TEST BANKS For Family Practice Guidelines, 6th Edition b
n n n n n n n n
y Jill C. Cash; Cheryl A. Glass
n n n n n n
Hypoglycemia nandnacutenischemicnstrokencannpresentnsimilarlynbecause:
•nA:bothnoxygennandnglucosenarenneedednfornbrainnfunction.
•nB:thenmajoritynofnstrokenpatientsnhavenanhistorynofndiabetes.
•nC:thenmostncommonncausenofnanstrokenisnhypoglycemia.
•nD:theynarenbothncausednbynlownlevelsnofnglucoseninnthenblood.n-
n ANSWER:•n A:bothn oxygenn andn glucosen aren neededn for n brainn function.
Reason:nAlthoughnstrokenandnhypoglycemia narentwondistinctlyndifferentnconditions,nth
eirnsignsnandnsymptomsnarenoftennsimilar.nThisnisnbecausenthenbrainnrequiresnbothnoxyg
ennandnglucosentonfunctionnnormally.nAnnacutenischemicnstrokenisncausednbynanlacknofno
xygenntonanpartnofnthenbrainnduentonanblockedncerebralnartery,nwhereasnhypoglycemia n(
lownbloodnglucosenlevel)ndeprivesnthenentirenbrainnofnglucose.nInneither ncase,nthenpatie
ntnpresentsnwithnsignsnofnimpairednbrainnfunctionn(ie,nslurrednspeech,nweakness,nalter
ednmentalnstatus).nBothnconditionsnmaynleadntonpermanentnbrainndamagenorndeathnifn
notntreatednpromptly.
Whenndealing nwithnannemotionallyndisturbednpatient,nyounshouldnbenMOSTnconcerned
n with:
•nA:gathering nallnofnthenpatient'snmedications.
•nB:safelyntransporting ntonthenhospital.
•nC:whether nthenpatientncouldnharmnyou.
•nD:obtaining nancompletenmedicalnhistory.n-nANSWER:YounselectednC;nThisnisncorrect!
Reason:nWhennmanaging nanynpatientnwithnannemotionalnornpsychiatricncrisis,nyournpri
marynconcernnisnyournownnsafety.nSafelyntransporting nthenpatientntonthenhospitalnisnyo
urnultimatengoal.nIfnpossible,nyounshouldnattemptntonobtainnanmedicalnhistorynandnshou
ldntakenanynofnthenpatient'snprescribednmedicationsntonthenhospital.nHowever,nthisnsho
uldnnotnsupercedenyournownnsafetynorninterferenwithnsafelyntransporting nthenpatient.
Younarenatnthenscenenwherenanmannpanickednwhilenswimming ninnansmallnlake.nYourniniti
alnattemptntonrescuenhimnshouldninclude:
•nA:rowing nansmallnraftntonthenvictim.
•nB:reaching nfornthenvictimnwithnanlong nstick.
•nC:throwing nanropentonthenvictim.
•nD:swimming ntonthenvictimntonrescuenhim.n-nANSWER:YounselectednB;nThisnisncorrect!
Reason:nGeneralnrulesntonfollownwhennattempting ntonrescuenanpatientnfromnthenwater ni
ncluden"reach,nthrow,nrow,nandnthenngo."nInnthisncase,nyounshouldnattemptntonreachnth
envictimnbynhaving nhimngrabnholdnofnanlargensticknornsimilar nobject.nIfnthisnisnunsuccessf
ul,nthrownthenvictimnanropenornflotationndevicen(ifnavailable).nIfnthesenarennotnavailable,n
rowntonthenpatientninnansmallnraftn(ifnavailable).nGoing nintonthenwater ntonretrieventhenvic
,timnisnanlastnresort.nThenrescuer nmustnbenanstrong nswimmer nbecausenpatientsnwhonareni
nndanger nofndrowning nareninnanstatenofnblindnpanicnandnwillnmakeneverynattemptntonkee
pnthemselvesnafloat,nevennifnitnmeansnforcing nthenrescuer nunderwater.
Hownshouldnyounclassifynanpatient'snnaturenofnillnessnifnhenornshenhasnanlownbloodngluco
senlevel,nbizarrenbehavior,nandnshallownbreathing?
•nA:Behavioral nemergency
•nB:Alterednmentalnstatus
•nC:Respiratorynemergency
•nD:Cardiacncompromisen-nANSWER:Thencorrectnanswer nisnB;
Reason:nThennaturenofnillnessn(NOI)nisnthenmedicalnequivalentntonmechanismnofninjuryn(
MOI).nAlterednmentalnstatusnshouldnbenthensuspectednNOIninnanynpatientnwithnanynfluc
tuationninnlevelnofnconsciousness,nwhichncannrangenfromnbizarrenbehavior ntoncompleten
unresponsiveness.nCausesnofnannalterednmentalnstatusnincludenhypo-
n or n hyperglycemia, n headn trauma,nstroke,n behavioral n crises,n drug n overdose,n andn shock,n
among nothers.
Anyoung nfemalenisnunresponsivenafter noverdosing nonnannunknownntypenofndrug.nHernre
spirationsnarenslownandnshallownandnhernpulsenisnslownandnweak.nWhichnofnthenfollowi
ngndrugsnisnthenLEASTnlikelyncausenofnher ncondition?
•nA:Seconal
•nB:Heroin
•nC:Cocaine
•nD:Valiumn-nANSWER:Thencorrectnanswer nisnC;
Reason:nOfnthendrugsnlisted,ncocainenwouldnbenthenleastnlikelyncausenofnthenpatient'snco
ndition.nCocainenisnancentralnnervousnsystemn(CNS)nstimulant;nyounwouldnexpectnher nt
onbenhypertensive,ntachycardic,ntachypneic,nandnperhapsnevennviolent.nHeroin,nValium
,nandnSeconalnarenallnCNSndepressantsnandncouldnexplainnherncondition.nHeroinnisnannill
egalnnarcoticn(opiate),nValiumnisnanbenzodiazepinensedative-
hypnoticndrug,nandnSeconalnisnanbarbiturate.nNarcotics,nbenzodiazepines,nandnbarbitur
atesnarenallnCNSndepressants.nWhenntakenninnexcess,ntheyncausenandecreasednlevelnofnc
onsciousness,nrespiratoryndepression,nbradycardia,nandnhypotension.
Activatedncharcoal nisncontraindicatednfornanpatientnwhonis:
•nA:consciousnandnalertnandnhasningestednanlargenamountnofnMotrin.
•nB:emotionallynupsetnandnhasningestedntwonbottlesnofnaspirin.
•nC:agitatednandnclaimsntonhaveningestednanbottlenofnTylenol.
•nD:awakenandnalertnandnhasnswallowednancommercialndrainncleaner.n-
n ANSWER:Youn selectedn D;n Thisn isn correct!
Reason:Activatedncharcoal nadsorbsn(sticksnto)nmanyningestednsubstances,npreventing nt
hemnfromnbeing nabsorbednintonthenbodynbynthenstomachnornintestines.nInnsomencases,n
younmayngivenactivatedncharcoal ntonpatientsnwhonhaveningestedncertainnsubstances,nifn
approvednbynmedicalncontrolnornlocalnprotocol.nActivatedncharcoal nisncontraindicatednf
ornpatientsnwhonhaveningestednannacidnornalkalin(ie,ndrainncleaner)nornanpetroleumnprod
,uctn(ie,ngasoline),nwhonhavenandecreasednlevelnofnconsciousnessnandncannotnprotectnth
eirnownnairway,nornwhonarenunablentonswallow.
ThenMOSTnobviousnwayntonreducenheatnlossnfromnradiationnandnconvectionnisnto:
•nA:movenawaynfromnancoldnobject.
•nB:increasenmetabolismnbynshivering.
•nC:wear nanthicknwind-proofnjacket.
•nD:moventonanwarmer nenvironment.n-nANSWER:younselectednD;nThisnisncorrect!
Reason:Innancoldnenvironment,nthenbodynhasntwonwaysnofnstaying nwarm:ngenerating nh
eatn(thermogenesis)nandnreducing nheatnloss.nRadiationnisnthentransfer nofnheatnbynradia
ntnenergy.nThenbodyncannlosenheatnbynradiation,nsuchnasnwhennanpersonnstandsninnancol
dnroom.nConvectionnoccursnwhennheatnisntransferredntoncirculating nair,nasnwhenncoolnai
rnmovesnacrossnthenbody'snsurface.nAnpersonnstanding ninnwindyncoldnweather,nwearing n
lightweightnclothing,nisnlosing nheatntonthenenvironmentnmostlynbynconvection.nThenqui
ckestnandnmostnobviousnwayntondecreasenheatnlossnfromnradiationnandnconvectionnisnto
n moven outn ofn then coldn environmentn andn seekn shelter n from n wind.n Shivering n increasesn t
henbody'snmetabolismnandnisnanmechanismnforngenerating nheat,nnotnreducing nheatnloss
.nLayersnofnclothing ntrapnairnandnprovidenexcellentninsulation;nthus,nlayerednclothing nde
creasesnheatnlossnbetter nthannansingle,nthicknjacket.nConductionnisnthendirectntransfer no
fnheatnfromnanpartnofnthenbodyntonancolder nobjectnbyndirectncontact,nasnwhennanwarmnh
andntouchesncoldnmetalnornice.nThenmostnobviousnwayntondecreasenheatnlossnbynconduc
tionnisntonremovenyournhandnfromnthencoldnobject.
Annear-drowning nisnMOSTnaccuratelyndefinednas:
•nA:complicationsnwithinn24nhoursnfollowing nsubmersionninnwater.
•nB:immediatendeathnduentonprolongednsubmersionninnwater.
•nC:survivalnfornatnleastn24nhoursnfollowing nsubmersionninnwater.
•nD:deathngreater nthann24nhoursnfollowing nsubmersionninnwater.n-
n ANSWER:Youn selectedn C;n Thisn isn correct!
Reason:Collectively,ndrowning nandnnear-
drowning narenreferredntonasnsubmersionninjuries.nDrowning nisndefinednasndeathnafter ns
ubmersionninnanliquidnmedium,nusuallynwater.nInnandrowning,ndeathnisneither nimmediat
enornoccursnwithinn24nhoursnfollowing nsubmersion.nNear-
drowning nisndefinednasnsurvival,natnleastntemporarilyn(24nhours),nafter nsubmersion.nItns
houldnbennoted,nhowever,nthatncomplicationsnsuchnasnpneumonianandnpulmonarynede
mancanncausendeathngreater nthann24nhoursnfollowing nsubmersion.nFornthisnreason,nalln
patientsnwithnansubmersionninjurynshouldnbentransportedntonthenhospital,nevennifntheyn
appear nfinenatnthenscene.
Anyoung nwomannreportsnsignificantnweightnlossnover nthenlastnmonth,npersistentnfever,n
andnnightnsweats.nWhennyounassessnher,nyounnotenthenpresencenofndarknpurplenlesionsn
covering nherntrunknandnupper nextremities.nYounshouldnsuspect:
•nA:end-stagencancer.
•nB:HIV/AIDS.
•nC:tuberculosis.
, •nD:rheumaticnfever.n-nANSWER:YounselectednB;nThisnisncorrect!
Reason:Weightnloss,nfever,nandnnightnsweatsncouldnindicatentuberculosisnornHIV/AIDS;n
however,nthendarknpurplenlesionsnonnthenskin,nwhichnarencallednKaposi'snsarcoma,naren
malignantnskinntumorsnandnarenanclassicnfinding ninnpatientsninnthenlater nstagesnofnAIDS.
An48-year-
oldnmalenbecamenacutelynhypoxic,nexperiencednanseizure,nandnisnnownpostictal.nThenM
OSTneffectivenwayntonpreventnanother nseizurenisnto:
•nA:dimnthenlightsninnthenbacknofnthenambulance.
•nB:placenhimninnthenrecoverynposition.
•nC:administer nhigh-flownsupplementalnoxygen.
•nD:givenhimnoralnglucosenifnhencannswallow.n-nANSWER:YounselectednC;nThisnisncorrect!
Reason:Younshouldnadminister nhigh-
flownoxygenntonallnpatientsnwhonarenactivelynseizing nandntonpatientsnwhonexperiencedn
anseizurenandnarenpostictal.nThisnisnespeciallyntruenifnthenseizurenwasncausednbynhypoxia
.nIncreasing nthenoxygenncontentnofnthenblood,nwhichnminimizesnhypoxia,nmaynpreventn
another nseizure.nThenrecoverynpositionnisnappropriatenfornuninjurednpatientsnwithnande
creasednlevelnofnconsciousnessnandnadequatenbreathing;nitnwillnhelpnmaintainnthenairw
aynandnfacilitatendrainagenofnsecretionsnfromnthenmouth,nbutnwillnnotnpreventnanother n
seizure.nOralnglucosenmaynpreventnanother nseizurenifnhypoglycemia nwasnthencausenofnt
henseizure.nYounshouldndimnthenlightsninnthenbacknofnthenambulancentonhelpnpreventnan
ynseizure,nnotnjustnthosenthatnarencausednbynhypoxia.
Whichnofnthenfollowing nconditionsnwouldnbenthenLEASTnlikelyntonbenpresentninnanpatien
tnwhonwasnsubmergedninnwater?
•nA:Spinalninjury
•nB:Gastricndistention
•nC:Hyperglycemia
•nD:Laryngospasmn-nANSWER:YounselectednC;nThisnisncorrect!
Reason:nManynfactorsncanncontributentonornresultnfromnansubmersionninjuryn(eg,ndrow
ning,nnear-
drowning).nItnisnnotnuncommonnfornanpersonntonexperiencenanspinalninjurynafter ndiving n
headnfirstnintonshallownwater,nespeciallynifnhenornshenisnunder ntheninfluencenofnalcohol.n
Whennanswimmernpanics,nhenornsheninitiallynswallowsnlargenamountsnofnwater,nresultin
gninngastricndistention.nGastricndistentionncanncausenaspirationnifnthenpatientnregurgitat
esnwater nduring nrescuenbreathing;nprotectnthenairway!nDuring nthenpanicnphase,nthenvic
timnexpendsnantremendousnamountnofnenergyn(andnglucose)nfromnflailing naroundninnth
enwater,npossiblynresulting ninnhypoglycemia.nInhaling nevennansmallnamountnofnfreshnorn
saltnwater ncannseverelynirritatenthenlarynx,nwhichnsendsnthenmusclesnofnthenlarynxnandn
vocalncordsnintonspasmn(laryngospasm),nresulting ninnairwaynblockagenandnhypoxia.
An42-year-
oldnmalenpresentsnwithnfever,nanseverenheadache,nandnanstiffnneck.nHenisnconscious,nbu
n n n n n n n n
y Jill C. Cash; Cheryl A. Glass
n n n n n n
Hypoglycemia nandnacutenischemicnstrokencannpresentnsimilarlynbecause:
•nA:bothnoxygennandnglucosenarenneedednfornbrainnfunction.
•nB:thenmajoritynofnstrokenpatientsnhavenanhistorynofndiabetes.
•nC:thenmostncommonncausenofnanstrokenisnhypoglycemia.
•nD:theynarenbothncausednbynlownlevelsnofnglucoseninnthenblood.n-
n ANSWER:•n A:bothn oxygenn andn glucosen aren neededn for n brainn function.
Reason:nAlthoughnstrokenandnhypoglycemia narentwondistinctlyndifferentnconditions,nth
eirnsignsnandnsymptomsnarenoftennsimilar.nThisnisnbecausenthenbrainnrequiresnbothnoxyg
ennandnglucosentonfunctionnnormally.nAnnacutenischemicnstrokenisncausednbynanlacknofno
xygenntonanpartnofnthenbrainnduentonanblockedncerebralnartery,nwhereasnhypoglycemia n(
lownbloodnglucosenlevel)ndeprivesnthenentirenbrainnofnglucose.nInneither ncase,nthenpatie
ntnpresentsnwithnsignsnofnimpairednbrainnfunctionn(ie,nslurrednspeech,nweakness,nalter
ednmentalnstatus).nBothnconditionsnmaynleadntonpermanentnbrainndamagenorndeathnifn
notntreatednpromptly.
Whenndealing nwithnannemotionallyndisturbednpatient,nyounshouldnbenMOSTnconcerned
n with:
•nA:gathering nallnofnthenpatient'snmedications.
•nB:safelyntransporting ntonthenhospital.
•nC:whether nthenpatientncouldnharmnyou.
•nD:obtaining nancompletenmedicalnhistory.n-nANSWER:YounselectednC;nThisnisncorrect!
Reason:nWhennmanaging nanynpatientnwithnannemotionalnornpsychiatricncrisis,nyournpri
marynconcernnisnyournownnsafety.nSafelyntransporting nthenpatientntonthenhospitalnisnyo
urnultimatengoal.nIfnpossible,nyounshouldnattemptntonobtainnanmedicalnhistorynandnshou
ldntakenanynofnthenpatient'snprescribednmedicationsntonthenhospital.nHowever,nthisnsho
uldnnotnsupercedenyournownnsafetynorninterferenwithnsafelyntransporting nthenpatient.
Younarenatnthenscenenwherenanmannpanickednwhilenswimming ninnansmallnlake.nYourniniti
alnattemptntonrescuenhimnshouldninclude:
•nA:rowing nansmallnraftntonthenvictim.
•nB:reaching nfornthenvictimnwithnanlong nstick.
•nC:throwing nanropentonthenvictim.
•nD:swimming ntonthenvictimntonrescuenhim.n-nANSWER:YounselectednB;nThisnisncorrect!
Reason:nGeneralnrulesntonfollownwhennattempting ntonrescuenanpatientnfromnthenwater ni
ncluden"reach,nthrow,nrow,nandnthenngo."nInnthisncase,nyounshouldnattemptntonreachnth
envictimnbynhaving nhimngrabnholdnofnanlargensticknornsimilar nobject.nIfnthisnisnunsuccessf
ul,nthrownthenvictimnanropenornflotationndevicen(ifnavailable).nIfnthesenarennotnavailable,n
rowntonthenpatientninnansmallnraftn(ifnavailable).nGoing nintonthenwater ntonretrieventhenvic
,timnisnanlastnresort.nThenrescuer nmustnbenanstrong nswimmer nbecausenpatientsnwhonareni
nndanger nofndrowning nareninnanstatenofnblindnpanicnandnwillnmakeneverynattemptntonkee
pnthemselvesnafloat,nevennifnitnmeansnforcing nthenrescuer nunderwater.
Hownshouldnyounclassifynanpatient'snnaturenofnillnessnifnhenornshenhasnanlownbloodngluco
senlevel,nbizarrenbehavior,nandnshallownbreathing?
•nA:Behavioral nemergency
•nB:Alterednmentalnstatus
•nC:Respiratorynemergency
•nD:Cardiacncompromisen-nANSWER:Thencorrectnanswer nisnB;
Reason:nThennaturenofnillnessn(NOI)nisnthenmedicalnequivalentntonmechanismnofninjuryn(
MOI).nAlterednmentalnstatusnshouldnbenthensuspectednNOIninnanynpatientnwithnanynfluc
tuationninnlevelnofnconsciousness,nwhichncannrangenfromnbizarrenbehavior ntoncompleten
unresponsiveness.nCausesnofnannalterednmentalnstatusnincludenhypo-
n or n hyperglycemia, n headn trauma,nstroke,n behavioral n crises,n drug n overdose,n andn shock,n
among nothers.
Anyoung nfemalenisnunresponsivenafter noverdosing nonnannunknownntypenofndrug.nHernre
spirationsnarenslownandnshallownandnhernpulsenisnslownandnweak.nWhichnofnthenfollowi
ngndrugsnisnthenLEASTnlikelyncausenofnher ncondition?
•nA:Seconal
•nB:Heroin
•nC:Cocaine
•nD:Valiumn-nANSWER:Thencorrectnanswer nisnC;
Reason:nOfnthendrugsnlisted,ncocainenwouldnbenthenleastnlikelyncausenofnthenpatient'snco
ndition.nCocainenisnancentralnnervousnsystemn(CNS)nstimulant;nyounwouldnexpectnher nt
onbenhypertensive,ntachycardic,ntachypneic,nandnperhapsnevennviolent.nHeroin,nValium
,nandnSeconalnarenallnCNSndepressantsnandncouldnexplainnherncondition.nHeroinnisnannill
egalnnarcoticn(opiate),nValiumnisnanbenzodiazepinensedative-
hypnoticndrug,nandnSeconalnisnanbarbiturate.nNarcotics,nbenzodiazepines,nandnbarbitur
atesnarenallnCNSndepressants.nWhenntakenninnexcess,ntheyncausenandecreasednlevelnofnc
onsciousness,nrespiratoryndepression,nbradycardia,nandnhypotension.
Activatedncharcoal nisncontraindicatednfornanpatientnwhonis:
•nA:consciousnandnalertnandnhasningestednanlargenamountnofnMotrin.
•nB:emotionallynupsetnandnhasningestedntwonbottlesnofnaspirin.
•nC:agitatednandnclaimsntonhaveningestednanbottlenofnTylenol.
•nD:awakenandnalertnandnhasnswallowednancommercialndrainncleaner.n-
n ANSWER:Youn selectedn D;n Thisn isn correct!
Reason:Activatedncharcoal nadsorbsn(sticksnto)nmanyningestednsubstances,npreventing nt
hemnfromnbeing nabsorbednintonthenbodynbynthenstomachnornintestines.nInnsomencases,n
younmayngivenactivatedncharcoal ntonpatientsnwhonhaveningestedncertainnsubstances,nifn
approvednbynmedicalncontrolnornlocalnprotocol.nActivatedncharcoal nisncontraindicatednf
ornpatientsnwhonhaveningestednannacidnornalkalin(ie,ndrainncleaner)nornanpetroleumnprod
,uctn(ie,ngasoline),nwhonhavenandecreasednlevelnofnconsciousnessnandncannotnprotectnth
eirnownnairway,nornwhonarenunablentonswallow.
ThenMOSTnobviousnwayntonreducenheatnlossnfromnradiationnandnconvectionnisnto:
•nA:movenawaynfromnancoldnobject.
•nB:increasenmetabolismnbynshivering.
•nC:wear nanthicknwind-proofnjacket.
•nD:moventonanwarmer nenvironment.n-nANSWER:younselectednD;nThisnisncorrect!
Reason:Innancoldnenvironment,nthenbodynhasntwonwaysnofnstaying nwarm:ngenerating nh
eatn(thermogenesis)nandnreducing nheatnloss.nRadiationnisnthentransfer nofnheatnbynradia
ntnenergy.nThenbodyncannlosenheatnbynradiation,nsuchnasnwhennanpersonnstandsninnancol
dnroom.nConvectionnoccursnwhennheatnisntransferredntoncirculating nair,nasnwhenncoolnai
rnmovesnacrossnthenbody'snsurface.nAnpersonnstanding ninnwindyncoldnweather,nwearing n
lightweightnclothing,nisnlosing nheatntonthenenvironmentnmostlynbynconvection.nThenqui
ckestnandnmostnobviousnwayntondecreasenheatnlossnfromnradiationnandnconvectionnisnto
n moven outn ofn then coldn environmentn andn seekn shelter n from n wind.n Shivering n increasesn t
henbody'snmetabolismnandnisnanmechanismnforngenerating nheat,nnotnreducing nheatnloss
.nLayersnofnclothing ntrapnairnandnprovidenexcellentninsulation;nthus,nlayerednclothing nde
creasesnheatnlossnbetter nthannansingle,nthicknjacket.nConductionnisnthendirectntransfer no
fnheatnfromnanpartnofnthenbodyntonancolder nobjectnbyndirectncontact,nasnwhennanwarmnh
andntouchesncoldnmetalnornice.nThenmostnobviousnwayntondecreasenheatnlossnbynconduc
tionnisntonremovenyournhandnfromnthencoldnobject.
Annear-drowning nisnMOSTnaccuratelyndefinednas:
•nA:complicationsnwithinn24nhoursnfollowing nsubmersionninnwater.
•nB:immediatendeathnduentonprolongednsubmersionninnwater.
•nC:survivalnfornatnleastn24nhoursnfollowing nsubmersionninnwater.
•nD:deathngreater nthann24nhoursnfollowing nsubmersionninnwater.n-
n ANSWER:Youn selectedn C;n Thisn isn correct!
Reason:Collectively,ndrowning nandnnear-
drowning narenreferredntonasnsubmersionninjuries.nDrowning nisndefinednasndeathnafter ns
ubmersionninnanliquidnmedium,nusuallynwater.nInnandrowning,ndeathnisneither nimmediat
enornoccursnwithinn24nhoursnfollowing nsubmersion.nNear-
drowning nisndefinednasnsurvival,natnleastntemporarilyn(24nhours),nafter nsubmersion.nItns
houldnbennoted,nhowever,nthatncomplicationsnsuchnasnpneumonianandnpulmonarynede
mancanncausendeathngreater nthann24nhoursnfollowing nsubmersion.nFornthisnreason,nalln
patientsnwithnansubmersionninjurynshouldnbentransportedntonthenhospital,nevennifntheyn
appear nfinenatnthenscene.
Anyoung nwomannreportsnsignificantnweightnlossnover nthenlastnmonth,npersistentnfever,n
andnnightnsweats.nWhennyounassessnher,nyounnotenthenpresencenofndarknpurplenlesionsn
covering nherntrunknandnupper nextremities.nYounshouldnsuspect:
•nA:end-stagencancer.
•nB:HIV/AIDS.
•nC:tuberculosis.
, •nD:rheumaticnfever.n-nANSWER:YounselectednB;nThisnisncorrect!
Reason:Weightnloss,nfever,nandnnightnsweatsncouldnindicatentuberculosisnornHIV/AIDS;n
however,nthendarknpurplenlesionsnonnthenskin,nwhichnarencallednKaposi'snsarcoma,naren
malignantnskinntumorsnandnarenanclassicnfinding ninnpatientsninnthenlater nstagesnofnAIDS.
An48-year-
oldnmalenbecamenacutelynhypoxic,nexperiencednanseizure,nandnisnnownpostictal.nThenM
OSTneffectivenwayntonpreventnanother nseizurenisnto:
•nA:dimnthenlightsninnthenbacknofnthenambulance.
•nB:placenhimninnthenrecoverynposition.
•nC:administer nhigh-flownsupplementalnoxygen.
•nD:givenhimnoralnglucosenifnhencannswallow.n-nANSWER:YounselectednC;nThisnisncorrect!
Reason:Younshouldnadminister nhigh-
flownoxygenntonallnpatientsnwhonarenactivelynseizing nandntonpatientsnwhonexperiencedn
anseizurenandnarenpostictal.nThisnisnespeciallyntruenifnthenseizurenwasncausednbynhypoxia
.nIncreasing nthenoxygenncontentnofnthenblood,nwhichnminimizesnhypoxia,nmaynpreventn
another nseizure.nThenrecoverynpositionnisnappropriatenfornuninjurednpatientsnwithnande
creasednlevelnofnconsciousnessnandnadequatenbreathing;nitnwillnhelpnmaintainnthenairw
aynandnfacilitatendrainagenofnsecretionsnfromnthenmouth,nbutnwillnnotnpreventnanother n
seizure.nOralnglucosenmaynpreventnanother nseizurenifnhypoglycemia nwasnthencausenofnt
henseizure.nYounshouldndimnthenlightsninnthenbacknofnthenambulancentonhelpnpreventnan
ynseizure,nnotnjustnthosenthatnarencausednbynhypoxia.
Whichnofnthenfollowing nconditionsnwouldnbenthenLEASTnlikelyntonbenpresentninnanpatien
tnwhonwasnsubmergedninnwater?
•nA:Spinalninjury
•nB:Gastricndistention
•nC:Hyperglycemia
•nD:Laryngospasmn-nANSWER:YounselectednC;nThisnisncorrect!
Reason:nManynfactorsncanncontributentonornresultnfromnansubmersionninjuryn(eg,ndrow
ning,nnear-
drowning).nItnisnnotnuncommonnfornanpersonntonexperiencenanspinalninjurynafter ndiving n
headnfirstnintonshallownwater,nespeciallynifnhenornshenisnunder ntheninfluencenofnalcohol.n
Whennanswimmernpanics,nhenornsheninitiallynswallowsnlargenamountsnofnwater,nresultin
gninngastricndistention.nGastricndistentionncanncausenaspirationnifnthenpatientnregurgitat
esnwater nduring nrescuenbreathing;nprotectnthenairway!nDuring nthenpanicnphase,nthenvic
timnexpendsnantremendousnamountnofnenergyn(andnglucose)nfromnflailing naroundninnth
enwater,npossiblynresulting ninnhypoglycemia.nInhaling nevennansmallnamountnofnfreshnorn
saltnwater ncannseverelynirritatenthenlarynx,nwhichnsendsnthenmusclesnofnthenlarynxnandn
vocalncordsnintonspasmn(laryngospasm),nresulting ninnairwaynblockagenandnhypoxia.
An42-year-
oldnmalenpresentsnwithnfever,nanseverenheadache,nandnanstiffnneck.nHenisnconscious,nbu
