NREMT Paramedic Cognitive ExamMedicalHard
A 72-year-old female resident of a nursing home is found by staff to be lethargic, disoriented, and hypotensive (BP 80/50 mmHg). Her skin is warm and flushed, and she has a temperature of 101.8°F (38.8°C), pulse 118 bpm, and respiratory rate 24 bpm. Her medical history includes diabetes and recurrent urinary tract infections. Which of the following is the most appropriate initial treatment strategy?
- APrepare for rapid transport to a stroke center.
- BAdminister oral glucose and monitor blood sugar levels.
- CInitiate immediate cooling measures and administer antipyretics.
- DAdminister a bolus of intravenous fluids and broad-spectrum antibiotics.
Show answer & explanationAnswer & explanation
Correct answer: D. Administer a bolus of intravenous fluids and broad-spectrum antibiotics.
The patient's presentation (lethargy, disorientation, hypotension, tachycardia, tachypnea, fever, warm/flushed skin, history of diabetes and recurrent UTIs) is highly suggestive of septic shock. The priority in septic shock is early recognition and aggressive management, including rapid administration of intravenous fluids to improve perfusion and broad-spectrum antibiotics to target the underlying infection.
Why the other options are wrong
- A. While altered mental status could suggest stroke, the combination of fever, hypotension, and signs of systemic inflammatory response (tachycardia, tachypnea, warm skin) points more strongly to septic shock, which requires different immediate interventions than stroke.
- B. Although she has diabetes, her symptoms are not classic for hypoglycemia (e.g., diaphoresis, tremors), and her hypotension and fever point to a more systemic issue. Administering oral glucose would delay critical interventions for sepsis.
- C. While the patient has a fever, cooling measures and antipyretics are secondary to addressing the underlying shock and infection. Her warm, flushed skin is a sign of vasodilation in sepsis, not primarily heatstroke.
Septic Shock Management
Emergency treatment for life-threatening organ dysfunction caused by a dysregulated host response to infection, characterized by persistent hypotension despite fluid resuscitation.
- Early recognition is crucial
- Rapid IV fluid resuscitation (30 mL/kg bolus)
- Prompt administration of broad-spectrum antibiotics
Memory trick: Fluids First, Bugs Next, Shock Stops!