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EMT scenarios (part 3)

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nojuyeme's version from 2017-08-02 19:33

Section 1

Question Answer
You are called to a local school playground for a 7-year-old female complaining of moderate epistaxis. She has no history and her mother has been called. The child is sitting in the nurse's office holding her face over a trash can. How would you best manage this patient?Have patient lean forward while pinching the nostrils together. Assess the airway to assure patency.
You are called to a lumberyard where a 25-year-old male had his ear cut completely off with a saw. Bleeding is controlled with direct pressure. He is alert and oriented. How would you best manage this patient?Transport in position of comfort. Apply high-flow oxygen. Bandage ear when bleeding is controlled. Wrap avulsed part in moist, sterile dressing and place in plastic bag. Keep cool. Monitor vital signs.
You are dispatched to a head-on motor vehicle crash. Your patient, a 67-year-old male, unrestrained driver, is unresponsive and has a very weak pulse and decreasing respirations as you pull him from the vehicle. Once you have him immobilized on the long backboard, he becomes apneic and pulseless. How would you best manage this patient?Immediately begin assisting ventilations with a BVM attached to 100% oxygen. Begin chest compressions. Rapid transport. Apply an AED as soon as possible. Continue CPR and continuously monitor the patient.
Your patient, a 22-year-old male, is complaining of a sudden onset of right-sided chest pain with a sudden onset of difficulty breathing. He tells you he was out running when it started. How would you best manage this patient?Apply high-flow oxygen. Monitor vital signs. Rapid transport in position of comfort. Continue to monitor patient for signs of distress en route to the hospital.
You are called to a significant motor vehicle crash where a 21-year-old female restrained driver is complaining of pain to the abdomen, but no other injury. She believes that the pain is just from the seat belt. She is alert and oriented and vital signs are all within normal limits. You explain that due to the mechanism of injury and her complaint of abdominal pain, she should be seen at the emergency room for evaluation. She agrees to go with you. How would you best manage this patient?C-spine immobilization. Apply high-flow oxygen. Normal transport unless patient's condition changes. Continue your assessment en route. Monitor vital signs and airway continuously.
You are dispatched to a fall at a residence where you find a 35-year-old male who tripped and fell onto a barbed wire fence. He has a bowel evisceration and is in extreme pain. His neighbor tells you that there was no trauma involved; he slipped and fell from a standing position onto the wire, tearing open his abdomen in the process. He lowered himself to the ground before passing out. He is voice responsive and tachycardic. His breathing is 24 and deep. How would you best manage this patient?Apply high-flow oxygen via nonrebreathing mask. Cover the abdominal contents with moist, sterile gauze and an occlusive dressing. Transport in the position of comfort (Probably supine with knees bent). Rapid transport. Monitor vital signs and airway continuously.
You are dispatched to a construction site for a 27-year-old male complaining of severe thoracic pain posteriorly. Coworkers tell you he was hit in the upper back by the bucket of a backhoe. He is alert and oriented and closer inspection reveals bruising and deformity over the left scapula with pain and crepitus on palpation. How would you best manage this patient?Evaluate ABCs and pulse/motor/sensation in all extremities. Apply high-flow oxygen. Splint fractured scapula using a sling and swathe. Transport patient in position of comfort. Consider c-spine immobilization if patient fell, was thrown, or complains of any neck pain. Upgrade to rapid transport if patient shows any signs of altered mental status, respiratory distress/compromise, or circulatory compromise.
You are dispatched to a rollover motor vehicle crash. Your patient is a 29-year-old female unrestrained driver complaining of severe lower back pain. She is slightly tachycardic, but the ABCs are all normal. While performing a rapid trauma assessment, you find crepitus and an unstable pelvis. She is becoming less responsive. How would you best manage this patient?Treat for shock (hypovolemic). Apply high-flow oxygen. Apply PASG with c-spine immobilization. Place patient in Trendelenburg's position. Keep patient warm. Rapid transport. Continue to reassess constantly en route to the hospital.
You are dispatched to a moderate damage motor vehicle crash. Your patient is a 52-year-old female, restrained driver, hit from the rear, complaining of neck and back pain. She is alert and oriented and her vital signs are within the normal limits. Pulse, motor, and sensory functions are intact in all extremities. How would you best manage this patient?Apply a cervical collar and hold manual stabilization. Use a short spinal extrication device. Secure patient to long backboard. Apply high-flow oxygen. Monitor vital signs and continue with assessment. Normal transport.
You are called to the scene of a baseball game where a 10-year-old boy was accidentally hit with a baseball bat on the left side of his head. He has a depression in the left temporal region and severe vomiting. He is pain responsive and bleeding is minimal. How would you best manage this patient?Cervical spine immobilization. Maintain the airway/apply high-flow oxygen-suction as needed. Cover the open laceration with gauze, being careful to gently press over the area to avoid further damage. Put patient on long backboard and rapid transport. Monitor vital signs en route.
You are dispatched to a residence for an 8-year-old girl complaining of a possible tibia fracture. Her mother tells you that she tripped when she jumped out of a swing and twisted her leg when she landed. The child is lying on the ground and is fairly calm. You see obvious deformity to the lower left leg. How would you best manage this patient?Talk to the child directly. Explain that you need to check for a pedal pulse before touching the child. Once equipment is prepared, show it to the child and explain how it will work. Explain that moving the injured leg will be painful and ask the mother to help by allowing the child to squeeze her hand, etc. Manipulate the leg as little as possible, but be expedient. Transport in the position of comfort, allowing the child to dictate movement within reason.
You are called to a residence for a 5-year-old child with a G-tube complaining of difficulty breathing. The child is more lethargic than normal, but is alert. He has retractions and is gasping with a respiratory rate of 48. How would you best manage this patient?High-flow oxygen - assist ventilations as needed via BVM device. Suction if needed. Transport child sitting up or with head elevated. Rapid transport. Continually monitor airway and vital signs en route.
You are dispatched to a residence for a possible drowning of a 7-year-old. When you arrive, the child is lying at the side of the pool where his father pulled him out. He is breathing shallowly at 8 breaths/min and has faint radial pulses. How would you best manage this patient?Suction the airway if needed. Immediately begin assisting ventilations with a BVM and 100% oxygen. Determine if c-spine control is needed. Rapid transport and continue assessment en route. Continue to monitor the airway and be alert for vomiting. Monitor vital signs and keep patient warm to prevent hypothermia.
You are called to a residence for a baby "not acting right." The infant, 6 months old, has unequal pupils, is unresponsive, and is posturing. He is breathing irregularly at about 32 breaths/min. The parents tell you he would not stop crying and then he started acting this way. How would you best manage this patient?Immediately begin hyperventilating the patient with a BVM device and 100% oxygen. Provide c-spine immobilization and check for a pulse - begin chest compressions if no pulse. Be alert for possible vomiting. Rapid transport. Monitor patient closely and continuously en route while continuing to ventilate. Alert the ER staff to the possibility of child abuse. Report the incident to the proper authorities as set forth by your EMS service.
You respond to a possible rape of a 13-year-old girl. Upon arrival, you find the police already on scene and the parents are very upset and belligerent. The girl is cowering in a chair in the corner of the room. The parents tell you that the perpetrator is a 19-year-old neighbor who attacked the girl and held her at knifepoint while he raped her. The police are handling the report and tell you they will follow you to the hospital to gather the girl's clothing for evidence. The mother also tells you that the girl has some moderate vaginal bleeding. How would you best manage this patient?If you are not female, have your female partner talk with the patient. Do not allow her to bathe, urinate, change clothes, etc. Take her out to the ambulance (preferably walking to prevent further humiliation). Close the doors to protect her privacy and question her about where she may hurt or be injured. Ask her if you may look at her vaginal area to assess the extent of injury and place a trauma dressing in her panties to help with bleeding control. Cover her with a sheet and assess any other injuries she may have. Take baseline vital signs and give oxygen if needed. Talk with patient en route to the hospital about whatever she wants to talk about. Monitor patient en route and give a thorough report to ER staff.
You are dispatched to a residence for seizures in progress. You arrive on the scene to find a 5-year-old male playing on the floor. He is flushed and very warm to touch. The parents tell you that he was "shaking with his eyes rolled back" for over 5 minutes. He has no history of seizures, but woke up with a runny nose this morning. How would you best manage this patient?Assess ABCs, apply high-flow oxygen if patient will tolerate. Place patient in ambulance and begin cooling him with tepid water. Prompt transport without lights and siren unless patient starts seizing again. Obtain further history en route. Be alert to the possibility of another seizure.
You are called to a child care center for a 3-year-old male with difficulty breathing. The patient is still alert, but gasping for breath when you arrive. His respirations are 52 and shallow. How would you best manage this patient? Position the child with the airway in a neutral sniffing position. Insert a nasopharyngeal airway. Assist ventilations with a BVM and 100% oxygen. Rapid transport, continuing assessment en route. Obtain SAMPLE history from staff en route.
You are dispatched to a single vehicle motor vehicle crash with minor damage to the front where the car rolled into a culvert at a low speed. Bystanders tell you that the driver, an 82-year-old male, slumped over the steering wheel before the vehicle veered off the road. The patient is now alert and says he does not remember what happened. He has a 2-inch laceration above his right eye with moderate bleeding. How would you best manage this patient?C-spine immobilization. Apply high-flow oxygen (especially important due to altered mental status that may have caused crash). Control bleeding with direct pressure. Rapid transport due to altered mental status - keep patient warm. Question patient about previous medical history and medications. Monitor vital signs and continue the secondary assessment en route.
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Section 2