FireMedic65 Posted April 8, 2009 Share Posted April 8, 2009 Why does your instructor not know the answer to the question? He should know the answer to these types of questions if he is going to ask you these types of questions. Good point Link to comment Share on other sites More sharing options...
akflightmedic Posted April 8, 2009 Share Posted April 8, 2009 Hell I do not know anymore now. I have re read and confused myself even more. I could be wrong, may be wrong...waiting on OP to come back and explain. I hate those tricky worded questions, cause it appears I was on the right track then I took a major detour into the ditch. I have no problem saying it appears A is the correct answer but still hate the way they word the question. Link to comment Share on other sites More sharing options...
chbare Posted April 8, 2009 Share Posted April 8, 2009 Ak, cyanosis is caused by lack of oxygenated blood circulating, when a person has hyperventilation, they have too much O2 in their system do they not? there fore would not have Cyanosis. I am going for the majority vote on this one, it is more than likely A as that is my first instinct response. Too much oxygen while on room air is not the primary concern. The associated respiratory alkalosis and acid base/electrolyte disturbance along with a left shift are primary concerns. Somebody else mentioned shallow breathing. It is possible to breath so shallow that you are either moving dead space or you do not have adequate minute volume. This question does not address any of these variables and is quite useless IMHO. Take care, chbare. Link to comment Share on other sites More sharing options...
FireMedic65 Posted April 8, 2009 Share Posted April 8, 2009 Hell I do not know anymore now. I have re read and confused myself even more. I could be wrong, may be wrong...waiting on OP to come back and explain. I hate those tricky worded questions, cause it appears I was on the right track then I took a major detour into the ditch. I have no problem saying it appears A is the correct answer but still hate the way they word the question. Unfortunately, these are the types of questions they ask in testing. A highly educated and experienced person like yourself, showed difficulty in interpreting the question. You could only imagine how difficult this can be for someone in school or just out of school. We know the material, but with questions worded like that with hardly any info, written purposely to confuse you... is just plain retarded. Some might say it helps with critical thinking, but I don't believe so. Link to comment Share on other sites More sharing options...
VentMedic Posted April 8, 2009 Share Posted April 8, 2009 (edited) Why does your instructor not know the answer to the question? He should know the answer to these types of questions if he is going to ask you these types of questions. Because they are teaching questions to pass an exam. EMT-Bs or even some Paramedics rarely have enough A&P to even understand the definition of hyperventilation. Acid-base and lab value interpretation are not taught to any great depth even in Paramedic school. Misuse of the word will also lead some to make a very incorrect working diagnosis. While psychogenic hyperventilation can be seen occasionally, tachypnea can be described in many ways for many reasons. the quality of the tidal volume and other findings in an assessment must be made. The quality of the VT must be considered or "hypoventilation" will be missed regardless of the respiratory rate. Psychogenic hyperventilation should not even be considered until other causes are explored closely. There is also limited determination of hyperventilation in the field unless you have the ability to do an arterial blood gas. An ETCO2 might help but again you may not know the gradient for the PaCO2 - PetCO2. If the person states they "hyperventilate" frequently, they may need more indepth evaluation than what even an ED doctor can provide since chronic HVS can indicate very serious problems which even if psychological, they must be addressed or the chemical changes in the body will start to create other problems which are organic. Other examples: A baby or child will breathe rapidly as they are nearing failure. A chronic lung or asthma patient may also increase their RR when their CO2 is rising and will appear very anxious but are not "hyperventilating". A chronic lung patient can also hyperventilate but their PaCO2 level could still be well above the text book norm and yet have their pH increased dramatically. Patients with pulmonary emboli or PNA (especiallly PCP) will breathe rapidly and may reduce their PaCO2 dramatically. With their increase in MV, they may also be able to maintain a decent SpO2. But, without the increased MV, they would present with hypoxia. People with increased temperature will breathe rapidly. Sepsis and metabolic acidosis will the pH and the body will try to compensate by increased RR. Learning a term such as hyperventilation with such a vague or broad definition without knowing much about the A&P or even the mechanisms that are associated with head injury, dka, metabolic acidosis or other factors that affect acid-base or the body's receptors to compensate is useless when there are other things that should be taught to have a foundation for proper assessment. And, when the instructor may not have enough A&P background to effectively teach these concepts or doesn't have the foresight to review what he/she will be teaching before class, the students only come from these classes with answers memorized or more questions. So, "A" would be my best guess for this poorly worded question as it is also the answer if taken as stated to be the most dangerous for making a working diagnosis without considering ALL the organic possibilities. Edited April 8, 2009 by VentMedic Link to comment Share on other sites More sharing options...
akflightmedic Posted April 8, 2009 Share Posted April 8, 2009 Thanks Vent, stellar reply as always!! Link to comment Share on other sites More sharing options...
Dustdevil Posted April 8, 2009 Share Posted April 8, 2009 (edited) It is definitely very poorly worded. But as already pointed out, so are many NR questions. Not that studying poorly worded questions helps you to pass a poorly worded exam, so it's not a positive thing to "train" people with trick questions. Hyperventilation NEVER causes cyanosis. Hyperventilation may well be present with cyanosis from other conditions. But again, hyperventilation itself NEVER causes cyanosis. So, although D caught my eye too at first because of it's confusing wording, it cannot be the answer because rarely ≠ never. "Almost always" is tricky because psychogenic hyperventilation is the only form of hyperventilation really addressed in paramedic school as a condition of it's own, with discussion of treatment. Metabolic and neurogenic hyperventilation are addressed more as a sign of other conditions rather than a condition itself. Consequently, the term hyperventilation takes on a preconception in medics' minds that leads them to focus on psychogenic causes. I'm betting that most medics do think of hyperventilation as being "almost always" psychogenic. But, of course, this is false. Edited April 8, 2009 by Dustdevil Link to comment Share on other sites More sharing options...
WolfmanHarris Posted April 8, 2009 Share Posted April 8, 2009 (edited) My EMT instructor was going over questions for the upcoming test the other day and he gave us this one: 1) Which of the following statements about hyperventilation is false? a. Hyperventilation is almost always due to psychogenic stress. b. Hyperventilation frequently causes numbness and or tingling and spasms in the hands and fingers. c. Hyperventilation may be a sign of head injury or diabetic problem or overdose. d. Psychogenic hyperventilation rarely causes cyanosis. He claimed that he thought the correct answer was C but after going over my notes it seems like the answer should be A. Could I get your opinion on this? Which answer do you think is right? Seriously?! Your instructor thought "C" was FALSE?? Epic FAIL. Tell the idiot to go look up kussmaul's respirations, acid-base balances, increasing ICP to start. Actually do one better, look it up yourself and start filling the holes in your education. If I were to pick one I would also pick "A" as "almost always" may be overstating the case. Psychogenic is definitely a common cause of hyperventilation though. I'm not too sure about "D" due to the "rarely" there. Certainly most hyperventilating patients will not be cyanotic, but I could forsee some patients showing the signs of hyperventilation but being cyanotic. Plus, the implication of picking "D" seems to be that psychogenic hypeventilation commonly causes cyanosis, which I would definitely say it wrong. So I'll stick with "A" and curse the poor wording and the surface treatment of a complicated process. Edited April 8, 2009 by DocHarris Link to comment Share on other sites More sharing options...
RomeViking09 Posted April 13, 2009 Share Posted April 13, 2009 My EMT instructor was going over questions for the upcoming test the other day and he gave us this one: 1) Which of the following statements about hyperventilation is false? a. Hyperventilation is almost always due to psychogenic stress. b. Hyperventilation frequently causes numbness and or tingling and spasms in the hands and fingers. c. Hyperventilation may be a sign of head injury or diabetic problem or overdose. d. Psychogenic hyperventilation rarely causes cyanosis. He claimed that he thought the correct answer was C but after going over my notes it seems like the answer should be A. Could I get your opinion on this? Which answer do you think is right? A is my off the hip answer... looking in the book (Nancy Caroline's Emergency Care in the Streets 6th Edition) we use for Medic "Hyperventilation occurs when people are in excess of metabolic need.." (Page 26.37) It goes on to say that head injury, OD, pH issues, stress, and chronic medical conditions that effect metabolic systems (like DM) are the major causes of Hyperventilation. I would say from reading in both the medic book and my EMT-I book that C is TRUE now on the EMT level you might not get into the metabolic as much and I could see how that might change your answer but I would say the BEST answer is A Hyperventilation NEVER causes cyanosis. Hyperventilation may well be present with cyanosis from other conditions. But again, hyperventilation itself NEVER causes cyanosis. So, although D caught my eye too at first because of it's confusing wording, it cannot be the answer because rarely ≠ never. Hyperventilation from a head injury can cause cyanosis (true it is a second condition) by without the hyperventilation and just the head injury you would not have the cyanosis, lower SpO2, or abnormal capnography Link to comment Share on other sites More sharing options...
VentMedic Posted April 13, 2009 Share Posted April 13, 2009 (edited) Hyperventilation from a head injury can cause cyanosis (true it is a second condition) by without the hyperventilation and just the head injury you would not have the cyanosis, lower SpO2, or abnormal capnography Hyperventilation is by definition a decrease in the PaCO2. With normal lung function, an increase in MV should increase PAO2 and PaO2. The oxygenation level should rise to whatever the barometric pressure (Pb) allows for. Note I used PaO2 since other factors will affect the SpO2 and it may not give an accurate indication of oxgenation and definitely not where the brain is concerned. Only an SjvO2 will determine that. You can have an SpO2 of 100% and the brain can be starving for O2 due to inefficient uptake or inadequate perfusing pressures. Manually/mechanically hyperventilating (taking PaCO2 level lower) can also cause more problems if the PaCO2 level is lower too much or the pH is raised too high. Take home message: You will have to go beyond your EMT book to adequately understand "hyperventilation". Edited April 13, 2009 by VentMedic Link to comment Share on other sites More sharing options...
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