid infection C: Lyme disease D: An allergic reaction

4. When administering epinephrine by auto injector, the EMT-B must hold the injector in place for approximately: A: 2 - 5 seconds.

B: 10 seconds. C: 20 seconds. D: 30 seconds.

5. An allergic reaction is an exaggerated response of the immune system to any substance. The body releases which of the following chemicals that causes the signs and symptoms of the allergic reaction? A: Histamine B: Epinephrine C: Adrenalin D: Benadryl

6. Upon arriving at the scene of a residence, where a patient is evidently having a "severe" allergic reaction to an ant bite, the EMT-B's initial action should be to: A: perform an initial assessment of the patient. B: immediately establish and maintain the patient's airway. C: perform a size-up of the scene prior to entering the residence. D: obtain a SAMPLE history in order to determine the patient's history.

7. A young male patient is experiencing signs and symptoms of anaphylaxis after being stung by a scorpion. His level of consciousness is diminished and you can hear stridorous respirations upon inhalation. The patient has a prescribed epinephrine auto injector with him. Initial management for this patient should include: A: assisting with the administration of the epinephrine. B: applying 100% oxygen via a nonrebreathing mask. C: providing positive pressure ventilation with a BVM device. D: elevating the patient's legs and keeping him warm with a blanket.

8. It is approximately 13:25 hours when you are dispatched for a man who complains of pain to his left hand. Upon arrival, you assess the man and find that he has a small wound in his hand that is slightly cyanotic in the center, surrounded by an area of

tenderness. The man states that he does not remember being bitten or stung by anything. He noticed the pain and discoloration approximately 6 hours after adding wood to his woodpile for the upcoming winter. Which of the following is most likelythe cause of this patient's presentation? A: A black widow spider bite B: The sting from a scorpion C: The bite from a brown recluse spider D: Envenomation from a coral snake

9. You are treating a man who was bitten by a rattlesnake. The patient complains of generalized weakness and is diaphoretic. There is a large, swollen area on his left lower leg with two distinctive puncture wounds. Appropriate management for this patient includes: A: applying ice to the area to decrease swelling. B: having the patient walk to diminish venom spread. C: placing the patient in a fully upright position. D: splinting the extremity to decrease movement.

10. A characteristic mark found on patients who have been bitten by a pit viper is: A: a row of small puncture wounds. B: a large puncture wound. C: a large puncture wound with a stinger. D: two small puncture wounds about 1/2 " apart.

11. A 19-year-old man who was bitten on the leg by a rattlesnake is found sitting on the ground leaning against a tree. The patient is weak and sweaty and states that his leg is burning. As you begin your assessment, the patient vomits and becomes very anxious. Your care for this patient should begin by: A: placing a cold pack over the bite area. B: giving him small sips of water to clear his mouth. C: placing a constricting band directly over the bite area. D: consulting with medical control and then lightly placing venous tourniquets above and below the bite.

12. Which of the following statements is TRUE regarding anaphylaxis? A: Most people who develop anaphylaxis die. B: Urticaria is a late sign of anaphylaxis. C: Anaphylaxis typically involves multiple organ systems. D: Hypotension is seen very early during the course of anaphylaxis.

13. Which of the following exposures would result in the MOST rapid onset of signs and symptoms of an anaphylactic reaction? A: Ingestion of penicillin B: Injection of penicillin C: Ingestion of shrimp D: A noninvenomated insect sting

ANSWERS NO 1.

2.

3.

4.

5.

ANS

REASON

c

Reason: These findings suggest a black widow spider bite.

c

Reason: For a patient with a sting, the stinger should be removed by scraping it off the surface of the skin with the edge of a card. Next, wash the areas with soap and water and apply ice or cold packs to the area, but not directly on the skin. (ECTSI 8, p. 410)

c

Reason: Lyme disease, which is caused by a tick, presents approximately 3 days after exposure and includes a rash that appears to have a "bulls-eye" in the center. Within a few more days or weeks, the patient will begin to complain of joint pain, especially in the knees. (ECTSI 8, p. 427)

b

Reason: When administering epinephrine via auto injector, the EMT-B should push the injector firmly against the thigh until the injector activates, about 5 - 10 seconds. This action will help prevent the kick that the springloaded syringe can cause when the needle is pulled from the injection site too soon. Hold the injector in place until the medication is injected (10 seconds). (ECTSI 8, p. 420)

a

Reason: The two chief chemicals released by the body that result in the signs and symptoms of an allergic reaction are histamines and leukotrienes. (ECTSI 8, p. 416)

c

Reason: As with any other call, the EMT-B must perform a scene size-up prior to entering the scene. Safety of the EMT-B and his or her partner is the primary concern on any call. (ECTSI 8, p. 419)

c

Reason: This patient does not have adequate respiratory effort (altered mental status and stridorous respirations), He therefore requires immediate positive pressure ventilations with a BVM device The airway must be secured and managed prior to any other treatmen

c

Reason: The brown recluse spider, identified by the violin-shaped mark on its back, possesses a cyotoxic venom, which means that it causes severe, local tissue damage. Typically, the patient will not recall being bitten because the bite itself is usually painless. Within hours of the bite, however, the site will become swollen and painful with the development of a pale, mottled, or cyanotic center. During the warmer months of the year, brown recluse spiders are typically found in dark areas, such as unused buildings, under rocks, and in woodpiles

9.

d

Reason: Appropriate management for a pit viper bite includes, keeping the patient calm, gently cleaning the area with soap and water or a mild antiseptic, splinting the affected extremity to protect it and decrease movement, and placing the patient in a supine position. NEVER apply ice to a snakebite, as it will increase the toxicity of the venom.

10.

d

Reason: A snake bite wound that has two small puncture wounds about apart is indicative of a pit viper bite. Discoloration and swelling will also be visible

11.

d

Reason: The first steps in caring for a patient with a snake bite is to inform medical control and, if possible, describe the snake. You will also need to discuss the use if venous tourniquets. They should be lightly placed above and below the bite.

12.

c

Reason: Anaphylaxis, which is not always life threatening, typically involves multiple organ systems

b

Reason: Of the following choices, the injection route will typically produce the most rapid onset of signs and symptoms of an anaphylactic reaction. Ingestion can take up to 30 minutes before symptoms begin. If a person is not invenomated, an exposure did not occur

6.

7.

8.

13.