Pretty Bay, Malta
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Normal mixed venous oxygen consumption (SvO2) in a healthy patient is:
Your patient is suffering a constellation of symptoms that can best be characterized with the pneumonic “Mad as a Hatter, Blind as a Bat, Dry as a Bone, Red as a Beet”. These symptoms characterize what category of drug ingestion?
The primary benefit of IABP insertion during the post-MI management of a patient with hemodynamic compromise is:
You are transporting a patient via ground critical care that is sedated, intubated, and on a mechanical ventilator. With this patient, what is the best method for knowing when to re-dose the sedatives and paralytics?
You are going to induce and paralyze a patient who was just extricated from beneath a fallen tree while cutting wood alone. It was estimated that the patient was entrapped for 3-4 hours before being found. The patient has a GCS of 7, pupils are sluggish to respond to light, he has recurrent vomiting, the pulse ox reads 92% on high flow, NIBP shows 102/62, MAP 72, pulse is 112. The patient has extensive pelvic and lower extremity trauma following the injury from the tree falling on him. In this situation, what would be your preferred agents for induction and paralysis?
Which of the following neonatal cardiac defects is most likely going to result in cyanosis?
What three syndromes fall under the “acute coronary syndrome” umbrella that critical care paramedics should be familiar with?
You are transporting a patient who suffered a diving accident and a subsequent decompression emergency. The patient is not being flown due to the gas law that explains the relationship between the ability of a gas to dissolve and the pressure in the closed container is?
Which arrangement of cot straps would afford the unresponsive patient the most security during interhospital transport?
Your critical care unit is dispatched to a community hospital to transport an obese post-cardiac arrest patient to a tertiary facility for ongoing care. Upon arrival, you find the ED physician and staff struggling to establish successful intubation using traditional intubation means. Currently the patient is has a normal cardiac rhythm but hypotensive, and is being ventilated with an ETC in place. The staff is ventilating through tube #1 of the device to get breath sounds. What should the critical care provider consider doing?
Your patient sustained blunt force injury to the right eye which resulted in blood in the anterior chamber, and a visible fluid level. This presence of blood in the anterior chamber is defined as what type of ocular injury?
After a particularly busy shift, you find that you are more tired than usual. Which one of the following stressors of working a ground based critical care unit is the least likely contributor to how your feeling?
If a patient has increased tactile fremitus over the left lower lung lobe, which of the below is the LEAST likely cause of it?
You have just completed an RSI procedure on a septic patient with respiratory failure and you are now preparing for transport. Which of the following interventions may the critical care paramedic use to ensure there is no accidental dislodgement of patient tubes or wires while transporting?
Which of the following is a recognized negative effect of placing a patient on a mechanical ventilator, assuming all settings and patient variables were correctly set and no other contraindications to mechanical ventilations exist?
Which of the following psychotropic medications would the critical care paramedic most likely anticipate a toxic reaction to from accidental overdose?
While performing a bedside assessment of a patient prior to transport, you note that the patient has a new onset of ptosis in her left eye. This likely means damage to what nerve?
Your patient has serum sodium level of 116. In this situation, the critical care paramedic should be most concerned about the potential for:
You are called to ground transport an adult male who was struck by a car 5 days earlier. He received multiple surgeries to repair extensive lower extremity fractures, pelvic fractures, and internal injuries. Despite initial improvement, the patient has developed respiratory distress leading to failure, intubation and ventilator management. What is the likely reason for this deterioration several days later?
Your elderly patient has accidently ingested a large quantity of their oral potassium supplement and has a potassium level of 7.5 mEq/L. Calcium chloride may be administered by the critical care paramedic because:
Which of the following findings is the most common predictor of sepsis in a neonate?
When estimating the depth of endotracheal tube insertion during a neonatal critical care transport, the paramedic should estimate the depth of insertion by using what formula?
You are preparing to transport a trauma patient from a community hospital. The results of the iSTAT show an elevated lactate level. What does this finding indicate?
When can a patient with a tension pneumothorax receive pleural decompression without a real need to attach a butterfly valve to prohibit air entrainment into the pleural cavity?
While giving a lecture about TBI to a group of new hires, the critical care medic is discussing the “Monroe-Kelly” hypothesis. Someone in the class asks for an explanation of this, what should the critical care paramedic respond with?
An 18-year-old man sustains partial thickness burns to the anterior aspect of his chest and abdomen, as well as circumferential burns to his arms and legs. These burns cover approximately what percent of the patient’s total body surface area?
While transitioning from in-utereo dependence on the placenta for nourishment and oxygenation to extra-utero reliance on the pulmonary system, why does a neonate have an initial diminishment in oxygenation capability?
Bi-level (Bi-Pap) ventilation differs from Continuous Positive Airway Pressure (CPAP) by what important difference?
While assisting in the Emergency Department between critical care transports, a cheerleader has been brought in by EMS that has been stung multiple times is exhibiting signs of severe respiratory distress, along with urticaria, angioedema, and hypotension. Paramedics established an IV with normal saline solution and administered oxygen. Appropriate intervention at this time is to:
While reviewing some lab values for a trauma patient you are about to transfer to a
definitive care facility, you note a lactate level of 4.6, a sodium level of 132,
potassium of 3.9, BUN of 14, and a creatinine level of 0.8. Of these values, what is
the greatest concern to the critical care provider?
During the morning brief with the pilot in charge, they explain that due to the weather today, the performance of the aircraft will be reduced as will the weight of the patient your crew will be able to transport. The weather in question is most likely?
What is the purpose of “tagging” the pediatric equipment bag with a removable plastic lock, as typically used on a critical care transport unit?
While transporting a patient during a long ground based inter-facility mission, the patient becomes more and more anxious, resulting in tachycardia, diaphoresis, and an elevating systolic pressure. So long as no contraindications exist, what medication could be administered to help the patient lower their anxiety level?
What hemodynamic variable would be the most illustrative of a patient with a failing left ventricle?
While performing tracheal suctioning on a patient you just performed a surgical cric on, you note the heart rate drops with each suctioning attempt. What is the most likely reason for this?
You are transporting a pediatric patient who was traumatized in an MVC three days prior. The patient is intubated and on a ventilator. Although breath sounds are present, the pulse oximeter is low. As you review the medical records, you note the patient has been diagnosed with IRDS. This refers to:
Which of the following airway techniques would be most beneficial to the critical care paramedic attempting to orotracheally intubate a septic pediatric patient?
What is the general drug class for the following medications: hydralazine, enalapril, and sodium nitroprusside?
You are managing a patient that is a suspected organophosphate poisoning victim. As you assess the patient’s clinical presentation, what mnemonic can help aid the common findings?
Which of the below would have the greatest negative impact on coronary artery perfusion, and thus, be avoided during management?
Your patient has eye opening to verbal stimuli, a purposeful motor response to noxious stimuli, and is somewhat confused. When providing your bedside report at the receiving facility, what would you calculate their GCS score to be?
You are transporting a patient with Stage 4 liver cancer. The patient receives high dose narcotics to help with pain. During transport, the patient is continuously deteriorating so you elect to administer narcan to reverse some of the narcotics effects. This intervention proves unsuccessful, and the patient slips into a coma. What may be the cause?
Which of the following injury patterns for an MI may help identify the patient who would require fluid therapy prior to nitrates and narcotics?
Which of the below would be the most desirable property of medications used prior to intubation during an RSI procedure?
The normal ICP pressure range is:
When determining the trauma victims “Revised Trauma Score” (RTS), which of the below parameters is NOT included in this assessment?
When initiating an umbilical vein catheter on a neonate, which of the below statements is most correct?
When looking at arterial blood gases, what should the critical care paramedic expect a normal PaCO2 value to be?
You are managing a patient with persistent hypotension, tachycardia, and tachypnea. With this minimal information, what type of hypoperfusion syndrome is the patient NOT experiencing?
You are transporting a patient with an ICP monitor which allows for drainage of CSF. If the need arises for flushing the drain, what type of solution should be used?
You are assessing a pediatric patient in the emergency department that was brought in by the parents. The patient is 14 months old, has retractions and nasal flaring, dry mucous membranes, and a rapid respiratory rate. You can hear bilateral wheezing upon auscultation. Which of the below medical problems is most likely causing the problem?
Of the following findings regarding the preparedness of the transport vehicle, which one would have the greatest impact on safety should the finding not be noticed?
You are transporting a patient with left sided thoracic trauma to your Level 1 trauma center. You have already completed an RSI procedure, and the patient is on a vent in A/C mode, with a Vt of 480, rate of 10, Fd02 of 1.0, PEEP of 2 cmH20, and a peak airway pressure of 23 cmH20. Due to the limited ability to auscultate because of ambient noise, which of the below findings could be used as an indication that a needle decompression may be warranted?
You are transporting an elderly patient via ground critical care. The patient has a diagnosed intracerebral hemorrhage and takes Coumadin. While enroute, you note the patient’s eyes are sluggish to respond to light, the systolic pressure has been climbing, and the pulse rate has trended down from 98 to 68 bpm. You anticipate that you will need to perform and RSI due to failing respiratory function. What is the most likely syndrome this patient is experiencing?
A common side effect of succinylcholine administration that the critical care paramedic should always consider when using this drug is:
You have been requested at an immediate care facility to transport a patient who brought himself in secondary to a small gas fire that happened in his garage. The patient currently is struggling to breathe and has obvious burns to the face and neck. You hear inspiratory stridor when he inhales deeply. The pulse ox is 92% on oxygen, the blood pressure is acceptable, and the heart rate is 110/min. Given this presentation, what should the critical care transport team do?
When looking at the blood glucose lab values for a neonate, which one of the below values would be considered normal?
During the management of a known overdose, what reversal agent can be used if the patient has a confirmed overdose of lorazepam?
You are transporting a pediatric patient who was just put on a vent due to respiratory failure. The patient displays hypoperfusion, pulmonary hypertension, hypoxemia, and DIC. The original reason for admittance to the hospital was for severe pneumonia. At this time, what do you believe the patient’s primary problem is?
You are preparing to transport a patient with an extensive cardiac history, and are reviewing the medical records. You read that the patient has a CVP line placed and a Swan-Ganz catheter. You note the CVP reading to be 9 mmHg, the PA pressure is 32/20, wedge of 20, a CI of 2.3, and SVR of 1,800 dynes. This constellation of findings best represents what clinical condition?
Following the emergent delivery of a preterm infant during the transport of a high risk OB/GYN patient, the mother is still experiencing significant post partum hemorrhage. What should the critical care paramedic do to help stop this bleeding?
The critical care paramedic is transporting a female patient in her third trimester of pregnancy. The transport was initiated due to ongoing weakness, vertigo, headache, and mild dyspnea. The blood pressure is 172/ 98 with a heart rate of 130/min and inspiratory rales noted. Urinanalysis shows elevated protein and you note edema to the extremities. Given this, the patient is probably suffering what emergency?
What effect does the drug activase exert on the body when administered?
Your patient was inside a building that caught on fire. The patient has partial thickness burns to the anterior trunk and circumferential burns to each leg. What would be the estimated body surface area burned?
Your critical care mobile unit has been dispatched to back up a local EMS service for an entrapped victim of a collision. Upon arrival, you are given a report by the local EMS provider. You are told that the patient is unresponsive with cool, clammy, diaphoretic skin, and cyanosis to the central and peripheral areas. No peripheral pulses are found, jugular veins are engorged, the NIBP reads 76/58, the monitor shows sinus tach at 140/min, and the respirations are 29 with equal breath sounds bilaterally. From this information, you would most likely suspect the patient is suffering from a(n)?
You and your partner have just delivered a premature infant in the back of your MICP unit during a long transport to the high risk OB/GYN hospital. The infant presents with central cyanosis, bradycardia, and apnea. After stimulating, warming, and positioning the infant, the heart rate is 60/min with no peripheral perfusion. What should the mobile critical care team do first?
The mobile intensive ground unit is called to transport an attempted suicide by ingestion patient who is now intubated and on a vent. Upon your arrival, you are handed the patient’s post intubation arterial blood gases. They read, pH 7.48, PaCO2 24 torr, PaO2 166 torr, HCO3- 24. What ABG disorder is present?
When managing a multisystem trauma patient with a known/suspected intracranial hemorrhage, what clinical manifestation should the critical care paramedic try to avoid by management in order to better improve the neurological outcome of the patient?
You are preparing to transport an obese female patient with CRF, that attempted to end her life by skipping dialysis multiple times in a row. The patient is obtunded with a wide complex rhythm on the monitor. The ED staff is preparing to intubate her, and you hear the ED physician say that her potassium is 7.9 mEq/L. Given this, following the RSI procedure, what other medications may be warranted?
While performing an emergent FAST exam on your abdominal trauma patient, you note the presence of blood in Morrison’s pouch. What does this finding represent?
Which of the following statements regarding pediatric arrest situations is most true?
What is the normal hemoglobin value for an adult male?
You are managing a pediatric patient with a head injury. Your role is to provide transport to the children’s hospital from the outlying ED. The patient has been sedated, paralyzed, and intubated by the referral agency. The blood pressure is currently minimally adequate. During transport, which of the below is NOT a desired clinical outcome?
While transporting a burn patient to the burn center, the IV that was infusing at a KVO rate has infiltrated. As you prepare to initiate another IV, what type of solution would you most likely NOT use?
Cerebral perfusion pressure in a head injured patient is computed from what two variables?
While transporting a patient on a mechanical ventilator, the alarm for “low minute volume” sounds, and immediately after that the “high airway pressure” alarm sounds. What should be the critical care paramedic’s initial suspicion as to why this is happening?
You are called to transport a pediatric patient who is experiencing ongoing seizure activity from an unknown etiology. When attempting to manage these seizures, which drug-dose combination would NOT be appropriate?
You are transporting a patient from an immediate care facility back to the emergency department for evaluation of a GI bleed. The patient has a pulse rate of 102/min, with a systolic blood pressure of 106 mmHg, and a pulse pressure of 24 mmHg. The skin is cool and clammy, the capillary refill is 3 seconds, and the respirations are 20/min. Given this presentation, the critical care paramedic should suspect the patient is in what clinical stage of shock?
What setting can be manipulated on a ventilator when a patient on SIMV is still failing to adequately oxygenate, despite the end tidal CO2 level being normal?
What is the primary property of paralytic agents used in the critical care ground environment?
Near the end of your shift, you are dispatched to an outlying hospital for a 39 year old female who has septic shock from a ruptured appendix. Upon arrival, you learn the patient is intubated and on the ventilator in the ICU. Once bedside, you find the following: intubation with a 7.0mm ET, SIMV mode at 12/min, Vt of 600, FiO2 .90%, and PEEP of 2 cmH20. The patient is on a levophed infusion at 9 mcg/min, and has just received post-intubation paralysis and sedation meds. Vitals are B/P 68/40, HR 132, RR of 12 via vent, SpO2 of 96%, and ETCO2 of 40 mmHg. The patient’s last hemodynamic readings from the triple lumen catheter were a CVP of 5 mmHg, PAWP of 6mmHg, and a calculated SVR of 600 dynes. What medication could the critical care paramedic add to help augment the blood pressure?
Why is bradycardia in a neonate treated so aggressively in the symptomatic patient?
What electrical change to the 12-Lead may be present in the patient with acute pericarditis?
While reviewing a 12-Lead ECG on a patient with ischemia you note they have ST elevation in leads V2, V3, and V4. If this patient was to develop bradycardia, what would be the most likely etiology?
Your critical care mobile unit has just received written medical directives for transporting high risk OB/GYN patients. While reviewing the document, you see that oxytocin will be added to the service’s drug license in order to meet this protocol. What is the mechanism of action for oxytocin?
In a patient suffering from heat exhaustion, what would you expect to happen to the patient’s systemic vascular resistance (SVR)?
Which of the following medications can be considered for a patient with increased intracranial pressure secondary to head trauma?
In a patient exposed to an environmental cold stressor, which of the below would be the best example of thermogenesis?
While reviewing the print out of an ICP monitor, you note that the P2 wave is taller than both the P1 and P3 waves. This wave morphology would best be represented by which of the following ICP values?
When preparing to perform a transtracheal jet insufflation procedure on a pediatric patient with inhalation injuries and an edematous glottis, where is the needle itself placed?
During the assessment of a burn patient that is on a vent, you note that the peak
airway pressure keeps climbing, and the oxygen saturation is deteriorating. The
patient has received partial and full thickness burns to the chest, right arm, and
abdomen in a failed suicide attempt. Prior to departing the referral facility, what may
the critical care transport team consider discussing with the referring physician to
improve oxygenation status?
What would be an appropriate initial dose of fentanyl for pain relief of a patient with an extremity burn?
What is the clinical indication to the ground critical care paramedic that the bougie is being used correctly during insertion?
You are managing an unstable medical patient with a pulmonary compliance disorder secondary to a spontaneous pneumothorax. While traveling enroute with this patient, they acutely deteriorate. Which of the below interventions being provided by the critical care paramedic most likely contributed to this deterioration?
You are requested to transport by ground a 40 year old male with a recent history of multisystem trauma. Despite initial improvement from the trauma during the first few days, on the seventh day at the hospital he developed shortness of breath that worsened to the point which he was electively intubated. Over the next several days the respiratory therapist needed to continually increase his oxygen requirements (currently on a FiO2 of 0.8) to maintain adequate saturation. His chest x-ray began to show “patchy white infiltrates” to the middle right lobe that resembled pulmonary edema per the medical records. Records also state that he was given diuretics due to the hemodynamic values of a CVP of 7 and a PCWP of 11. Why did the diuresis not make any clinical difference?
Which of the following stressors would have the greatest impact on the critical care paramedic’s ability to function in a ground unit?
When looking at a lateral neck x-ray to determine if you need to immobilize a patient prior to transporting in your mobile critical care unit, which of the following is most correct?
You have just delivered a baby that is 2 weeks early. Upon assessment of the first APGAR score, you note the following: the body and extremities are cyanotic, the heart rate is 108, facial grimacing is present, spontaneous motion is limited to major joints, and the infant has a weak cry. What would you calculate the score to be?
What type of radiation emergency should the critical care mobile team stay physically furthest away from until proper decontamination is carried out?
According to prehospital providers, an unrestrained driver of an auto reportedly struck a bridge abutment while traveling at 70 mph. Given this, when the patient struck the interior components of the auto, what was the rate of speed in doing so?
You are preparing to transport a patient back to your larger hospital. As your partner starts to switch over equipment, you note the patient has a triple lumen catheter inserted with dobutamine running at 8 mcg/kg/min, and sodium nitroprusside running at 9 mcg/kg/min. The patient’s vitals are: B/P 82/60, HR 104, RR 28, and a CVP reading off the triple lumen of 1 mmHg. Which of the following interventions should the critical care paramedic do?
You are transporting a vent dependent patient with known development of MODS who is now entering into ARDS. During this patient management, which ventilatory parameter is utilized to meet oxygenation goals?
You are transporting a multisystem trauma patient back to the university based medical center. Due to this, what is the likely trauma rating the hospital is accredited at in order to receive this patient?
You are managing a 75 kg patient who is sedated, paralyzed, intubated, and on a ventilator. The vent settings are: Mode A/C, Vt 450 ml, Rate 10, FiO2 0.80, I/E time of 1:2, and PEEP of 2 cmH20. Currently, the patient has a B/P of 142/80, heart rate of 98, and a pulse ox of 98%. The ETCO2 reads 51 mmHg. What, if any, variable of the ventilator needs to be altered?
If you are transporting a burn patient from the ED to the regional burn center, and the patient’s blood pressure continues to drop as the pulse rate increases, what should the critical care paramedic consider as the probable etiology for the shock?
Which of the following disturbances could worsen intracranial pressure?
During the post-management of a traumatized patient, what condition may develop in which there is a loss of the integrity of the pulmonary capillary membrane, resulting in O2 and CO2 diffusion difficulties?
Your patient is being transferred to a distant facility with neurological specialty in cord injuries. The patient you’re transporting has gross function to the legs, but the arms are completely paralyzed. Given this presentation, what type of cord injury have they sustained?
When preparing to transport a high risk OB/GYN patient with a mal-positioned fetus, you are told by the OB nurse that the patient is fully dilated. This means:
Which of the following medications are included in the drug category of “inhaled beta agonist”?
You arrive on scene to back up an Advanced EMT unit for a multisystem trauma patient. Upon arrival, the onscene EMS providers have placed an ETC tube and are ventilating through port #1, which produces bilateral breath sounds. Transport to the hospital is 35 minutes away and the weather precludes the ability to airevac them out. What should be the critical care paramedic’s next actions be regarding this airway?
You are transporting a trauma patient from a community hospital to the trauma center. The patient has a right sided hemopneumothorax as evidenced on the CXR. A chest tube has been placed and ventilation has only been somewhat successful on the ventilator. What may be the reason for this?
You have a multi-trauma patient with a GCS of 10. The patient’s blood pressure is 102/90 mmHg, respirations are 24, the pulse ox is 95%, and the MAP is 94 mmHg. When providing your report to the receiving facility, you would give them what numeric score for the RTS?
Why is the head of an infant protected from the cold during transitioning to the ambulance by the critical care paramedic?
Which of the below changes in a pregnant female’s body at full term contributes to the inability to appreciate hypovolemia as readily as a non-pregnant female?
You are about to initiate a transport with a patient who is in a coma secondary to liver failure. As you start to load the patient into the rear of the mobile critical care unit, he begins to seize. What drug and dose would be most appropriate at this time?
Which of the below airway/ventilation procedures is generally avoided in infants and younger pediatrics patients?
Near the end of your shift, you are dispatched to an outlying hospital for a 39 year old female who has septic shock from a ruptured appendix. Upon arrival, you learn the patient is intubated and on a ventilator in the ICU. Once bedside, you find the following: intubation with a 7.0mm ET, SIMV mode at 12/min, Vt of 600, FiO2 .90%, and PEEP of 5 cmH20. Levophed is infusing at 9 mcg/min, Propofol at 60 mcg/kg/min and a Zosyn infusion, all through the triple lumen catheter. Vitals are B/P 66/40, HR 132, RR of 12, SpO2 of 96%, and ETCO2 of 46 mmHg. The patients last hemodynamic readings were a CVP of 3 mmHg, PAWP of 6mmHg, and a calculated SVR of 600 dynes. What should be the critical care paramedic’s first action regarding the blood pressure?
Your 56 year old asthma patient has a history of asthma and is experiencing an acute attack. His B/P is 152/90, HR is 136/min, and respirations are 36. He is cyanotic and is using accessory muscles to breathe. Upon auscultation of the lungs, no wheezing is appreciated. His mental status is rapidly declining. From this presentation, you should assume that:
What laboratory value typically becomes elevated following a burn that damages a significant portion of the body?
When transporting a critically ill patient in a ground based mobile unit, a family member wants to accompany the patient during the mission. If allowed, where should this person be seated?
The mechanism behind burn shock starts with:
While reviewing the medical records for a patient with a GI disorder that you are transporting, you read that the referring physician has placed a Sengstaken Blakemore tube. This intervention most likely means what?
You are transporting a patient who fell outside while walking a remote road, and was exposed to the high temperatures during the majority of the day. The patient has an altered mental status and marginally normal vitals. As you cool this patient, why is it important to not cool to the point of shivering?