CEP Medical Emergencies & Patient Transport 5 — Questions and Answers
Question 1: A patient is found unresponsive with pinpoint pupils and a respiratory rate of 4 breaths/min. After naloxone administration with minimal improvement, what should you suspect?
- Pure opioid overdose requiring more naloxone
- Mixed drug ingestion involving sedatives in addition to opioids (Correct answer)
- Traumatic brain injury
- Pontine hemorrhage only
Correct answer: Mixed drug ingestion involving sedatives in addition to opioids
Incomplete naloxone response suggests co-ingestion of non-opioid CNS depressants such as benzodiazepines or alcohol that naloxone does not reverse.
Question 2: During transport of a patient with acute pulmonary edema, which intervention helps reduce preload and improve respiratory distress most rapidly in a normotensive patient?
- IV fluid bolus of 500 mL NS
- Nitroglycerin sublingual or infusion (Correct answer)
- High-dose furosemide IV push
- Prone positioning
Correct answer: Nitroglycerin sublingual or infusion
Nitroglycerin rapidly reduces venous preload and pulmonary congestion in normotensive acute pulmonary edema.
Question 3: A patient with a history of epilepsy has a witnessed generalized tonic-clonic seizure that stops spontaneously after 2 minutes. She is now postictal. What is the priority transport consideration?
- Immediate airway management and oxygen; transport to ED (Correct answer)
- No transport needed if she returns to baseline
- Administer lorazepam prophylactically before transport
- Delay transport until she is fully alert and oriented
Correct answer: Immediate airway management and oxygen; transport to ED
Even a self-terminating seizure requires assessment, airway management, oxygen administration, and ED evaluation to rule out precipitating causes.
Question 4: Which sign is most specific for tension pneumothorax in a patient on positive pressure ventilation?
- SpO2 drop to 90%
- Tracheal deviation away from the affected side
- Decreased breath sounds unilaterally
- Hypotension with distended neck veins (Correct answer)
Correct answer: Hypotension with distended neck veins
Hypotension combined with JVD indicates obstructive shock from mediastinal shift, which is the most specific hemodynamic sign of tension pneumothorax.
Question 5: A patient with known Type 1 diabetes is confused and diaphoretic. Blood glucose reads 38 mg/dL. He is unable to swallow safely. What is the correct treatment?
- Oral glucose gel placed inside the cheek
- Dextrose 50% IV or glucagon 1 mg IM/IN if no IV access (Correct answer)
- Insulin hold and reassessment in 5 minutes
- Normal saline 1 L IV to dilute excess insulin
Correct answer: Dextrose 50% IV or glucagon 1 mg IM/IN if no IV access
Patients unable to protect their airway should receive IV dextrose; glucagon IM/IN is the alternative when IV access is unavailable.
Question 6: When performing interfacility transport of a patient with an intra-aortic balloon pump (IABP), what is a critical transport consideration?
- The IABP must be turned off during movement to prevent injury
- Maintain continuous ECG monitoring to ensure proper balloon timing (Correct answer)
- Place patient in Trendelenburg to maintain balloon pressure
- Remove the IABP catheter before transport to reduce infection risk
Correct answer: Maintain continuous ECG monitoring to ensure proper balloon timing
IABP function depends on ECG-triggered timing; continuous monitoring ensures effective counterpulsation and early detection of dysrhythmias during transport.
Question 7: A patient presents with abrupt onset of tearing back pain radiating to the abdomen, hypertension, and unequal blood pressures between arms. Which diagnosis is most likely?
- Aortic stenosis exacerbation
- Aortic dissection (Correct answer)
- Myocardial infarction with cardiogenic shock
- Pulmonary embolism
Correct answer: Aortic dissection
Tearing or ripping pain with BP differential between extremities is the classic presentation of aortic dissection requiring emergent surgical evaluation.
CEP Medical Emergencies & Patient Transport 5
A patient is found unresponsive with pinpoint pupils and a respiratory rate of 4 breaths/min.
After naloxone administration with minimal improvement, what should you suspect?