Thinking & Linking/Critical Thinking/Pathophysiology to Practice

Question 1

You are assessing a patient who complains of “feeling dizzy.” On primary assessment, her breathing appears to be adequate, but when you apply the pulse oximeter during vital signs measurement, you note that her blood oxygen saturation reading is 92 percent. You know that a normal reading would be at least 96 percent. What intervention should you take to improve this patient’s oxygen saturation? What technique and equipment would you use?

Answer 1

To improve the patient’s oxygen saturation, you should administer low-concentration oxygen using a nasal cannula. This is appropriate because the patient’s oxygen saturation is 92 percent, which indicates mild hypoxia. The nasal cannula is a suitable device for delivering low-concentration oxygen, typically at a flow rate of 1-6 liters per minute.
Here’s a step-by-step approach:
1. Assess the Patient: Ensure the patient’s airway is clear and that they are in a comfortable position.
2. Apply the Nasal Cannula: Place the prongs of the nasal cannula into the patient’s nostrils and adjust the tubing over the ears for comfort.
3. Set the Oxygen Flow: Adjust the oxygen flow rate to between 1-6 liters per minute, depending on the patient’s needs and your clinical judgment.
4. Monitor and Reassess: Continuously monitor the patient’s oxygen saturation and reassess their condition to determine if adjustments are needed.
Remember, oxygen is a drug, so use it judiciously and reassess the patient periodically to ensure their needs are being met effectively.

Question 2

At the scene of a motor-vehicle collision, you are caring for a patient with multiple injuries. Because his breathing was obviously inadequate (shallow and rapid), you initiated artificial ventilation with a bag–valve–mask unit. However, a subsequent reading on this pulse oximeter shows his blood oxygen saturation level—even with assisted ventilations—is only 90 percent. What can you do to attempt to improve his oxygen saturation level?

Answer 2

To improve the patient’s oxygen saturation level, you can take several steps. First, ensure that the bag-valve-mask (BVM) is being used effectively. Check for a proper seal around the mask to prevent air leaks, and ensure that the ventilation rate is appropriate—typically around 12 breaths per minute for an adult. You should also verify that the oxygen source is delivering high-concentration oxygen, as inadequate oxygen flow can lead to suboptimal saturation levels.
Additionally, reassess the patient’s airway to ensure it is clear of obstructions. If the patient is tolerating it, consider using an oropharyngeal airway to maintain patency. Monitor the chest rise to confirm that ventilations are effective, and listen to breath sounds to ensure air is reaching the alveoli. If the patient’s condition does not improve, consider requesting advanced life support (ALS) for further intervention. Regularly reassess the patient’s oxygen saturation and adjust your approach as needed. Remember, oxygen is a drug, and its administration should be based on clinical judgment and continuous assessment.

Question 3

How much time should the EMT spend looking for a pulse when the radial pulse is absent or extremely weak?

Answer 3

When an EMT is unable to detect a radial pulse or finds it extremely weak, they should not spend excessive time searching for it. Instead, they should quickly assess for a pulse at a more central location, such as the carotid artery in adults or the brachial artery in infants. This is crucial because a delay in confirming pulselessness can postpone necessary interventions like CPR. If the pulse is not definitely felt, the EMT should proceed with chest compressions to ensure the patient receives timely care.

Question 4

What if you can’t find a pulse at any vein but they seem fine?

Answer 4

If you can’t find a pulse at any vein but the person seems fine, it’s important to consider other signs of their well-being. Check for other vital signs such as breathing, skin color, and level of consciousness. Sometimes, a pulse can be difficult to detect due to factors like low blood pressure or poor circulation, but if the person is alert, responsive, and breathing normally, they may still be stable.

In such situations, ensure that you are using the correct technique to find the pulse and consider checking at different sites, such as the carotid artery in the neck. If you remain uncertain, it’s always best to err on the side of caution and seek further medical evaluation to ensure the person’s safety. Remember, your role as an EMT is to prioritize the patient’s needs and ensure they receive appropriate care. Keep monitoring their condition and be ready to act if their status changes.

Question 5

What would erring on the side of caution be in this situation?

Answer 5

Erring on the side of caution in this situation means taking proactive steps to ensure the person’s safety, even if they appear fine. Here are some actions you might consider:

Reassess Vital Signs: Double-check for other vital signs like breathing, skin color, and level of consciousness. Ensure you’re using the correct technique to find the pulse, as described in your textbook.

Consider Other Causes: Be aware of conditions like a ventricular assist device, which can result in no detectable pulse despite the person being stable.

Seek Medical Evaluation: If you’re unsure, it’s wise to seek further medical evaluation. This could involve contacting a healthcare professional or transporting the person to a medical facility for a thorough check-up.

Monitor Continuously: Keep monitoring the person’s condition for any changes. If they show signs of distress or their condition worsens, be prepared to act quickly.

By taking these steps, you ensure that you’re not overlooking any potential issues, prioritizing the person’s health and safety. Remember, it’s better to be cautious and find everything is fine than to miss a critical issue.

Question 6

Sometimes a patient’s heart will have an electrical problem and beat more than 200 times a minute. Why is the pulse so weak in such a patient?

Answer 6

When a patient’s heart beats more than 200 times a minute, it is experiencing a condition known as tachycardia, which is an electrical problem. In this situation, the heart is beating so rapidly that it doesn’t have enough time to fill with blood between beats. As a result, the amount of blood being pumped out with each beat is reduced, leading to a weak pulse. This is because the pulse force, which is the pressure of the pulse wave as it expands the artery, is diminished. The heart’s rapid rate compromises its ability to effectively circulate blood, causing the pulse to feel weak and thready. Understanding this helps in recognizing the importance of addressing electrical problems in the heart to ensure proper blood circulation and pulse quality.

Question 7

When someone has lost a significant amount of blood, the adrenal glands secrete epinephrine (adrenaline), which causes pale, sweaty skin. What effect does epinephrine have on blood vessels, leading to this condition?

Answer 7

When someone loses a significant amount of blood, the body responds by releasing epinephrine (adrenaline) from the adrenal glands. This hormone plays a crucial role in the “fight-or-flight” response. One of its primary effects is vasoconstriction, which means it causes blood vessels to constrict or narrow. This action is particularly pronounced in the skin, kidneys, and gastrointestinal tract.

Skin: The constriction of blood vessels in the skin leads to a pale appearance because less blood reaches the surface. Additionally, sweat glands are activated, causing the skin to become sweaty.
Kidneys and GI Tract: In the kidneys, vasoconstriction reduces urine production to conserve fluid. In the gastrointestinal tract, it can lead to nausea and vomiting as the body prioritizes blood flow to vital organs like the heart and lungs.
This vasoconstriction helps redirect blood flow to essential organs, maintaining blood pressure and supporting vital functions during blood loss.

Question 8

Why is chronically high diastolic pressure strongly associated with heart disease?

Answer 8

Chronically high diastolic pressure, also known as diastolic hypertension, is a condition where the pressure in the arteries remains elevated during the relaxation phase of the heart cycle. This phase is crucial as it allows the heart to refill with blood. When diastolic pressure is consistently high, it increases the stress and wear on cardiac structures. This persistent pressure can lead to damage over time, significantly raising the risk of heart disease, stroke, and kidney disease. The heart and blood vessels are under constant strain, which can lead to structural changes and impaired function, contributing to cardiovascular complications.