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During the triage process, which of the following injuries or
conditions would classify a patient as a high priority?
A: Unilateral femur fracture and tachycardia
B: A large avulsion to the arm and an altered mental status
C: Partial-thickness burns with no respiratory difficulty
D: Pulselessness and apnea - ANSWER-B: A large
avulsion to the arm and an altered mental status
Reason:
During triage, patients with an altered mental status, who
are in shock, or who have problems with airway, breathing,
or circulation, are potentially salvageable and are given
immediate priority. Patients who are pulseless and apneic
have low priority in a mass-casualty situation. If you focus
your efforts on cardiac arrest patients, who will most likely
not survive anyway, patients who could have potentially
been saved will die as well. Remember, the goal of triage
is to provide the greatest good for the greatest number of
patients.
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You are assessing a 26-year-old woman who is 38 weeks
pregnant and is in labor. She tells you that she was
pregnant once before, but had a miscarriage at 19 weeks.
You should document her obstetric history as:
A: gravida 0, para 2.
B: gravida 2, para 1.
C: gravida 1, para 1.
D: gravida 2, para 0. - ANSWER-D: gravida 2, para 0.
Reason:
Gravida is the term used to describe the number of times
a woman has been pregnant, regardless of whether or not
she carried the infant to term. Para is the term used to
describe the number of times a woman has carried a fetus
beyond 28 weeks, regardless of whether or not the infant
was born dead or alive. Because your patient is currently
pregnant and was pregnant once before, she is gravida 2.
However, because she had a miscarriage with her first
pregnancy (she did not carry beyond 28 weeks), and has
not yet delivered the baby she is currently carrying, she is
para 0. When she delivers, she will become gravida 2 and
para 1.
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In which of the following situations would you MOST likely
encounter agonal gasps?
A: Significant hypoxemia, regardless of the cause
B: Shortly after becoming unresponsive and pulseless
C: Occlusion of the posterior pharynx by the tongue
D: Any patient who is unresponsive due to hypoxia -
ANSWER-B: Shortly after becoming unresponsive and
pulseless
Reason:
Agonal gasps are occasional, irregular, and ineffective
breaths. They are commonly observed in patients shortly
after they become unresponsive and pulseless (cardiac
arrest). Agonal gasps may also be observed in patients
with a severe brain injury or cerebral anoxia (complete
absence of oxygen). Patients with agonal gasps require
some form of positive-pressure ventilation. Hypoxemic and
hypoxic patients typically present with tachypnea
(increased respirations) in an attempt to eliminate carbon
dioxide and bring in more oxygen. However, as the
hypoxic patient begins to decompensate, his or her
respirations often become slow (bradypnea). If the tongue
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is occluding the posterior pharynx, a characteristic snoring
sound is typically heard.
A 60-year-old man presents with chest pain and difficulty
breathing. He is pale, diaphoretic, and in severe pain. As
your partner applies supplemental oxygen, you assess his
vital signs. His blood pressure is 180/90 mm Hg, pulse is
110 beats/min and irregular, and respirations are 24
breaths/min and labored. You ask him if has taken any
nitroglycerin and he tells you that he does not have any
but his wife does. You should:
A: complete your focused physical examination and
prepare the patient for immediate transport to an
appropriate hospital.
B: have him swallow up to four enteric-coated aspirin,
continue oxygen therapy, and promptly transport him to
the hospital.
C: transport at once, apply the AED in case he develops
cardiac arrest, and monitor his vital signs en route to the
hospital.
D: contact medical control and request permission to
assist the patient with up to three doses of his wife's
nitroglycerin.