What can the paramedic expect to find when evaluating the pupillary response of a patient suspected of suffering from herniation?

Correct Answer: A

Rationale: The correct answer is A: Bilateral pupil dilation. When evaluating a patient suspected of suffering from herniation, the paramedic can expect to find bilateral pupil dilation due to increased intracranial pressure affecting the oculomotor nerve. This dilation is a result of the pressure compressing the nerve fibers, leading to loss of parasympathetic tone and unopposed sympathetic tone causing the pupils to dilate. Choices B, C, and D are incorrect: B: A unilaterally, unequal and non-reactive pupil - This is more indicative of a localized eye injury or nerve damage, not herniation. C: Bilaterally, unequal and non-responsive pupils - This may indicate severe neurological damage or brainstem dysfunction, not specifically related to herniation. D: Sluggish response, but equal pupils - This response is unlikely in cases of herniation where rapid changes in pupillary response are more common.

Correct Answer: C

Rationale: The correct answer is C: Directly into the vallecula. Placing the tip of the curved Macintosh blade directly into the vallecula allows for optimal visualization of the glottis during intubation. By lifting the epiglottis indirectly, the blade creates space for passage of the endotracheal tube. Placing the blade directly under the epiglottis (A) may obstruct the view. Placing it in the space below the vallecula (B) may not provide sufficient elevation. Placing the blade directly on the epiglottis (D) can cause trauma and obstruct the view.

Correct Answer: C

Rationale: Step 1: Establishing a diagnosis of shock involves assessing for clinical evidence of inadequate organ perfusion, such as altered mental status, tachycardia, and cool clammy skin. Step 2: This clinical evidence is crucial as it indicates the body's organs are not receiving enough oxygen and nutrients due to poor perfusion. Step 3: Identifying inadequate organ perfusion helps differentiate shock from other conditions with similar symptoms. Step 4: The other choices are incorrect because systolic blood pressure alone is not sufficient for diagnosing shock (A), closed head injury is not a defining feature of shock (B), and response to fluid infusion is important but not the sole criterion (D). Summary: Choice C is correct as it focuses on the key clinical feature of inadequate organ perfusion, while the other choices either focus on single parameters or unrelated conditions.

Correct Answer: C

Rationale: The correct answer is C: Breath sounds. In cardiac tamponade, there may be muffled or distant heart sounds due to the accumulation of fluid around the heart, impacting its ability to pump effectively. In tension pneumothorax, breath sounds may be absent or decreased on the affected side due to lung collapse. This differentiation is important as cardiac tamponade requires emergent pericardiocentesis, while tension pneumothorax necessitates needle decompression. Choices A, B, and D are not as useful in differentiating between the two conditions. Tachycardia may be present in both conditions, pulse volume may be decreased in both, and pulse pressure may be narrowed in both due to decreased cardiac output. Breath sounds are a key differentiating factor in this scenario.

Correct Answer: D

Rationale: The correct answer is D: Performing lower extremity fasciotomies. In this scenario, the man's leg was trapped under the car for a prolonged period, leading to potential compartment syndrome. Fasciotomies can release pressure in the compartments, improving blood flow and potentially salvaging the limb. A: Applying skeletal traction may help stabilize the leg, but it does not address the underlying compartment syndrome. B: Administering anticoagulant drugs is not indicated for compartment syndrome and may increase the risk of bleeding. C: Administering thrombolytic therapy is not appropriate for compartment syndrome and may lead to further complications. In summary, lower extremity fasciotomies are the most appropriate intervention to improve chances for limb salvage in this case.