10 free Paramedic practice questions: Environmental and Submersion Emergencies

Persistent hypoglycemia: The glucose is 126 after the dextrose, so it is no longer low. The brain is getting glucose now, and more dextrose would treat a number that is already fixed.

Severe hypothermia: a temperature below roughly 82°F. Those patients may be unresponsive, rigid, and look lifeless. This patient is at 86°F, still responds, and has a pulse you can find.

Stroke: The face is symmetric and all four extremities move equally, which points away from a stroke. A temperature of 86°F already explains the mental status.

Rough handling irritated the myocardium during the move: This patient was handled gently and kept horizontal, so there was no rough move to blame. The change came right after the packs went on the limbs.

The core temperature rose too quickly: Rewarming the core too fast would show up as a rising core temperature. This core temperature fell from 86°F to 84°F, so the core did not rise at all.

The hypothermia was progressing on its own: The vital signs were the same on two checks 10 minutes apart and changed only after the crew warmed the limbs. That timing points at the packs, not at hypothermia getting worse on its own.

Whether the patient has been eating and drinking less since the heat wave began: Dehydration is real here, and the dry mucous membranes show it. A patient losing fluid to the heat and a patient with an infection both run dry. A yes to this question fits either cause and separates nothing.

Whether the apartment has stayed above 90°F for many hours since the heat wave began: A long time in the heat is what causes heat stroke. The wall thermometer already reads 94°F. More hours in a hot room only confirm a long exposure. More hours do not tell you whether an infection is also raising the temperature.

Whether the patient takes a diuretic or another blood pressure medication: A diuretic adds to heat illness and lowers the pressure. A diuretic adds to the fluid loss in an infection just as well. This question fits both causes and does not tell you what is making the patient hot.

Heat exhaustion from the heat wave: Heat exhaustion leaves the mental status normal, and this patient is drowsy and gives the same answer to a different question. A heat exhaustion patient is still compensating, with a normal or slightly high temperature. This pressure is 86/50, and the temperature is below normal at 96.2°F.

Heat stroke from the heat wave: This patient is cool and moist at 96.2°F. Heat stroke brings hot skin and a temperature usually above 104°F.

Cardiogenic shock from a heart attack: Cardiogenic shock backs fluid up into the lungs and the neck veins, and this patient has clear lungs and flat neck veins. Those findings mean the patient is low on volume, not backed up with fluid.

Continue cold packs to 98.6°F and give isotonic fluid in small boluses: The temperature is already 101.6°F, and cooling stops at roughly 102°F. Cooling past that point brings on shivering, and shivering makes heat. The confusion that is left is a perfusion problem, and more cooling cannot fix a perfusion problem.

Continue cold packs to 98.6°F and start a norepinephrine infusion: At 101.6°F, this patient is already below the roughly 102°F where cooling stops, so the cold packs should come off. Norepinephrine is also too early, because a vasopressor treats vessel tone after the volume has been replaced, and no fluid has gone in yet.

Stop active cooling and start a norepinephrine infusion: No fluid has gone in yet, so norepinephrine comes too early. In septic shock, fluid comes before a vasopressor. Norepinephrine is for a pressure that stays low after fluid has gone in.

The cold packs fell short once the infection progressed to heat stroke: A high temperature with confusion sounds like heat stroke, and more cooling would make sense for heat stroke. In heat stroke, the body has lost control of its temperature. This patient's body is fighting the cold with chattering teeth and shaking arms. The cough and chills point to an infection. The temperature rose to 103.9°F only after the packs went on. More cold packs would only cause more shaking.

The cold packs stayed on past the stopping point, so the temperature is rebounding: Overshoot is the reason cooling stops at about 102°F, and shivering is how overshoot makes heat. Overshoot means the temperature was pushed too low. This temperature rose from 102.8°F. The shivering started because the packs went on a body defending a raised set point, not because the packs stayed on too long.

The cold packs insulate the skin, which traps heat and drives the temperature up: This option treats a cold pack like a blanket. A cold pack pulls heat out of the skin. A cold pack does not hold heat in, so the rise did not come from trapped heat.

Heat cramps: Weakness, nausea, and a blood pressure of 100/62 are not part of heat cramps. Heat cramps are painful muscle spasms after heavy sweating, with a normal mental status.

Heat stroke: This patient is sweating heavily and is still oriented, so the cooling system is still working. In heat stroke the sweating has stopped, the skin is hot, dry, and flushed, and the mental status is altered. The temperature here is 100.9°F, well under 104°F.

Heat syncope: a brief loss of consciousness from blood vessels widening in the heat. The patient wakes up and is back to normal quickly. This patient never lost consciousness. The problem here is ongoing weakness and nausea, not a fainting spell.

Heat cramps: cannot explain a patient who has stopped sweating and responds only to pain. Cramps are painful muscle spasms after heavy sweating, and the mental status stays normal.

Heat exhaustion: The skin is hot and dry and the patient responds only to painful stimuli, so this is not heat exhaustion. In heat exhaustion the patient is still sweating heavily, with cool, clammy, pale skin and a normal or near normal mental status.

Heat syncope: a brief loss of consciousness, and the patient returns to normal quickly. This patient is still unresponsive except to pain, with a temperature of 106.2°F. This patient is not coming back to baseline.

Alertness improves: Alertness does not improve as hypothermia moves from mild to moderate. The patient is getting colder, and the level of consciousness declines as that happens. A cold patient who stops shivering is getting worse.

Shivering becomes more vigorous: Vigorous shivering is the mild stage, when the body can still make heat. Shivering does not keep getting stronger as the patient cools; in moderate hypothermia it stops because that ability is lost.

Respiratory rate rises: Cold slows the body down, so in moderate hypothermia the pulse and respiratory rate both slow instead of rising.

Sit the patient upright to ease breathing: Sitting the patient upright treats this as a breathing problem, and nothing here says breathing is the issue. Moving a cold patient into a new position is the kind of jostling that can set off ventricular fibrillation, and the patient is kept horizontal.

Rub the patient's arms and legs to restore circulation: Rubbing the arms and legs is rough handling, and in this patient's cold, irritable heart, rough handling can set off ventricular fibrillation.

Apply heat packs to the patient's hands and feet first: Heat packs go on the trunk, not the hands and feet. Warming the extremities first in moderate or severe hypothermia sends cold, acidotic blood from the limbs back to the core.