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  1. You are called to the lake to meet a patient coming in on a boat who is having difficulty breathing. When you arrive, the boat has just docked and friends are removing the patient from the boat. When you do your history, you find that this 30-year-old female was scuba diving in 65 feet of water when her tank malfunctioned. She was forced to hold her breath and surface rapidly. Currently, she is having difficulty breathing, her skin is wet and "ashen" in appearance. Her blood pressure is 90/60, her respirations are 30, and her pulse is 120 with an oxygen saturation of 82%. Her lung sounds are clear on the right and almost completely absent on the left. · The most likely cause of this patient's shortness of breath is a pneumothorax (air between the pleura) caused by her rapid ascent from depth. Using the concept of Boyle's law, explain what happened to cause this pneumothorax and why. That is, in your own words, explain why Boyle's law is the culprit for the pneumothorax and why the breach of the potential space between the visceral and parietal pleura caused the pneumothorax. · Your patient's normal minute ventilation is 6000ml of air while her alveolar ventilation is only 4200ml. Why is there a difference of 1800ml between these two volumes? Explain in your own words. · Explain in detail how an oxygen molecule gets into the blood stream, is carried to the cells, gets to the cells from the blood, and subsequently, how the waste products (carbon dioxide) return to the atmosphere. · Your patient's normal respiratory rate is between 12 and 18. Currently, your patient is breathing faster than normal. Explain how chemoreceptors, lung receptors, and the nervous system control ventilation.
  2. You have been dispatched to a potential suicide. At the scene, law enforcement officers arrive and advise you that this is an 18-year-old male patient with a single gun shot wound (GSW) to the head. The patient is unconscious but still breathing about four times a minute. When you arrive on scene, the patient takes his last breath but continues to have a pulse. · What options do you have? · What, if anything, must you do differently because this is a crime scene? · Would there be a difference in your treatment if you knew that the patient wanted to be an organ donor?
  3. You arrive on scene to find an elderly gentleman sitting in his recliner. He is obviously disturbed that you are here. He says that his wife called you after he told her not to. When you talk with the gentleman, you find that he is having a significant amount of chest pain that radiates down his left arm and into his jaw. He says that he is tired of hospitals and does not want you to do anything for him. He tells you that he has a long history of heart problems and was recently told he needed a heart transplant. You try to convince the man to let you transport him to the hospital for treatment, but he continues to refuse care. You ask him and his wife if he has some form of advanced directive there at home, and they tell you that "the doctor is working on it but has not sent it home yet." WHAT DO YOU DO? · What options do you have? · Is there anything you can say or do to convince the patient to go to the hospital? · What if he becomes unconscious before you leave; will your approach change then? · Would your approach be any different if the patient had a valid advance directive present?
  4. You and your partner are returning a patient from the Emergency Department to the local nursing home in an ambulance. Your partner is attending to the patient, and you are driving. You put the radio on your favorite music station and crack the windows to let the crisp winter air in. While you are waiting at a stoplight, a small pickup truck blasts through the red light and hits a man riding a moped, knocking him 10 feet into the air and slamming him on the asphalt. Initially, you are so shocked that you can't remember what the name of the road is. You finally compose yourself enough to call in the accident. What should you do? · Do you have a "duty to act" or not? Why do you feel this way? · What are your duties with respect to your partner and the patient you are currently transporting? · What are the potential consequences of your actions? What would have been the consequences if you made another choice?
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