Can you solve this ALS Scenario?
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ALS and Morphine
A 51 year – old woman who is profusely diaphoretic and hypertensive reports crushing substernal chest pain and severe shortness of breath. She has a history of hypertension. She chewed 2 low – dose aspirins at home and is now receiving oxygen in the ambulance. Which treatment is appropriate?:
a) Morphine and then nitroglycerin, but only if morphine fails to relieve the pain: TRUE / FALSE.
b) Nitroglycerin and then morphine, but only if ST elevation is > 2 mm and no contraindications exist: TRUE / FALSE.
c) Nitroglycerin and then morphine, but only if nitroglycerin fails to relieve the pain and no contraindications exist: TRUE / FALSE.
d) Nitroglycerin only because chronic hypertension is a contraindication for morphine: TRUE / FALSE.
ALS Pulmonary Embolism
Which of the following is/are not considered high risk factors for pulmonary embolism?:
a) Postpartum: TRUE / FALSE.
b) Oral contraceptives: TRUE / FALSE
c) Quimiotherapy: TRUE / FALSE
d) Spinal cord injury: TRUE / FALSE
Acidosis
A 21 year – old woman complaining of progressive polyphagia, polydipsia and polyuria in the last month, presents to the Emergency Department complaining of abdominal pain and vomiting. Her arterial blood gas shows:
pH 6.85
PaCO2 0.99 kPa (7.42 mmHg)
PaO2 21.6 kPa (162 mmHg)
HCO3 4.3 mmol/l
Na: 137 mmol/l
K: 3.6 mmol/l
Cl: 120 mmol/l
BE: -29.8 mmol/l
Which of the following statements is/are correct?:
ALS Capacity
A North East Ambulance Service attends an emergency call of a 95 year – old lady complaining of chest pain. On arrival to the house the patient is in bed, awake, pale with HR 30 bpm, RR 15 bpm and BP 67/46 mmHg. She says that she was a nurse, knows about DNACPR (do not attempt cardiopulmonary resuscitation) and would like not to be taken to hospital or being resuscitated. You wonder if she has capacity. To have capacity to take a healthcare decision, a patient must be able to:
A. Understand information relevant to the decision being made: TRUE / FALSE.
B. Score 12 or above on the Glasgow Coma Scale or 25 or above on the mini mental state exam: TRUE / FALSE.
C. Communicate their decisions either verbally or non – verbally: TRUE / FALSE.
D. Depend on family for Next of Kin to make the decision on their behalf: TRUE / FALSE.
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