NREMT Review Exam 2

An adult female was cooking when there was a flare-up that resulted in burns to her entire chest, entire abdomen, and circumferential to lower part (elbow to hands) of both arms. Using the Rule of Nines, what percentage of body surface area is burned on this patient? 27% 36% 45% 18%

27% RATIONALE The Rule of Nines assigns the following percentages for an adult: head - 9%, chest - 9%, abdomen - 9%, upper back - 9%, lower back - 9%, each arm - 9%, each leg - 18%, and groin - 1%. Applying the Rule of Nines to this scenario gives us the following: the chest (9%), abdomen (9%), and half of each arm (2 X 4.5% = 9%) for a total of 27% of body surface area burned.

A 14 year old female complains of difficulty breathing and vertigo. You note she has hives on her chest and abdomen. After completing the primary assessment, what is the most important element of your SAMPLE history? L P E A

A RATIONALE This patient is likely having an anaphylactic reaction. As such it would be very important to identify A for "allergies." Past medical history, last oral intake, and events leading up to your arrival would all be important, but given the symptoms, allergies might shed the most light.

Which one of the following would be considered a significant mechanism of injury? Motor vehicle crash at 30 mph with no passenger compartment intrusion Six-foot male falls eight feet without a loss of consciousness 63 year old female falls and sustains an angulated tibia/fibula fracture A 3 year old male falls 11 feet without loss of consciousness

A 3 year old male falls 11 feet without loss of consciousness RATIONALE A fall of greater than 10 feet for a pediatric patient is considered a significant mechanism of injury. For adults, a serious mechanism is considered in any fall greater than three times their height. An angulated tibia/fibula fracture can be serious, but an isolated injury does not necessarily indicate more severe injuries. Passenger compartment intrusion is generally considered an indicator of significant mechanism of injury.

You are treating a bariatric patient with a pathological lumbar fracture. During the difficult patient handling, positioning, extrication, and transport on the cot, there are multiple times when you must lay the patient flat. During these times, what vital bodily function must be diligently monitored? Breathing Airway Circulation Mental status

Breathing RATIONALE Bariatric patients are very obese. Often these patients have pathological fractures from their own weight and inactivity. These patients commonly sit up all day and even sleep sitting with their head up at night. Because of their weight, lying supine places significant pressure on the diaphragm making it nearly impossible for them to breathe. As such, always be prepared to assist the patient with a BVM when the need arises to lay them supine for any period of time. If they are still conscious, they can usually maintain their own airway. Their circulatory status is not affected by position.

When you respond to the residence of an ill 20 month old, you observe a pale, limp child with a weak cry being held by his mother. You attempt to get both a radial and brachial pulse but they are too weak. Using a stethoscope, you hear the heart beating rapidly. The skin is cool and clammy, and his respirations are rapid. The physical exam is negative for DCAP-BTLS. The mother tells you that the baby's diaper has been dry for hours and that he has had very poor oral intake for the past two days.

Dehydration (shock) RATIONALE This patient is showing signs of shock. Based on the physical findings and history, dehydration seems to be a likely cause. There are no signs of trauma. There are no hives or swelling, so an allergic reaction is not likely. With an infection, most of the time, the skin is warm to the touch and flush, not cool and clammy.

During the interview of a female patient thought to be experiencing a spontaneous abortion, she relays to you a prenatal history of poor nutrition, drug abuse, and smoking. During what stage of the fetal development would these habits have the greatest potential for malformation? Implantation Fetal stage Fertilization Embryonic stage

Embryonic stage RATIONALE During the embryonic stage, cellular division of the fetus is most rapid and most susceptible to malformation due to poor maternal habits. Fertilization occurs when the mother's egg is fertilized. Implantation occurs when the fertilized egg attaches itself to the uterine wall. The fetal stage occurs after the fragile embryonic stage.

Which one of the following reasons best indicates the importance of suctioning the nose of an infant in respiratory distress? The nasopharynx is more proximal in an infant. Infants rely upon their nose to breathe more than do adults. Suctioning allows for the insertion of a nasopharyngeal airway. Infants produce more nasal secretions than adults.

Infants rely upon their nose to breathe more than do adults. RATIONALE Although infants are not really "obligate nose breathers," they do rely more upon their nose to breathe than adults. Suctioning the nose can significantly increase airflow and minute volume. The proximity of the nasopharynx and insertion of a nasopharyngeal airway have little to do with the value of nasal suction. Infants do not necessarily produce more nasal secretions compared to adults.

Which one of the following uses negative pressure to move air? Exhalation Inhalation Bag-valve mask ventilation Manually triggered ventilation

Inhalation RATIONALE Inhalation is accomplished by creating negative pressure in the chest. Exhalation is accomplished by raising internal chest pressures. Both bag-valve mask ventilation and manually triggered ventilation use positive pressure to move air.

Why does tension pneumothorax lead to shock? Pain limits the movement of the chest wall. Air in the pleural space collapses the lung. Pressure built up in the pleural space compresses the heart. Pressure in the pleural space limits the movement of the diaphragm.

Pressure built up in the pleural space compresses the heart. RATIONALE Shock from a tension pneumothorax is obstructive in nature. That is, it is caused by pressure in the pleural space compressing the heart and great vessels, limiting its filling capability. This causes a drop in cardiac output. The lung may collapse, but typically shock is not seen until the heart is compressed. Limited movement of the diaphragm and the chest wall may lead to difficulty and inefficient breathing, but not typically shock.

There are multiple tasks the EMT is responsible for on each EMS run. If the EMT must coordinate the rescue of a patient who is trapped under rubble from a building collapse, this is an example of which EMT role? Provision of scene leadership Maintaining vehicle readiness Maintenance of medical and legal standards Provision of rescue services

Provision of scene leadership RATIONALE There is a myriad of skills and responsibilities the EMT must assume on each EMS incident. If the EMT is called upon to coordinate the actions of multiple other people during an extrication, this is known as provision of scene leadership. Maintenance of the vehicle must occur prior to the call. Maintaining medical and legal standards occurs throughout the incident, but does not pertain directly to the extrication. Providing rescue services is one component of the scene but not the best answer.

Which one of the following would be an injury limited to medium- and high-velocity penetrating trauma? Rupture of gas-filled organs Permanent cavity Internal bleeding Temporary cavity

Temporary cavity RATIONALE A temporary cavity is created by the cavitation associated with medium- and high-velocity penetrating trauma. Low-velocity penetrating trauma does not create this type of wound. All penetrating trauma can cause internal bleeding and rupture of gas-filled organs.

When completing a scene size-up at a work site construction accident where a forklift was accidentally driven into the side of a tanker-trailer, you can see vapor clouds arising from the trailer. What should be assumed regarding this observation? The contents are flammable The contents are of no threat to human life The contents should be considered dangerous The contents are under pressure

The contents should be considered dangerous RATIONALE Vapor clouds erupting from a breached container indicate that the contents within are both volatile and lighter than ambient air. Since they are a vapor, they can be inhaled if you should come too close to the accident without proper protective equipment. Consider any gas, vapor, or liquid release from a container to be dangerous to health until someone with proper education and knowledge about the spill evaluates the scene.

Which one of the following best describes why abnormally fast heart rates cause a drop in cardiac output? Fast rates are always disorganized and lead to the inability of the heart to pump. The heart does not have enough time to fill between beats. Fast rates are always caused by hypovolemia. Fast heart rates cause weak contractions of the ventricles.

The heart does not have enough time to fill between beats. RATIONALE Abnormally fast heart rates cause poor filling of the heart. Contraction strength may be the same, but because diastole is so short, less blood enters the ventricles. Hypovolemia can cause fast heart rates, but often tachycardic dysrhythmias are the singular problem. Ventricular fibrillation is a fast, disorganized rhythm that defeats the heart's ability to pump, but not all fast heart rates are V-Fib.

While assessing the neck of a 72 year old woman who is in the Fowler's position you observe bulging neck veins. She tells you she felt this way the last time she had fluid built up in her lungs. Of the following, which one is the most likely underlying reason for this finding? There is too much blood in the body. This is a severe allergic reaction. The heart is not pumping effectively. There is a blood clot in the neck restricting flow.

The heart is not pumping effectively. RATIONALE Bulging neck veins is a sign that the heart is not pumping effectively, which might be the case of a patient in congestive heart failure with fluid building up in the lungs. A tension pneumothorax also may have bulging neck veins as one of its signs. Flat veins would be observed in a severe anaphylactic reaction.

Which one of the following best describes why blind finger sweeps should be avoided in pediatric obstructed airway procedures? The windpipe is soft and pliable in pediatric patients. The tongue is proportionately larger in pediatric patients. The upper part of the trachea is funnel-shaped in pediatric patients. The mouth is much smaller in pediatric patients.

The upper part of the trachea is funnel-shaped in pediatric patients. RATIONALE The upper aspect of a pediatric trachea is funnel-shaped and allows foreign objects to be pushed below the vocal cords easily. For this reason, you should avoid blind finger sweeps. The mouth is smaller, the trachea is pliable, and the tongue is proportionately larger, but these characteristics are not related to finger sweeps.

Upon arrival at the scene of a two-vehicle MVC, you are directed by the fire department to a patient who was thrown from his vehicle. As you complete your primary survey, you note the patient is unresponsive with blood in the airway. Breathing is present and tachypneic. Peripheral pulses are absent. The patient has significant facial trauma and a grossly deformed left leg. Given the findings of the primary assessment, how would you categorize the patient's physiologic status? Potentially unstab

Unstable RATIONALE This patient would be categorized as "unstable". He displays an altered mental status (unresponsive), a partially occluded airway, and multiple fractures of long bones that can lead to vascular and hemorrhagic disturbances. In addition, the facial trauma may continue to complicate the airway. A patient who is stable or stable with potential for instability would initially display intact airway, breathing, circulatory, and mental status functions.

Your patient has just finished actively seizing after a grand mal seizure. You should loosen clothing. transport. provide oxygen. protect the airway.

protect the airway. RATIONALE Your priority is the airway. After protecting it, provide oxygen. Restrictive clothing should have been loosened while the patient was actively seizing. After the ABCs are treated, the patient should be packaged for transport and taken to the most appropriate facility.

Before inserting a nasopharyngeal airway you should measure it from the tip of the nose to the corner of the mouth. tip of the nose to the earlobe. corner of the mouth to the angle of the jaw. tip of the nose to the sternal notch.

tip of the nose to the earlobe. RATIONALE A nasopharyngeal airway is measured from the tip of the nose to the earlobe. You should always take time to accurately measure an airway adjunct because a device that is the wrong size can impair air movement.

At what rate should you ventilate an apneic patient who still has carotid and radial pulses? 20 times per minute 12 times per minute 8 times per minute 16 times per minute

12 times per minute RATIONALE According to current American Heart Association standards for ventilation assistance for a patient who is not breathing but still has spontaneous circulation, the appropriate rate of ventilations should be 10-12 per minute. Always ensure the ventilations result in chest rise and fall and that alveolar breath sounds are present during artificial ventilation.

You respond to a known hazardous materials incident. A harmful gas has been released. Which one of the following describes the most appropriate placement for the ambulance? Upwind and downhill Downwind and downhill Upwind and uphill Downwind and uphill

Upwind and uphill RATIONALE To maximize safety, the ambulance should be positioned upwind, so that the harmful gas is blown away from the unit, and uphill, so that any harmful substances run downhill away from the ambulance.

A 26 year old male is unconscious after a motor vehicle crash. His airway is patent but he is breathing very rapidly. His respiratory rate is 58, and you notice he is slightly cyanotic. In this case, the most important reason to initiate positive pressure ventilation is to increase tidal volume. treat rising intracranial pressure. treat apnea. slow the respiratory rate.

increase tidal volume. RATIONALE This patient is likely in respiratory failure because his respiratory rate has decreased tidal volume to an insufficient amount. Positive pressure in this case should be used to increase tidal volume. It is unlikely that positive pressure will be able to slow the rate. This patient is not apneic, and the treatment of intracranial pressure would be secondary to treating respiratory failure. PREVIOUS

A 29 year old male has been involved in a motorcycle crash. He has a large abrasion on his left thigh and lower leg. The most significant threat from this type of injury would be pain. infection. serious bleeding. nerve damage.

infection. RATIONALE The most serious complication resulting from a large abrasion is infection. As the skin is scraped away, dirt, rocks, and other foreign bodies are transferred into the soft tissue. This causes a high rate of infection. Bleeding is not usually severe. Pain can be tremendous, but it is not the most serious threat. Nerve damage can be possible, but is less likely in injuries that primarily affect only the outermost layers of soft tissue.

During your pre-shift ambulance inspection, you notice that one of the box warning flashers has burned out. You should immediately take the ambulance out of service and notify maintenance. remove the light because it is not necessary. notify your relief of the problem and let them handle it. keep the ambulance in service and make an appointment with maintenance as soon as possible.

keep the ambulance in service and make an appointment with maintenance as soon as possible. Although all warning lights are important, a side flasher is probably not a reason to take the ambulance out of service immediately. You should keep the ambulance in service and deal with the problem as soon as possible. Leaving problems for your relief to deal with shows a lack of professional responsibility.

Disruption of upper airway patency in severe anaphylaxis is most likely caused by overproduction of mucus. severe bronchoconstriction. vasodilation. laryngeal edema.

laryngeal edema. RATIONALE Disruption of upper airway patency in severe anaphylaxis is most likely caused by laryngeal edema. Tissues above and below the glottic opening swell to the point of impairing the flow of air. Bronchoconstriction is a common problem associated with anaphylaxis, but affects the lower airway. Vasodilation may be a cause of severe shock, but does not affect the airway. Mucus may be produced, but typically would not impair the upper airway.

An 81 year old female COPD patient complains of three days of shortness of breath. She is alert, but you notice cyanosis in her fingernails and lips. The most appropriate oxygen delivery method for this patient would be a Venturi mask at 6 Lpm. non-rebreather mask at 12 Lpm. nasal canula at 4 Lpm. partial rebreather mask at 15 Lpm.

non-rebreather mask at 12 Lpm. RATIONALE This patient is hypoxic as evidenced by the difficulty breathing and cyanosis. She needs supplemental oxygen. A non-rebreather mask would be most appropriate. Although there is a potential for her to breathe via a hypoxic drive due to her COPD, the risk of hypoxia far outweighs the risk of apnea associated with high-flow oxygen. A nasal cannula might be an option, but only if she would not tolerate the mask. Venturi masks and partial rebreathers simply would not supply enough oxygen under the circumstances.

You transport a routine patient without incident. Immediately after transferring care to the ED, the dispatcher radios you that a priority call is holding. The stretcher has not been changed but does not appear dirty. You should notify dispatch that you will be delayed while changing the stretcher linen. drape a clean sheet over the soiled linen and respond to the call. straighten the linen and respond to the call. pull the soiled linen off and respond with no linen on the stretcher.

notify dispatch that you will be delayed while changing the stretcher linen. RATIONALE Your next patient deserves a clean stretcher. You should delay the next call for the short time it takes you to properly ready your equipment. Covering the soiled linen or using the stretcher without linen is not acceptable preparation.

A 10 year old male has spilled hot water from a pan onto his chest. The skin is turning red and blisters have begun to form. You would most likely classify this type of burn as a superficial burn. full thickness burn partial thickness burn. fourth-degree burn.

partial thickness burn. RATIONALE A partial thickness burn typically includes redness, severe pain, and blisters. In this case, the burn is a partial thickness burn. A superficial burn would not include blisters and a full thickness burn would be charred, dry, and white. A fourth-degree burn goes down to the bone, which has not occurred in this case.

You respond to the scene of an explosion. Your scene size-up indicates that this situation may have been an intentional terrorist incident. Your most immediate concern should be protecting yourself from a secondary device. containing the scene. beginning triage. notifying the appropriate law enforcement agencies.

protecting yourself from a secondary device. RATIONALE A secondary device is a very real threat in a terrorist-related explosion. Notifications, triage, and containment are all important elements, but should only be conducted after the scene has been deemed safe.

The Cincinnati Prehospital Stroke Scale is used to track the incidence of acute stroke in a system. identify the severity of stroke symptoms using 1-10 scale. rapidly assess the likelihood of acute stroke. determine the timing of acute stroke symptoms.

rapidly assess the likelihood of acute stroke. RATIONALE The Cincinnati Prehospital Stroke Scale is a system used to rapidly identify stroke signs and quantify the likelihood of acute stroke. To some extent, it does assess severity, but not by using a 1-10 scale. Assessing the timing will be an important assessment element, but is not part of this system. The Cincinnati Prehospital Stroke Scale does not track the incidence of stroke.

You notice that a series of difficult calls has produced an abnormal amount of work-related stress. You should pick up an additional shift to take your mind off the stress. work your way through it, because those feelings will pass. hide the signs of stress so your co-workers won't think you are weak. reach out to a supervisor and discuss your concerns.

reach out to a supervisor and discuss your concerns. RATIONALE Work-related stress can have a real, physiologic effect. In this case, you should reach out to a supervisor to obtain help in dealing with your stress. Stress happens to even the strongest providers, so you certainly should not be afraid to seek help. You should definitely not add more work or hide your feelings.

An electrician working on a dryer was thrown back after receiving an electrical shock. You notice a small burn on his hand, but no other injuries. The patient has bandaged his hand himself and does not wish to be transported. The most important reason to encourage this patient to be transported is potential traumatic injuries as a result of being thrown. potential nerve damage in his hand. the potential for cardiac complications. the risk of infection due to the burn.

the potential for cardiac complications. RATIONALE Electrical shock can lead to serious and life-threatening cardiac dysrhythmias. In this case, the patient should be transported for a cardiac evaluation. Infection and nerve damage are both possible, but not as immediately life-threatening as potential cardiac complications. Traumatic injuries are possible, but not apparent in this patient.

You are working on the scene of a highway motor vehicle crash. Traffic is moving past the crash site. In order to protect yourself, you should turn on the ambulance headlights so that oncoming traffic will be warned. position a provider to direct oncoming traffic and deploy road flares. use the ambulance's siren to warn oncoming traffic. wear a reflective vest and limit on scene time.

wear a reflective vest and limit on scene time. RATIONALE Highway scenes pose a tremendous risk to responders. Reflective clothing is a required protective measure, but should not be depended on alone to protect you. The best way to be safe is to also limit your time on scene and exposure to traffic. Personnel directing traffic are at high risk themselves and headlights in the face of oncoming traffic actually obscure vision and make the scene more dangerous. Sirens will be difficult to hear and are not a particularly effective warning device on a highway scene.

A patient diagnosed with bone cancer will typically experience what other problems? Cardiac emergencies Bone fractures Respiratory distress Gastrointestinal distress

Bone fractures RATIONALE A patient with bone cancer typically experiences pathologic fractures due to cancer weakening bone strength. In fact, in many patients, the first indication of bone cancer is when they fracture a bone unexpectedly. Respiratory, cardiac, or gastrointestinal findings may be present in a patient with bone cancer, but failure of these systems is likely due to a problem with that specific system.

A patient was a rear seat occupant in a vehicle that was struck from behind by a tractor-trailer that couldn't stop fast enough. There was significant external damage to the car with minimal passenger compartment damage. The patient sustained a vertebral injury. Given this mechanism, what region of the spine would most likely be injured? Lumbar Cervical Sacral Thoracic

Cervical RATIONALE The most common vertebral injury occurs in the cervical region. This is because the vertebrae here are relatively small and are subject to "whiplash" injuries due to the weight of the head with sudden acceleration or deceleration mechanisms. The thoracic region is least injured due to the articulation with the rib cage. The lumbar region is frequently injured while lifting and moving patients, and the sacral region is rarely injured since it is comprised of other bones that make up the strong pelvic girdle.

Your patient is a cross-country motorcycle racer who crashed his motorcycle into a group of trees. Although he was helmeted, he sustained blunt trauma to the anterior neck and is now dyspneic. Damage to what structure in the neck can cause airway occlusion and death to the patient? Mandible Larynx Cervical vertebrae Trachea

Larynx RATIONALE When looking at the anterior neck, the most prominent point is at the larynx (Adam's apple). When this structure is damaged from either blunt or penetrating trauma, the loss of structural integrity can cause airway swelling and closure at the glottic opening - the final common pathway for air to enter the lungs.

You are caring for a pediatric trauma patient who was not properly belted into her car seat and was thrown from the vehicle when it exited the road and rolled multiple times. Given what is known about pediatric trauma and pediatric arrest situations, if this patient does go into cardiopulmonary arrest, what is the most likely cause? Loss of airway patency Uncontrolled hemorrhage Spinal trauma Loss of vascular tone

Loss of airway patency RATIONALE Pediatric patients are resilient when it comes to trauma. They have very vigorous compensatory mechanisms to help combat various types of body disturbances from trauma. The one bodily function that results in the most immediate death in either a medical emergency or traumatic emergency is loss/failure of the airway and/or breathing components.

An 18 year old male has fallen 30 feet from a ladder. He is semi-conscious and breathing rapidly. You feel for a radial pulse but it is absent in both arms. He does have a carotid pulse. What does this finding most likely indicate? Low blood pressure Hypothermia Cardiac arrest Two broken arms

Low blood pressure RATIONALE Given the mechanism of injury and fast respiratory rate, an absent radial pulse most likely indicates a low blood pressure and hypotensive shock. Cardiac arrest can be immediately ruled out by the presence of a carotid pulse. Fractures and hypothermia can cause absent pulses, but both are less likely given this scenario.

A 16 year old female has fallen in front of her school. She complains of ankle pain. A crowd has gathered. What is the best strategy for assessing this patient? Move the patient into a common area inside the school building. Dismiss the crowd with a loud voice. Assess the patient where you found her. Move the patient to the ambulance and out of the view of the crowd.

Move the patient to the ambulance and out of the view of the crowd. RATIONALE The best strategy to obtain an accurate assessment of an adolescent is to respect their modesty and sensitivity to peer pressure. When possible remove the patient from the view of onlookers. In this case, the ambulance provides a semi-private area to complete your assessment and treatment.

An elderly male is complaining of fatigue, malaise, nausea, shortness of breath, and significant swelling of the ankles. All of these, he states, have developed over the past 12-24 hours. He has a history of MI, hypertension, diabetes, and prostate cancer. He takes blood pressure medication and aspirin daily. After oxygen therapy, what other medication might you administer? Nitroglycerin MDI Activated charcoal Aspirin

Nitroglycerin RATIONALE The patient with diabetes is not likely to experience chest pain from a heart attack because of nerve damage from his diabetes. As such, you will have to rely on other associated findings indicative of a coronary event such as dyspnea, weakness, and edema. After meeting protocols and following approval from medical control, you may administer a nitroglycerin tablet. The use of MDI or activated charcoal is not warranted for this presentation, and if the patient already takes aspirin daily, it is typically not re-administered.

During the insertion of an OPA in a patient with sonorous airway sounds, you witness your partner not properly size the device before insertion. Should the OPA inserted be too large, what would the likely complication to airway patency be? Oral trauma Under-ventilation Occlusion of the airway Tracheal collapse

Occlusion of the airway RATIONALE It is imperative the EMT properly sizes all airway adjuncts prior to insertion. In the case of an OPA that is too large, the likely complication is that the distal tip will rest too low in the hypopharynx and actually force the epiglottis to close over-top of the glottic (tracheal) opening. This will impede airflow into the lungs despite the airway holding the tongue anterior. Oral trauma typically results from aggressive insertion, regardless of size, and tracheal collapse occurs from loss of the cartilaginous support encircling the trachea. Under-ventilation can occur from an incorrectly sized OPA, but the question was inquiring as to what would happen to airway patency, not breathing sufficiency.

Of the following situations, which may be the most dangerous for the EMT to enter? Neighborhood drinking establishment for a "man down" One-car MVC on a heavily traveled freeway Crowded shopping mall on the day before Christmas Fight at a local high school in which police are already on scene

One-car MVC on a heavily traveled freeway RATIONALE Although any scene has the potential to be hazardous, and certainly all of the above provide some concern, the one that will require the EMT to exercise the most caution is the MVC on the heavily traveled freeway. Often traffic continues to move around the accident site. Those who pay more attention to the crash than the road, those not paying attention at all, and intoxicated drivers are all risks to the EMT at this scene.

A factory explosion on the outskirts of your EMS response area has injured 15 to 25 workers. According to protocols, the first unit in will implement the START Triage System. What are the assessment parameters that are used to determine patient placement into treatment sectors? Mental status, blood pressure, respiratory status Perfusion status, respiratory status, mental status Heart rate, respiratory rate, mental status, blood pressure Heart rate, mental status, blood pressure

Perfusion status, respiratory status, mental status RATIONALE The START Triage System uses the "RPM" mnemonic to help identify the specific assessment parameters used to classify patients. This stands for respiratory status, perfusion status, and mental status.

A 17 year old pregnant female presents with altered mental status. Her boyfriend notes she is 40 weeks pregnant with twins and states, "I can't wake her up." She presents confused and is flushed with obvious swelling in her hands and face. Her vital signs are P 90, R 28, and BP 200/112. What is the most likely immediate complication for this patient? Internal bleeding Seizures Stroke Imminent delivery

Seizures RATIONALE The patient's mental status, edema, and blood pressure indicate pre-eclampsia. The highest concern associated with pre-eclampsia would be the potential for eclamptic seizures. There is no indication of imminent delivery or internal bleeding. Stroke is possible, but less likely than seizures.

Arriving at the home of a patient who has chest pain, you are told that she has an automatic implanted cardiac defibrillator (AICD). After your assessment, you begin to gather a SAMPLE history. Before you finish, the patient loses consciousness. You determine she is apneic and pulseless. Of the following, which one is the most appropriate action to take? Contact medical control for orders. Wait for the patient's AICS to respond. Do CPR but do not connect an AED. Start CPR and attach an AED.

Start CPR and attach an AED. RATIONALE This patient should be treated like any patient who has gone into cardiac arrest. Immediately start CPR and connect the AED. If the patient's AICD responds while giving CPR, it poses no threat to caregivers. There is no need to contact medical control, that is time wasted. If the patient's AICD discharges and the patient returns to a rhythm, then your AED will determine that "no shock is advised."

A 21 year old female has open, midshaft fractures of her radius and ulna. Bleeding is severe. After applying direct pressure, which one of the following steps would be most appropriate to help control the bleeding? Apply an ice pack to the wound. Apply pressure to the distal radial artery pressure point. Place an occlusive dressing over the wound. Straighten and splint the arm.

Straighten and splint the arm. RATIONALE Splinting an open fracture can help control bleeding. Pressure points are believed to have limited effectiveness, but the distal radial artery is located below the point of the injury and therefore would be inappropriate anyway. Cold application could help, but not before splinting. An occlusive dressing would be of no use. This is a good example of a "best answer" question because the ideal answer would have been tourniquet but it was not a listed choice.

A patient has suffered a penetrating chest injury following an explosion at a construction site. You have applied an occlusive dressing to the wound and initiated PPV for ventilatory insufficiency. Shortly thereafter, the patient's heart rate increases, he becomes cyanotic, and the pulse ox drops. The patient is now totally unresponsive and he is difficult to ventilate. What is the most likely reason for this patient's acute deterioration? Flail segment Atelectasis Cardiac tamponade Tension pne

Tension pneumothorax RATIONALE Due to the proximity of the lung tissue to the thoracic wall, a penetration injury through the thorax will also commonly perforate the lung. During ventilation, airflow can exit the damaged lung and start to occupy space within the pleural cavity. With the occlusive dressing applied externally there is no way for the air to escape, so the patient' s pulmonary function continues to deteriorate. Atelectasis is when you have alveolar or lung collapse (but not necessarily a tension pneumothorax), cardiac tamponade will not result in difficulty in ventilating the patient, and a flail segment is commonly from blunt trauma and not penetration injury.

During the assessment of a 17 year old female patient with abdominal pain and flank bruising, you are gathering the SAMPLE history and OPQRST findings. If you suspect that the patient is suffering from an ectopic pregnancy, who is the best person to direct these and other questions to? The grandparents The parent The patient The patient's boyfriend

The patient RATIONALE As soon as the patient is old enough to understand the questions and respond appropriately, they should be the preferred source for all information regarding the current situation (i.e. SAMPLE and OPQRST). Since the patient is a minor, the parents may want to help, but only rely on them for information not known by the patient. The use of grandparents or her boyfriend would be stepping backward in the specificity and correctness of the information learned during the assessment.

Your patient states he has asthma. Asthmatics can develop wheezing. Which of the following best describes the progression of wheezing as the patient's condition worsens? Wheezing will be heard on exhalation only, just louder and louder. Wheezing will be heard initially on exhalation. Eventually the wheezing will be heard on inhalation and exhalation. Inhalation wheezing will be eventually followed by exhalation wheezing. Wheezing will be very loud initially on inhalation. Over time it will b

Wheezing will be heard initially on exhalation. Eventually the wheezing will be heard on inhalation and exhalation. RATIONALE The wheezing sound is created by turbulent airflow from bronchoconstriction and irregularities to the lumen of the bronchioles. During exhalation, airflow exits the lungs with lower velocity (due to passive exhalation). Therefore wheezing is more likely to present with minimal bronchoconstriction. During inhalation when the air is moving with higher velocity, the bronchioles open up slightly and wheezing may not be heard initially. However, once the degree of bronchoconstriction becomes severe enough, then the patient will wheeze during both the exhalation and inhalation phases.

A 70 year old female complains of acute onset pressure in her jaw. She denies pain but notes the discomfort radiates into her neck. She is alert and her vital signs are P 90, R 20, and BP 160/68. You should administer aspirin and initiate transport. attach the AED. refer this patient to her dentist. request ALS and await their arrival.

administer aspirin and initiate transport. RATIONALE Myocardial infarction pain can present atypically and commonly is described as pressure or discomfort. In this case, you should initiate transport and administer aspirin. ALS care might be necessary, but you should not delay transport waiting for their arrival. An AED should not be attached to a conscious patient.

A 50 year old male has suffered a deep laceration to his leg in an industrial accident and has lost a great deal of blood. You initiate hemorrhage control and stop the bleeding with a pressure dressing. You should next administer high-concentration oxygen via non-rebreather mask. complete a rapid trauma assessment. wrap the patient in blankets to retain body temperature. initiate rapid transport.

administer high-concentration oxygen via non-rebreather mask. RATIONALE Blood loss is a clear indication for supplemental oxygen administration. Rapid transport and temperature regulation will be essential, but only after administering oxygen. Completing a trauma assessment also will be important, but only after completing the necessary interventions as dictated by the primary assessment.

You are first on scene at a motor vehicle crash involving multiple vehicles. After ensuring that the scene is safe, you should begin treating patients. move the injured patients to a treatment sector. attempt to determine what additional resources are necessary. attempt to determine the cause of the motor vehicle crash.

attempt to determine what additional resources are necessary. RATIONALE Assessing the need for additional resources is an essential element of the scene size-up and should be completed immediately. Treatment will occur after adequate resources have arrived. Movement of patients will come much later. Although it may be important to assess the forces that caused the crash, that is not a higher priority than obtaining adequate resources.

A 26 year old male crashed his motorcycle and was found unconscious on the ground. You notice he is not breathing and has blood coming from his mouth. You should first open the airway with a jaw thrust. perform a finger sweep. suction the airway. begin positive pressure ventilation.

suction the airway. RATIONALE Although this patient needs an open airway, positive pressure ventilation, and possibly even CPR, the airway must first be cleared. Opening the airway when there is frank blood present will cause that blood to enter the lungs. A finger sweep may be necessary if foreign objects are present, but the most immediate step to take is suction.

You are caring for a patient who was thrown off a motorcycle when it struck a car. The patient was not wearing a helmet. Currently, the patient has a GCS of 10, a spontaneous respiratory rate of 28/minute, a systolic blood pressure of 96 mmHg, and a heart rate of 110. Based on this information, the patient's computed Revised Trauma Score would be 7. 5. 11. 9.

9. RATIONALE The Revised Trauma Score (RTS) is based on the patient's systolic blood pressure, spontaneous respiratory rate, and Glasgow Coma Score. A score of 0 - 4 may be given for each of the three areas. Total scores may range from 0 to 12. In this case: Respiratory rate of 28/min = 4Systolic blood pressure of 96 mmHg = 4GCS of 10 = 3 The patient has an RTS of 11.

You are assessing a male patient with COPD and respiratory distress. The patient displays nasal flaring, tripod positioning, absent basal breath sounds, and tachypnea. Of these findings, which is most suggestive of inadequate breathing? Absent basal breath sounds Nasal flaring Tachypnea Tripod positioning

Absent basal breath sounds RATIONALE There are a number of findings that are consistent with respiratory distress, regardless of etiology. However, if the EMT is trying to determine if the patient is breathing adequately or not, they need to assess the quality of air exchange. This is best determined by the presence or absence of alveolar breath sounds. The other findings are indicative of the body working harder to breathe, but they do not alone confirm the patient is breathing adequately or not.

After a particularly bad call involving a pediatric trauma arrest, you notice your partner is extremely agitated, sweating, verbally aggressive, and pacing about the station muttering to himself. These findings may be indicative of what kind of stress reaction? Delayed Cumulative Progressive Acute

Acute RATIONALE Acute stress reactions are most often manifested in care providers after a particularly difficult call, especially if it involves pediatric patients, family members, or situations in which maximal effort was expended but the desired patient outcome was not realized. Stress that accumulates over time has a more random presentation or may affect all aspects of the provider's life (home, work, leisure, etc.).

A 29 year old female has been ejected from a vehicle during a high-speed motor vehicle crash. She is found unconscious, and you note an unstable pelvis. Her vitals are P 130, R 38, and BP 60/44. What is the most appropriate method to splint her pelvis? Place pillows on either side of her pelvis Use straps to fixate her legs together Place a pillow beneath her knees Apply and inflate the pneumatic anti-shock garment (PASG).

Apply and inflate the pneumatic anti-shock garment (PASG). RATIONALE The pneumatic anti-shock garment (PASG) can be used quickly and effectively to immobilize a pelvis. Methods using pillows and straps may be effective, but generally take longer and are less effective than the PASG.

You are called to a childcare center for a 10 year old boy with a quick onset of respiratory distress. You find the patient sitting on a step in a tripod position. The patient can only speak in short sentences and is using accessory muscles to breathe. You learn from the care providers that the patient has a respiratory disease that requires the occasional use of a metered dose inhaler, which they have tried with no success. The child displays wheezing in all lung fields, a nonproductive cough,

Asthma RATIONALE The age of the patient, the presence of wheezing, the history of a pulmonary disease treated with a metered dose inhaler, and chest "tightness" are all consistent findings of asthma. Pneumonia will have a slower onset including fever and malaise. Emphysema is more consistent with late adulthood and elderly patients. Bronchiolitis is seen more frequently in younger patients, typically less than two years of age.

You respond to a business office where a 50 year old male is having difficulty breathing. Upon arrival you find him sitting in a chair with cyanosis around the lips, fatigue, and extreme diaphoresis. When he speaks, he uses only one- or two-word sentences, and he appears to be extremely anxious. Based on this information, which device is probably best for administering oxygen? Venturi mask Non-rebreather mask Bag-valve mask Nasal cannula

Bag-valve mask RATIONALE This patient appears to be in acute respiratory distress that is rapidly progressing to failure. Therefore, you should provide ventilatory assistance with a bag-valve mask using an oxygen reservoir. The other three devices will deliver varying amounts of oxygen; however, based on how poorly the patient is breathing, they will not be effective at getting the oxygen to the alveoli.

Epinephrine is a medication administered to a patient who is experiencing an acute allergic reaction due to its alpha and beta effects. One side effect is cardiac irritability and tachycardia. What property of epinephrine is responsible for this? Beta1 Beta2 Alpha1 Alpha2

Beta1 RATIONALE Epinephrine is the drug of choice for acute allergic reactions due to its ability to reverse some of the bronchoconstriction (beta2 effect), and airway swelling and systemic hypotension (alpha1 and alpha2 effects). However, the beta1 effect of epi causes an increase in cardiac heart rate and force of contraction which may be detrimental should the patient not be oxygenating the myocardium well. This is why epi is used with caution if the patient is over 30 years of age.

Your patient is a 32 year old hunter who has fallen from a tree. You perform a physical examination and find his vital signs are P 140 and thready, R 30 and shallow, and BP 80/50. His skin is pale and cool. Which one of the findings indicates that this patient is in decompensated shock? Skin color and temperature Blood pressure Respiratory rate Pulse rate

Blood pressure RATIONALE Decreasing blood pressure is a late sign of shock that indicates this patient is decompensating. Rapid pulse and increased respiratory rate are usually an indication that the patient is in compensated shock. The skin condition, color. and temperature indicate shock but not necessarily decompensated shock.

A 20 year old male has been rescued from a fire. He complains of a headache and shortness of breath. Your pulse oximeter reads 95%. Why might the pulse oximeter be inaccurate in this situation? Carbon dioxide might be occupying the hemoglobin. The patient might be hyperventilating. The patient might be hypothermic. Carbon monoxide might be occupying the hemoglobin.

Carbon monoxide might be occupying the hemoglobin. RATIONALE Smoke inhalation can cause high levels of carbon monoxide in the blood. Those molecules can take up space on the hemoglobin in the place of oxygen. The pulse oximeter does not differentiate between oxygen and carbon monoxide and therefore can give a false reading. The pulse oximeter does not measure carbon dioxide, so high or low levels (as would be the case with hyperventilation) should have no effect on oximetry readings. Hypothermia can affect the accuracy of oximetry, but in this case, carbon monoxide is the more likely problem.

When requesting a helicopter to your emergency scene the flight program will need certain information before launching an aircraft to your location. Of the following, which is the LEAST useful bit of information that the dispatcher from the flight program will need from you? Radio frequency for communication EMS department name Location of landing zone, and nearby hazards Nature of incident

EMS department name RATIONALE All the above-mentioned information is going to be asked by the flight program dispatcher. However, in terms of information importance in order to get the helicopter to your scene and assure a safe and smooth transition, the nature of incident, landing zone coordinates with hazards, and radio frequency will best prepare the helicopter crew to safely land at your location. Although the EMS department name is important for the dispatcher, it does not have a large impact on the ability of the flight crew to land at your scene. From the air, the flight crew will be able to spot the emergency vehicles - not the name written on the side of the ambulance.

Your patient is complaining of severe respiratory distress and has trouble speaking in full sentences. He makes it obvious through hand gestures and shaking his head "yes" to you that he wants your help. What type of patient consent would this legally fall under? Non-verbal consent Implied consent Informed consent Expressed consent

Expressed consent RATIONALE If the patient makes gestures indicating they want your help (hand gestures, nodding head, etc), the type of consent being employed is "expressed". It may use non-verbal cues to do so, but it is still expressed consent. Informed consent is when the patient first agrees to every step of your care prior to you doing it. Implied consent is applicable to an unresponsive or confused patient who cannot make relevant or reliable judgments regarding their care due to an altered mental status.

A 19 year old male complains of fever, sweating, and persistent cough for one week. He is currently not coughing. While treating this patient, which one of the following would be the most appropriate level of personal protection? Gloves Eye protection HEPA mask Gown

HEPA mask This patient's symptoms point to the possibility of tuberculosis. To best protect yourself from this disease, respiratory protection is necessary. Gloves and gowns protect EMTs from contact exposures but do not address the respiratory route. Eye protection prevents particles from entering the eye but also does not provide respiratory protection.

Which one of the following reasons explains why you might have a higher index of suspicion for spine injury in a pregnant female compared to a nonpregnant female? Hormones released during pregnancy cause ligaments to stretch. The spinal column is stretched during pregnancy. A large fetus makes falling backward more likely. Hormones released during pregnancy cause bones to become more brittle.

Hormones released during pregnancy cause ligaments to stretch. RATIONALE Hormones secreted during pregnancy allow ligaments to stretch more than usual. This makes all joints, including the joints of the vertebrae, more vulnerable to subluxation and dislocation. Bones do not become brittle during pregnancy and the spinal column does not stretch more than usual. Perhaps a fetus might make falling backward more common, but this should not be a reason for an increased incidence of spine injuries.

You are assigned to work with a new partner. As you check the ambulance he tells you that he prefers to leave the portable oxygen tank out of its normal rack and on the bench seat so it is easier to grab from the outside. Which one of the following would be the most appropriate response? I am not comfortable leaving equipment unsecured in the patient compartment That's fine. That's fine, I'll secure it if we load a patient. Only if we place the jump bag next to it to keep it in place.

I am not comfortable leaving equipment unsecured in the patient compartment RATIONALE All equipment should be secured in the ambulance. Convenience is not a reason to create a safety hazard. In this case, you should tell your partner that you are uncomfortable with his practice

What detrimental side effect occurs at the cellular level when the body's metabolism shifts from aerobic to anaerobic metabolism? Creation of high levels of ATP that damages cellular walls Lactic acid production Hyperactivity of sodium/potassium pump Diminished liberation of lysosomal enzymes

Lactic acid production RATIONALE In hypoperfusive states, the body cannot meet the metabolic demands of tissue cells and there is a shift from aerobic to anaerobic metabolism that results in acidosis, low levels of ATP, failure of the sodium/potassium pump, and liberation of damaging enzymes inside the intracellular lysosomes. All of these cellular changes, including acidosis, hasten cellular death.

A 70 year old female is complaining of chest pain and shortness of breath. Which one of the following detailed assessment findings might be relevant to her current condition? Normal distal sensory and motor function Pedal edema Bruising on her forearms Equal and reactive pupils

Pedal edema RATIONALE Pedal edema often indicates a previous history of congestive heart failure. This is a relevant finding given her current chest pain. Good sensory and motor function and pupil reactivity are important, but not specifically related to the current chief complaint. Arm bruising is not likely to be a related finding.

A pediatric patient with a history of epilepsy is experiencing a grand mal seizure. Upon your arrival the patient is still seizing, is ashen in color, his jaw is clenched shut, and it appears as if there is vomit escaping from between his teeth. During what phase of a seizure will you most likely be able to clear the airway of these secretions? Postictal Clonic Aura Tonic

Postictal RATIONALE Other than trying to suction the airway out with a flexible catheter through the nasopharynx, the EMT will have to wait till the seizure is over and the patient is in the postictal phase. The aura phase is the hallmark that the seizure is about to begin, and during the tonic and clonic phases, there is ongoing muscular contraction alternating with relaxation (the jaw will likely still be clenched).

Which one of the following is a sign of left-sided heart failure? Pulmonary edema Abdominal edema Sacral edema Pedal edema

Pulmonary edema RATIONALE As a result of damage to the left side of the heart, blood backs up into the lungs. This may be auscultated as crackles or rales in the lungs. When the right side of the heart is in failure and not pumping properly, then fluid backs up in the abdomen, lower extremities (pedal edema), and lower back (sacral edema).

A patient presents with dyspnea, accessory muscle use, a diminishing pulse ox reading on oxygen, chest pain, inspiratory rales, and tripod positioning. He states that the trouble breathing started before the chest pain. He has a history of heart failure and hypertension. This patient is likely experiencing what respiratory emergency? Bronchitis Pulmonary edema Asthma Cardiogenic shock

Pulmonary edema RATIONALE Given the history and presentation, the patient is likely going into pulmonary edema secondary to heart failure. The fact the dyspnea started prior to the chest pain suggests that poor oxygenation is now stressing the heart. Asthma and bronchitis are both pulmonary conditions, but typically do not present with rales. Finally, the patient may go into cardiogenic shock, but this is not a respiratory emergency - it is a cardiac emergency.

A patient with chest pain is being evaluated and tells you the pain is sharp and feels like it is cutting through his chest. What letter of the mnemonic OPQRST does this answer? Q P T S

Q RATIONALE In the mnemonic OPQRST, "Q" stands for quality and how the patient describes the pain. "P" stands for provoke, and what triggers the pain. "S" stands for severity, which is usually evaluated on a 10-point scale. "T" stands for time, or when the pain started.

During the assessment of a patient with chest pain from a suspected heart attack, he describes the pain as "dull" and "heavy" in nature. This description best serves as the answer to what question in the OPQRST history? Radiation Severity Quality Provocation

Quality RATIONALE The "quality" of the pain is the description of the type of pain per the patient, usually given in adjectives (e.g. crushing). Severity utilizes a 1-10 scale to rate the pain, whereas radiation answers the question as to if the pain moves anywhere else in the body. Finally, Provocation refers to what makes the pain worse, or agitates it.

A 24 year old suspected overdose patient is found lying on the floor of his apartment. He is unresponsive with slow labored respirations. When you attempt to insert an oropharyngeal airway (OPA), the patient gags. What is the most appropriate next step? Leave the OPA and suction. Remove the OPA. Flex the head forward . Pull the OPA back a little.

Remove the OPA. RATIONALE An OPA is used only in a patient who does not exhibit a gag reflex. When a patient does start to gag, the OPA should be removed immediately. Pulling the OPA back or leaving the OPA in place with suctioning will resolve the gagging but may cause vomiting (a significant airway obstruction). Flexing the head forward is inappropriate because it can cause additional blockage of the airway.

You are caring for a neonate who you suspect is severely depressed and in need of aggressive resuscitation. Which of the below clinical findings would support your suspicion? Cyanotic extremities with pink core Respiratory rate 64/minute Heart rate 172/minute APGAR score of 6

Respiratory rate 64/minute RATIONALE Although the assessment of the baby and determination of clinical status should take into consideration multiple measures, there are some clinical findings that are so significant they can individually infer that the baby's status is critical. In this situation, the respiratory rate >60/min a sign of criticality. Although the other findings of the APGAR, skin findings, and heart rate are abnormal for a newborn, they are not individually representative of neonatal criticality.

You have just completed your emergency vehicle operation program for the local EMS service you work for. When you come in for your next shift, you are assigned an EMS intern who asks you about this class, and wants to know what the class is about. Of the following statements, which would be the most accurate in describing such a class? To ensure that you always take the shortest route to an emergency. The primary goal is to learn how to always arrive safely at your destination. The purpose is

The primary goal is to learn how to always arrive safely at your destination. RATIONALE The ability and responsibility for driving an ambulance under emergency conditions should never be taken lightly. To help better prepare new providers, most EMS systems have some type of course that includes hands-on learning about how to operate an ambulance "on the red." The goal for these courses is always to arrive at the destination safely. This may include selecting a route, dealing with other drivers on the road, and that ambulances handle differently than cars - but all these factors play a collective role, not individual roles, in arriving at the scene safely.

After finishing a radio report detailing your chest pain patient, the medical control physician instructs you to administer nitroglycerin. The patient does not take this medication, and in your state EMTs do not administer it. However, the medication is carried on your ambulance for use by paramedics. In this case, administering nitroglycerin would be a violation of your scope of practice appropriate only if the patient had clear indications. acceptable because your were directed by a physici

a violation of your scope of practice. RATIONALE In this case, giving the medication would violate your scope of practice. Although physician medical control is always helpful, it cannot direct you to conduct activities that you have not been trained to do. Although the patient might have the indications and agree, this medication should not be administered.

An 81 year old diabetic female presents with altered mental status. She is conversational but confused as to where she is. She is pale and diaphoretic and her blood glucose is 62 mg/dL. You should first initiate rapid transport. apply high concentration oxygen via non-rebreather mask. complete a detailed assessment to look for potential injuries. administer a tube of oral glucose.

administer a tube of oral glucose. RATIONALE Administration of oral glucose would be the most important priority as her blood glucose level identifies hypoglycemia. It may not be profoundly hypoglycemic but it is symptomatic. Transport may be indicated, but glucose administration may resolve the problem immediately. Oxygen and a detailed assessment are appropriate, but not before glucose.

An 18 month old female has had a tonic-clonic seizure. You note the child is lethargic, flushed, and hot. The mother states she has had ear pain for the last eight hours. Her vital signs are P 122, R 28, and BP 94/52. Treatment of this patient should include administration of high flow oxygen via non-rebreather mask. administering cool fluids by mouth. immersing the patient in a 96-degree cool bath. placing cold packs on her groin and axilla.

administration of high flow oxygen via non-rebreather mask. RATIONALE This patient likely had a febrile seizure. More assessment would be necessary, but given the fact she had a tonic-clonic seizure and is still lethargic, oxygen would be most appropriate. It would be inappropriate and potentially dangerous to use a cool bath or cold packs. Cool fluids by mouth might help later, but not as long as her mental status is diminished.

A 31 year old male is being arrested by police. As you arrive, police officers are attempting to restrain the patient in order to place him in handcuffs. The patient is extremely combative and is fighting with great force. As the struggle continues, one of the officers says, "I don't think he is breathing." A respiratory arrest in this type of situation is most likely associated with an underlying respiratory problem. officers choking the patient. agitated delirium. a reaction to pepper spray.

agitated delirium. RATIONALE Agitated delirium occurs in a small number of patients who exhibit abnormal agitation and combativeness, particularly when being restrained. Respiratory arrest is unusual but can occur. It would be unlikely that officers choked the patient to the point of respiratory arrest and nothing in the question points to this happening. Pepper spray does not typically cause any such type of reaction. The patient could have an underlying respiratory problem, but in this case, agitated delirium is the more likely presentation.

A 90 year old female is complaining of sharp, steady abdominal pain. When you palpate her abdomen, you feel a pulsating mass in the lower left quadrant. This finding most likely indicates a(n) bleeding ulcer. enlarged spleen. bowel obstruction. aortic aneurysm.

aortic aneurysm. RATIONALE Pain and a pulsatile mass indicate an aortic aneurysm. A bowel obstruction typically presents with waxing and waning pain. An ulcer can cause pain but does not typically cause a mass. An enlarged spleen might cause a mass, but would not typically be able to be palpated.

A 35 year old male has lacerated his upper thigh with a chain saw. The wound is bleeding profusely. He has no other obvious injuries. You should first apply direct pressure with a clean dressing. apply a tourniquet. cut away clothing to expose the wound. apply a pressure bandage.

apply direct pressure with a clean dressing. Direct pressure is the place to start. Unless clothing directly interferes with direct pressure there is no need to expose immediately. A pressure bandage may help, but bleeding control should be attempted with direct pressure first. If this fails, a tourniquet should then be utilized.

A 6 year old male is ventilated through a home respirator. You were called today because his oxygen saturations have been low. As you assess the patient, you notice many secretions in his tracheostomy tube and gurgling on inhalation. You should contact medical control for instructions on suctioning a tracheostomy tube. attempt to suction the tube using a standard rigid suction catheter. use positive pressure ventilation to clear the tracheostomy tube. ask the patient's parents to assist you

ask the patient's parents to assist you with suctioning the tracheostomy tube. RATIONALE The patient's parents are the best source of information on how to suction the patient's tracheostomy tube. They will likely have the knowledge and appropriate equipment. Medical control might help you, but the parents are likely a better, more immediate source of information. A rigid suction catheter will not fit in a tracheostomy tube and the tube should be suctioned prior to initiating positive pressure ventilation.

Your scene size-up reveals a hazardous gas has been accidentally released. You stage away from the scene at an appropriate distance but can visualize the damaged tank truck. You should next begin evacuation of vehicles downwind from the accident. attempt to visualize and count any injured patients. attempt to identify the hazardous-materials placards on the tank truck. contact dispatch to warn other responders of the hazard.

contact dispatch to warn other responders of the hazard. RATIONALE A scene size-up is used to identify safety hazards. Here you have to take steps to protect yourself first, but then you must take steps to protect other responders. You should immediately notify dispatch and warn other incoming units. Evacuation will be important, as will triage and hazard identification, but the immediate priority will be the safety of fellow responders.

You are called to respond for a 74 year old male having chest pain. On arrival, the patient greets you at the door and tells you he is fine and does not need help. You note, however, that he is sweaty, pale, and gripping his chest. You should have the patient's wife contact his family physician. leave the scene because the patient does not want your help. discuss with the patient your concerns based on your scene size-up. have the patient sign the appropriate refusal documents and leave.

discuss with the patient your concerns based on your scene size-up. RATIONALE The scene size-up reveals signs that should concern you. Diaphoresis, pale skin, and the patient clutching his chest all indicate a more serious condition. Before leaving, you should certainly discuss those concerns with the patient. The patient may still refuse and if so, he should sign the appropriate paperwork, but be sure to discuss the risks and your recommendations first. The family physician might help, but it is likely that he would only reinforce the concerns you already have.

A 1 year old male has had a fever for three days and now has developed wheezing and severe respiratory distress. You notice his skin is hot and cyanotic around the lips. The patient suddenly begins to seize. The most likely cause of the seizure in this patient would be epilepsy. toxic ingestion. fever. hypoxia.

hypoxia. RATIONALE This child's history and the cyanosis at his lips point to hypoxia as the most likely cause of this seizure. Fever often causes seizures in children, but given the findings, hypoxia is more likely. Epilepsy and toxic ingestions also cause seizures but are improbable under these circumstances.

A 12 year old male has injured his knee after a minor bicycle crash. He is alert and complains only of knee pain. After completing your primary assessment, you should initiate rapid transport. complete a rapid trauma assessment. complete a detailed physical exam. initiate a focused examination of the patient's knee.

initiate a focused examination of the patient's knee. RATIONALE Although this patient has an injury related to trauma, the mechanism is not significant and his injuries are limited to his leg. Therefore, you should initiate a focused assessment of his extremity after finalizing the primary assessment. Rapid transport is most likely not necessary. A rapid trauma assessment would be used for a patient with a more significant mechanism of injury or more severe actual injuries. A detailed assessment can be completed after the focused examination. PREVIOUS

An 18 year old female tells you that she has ingested 48 amitriptyline pills. She notes she was trying to harm herself and took the pills about 20 minutes ago. She is alert and her vital signs are P 120, R 20, and BP 100/60. You should first induce vomiting. contact poison control. request ALS and await their arrival. initiate transport immediately.

initiate transport immediately. RATIONALE Overdose and intentional ingestion patients can decompensate rapidly. You should initiate immediate transport. Poison control and ALS will be very important, but should not delay moving this patient toward the hospital. Inducing vomiting is only appropriate under very specific circumstances and is not a common treatment.

A 64 year old male complains of steady abdominal pain radiating across both upper quadrants. He also complains of nausea. His vital signs are P 100, R 20, and BP 158/90. Given his presentation, you should first administer antacids to treat the nausea. conduct a thorough patient history to identify prior medical conditions. initiate transport to rule out acute myocardial infarction. examine the abdomen more carefully to determine the cause of the pain.

initiate transport to rule out acute myocardial infarction. RATIONALE Myocardial infarction should always be a consideration with abdominal pain. More assessment is important, including medical history and physical exam of the abdomen, but should be done after transport is initiated. Keep in mind that time is of the essence in the treatment of an acute myocardial infarction. Antacids should not be administered.

The appropriate technique for splinting a midshaft tibia/fibula fracture is to immobilize the fracture and the joint below it. site of the fracture. fracture and the joint above it. joint above and below the fracture.

joint above and below the fracture RATIONALE Proper splinting technique requires immobilization of the fracture site plus the joint above and below the site of the injury. Because the movement of the joints often moves the articulating bone, immobilizing just the fracture site could allow for movement of the fractured bones. Similarly, immobilizing just one joint could allow for excessive movement.

The most important benefit of a unified command would be assigning one overall commander to oversee all agencies. allowing different chiefs to make decisions independently. allowing more than one agency to design tactics for dealing with an incident. preventing more than one set of tactics at a single incident.

preventing more than one set of tactics at a single incident. RATIONALE A unified command prevents multiple agencies from developing competing plans and tactics. It is designed to allow multiple agencies and chiefs to make decisions in a unified manner and develop one overall set of tactics for dealing with a large-scale incident. In unified command, more than one agency will share the overall command of an incident.

You are working at a multiple casualty incident. Your assignment is secondary triage. Your responsibilities would likely include requesting additional resources. identifying the number of initial patients. rapidly assigning an initial priority of treatment for all patients. reassessing previously triaged patients to account for patient deterioration.

reassessing previously triaged patients to account for patient deterioration. RATIONALE Secondary triage is typically an opportunity to review the triage that has been previously completed. Typically, a primary pass through will have been completed and now you are looking for patient deterioration or issues not seen on the initial review. Typically, numbers and priorities have already been assigned. Resource allocation is the responsibility of the incident commander.

You arrive first on the scene of a serious motor vehicle crash. You observe a minivan with massive front end damage and four people inside the vehicle. As you complete your scene size-up, you should first triage the four minivan patients. begin treating the most injured patient. notify the local trauma center. request extrication resources.

request extrication resources. RATIONALE Rescue resources should be contacted first to account for response times and because extricating patients can take additional time. Activating resources immediately will minimize the effect of time. Notification of the hospital will be important, but is not as time sensitive as activating extrication resources. Triage and treatment can be accomplished after resources are requested.

You are on the scene of a multiple casualty motor vehicle crash. You have just loaded a patient who had severe bleeding. Your partner now asks you to assist him with a patient who has stopped breathing. You should first return to the ambulance to change your gloves. use an alcohol-based cleanser to clean the soiled gloves. initiate care on the second patient as long as there is no visible blood on your gloves. remove your soiled gloves and initiate care on the second patient.

return to the ambulance to change your gloves. RATIONALE You should always change gloves between patients. In this case, care must be slightly delayed so that you can take the important steps necessary to protect yourself. Gloves should never be cleaned or reused because the integrity and cleanliness cannot be guaranteed.

A 7 year old male has been stung in the leg by a bee. He complains of pain. You note redness and slight edema at the site. You also note the stinger is still in place at the site of the sting. You should administer an epinephrine auto-injector. apply a cold pack on top of the sting. scrape the stinger away with a credit card. remove the stinger with tweezers.

scrape the stinger away with a credit card. RATIONALE The stinger should be scraped away before covering the site. Using tweezers would not be correct because squeezing the stinger often injects further toxins. A cold pack would be helpful after removing the stinger. An auto-injector is not yet indicated.

A 28 year old female has ingested about 30 unknown pills. She is semiconscious and her vital signs are P 128, R 12, and BP 88/40. Poison control notes that activated charcoal should be administered. In this case, charcoal is contraindicated because she has an altered mental status. her blood pressure is too low. the pills are unknown. her breathing is too slow.

she has an altered mental status. RATIONALE Altered mental status is a contraindication to the administration of activated charcoal because she could aspirate if the charcoal caused vomiting. It may be given to a patient with low pressure and in the instance of unknown pill ingestions. Her respiratory rate is troubling but does not necessarily rule out charcoal administration.

Your service's quality improvement (QI) committee asks you to discuss a recent run. This means something about that run needs to be discussed to improve quality of care. a patient must have lodged a formal complaint regarding either you or your partner. you obviously have done something wrong. there has been a protocol violation and you will be disciplined.

something about that run needs to be discussed to improve quality of care. RATIONALE Quality improvement involves the discussion of issues pertaining to improving care. Being involved in a quality improvement process does not necessarily mean you have done something wrong or that you are being disciplined. As a professional, you should accept quality improvement as a process designed to make you better at what you do.

An EMT applies a traction splint upside down. By doing this he has violated his duty to act. advance directive. standard of care. scope of practice.

standard of care. RATIONALE The standard of care refers to what another similarly trained provider would do under the same circumstances. By putting the splint on upside down, the EMT has violated the standard of care. The duty to act defines why the EMT is there. The scope of practice defines the types of skills he is able to perform. An advance directive refers to orders given about end-of-life care.

A 72 year old male patient is found in cardiac arrest. The family on scene states that the patient did not wish to be resuscitated and asks you not to start CPR. There is no "do not resuscitate" order. You should contact law enforcement to remove the family. ask the family to sign a "do not resuscitate" order. start resuscitative efforts. honor the family's wishes and not start CPR.

start resuscitative efforts. RATIONALE Although the patient may have expressed his wishes to the family, the lack of a "do not resuscitate" order requires resuscitative efforts. Typically, a "do not resuscitate" order requires the patient's signature and as the patient is now in cardiac arrest, he is unable to complete that requirement. Removing the family from the scene would likely cause more harm than good.

A 72 year old patient has a severe nosebleed. The patient begins to cough and choke. This airway compromise is possible because the patient is unable to breathe through his nose. blood is passing through the nasopharynx. air can no longer be humidified by the nose. the patient has an additional breathing disorder.

the patient is unable to breathe through his nose. RATIONALE In this case, airway compromise is possible because blood is moving from the nose into the airway through the nasopharynx. The patient may not be able to breathe through his nose, but that usually is not a cause of airway compromise. The nose does humidify the air, but a lack of humidification would not likely cause harm. The patient may have a secondary breathing problem, but the blood would be the more likely culprit.