CP3 Short Answer Quiz: Physiological Effects in Emergency Scenarios

This document presents a student's solutions to a short answer quiz focusing on physiological effects in various emergency and trauma scenarios. The quiz covers topics such as chemoreceptor stimulation in response to blood loss and drug overdose, hormonal mechanisms activated during vomiting and blood loss, and the progression of multiple organ dysfunction syndrome (MODS). It also addresses local and systemic signs and symptoms of strep throat, altered immunological reactions like allergy and autoimmunity, and the physiological basis for vital sign changes in hypovolemic shock. Furthermore, the quiz explores factors affecting oxygen and hemoglobin affinity, heart rate and peripheral perfusion changes in different types of shock, and the baroreceptor reflex mechanism for blood pressure control. Desklib is a valuable resource for students seeking similar solved assignments and study materials.

RUNNING HEAD: SHORT ANSWER QUIZ 1
SHORT ANSWER QUIZ
Students name
Course
Institutional affiliation

SHORT ANSWER QUIZ 2
CP3 4.2 - SHORT ANSWER QUIZ
Question 15 of 19
Describe the physiological effects of chemoreceptor stimulation in the following situations.
a. A 36-year-old adult has a massive haemothorax from a gunshot wound. Blood pressure is
76/60 mm Hg.
Massive blood loss leads to hypoxemia that are detected by the chemoreceptors. They
have connections to the vasomotor centre of the medulla. They will produce vasoconstriction
by input to the sympathetic nervous system leading to blood pressure increase.
b. A 17-year-old patient who took a drug overdose has a shallow respiratory rate of 8
breaths/min. Arterial blood gas tests reveal a Pco2 of 60 mm Hg
Chemoreceptor stimulation in response to the decreased PCO2 leads to the activation
of the vasomotor centre. The vasomotor centre of the medulla increases the depth and rate of
respiration to help eliminate the excess carbon dioxide.
c. A 47 -year-old man who had a large inferior myocardial infarction has progressively
deteriorated. He is now unconscious and has a weak carotid pulse and no obtainable blood
pressure. Describe the physiological effects that ensue when the central nervous system
ischemia response is initiated.
Reduced blood flow reduction to the vasomotor centre can be enough to cause
ischemia. When this occurs, there is excitation of the neurons raising the arterial blood
pressure due to vasoconstriction from the sympathetic discharge. If ischemia lasts longer,
vagal centres are activated leading to slowing of the heart rate and peripheral vasodilation.

SHORT ANSWER QUIZ 3
Question 16 of 19
A 65-year-old alcoholic man states that he had a sudden onset of vomiting. The emesis
contains bright red blood, and he continues to vomit. Vital signs are blood pressure - 94/78
mm Hg - pulse - 132 beats/min (bpm) and respirations - 28 breaths/min. Describe the effects
of the following three hormonal mechanisms, which will be activated.
a. Adrenal medullary mechanism
The medulla produces primarily the catecholamines epinephrine, norepinephrine and
dopamine (Wong, 2006). During physiologic, physical or environmental stress for example
bleeding in this case, the body perceives a threat to normal homeostatic balance and initiates
a response via the hypothalamus (Barrett, Barman, Boitano, & Brooks, 2009). A sympathetic
nervous discharge will travel through the spinal cord and the sympathetic preganglionic
neuron to synapse with chromaffin cells of the adrenal medulla to release mainly epinephrine
(De Diego, Gandia, & Garcia, 2008). Epinephrine has various effects on target organs
including increasing the heart rate, blood pressure, vessel constriction to divert blood from
non-essential organs like skin to more essential organs like heart and brain, increasing the
metabolic rate and pupillary dilatation just to name a few (Waugh & Grant, 2010).
b. Renin-angiotensin-aldosterone mechanism
Bleeding causes a reduction in renal blood flow which is detected by the
juxtaglomerular cells of the kidney (Moon, 2013). They secrete renin, which enzymatically
turns angiotensinogen to angiotensin 1. Angiotensin 1 is then turned by angiotensin
converting enzyme to angiotensin 2 a potent vasoconstrictor that increases the peripheral
resistance hence the blood pressure. It also stimulates the adrenal cortex to produce

SHORT ANSWER QUIZ 4
aldosterone, a hormone whose principle action is salt and water retention (Moon, 2013). This
aims to increase blood volume, cardiac output, and blood pressure.
c. Vasopressin mechanism
Vasopressin is released from the posterior pituitary in response to sympathetic activity
and hyperosmolarity of blood. It is released into circulation to exert its effects on the kidneys
and the blood vessels. In the blood vessels it is a powerful vasoconstrictor reducing which in
this case would raise the blood pressure by increasing the peripheral resistance. In the kidney
it promotes water reabsorption maintaining blood volume, cardiac output and in turn blood
pressure.
Complete the following paragraph using the following words/ phrases:
 cellular acidosis and impaired cellular function
 coagulation
 complement, coagulation and kallikrein/kinin
 endothelium
 endotoxins and inflammatory mediators
 hypotension and hypoperfusion
 interstitial
 oedema formation, cardiovascular instability and clotting abnormalities
 organ
 permeable
 systemic vascular resistance
 thrombus
 vascular endothelial

SHORT ANSWER QUIZ 5
Multiple organ dysfunction syndrome (MODS) begins with (a) damage caused
by (b) which are released into the circulation. This causes the vascular (c)
to become (d) , which allows fluid and cells to leak into the (e)
spaces, increasing (f) . Three plasma enzyme cascades are then
activated. They are (g) . Phagocytes cause further
damage to the endothelium, causing uncontrolled (h) and the formation of
microvascular (i) and tissue ischemia. Bradykinin contributes to low (j)
. The overall effect of the three complement systems is (k)
. Initially, the body compensates for
these changes, but ultimately tissue hypoxia causes (l) .
Finally, multiple (m) failure occurs.
Q 17
Your partner is off sick with a diagnosis of strep throat. Describe whether the following signs
and symptoms experienced during this illness are local or systemic and give at least one
inflammatory mechanism that causes the sign or symptom.
a. Oedematous throat
This is a local sign. It is due to serous pattern of inflammation. During inflammation,
inflammatory mediators are release in response to a pathogen. As part of the vascular
vascular endothe
endotoxins and in
endothelium permeable
interstitial hypotension and h
coagulation and kallikrein/ kinin
coagulation
thrombus
systemic vascular
cardiovascular instability and clotting abnormalities
impaired cellular function
organ

SHORT ANSWER QUIZ 6
response there is redness due to increased vascularity with oedema due to outpouring of fluid
from the leaky dilated vascular channel
b. Purulent drainage
This is also a local symptom and is due to suppurative inflammation. There is
attraction of leukocytes to the injury site. It is manifested by collection of purulent exudate
consisting of dead neutrophils, oedema fluid and necrotic tissue.
c. Fever
Fever is a systemic sign. It is caused by release of cytokines into circulation that reset
the body’s thermoregulation mechanisms leading to failure of heat regulation.
d. Red throat
This is a local sign and is due to increased vascularity at the inflammatory site as the
body tries to mobilize inflammatory mediatory to reach the area.
e. Difficulty swallowing
This is also a local symptom and could be attributed to the inflammatory process that
causes exudation of fluid into the interstitial space leading to oedema and narrowing of the
food passage.

SHORT ANSWER QUIZ 7
Question 19 of 19
For each statement below, note which one of three types of altered immunological reaction
has occurred: allergy, autoimmunity, or isoimmunity.
a. You are dispatched to a private residence to care for a 46-year-old woman who began to
experience dyspnea, a swollen face, and hives after taking a penicillin tablet prescribed by her
dentist.
This is an allergic reaction.
b. You are transferring a patient to a dialysis centre for care after his body rejected his kidney
transplant.
This is an isoimmunty reaction
c. You notice that your eyes water and get puffy and your hands become very red and itchy
when you wear latex gloves at work.
This is an allergic reaction.
d. Your patient, a 30-year-old woman, is having chest pain. The family tells you she has
systemic lupus erythematosus with cardiac and pulmonary involvement.
This is an autoimmune reaction.

SHORT ANSWER QUIZ 8
Emergency & Trauma Care for Nurses and Paramedics (2nd Edition)
Read Chapter 20, "Physiology for emergency care".
CP3 4.4 - CASE STUDY QUIZ
Case Study #1
Dale is a 24-year-old man who has crashed his car head-on into a power pole. He was the
only occupant. The accident occurred in a 60km/h zone, but witnesses report that the car was
speeding. The car is caved in against the pole but the windscreen is intact. When the
paramedics arrive, Dale is sitting on the footpath beside the vehicle. He is noted to be
conscious and alert, and there is no obvious external trauma or bleeding. He is complaining
of pain in his lower abdomen and is pale and sweaty; his skin is cool to touch. Dale’s vital
signs are: HR 126 beats/min, BP 85/50 mmHg, RR 28 breaths/min, Spo2 96% and GCS 15.
Spinal motion restriction practices are applied, oxygen applied via a mask at 8L/min, IV
access obtained and IV analgesia administered. Dale is prepared for transfer to the local
hospital; and IV fluids are commenced en route. The paramedics transfer Dale to the nearest
trauma centre where his vital signs are: HR 128 beats/min, BP 90/60 mmHg, RR 26

SHORT ANSWER QUIZ 9
breaths/min, SpO2 99%, and GCS 15. He is receiving oxygen at 8L/min and continues to
complain of lower abdominal pain.
Question 1 of 4
Explain the physiological basis for the vital-sign findings—the patient has no significant
medical history and is not taking any medications that may cause vital sign changes.
Dale is in hypovolemic shock. It is as a result of inadequate tissue perfusion which if
untreated leads to cell death (Brunner and Suddath, 2013; Mikhail, 2009). This is likely to
have been caused by internal bleeding. According to Smelterz et al, (2011) hypovolemic
shock has four stages. The initial stage, compensatory stage, progressive stage and
refractory/irreversible stage.
There is sympathetic nervous system stimulation which causes the release of
catecholamine; adrenaline and norepinephrine (Kreimeier, 2016). This causes
vasoconstriction, increased heart rate (above 100 bpm) and increased heart contractility. This
is an attempt to increases the tissue perfusion. In addition to this, the body shunts the blood
from organs such as kidneys, skin, and the gastrointestinal tract. The blood is directed to the
vital organs, brain, and heart. Due to the shunting of blood, the patient's skin is usually
clammy and cold, there is hypovolemia and hypoxia which lead to cyanosis depicted by the
dusky pink color of peripheries. Urine output and bowel sounds reduce too due to this
shunting. There is activation of the renin-angiotensin-aldosterone system that leads to
increased anti-diuretic production which in turn causes water retention. Due to reduced
perfusion, the body reverts to anaerobic respiration producing a metabolic acidosis
necessitating the patient to hyperventilate (respiratory rate of 20-30) to remove excess acid.

SHORT ANSWER QUIZ 10
Question 2 of 4
What determines the affinity between oxygen and haemoglobin, and how does hypothermia
impact this affinity?
This is best exemplified by the oxygen dissociation curve which is the relationship
between partial pressure of oxygen and oxygen saturation. The factors that affect this affinity
are said to shift the curve. Those that shift the curve to the right include increase in
temperature, 2,3- DPG and a decrease in ph. This in essence is a decrease in haemoglobin
affinity for oxygen. Factors that shift it to the left include hypothermia, decrease in 2.3-DPG
and increase in PH.
Question 3 of 4
In the presence of hypotension, what changes will occur to heart rate and peripheral perfusion
in the following types of shock?

SHORT ANSWER QUIZ 11
A. Hypovolaemic
The heart rate will increase as the peripheral perfusion decreases.
B. Septic
The heart rate will increase as peripheral perfusion increases.
C. Neurogenic
The heart rate will slow as the peripheral resistance increases.
D. Anaphylactic
The heart rate will increase as peripheral perfusion increases.
E. cardiogenic.
The heart rate increases as the peripheral perfusion reduces.
Question 4 of 4

SHORT ANSWER QUIZ 12
What mechanism initiates a systemic response to a reduction in blood pressure? Briefly
outline the main stages of the body’s response to a reduction in blood pressure and describe
potential masking agents.
The baroreceptor reflex is the principle negative feedback mechanism for blood
pressure control (Martini, Nath, & Bartholomew, 2015). The baroreceptors are located in the
arch of the aorta and the carotid sinus and they detect minor changes in blood pressure as
they are pressure sensitive (Waugh & Grant, 2010). They have neural connections to the
cardiovascular centers in the pons and medulla of the brainstem. The cardiovascular center
increases sympathetic nervous activity to the heart. This has the effect of increeasing the
heart rate and effectively increasing the stroke volume.
The cardiovascular center including the vasomotor center in the medulla also acts on
the blood vessels by increasing the sympathetic discharge to the vessels. The action of the
sympathetic nervous system on smooth muscles of the blood vessels is to cause
vasoconstriction (Martini, Nath, & Bartholomew, 2015). This increases the peripheral
resistance, the second factor in blood pressure control, which increases the blood pressure.
Potential masking occurs due to anxiety as neural mechanisms fail to adequately
control the pressure. This is because higher centres have inputs to the cardiovascular center.
Mosby'™s Paramedic Textbook 4th Edition€