#233: Which of the following patients with diabetes is the BEST candidate for oral
glucose?
A) confused patient who has cool, clammy skin
B) A confused patient with suspected hypterm-3erglycemia
C) A semiconscious patient with pale clammy skin
D) An unresponsive patient who took too much insulin - answerA) confused patient who
has cool, clammy skin
Oral glucose is indicated for patients with diabetes who are in insulin shock
(hypoglycemic crisis) and for any patient with symptomatic hypoglycemia (as
documented by glucometer). The patient must be conscious and alert enough to be able
to swallow the glucose, which comes in a tube of gel. If the patient is unresponsive or
otherwise unable to swallow the glucose, you should provide rapid transport, providing
the appropriate airway management en route, and consider an ALS intercept.
#234: Unresponsiveness, shallow breathing, and constricted pupils are indicative of
which type of drug overdose?
A) Narcotic
B) Marijuana
C) Barbiturate
D) Amphetamine - answerA) Narcotic
Signs of a narcotic (opiate/opioid) overdose from drugs such as heroin, morphine
(Astromorph, Duramorph), meperidine (Demerol), and codeine include altered mental
status; slow, shallow breathing; pupillary constriction (miosis), hypotension; and
bradycardia. Narcotics are central nervous system depressants that, when taken in
excess, suppress the vital functions necessary for life, such as breathing, heart rate,
and blood pressure. Barbiturates produce the same effects; however, the pupils are
typically dilated (mydriasis), not constricted. Marijuana and amphetamine drugs are
central nervous system stimulants and, therefore, would cause the patient to become
restless or even combative.
#235: EMTs are assessing a man who is under the influence of an unknown substance.
The patient is agitated, his BP is 180/100 mm Hg, his pulse rate is 150 beats/min, and
his skin is hot to the touch. Which of the following drugs would MOST likely cause these
signs and symptoms?
, A) Heroin
B) Cocaine
C) Alcohol
D) Valium - answerB) Cocaine
Cocaine is classified as a sympathomimetic, which means that it mimics the effects of
the sympathetic nervous system. It is a very powerful stimulant. When overstimulated,
the sympathetic nervous system produces signs and symptoms such as hypertension,
tachycardia, and agitation or combativeness. Because the patient's metabolic rate is so
high, more heat energy is produced, resulting in a high body temperature. Heroin,
diazepam (Valium), and alcohol are all nervous system depressants. Patients who
overdose on nervous system depressant drugs would be expected to present with a
decreased level of consciousness (including coma), hypoventilation, bradycardia, and
hypotension. The patient's clinical presentation is not consistent with a nervous system
depressant overdose.
#236: A 16-year-old, 125-pound man ingested a bottle of aspirin approximately 20
minutes ago. Medical control orders you to administer activated charcoal in a dose of 1
g/kg. How much activated charcoal should you administer?
A) 51 g
B) 54 g
C) 57 g
D) 60 g - answerC
#237: - answer
#238: You are at the scene where a man panicked while swimming in a small lake. Your
initial attempt to rescue him should include:
A) throwing a rope to the victim.
B) rowing a small raft to the victim.
C) swimming to the victim to rescue him.
D) reaching for the victim with a long object. - answerA?
#239: A 60-year-old man presents with an acute onset of confusion and slurred speech.
Which of the following assessments would be the MOST likely to reveal the possible
cause of his altered mental status?
A) Oxygen saturation
B) Blood glucose level
C) Palpation of the skull
D) Systolic blood pressure - answerB) Blood glucose level
Altered mental status can be caused by a multitude of conditions, and they are too
numerous to mention here. In this patient, the additional sign of slurred speech may
help narrow your differential diagnosis; stroke and hypoglycemia both often present with
slurred speech. Therefore, the patient's blood glucose level would most likely provide
information as to the possible cause of his presentation; it should be assessed as soon
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