Your adult patient presents with shortness of breath and chest pain. She reports the pain began last night and has worsened. She is breathing 28 times per minute with a SpO2 of 96 percent on room air. She reports the pain worsens when asked to take a deep breath. Lung sounds are equal with a grating sound heard on inhalation. The patient's heart rate and blood pressure are normal. She is showing a sinus rhythm with a first-degree atrioventricular block present in lead II on the ECG. Which of the following is most likely the cause of her complaints?

Correct Answer: A

Rationale: The correct answer is A: Pleurisy. Pleurisy is inflammation of the pleura, the lining surrounding the lungs. The patient's symptoms of chest pain worsened by deep breathing, grating sound on inhalation, and normal heart rate suggest pleurisy. The absence of other cardiac symptoms, such as abnormal ECG findings or elevated troponin levels, makes acute myocardial infarction less likely (C). Asthma (B) typically presents with wheezing and respiratory distress, which are not seen in this patient. Bronchitis (D) usually presents with productive cough, which is not described here. Pleurisy fits the clinical presentation of chest pain worsened by breathing, pleural friction rub, and normal heart rate.

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: D

Rationale: The correct answer is D: Naloxone. Meperidine hydrochloride is an opioid analgesic, and naloxone is an opioid antagonist that can reverse opioid overdose effects by competing for opioid receptor sites. Step 1: Identify the medication ingested (meperidine). Step 2: Recognize that meperidine is an opioid. Step 3: Understand that naloxone is an opioid antagonist that can reverse opioid effects. Step 4: Administer naloxone to competitively block opioid receptors and reverse the adverse effects. Activated charcoal (A) is used for certain poisonings, not opioids. Atropine (B) is a medication used for bradycardia and not effective for opioid overdose. Romazicon (C) is a benzodiazepine receptor antagonist, not indicated for opioid overdose.

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.