EMS1055 FINAL EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS GRADED A++ LATEST UPDATE
Know how to read a blood pressure.
Systolic pressure: high reading during contraction (systole)
Diastolic pressure: low reading during relaxation (diastole)
Normal is patient dependent (not necessarily 120/80)
Width: 40% of upper arm circumference
Length: 80% of upper arm circumference
Palpate the brachial artery then center the inflatable cuff over the brachial artery with
the lower border 2.5 cm above the antecubital crease.
Secure the cuff -snug, not tight. Inflate the cuff at the level of the heart with the fingers
of your opposite hand, palpate the radial pulse and inflate the cuff until it disappears.
Wait 15-30 seconds
Then place the bell of your stethoscope lightly over the brachial artery repeat inflation of
cuff to 20 -30 mmHg above the level that the pulse went away to avoid an error due to
an auscultatory gap.
Deflate the cuff at a rate of 2-3 mmHg/secondØFirst sound = systolic blood
pressureØDisappearance of sound = diastolic blood pressure
auscalatory gap
,A silent interval that may be present between the systolic and diastolic blood pressures,
i.e. the sound disappears for a while, then reappears
Know the pulse points and what they mean in regards to SBP
carotid
femoral
radial
pedal
carotid pulse
the pulse felt along the large carotid artery on either side of the neck
60 mmHg
femoral pulse
pulse of the femoral artery felt in the groin
70mm Hg
radial pulse
the pulse felt at the wrist
80 mmHg
pedal pulse
The pulse rate obtained on the top of the foot
90-100 mmHg
Know the types of shock.
Cardiogenic
hypovolemic
distributive (septic,anaphylactic, neurogenic)
,obstructive (mechanical)
insulin
cardiogenic shock
A state in which not enough oxygen is delivered to the tissues of the body, caused by
low output of blood from the heart. It can be a severe complication of a large acute
myocardial infarction, as well as other conditions. Most commonly caused by AMIOther
causes: myocarditis, myocardial contusion"Pump Problem" Decreased CO leads to
hypoperfusionHeart begins to fail standard shock treatment applies. The patient may
not tolerate supine or Trendelenburg position. Treatment is advanced and complicated.
Transport to a cardiac facility critical. Time is tissue!
hypovolemic shock
Volume issue due to blood loss in traumaBlood loss covered in previous lecture be due
to dehydration in medical very young and very old more susceptible
anaphylactic shock
A severe reaction that occurs when an allergen is introduced to the bloodstream of an
allergic individual. Characterized by bronchoconstriction, labored breathing, widespread
vasodilation, circulatory shock, and sometimes sudden death.
BIG 3 wheezes, urticaria, pruritus
obstructive (mechanical) shock
Tension PneumothoraxAir trapped in the thoracic cavity with the shifting of mediastinal
structuresLife threateningSigns of shockCan be spontaneous (Male, tall, thin)Absent
lung sounds on affected sidePericardial tamponadeFluid buildup in the pericardial
, causes compression of the heartLife threateningBeck's Triad Narrowing pulse pressure
Muffled heart sounds JVD
clinical signs: Distended neck veins
Cyanosis
Catecholamine effects
Pallor, tachycardia, diaphoresis
insulin shock
Not a true shockAlso called hypoglycemiaIssue due to low blood glucose levels, not
hypoperfusionCommon cause is when a patient injects insulin, but does not eat in
timeCan affect non-diabeticsPatients have their own glucometersnormal BGL 70-110
mg/dLBGL below 40 mg/dL will show LOW on glucometerBGL above 500 mg/dL will
show HIGH on glucometerCan look similar to shockSkin pale, cool, diaphoreticAltered
mentation (confused, unconscious)Seizures can occurIf the patient is able to
swallow:Oral glucose¡Juice with added sugarPatient MUST eat afterwardsIf the patient
cannot swallow:Immediate transportNeeds IV glucose
neurogenic shock
Any factor that stimulates parasympathetic activity or inhibits sympathetic activity of
smooth vascular muscles can cause neurogenic shock, which results in widespread and
massive vasodilation.Spinal cord injury above T6Spinal anesthesia¡Vasomotor center
depressionMay take hours to appearDifferent than typical shockSkin warm and
dryBradycardiaPoikilothermia: unable to control body temperature
septic shock
COMPLETE SOLUTIONS GRADED A++ LATEST UPDATE
Know how to read a blood pressure.
Systolic pressure: high reading during contraction (systole)
Diastolic pressure: low reading during relaxation (diastole)
Normal is patient dependent (not necessarily 120/80)
Width: 40% of upper arm circumference
Length: 80% of upper arm circumference
Palpate the brachial artery then center the inflatable cuff over the brachial artery with
the lower border 2.5 cm above the antecubital crease.
Secure the cuff -snug, not tight. Inflate the cuff at the level of the heart with the fingers
of your opposite hand, palpate the radial pulse and inflate the cuff until it disappears.
Wait 15-30 seconds
Then place the bell of your stethoscope lightly over the brachial artery repeat inflation of
cuff to 20 -30 mmHg above the level that the pulse went away to avoid an error due to
an auscultatory gap.
Deflate the cuff at a rate of 2-3 mmHg/secondØFirst sound = systolic blood
pressureØDisappearance of sound = diastolic blood pressure
auscalatory gap
,A silent interval that may be present between the systolic and diastolic blood pressures,
i.e. the sound disappears for a while, then reappears
Know the pulse points and what they mean in regards to SBP
carotid
femoral
radial
pedal
carotid pulse
the pulse felt along the large carotid artery on either side of the neck
60 mmHg
femoral pulse
pulse of the femoral artery felt in the groin
70mm Hg
radial pulse
the pulse felt at the wrist
80 mmHg
pedal pulse
The pulse rate obtained on the top of the foot
90-100 mmHg
Know the types of shock.
Cardiogenic
hypovolemic
distributive (septic,anaphylactic, neurogenic)
,obstructive (mechanical)
insulin
cardiogenic shock
A state in which not enough oxygen is delivered to the tissues of the body, caused by
low output of blood from the heart. It can be a severe complication of a large acute
myocardial infarction, as well as other conditions. Most commonly caused by AMIOther
causes: myocarditis, myocardial contusion"Pump Problem" Decreased CO leads to
hypoperfusionHeart begins to fail standard shock treatment applies. The patient may
not tolerate supine or Trendelenburg position. Treatment is advanced and complicated.
Transport to a cardiac facility critical. Time is tissue!
hypovolemic shock
Volume issue due to blood loss in traumaBlood loss covered in previous lecture be due
to dehydration in medical very young and very old more susceptible
anaphylactic shock
A severe reaction that occurs when an allergen is introduced to the bloodstream of an
allergic individual. Characterized by bronchoconstriction, labored breathing, widespread
vasodilation, circulatory shock, and sometimes sudden death.
BIG 3 wheezes, urticaria, pruritus
obstructive (mechanical) shock
Tension PneumothoraxAir trapped in the thoracic cavity with the shifting of mediastinal
structuresLife threateningSigns of shockCan be spontaneous (Male, tall, thin)Absent
lung sounds on affected sidePericardial tamponadeFluid buildup in the pericardial
, causes compression of the heartLife threateningBeck's Triad Narrowing pulse pressure
Muffled heart sounds JVD
clinical signs: Distended neck veins
Cyanosis
Catecholamine effects
Pallor, tachycardia, diaphoresis
insulin shock
Not a true shockAlso called hypoglycemiaIssue due to low blood glucose levels, not
hypoperfusionCommon cause is when a patient injects insulin, but does not eat in
timeCan affect non-diabeticsPatients have their own glucometersnormal BGL 70-110
mg/dLBGL below 40 mg/dL will show LOW on glucometerBGL above 500 mg/dL will
show HIGH on glucometerCan look similar to shockSkin pale, cool, diaphoreticAltered
mentation (confused, unconscious)Seizures can occurIf the patient is able to
swallow:Oral glucose¡Juice with added sugarPatient MUST eat afterwardsIf the patient
cannot swallow:Immediate transportNeeds IV glucose
neurogenic shock
Any factor that stimulates parasympathetic activity or inhibits sympathetic activity of
smooth vascular muscles can cause neurogenic shock, which results in widespread and
massive vasodilation.Spinal cord injury above T6Spinal anesthesia¡Vasomotor center
depressionMay take hours to appearDifferent than typical shockSkin warm and
dryBradycardiaPoikilothermia: unable to control body temperature
septic shock
