10 free AEMT practice questions: Shock Recognition and Fluid Resuscitation

Correct answer · Hypovolemic shock, from the volume lost through vomiting and diarrhea

Start at the neck. Flat veins mean the system is underfilled, which leaves hypovolemic and distributive on the table and takes the other two off it. Then look at the skin. Cool, pale, and moist means the vessels clamped down to protect what fluid is left, which is the volume category. Warm, red, and dry would have sent you to distributive instead. Three days of vomiting and diarrhea is fluid leaving the body, and that 98 over 76 is worth a second look on its own, because the systolic is drifting down while the diastolic climbs on clamped vessels.

Correct answer · As a pre-arrest finding that calls for immediate oxygenation and ventilation

A heart rate that falls in a sick child is one of the few findings that should make your stomach drop. Children hold cardiac output up almost entirely by heart rate, so a rate coming down in a child who is getting harder to wake is not the fever breaking and it is not recovery. It means the compensation has run out and arrest is close. What this child needs immediately is oxygenation and ventilation, because hypoxia is the most common road into pediatric arrest. Falling responsiveness, a systolic of 72, and a saturation of 88 percent on high flow oxygen are all pointing the same direction.

Correct answer · Perfusion is failing, because the heart rate has climbed past the systolic

Two early markers are doing the same job here, and blood pressure is not one of them. Pulse pressure is systolic minus diastolic, normally around 30 to 40 in an adult. This patient is at 22, and the reason is that the systolic drifted down as stroke volume fell while the diastolic climbed on clamped vessels. Shock index is the second marker. Divide the heart rate by the systolic, and anything above roughly 0.9 to 1.0 says significant hypoperfusion. The quick mental version is that a heart rate above the systolic number is a problem, and 116 against 104 crosses that line. Pancreatitis pulls a large volume of fluid into inflamed tissue where the circulation cannot reach it, so the tank empties without anything being spilled.

Correct answer · The dextrose is metabolized and the free water left behind spreads body wide

Dextrose 5 percent in water is isotonic while it sits in the bag, which is why it looks like a resuscitation fluid on a shelf. Once it is inside the patient the dextrose is metabolized and what remains is free water, and free water distributes across total body water instead of staying in the vessels. That gives you almost no intravascular expansion while diluting the electrolytes the patient still has. Its real jobs are as a carrier fluid or a keep vein open line. When you need volume you want an isotonic crystalloid that stays in the extracellular space, which at this level means normal saline or Lactated Ringer's.

Correct answer · About 480 mL, from an estimated weight of 24 kilograms

With no tape and no caregiver number, the common convention for children one to ten years old estimates weight in kilograms as twice the age in years plus eight. Twice eight is sixteen, plus eight is twenty four kilograms, and twenty milliliters per kilogram of that is 480 mL. Two things are worth carrying along with the formula. It runs low toward the top of its range, which is why a length based tape or a recent weight from a caregiver beats it whenever either exists. The number you calculate is also a starting bolus rather than a total, so you reassess heart rate, capillary refill, mental status, skin signs, and lung sounds afterward before deciding whether a second one follows.

Correct answer · Room temperature fluid is well below body temperature and cools the patient

Room temperature fluid feels warm in your hand and is still well below body temperature, and a liter or two of it will cool a patient who is already struggling to hold heat. That matters because hypothermia, acidosis, and coagulopathy reinforce one another, each one making the other two worse. Keeping a shock patient warm is genuine treatment rather than comfort care, since hypothermia impairs clotting and worsens acidosis. Warming the fluid, warming the compartment, and covering the patient are all the same intervention.

Correct answer · Slow the ventilation rate back to the correct number and recheck the value

A falling end tidal value usually means falling perfusion, and that is the rule this scenario is built to collide with. Ventilating too fast blows off carbon dioxide and drops the value for reasons that have nothing to do with blood flow, so a hyperventilated patient looks exactly like a deteriorating one on the monitor. Thirty ventilations a minute in an adult is the contaminated variable, and until it is fixed the number cannot be interpreted at all. There is a second reason to fix it that has nothing to do with the reading. Fast, forceful positive pressure ventilation raises the pressure inside the chest, cuts the blood returning to the heart, and genuinely lowers cardiac output in a patient who is already dry. The reading is both falsely low and truly low at once, and slowing down treats both.

Correct answer · Place an intraosseous line, since the decision rule for this patient is met

The decision rule is two failed peripheral attempts or ninety seconds of trying, whichever comes first, in a patient sick enough that access cannot wait. This patient meets both halves of it. Confusion, mottled skin, a weak radial pulse, and a systolic of 78 are decompensated shock, and collapsed veins are precisely the situation the intraosseous route exists for. The marrow cavity is a venous plexus that does not collapse and drains into the central circulation, so anything you would give intravenously goes by this route at the same dose, isotonic crystalloid included. Plan for the practical side too. The line will not run by gravity, so you need a pressure bag or syringe pushes, and it gets flushed with 5 to 10 mL in an adult before anything moves.

Correct answer · Supine and kept warm, since routine head down positioning is not recommended

Routine head down positioning and passive leg raising are no longer recommended as shock treatment. The shock patient without a contraindication goes supine, and the exception is the patient in cardiogenic shock or pulmonary edema who cannot tolerate lying flat, who gets positioned upright or semi upright so breathing stays possible. What does belong on the list alongside position is warmth. Keeping the patient warm is genuine treatment rather than comfort care, because hypothermia impairs clotting and worsens acidosis. A blanket and a warm compartment do more for this patient than a tilted stretcher ever will.

Correct answer · Isotonic crystalloid, since the vessels are dilated and leaking their volume

Anaphylaxis is the fastest version of distributive shock. Histamine dilates the vessels and makes them leaky within minutes, so the fluid is still in the body and simply no longer inside the container. Intramuscular epinephrine reverses the dilation directly and it has clearly done its job on the airway here. What is left is a container still too large for the volume inside it, and the AEMT tool for that is isotonic crystalloid. An AEMT whose anaphylaxis patient remains hypotensive after the intramuscular dose and airway management treats the remaining problem with fluid, not with an epinephrine push into the vein.