# How would you answer this one.....



## Fire3456 (Mar 11, 2008)

Anyone interested in starting a thread, where you could post a possible test question ... or problem that you come across....that you find is a little difficult because of 2 similar answers.  Or it may be contrary to what you've been told or learned.  

People could post their answers..and reason for the answer.  

I don't want to start a thread to waste space.  I just thought it could be helpful.  Besides...just because you finish the NR test (as someone else posted) doesn't mean its over with!  There's always the refreshers! And it really is a constant learning experience. ( Especially when the AHA keeps changing things!!!    ) 

Just a thought.


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## Ridryder911 (Mar 11, 2008)

I believe that is a great idea as long as it is NOT a test question from the NREMT or even could be considered similar to their test. Remember, it is a copyrighted test and any violation could lead to problems. 

R/r 911


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## Fire3456 (Mar 11, 2008)

*Heat Exhaustion/Stroke*

Ok...I'll just keep the Questions as a "for instance" in my own words.  Since I haven't taken the NR yet...I didn't steal it from their test.

The situation:

95 degrees outside.  You arrive and find a semi-conscious man outside on the ground.  He is sweaty and his skin is red and hot,   What would be the first step in your management of this patient.

a)Make sure he has an open airway
b)administer O2 NRB
c)Move him to a cooler area
d)Cool him rapidly with ice packs.

I figured...Airway Airway Airway...  So I chose "A" (which is incorrect according to 2 sources of study material).

Reason: without a patent airway and adequate ventilation...the pt will crash in a very very short time..hot or cold.

I can't find a good reason why "Airway" isn't number one in this situation.
Maybe because he's "semi-conscious", they don't consider airway a high priority (Still...wouldn't you quick check to make sure???)

Anyone?


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## Sapphyre (Mar 11, 2008)

Well, keeping in mind I'm just a student, and not all that far into my training...

To me, semi-concious implies that his airway is ok, at least for the moment.  Red, hot and sweaty kind of implies, to me, that this may be a heat injury, so, lets move him to a cooler area.  Of course, I could be wrong, and will now go check my book.

ah, book says Oxygen, and that was my second choice.


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## roxychick (Mar 11, 2008)

Fire3456 said:


> Ok...I'll just keep the Questions as a "for instance" in my own words.  Since I haven't taken the NR yet...I didn't steal it from their test.
> 
> The situation:
> 
> ...



I've seen this test question before and the answer is actually C.
*
Here is what the book says:*
A patient with hot skin that is either moist or dry represents a dire medical emergency. Cooling the patient takes priority over everything other than ABC management. Provide the following care:
1. Remove the patient from the source of the heat and place him in a cool environment
2. Remove as much of the patient's clothing as possible
3. Administer oxygen
4. Immediately begin to cool the patient.

:wacko:


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## Fire3456 (Mar 11, 2008)

Good one Roxy... It doesn't matter that he's 'moist'.  Its considered Heat Stroke.  And the books say...Move him out of the heat first.  Take off clothing second.  O2 third.  

(In real life....I still say at least CHECK his airway. It only takes seconds!)

I guess, if you were to determine this condition, under your "initial assesment", as a life threat (which it is), you'd treat it first before your ABC's.


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## roxychick (Mar 11, 2008)

Fire3456 said:


> Good one Roxy... It doesn't matter that he's 'moist'.  Its considered Heat Stroke.  And the books say...Move him out of the heat first.  Take off clothing second.  O2 third.
> 
> (In real life....I still say at least CHECK his airway. It only takes seconds!)
> 
> I guess, if you were to determine this condition, under your "initial assesment", as a life threat (which it is), you'd treat it first before your ABC's.



I think it makes sense with this order. I mean if you start treating the patient on the spot...he's still exposed to the climate so really, the care that you're providing is not gonna help at all. That's just me tho


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## Ridryder911 (Mar 11, 2008)

Crappy question, there is NO such thing as a semi-conscious or lethargic patient. Hopefully, the NREMT will give you LOC per AVPU system.

Airway, should be the first treatment. Removing him from the source is important since it will continue, but not having an airway will cause more immediate death. 

R/r 911


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## rescuepoppy (Mar 11, 2008)

Just a thought but if the air way is compromised long enough the patient WILL assume room temperature!


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## enjoynz (Mar 12, 2008)

I would have picked (C) too.
Take the patient to a cool or shady area (or air conditioned ambulance).
As it says they are semi-conscious, I assume that would be V or P of AVPU,
so the patient would have an airway.
So I would position the patient in the recovery position, (I'm not sure if you use that position much in the States) to maintain his airway should he decided to go unconscious or vomit. 
Place cold packs under armpits, etc,etc to cool patient down, and transport.

Cheers Enjoynz


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## ironguy321 (Mar 12, 2008)

Would you move the Pt. AND at the same time make sure they have an airway?

[Not trying to answer question as A,B,C,D but what to do in the field]


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## Fire3456 (Mar 13, 2008)

*How much to assume??*

I've come across several questions, where you have to try and determine how far into the patient care is the question is indicating.  

Generally people are saying...if its not written down in the question....don't assume its been done.  Makes sense to me.  Here's a type of question that has come up a few times...

A 45 y/o woman has acute shortness of breath and 30/min respirations.  How would you manage this patient.

a) Begin with assisted ventilations
b) Apply 02 via NRB
c) Assess breathing quality
d) Begin Detailed exam.

I'm thinking the progression is - assess rate and quality, then O2/airway interventions as needed.

But....the fact the question says the woman is short of breath, and breathing at 30/min..... does that indicate the "rate and quality" step has already been completed?

I have to 'guess' what the question writer's intent was. 
(using the logic stated above....I got it wrong!) :unsure:


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## roxychick (Mar 13, 2008)

Fire3456 said:


> A 45 y/o woman has acute shortness of breath and 30/min respirations.  How would you manage this patient.
> 
> a) Begin with assisted ventilations
> b) Apply 02 via NRB
> ...



I would say the answer might be A. I could be wrong tho. lol Only cause it takes 2 adequates to make an adequate breathing. If one is already inadequate...then it's an inadequate breathing. lol Did that make sense at all? Anyways, if the respiration rate was in the normal ranges then I would choose C.

:unsure:


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## Ridryder911 (Mar 13, 2008)

Thus is another poorly written question, with inadequate information and inadequate information. 

One could be hyperventilating with respiratory rate of > 30 minute, would you assist her or apply oxygen? Would you assess breathing quality (of course, but one can question if that has been performed), as well the last answer is most correct for medical assessment, that is if they are able to answer the questions (again, one should not be asking ton of questions, awhile some is having breathing problems).

This why NREMT usually uses stem key type, and scenario based, as well as distractor type, so a better answer can be made. 

R/r 911


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## Fire3456 (Mar 13, 2008)

I agree...a poorly written question...which leave you asking endless questions about the patients condition....is this the report you received before you made contact or what you found out during your assessment?....is she conscious?... LOC?....Cyanotic?... Was she jogging when this came on?..etc...   Just not enough information to make a solid choice.  

I picked O2 via NRB (because I assumed she was conscious).  I had to assume, because it gave the rate and quality (I know there's more to 'quality') the breathing assessment was done. I assumed she was conscious because it didn't say she was unconscious....(if its not written down, don't factor it into the question)

Anyway.. in both sources...the answer was "Assess the Breathing Quality"


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## fma08 (Mar 13, 2008)

Fire3456 said:


> Ok...I'll just keep the Questions as a "for instance" in my own words.  Since I haven't taken the NR yet...I didn't steal it from their test.
> 
> The situation:
> 
> ...


i can see C as being the right answer, removing the pt from the environment is a good idea with emergencies that require such, kind of one way to look at it, you cant maintain an airway on someone floating in water, gotta get them out of the water first, and if its winter, out of the water and into your warm rig.


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## Fire3456 (Mar 19, 2008)

*Is the answer out of sequence?*

I've been getting practice questions where the answer seems to be out of sequence with what the 'normal' steps/procedures specify. (I know each 'call' is different, depending on the circumstance)  Here's the latest question I have come across:

42 y/o man ejected 50' from his car after hitting a bridge pillar.  After manually stabilizing his head you:

a) Assess his breathing
b) Grasp the angles of the jaw and lift
c) Administer High Flow O2
d) Determine the patient's LOC

Sooo in your trauma/medical assessment/management sheet (for the practical tests) and in the books...there is a clear order of steps to take.  
Scene Size up  , 
Initial assessment .. which is General Impression/MOA, Determine responsiveness, Chief Complaint/life threats, ABC's, determine priority of pt.

I figured...you've already seen the MOA, done C-spine, ...wouldn't you determine his level of consciousness then assess his breathing?

Their answer was "B", Jaw lift.  

During our classes (and the way I do it on the street) we always approached the pt and determined the LOC as we got ready to do the ABC's. If they answer you, you've determined at least some kind of patent airway (you'd still check their breathing rate and quality)... and can continue the ABC's .

The way I see it, determining the LOC can quickly give you hints to what else is going on and what you need to do next.

So I picked "d"....which was incorrect according to the answer key.

Maybe the test writer was thinking the MOA was significant enough and life threatening that you could skip determining LOC???

Of course if it was apparent he wasn't breathing, or apparent he was unconscious, I'd go directly to the airway step.  Still, it takes a second, as you approach the pt, to yell "are you ok" to see if there is any response (eye shift) at all.

(ok..I know there's the discussion of not getting the pts attention, if he has a possible spine injury, until you stablize the spine...so he doesn't shift an injured spine to look at you)

Comments?


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