EMT REVIEW EXAM 2

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

11.

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?

Bag-valve mask

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

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?

Cervical

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?

Expressed consent

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.

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

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

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 to the ambulance and out of the view of the crowd.

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

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?

Occlusion of the airway

Of the following situations, which may be the most dangerous for the EMT to enter?

One-car MVC on a heavily traveled freeway

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?

Pedal edema

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

Why does tension pneumothorax lead to shock?

Pressure built up in the pleural space compresses the heart.

Which one of the following is a sign of left-sided heart failure?

Pulmonary edema

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?

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?v

Start CPR and attach an AED.

Which one of the following would be an injury limited to medium- and high-velocity penetrating trauma?

Temporary cavity

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?

Tension pneumothorax

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 should be considered dangerous

Which one of the following best describes why abnormally fast heart rates cause a drop in cardiac output?

The heart does not have enough time to fill between beats.

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?

The heart is not pumping effectively.

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 patient

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.

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.

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.

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)

aortic aneurysm.

You are first on scene at a motor vehicle crash involving multiple vehicles. After ensuring that the scene is safe, you should

attempt to determine what additional resources are necessary.

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

contact dispatch to warn other responders of the hazard.

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

initiate transport to rule out acute myocardial infarction.

The appropriate technique for splinting a midshaft tibia/fibula fracture is to immobilize the

joint above and below the fracture.

bleeding. Your partner now asks you to assist him with a patient who has stopped breathing. You should firs

return to the ambulance to change your gloves.

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

the potential for cardiac complications.

Before inserting a nasopharyngeal airway you should measure it from the

tip of the nose to the earlobe.

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

wear a reflective vest and limit on scene time.

At what rate should you ventilate an apneic patient who still has carotid and radial pulses?

12 times per minute

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%

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?

A

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

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

Which one of the following would be considered a significant mechanism of injury?

A 3 year old male falls 11 feet without loss of consciousness

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

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?

Acute

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?

Apply and inflate the pneumatic anti-shock garment (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, and says his chest is "tight". This presentation is most consistent with what pulmonary disease?

Asthma

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

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?

Blood pressure

A patient diagnosed with bone cancer will typically experience what other problems?

Bone fractures

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 monoxide might be occupying the hemoglobin.

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. Which of the following is most likely this patient's problem?

Dehydration (shock)

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?

EMS department name

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?

Embryonic stage

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?

HEPA mask

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

Which one of the following reasons best indicates the importance of suctioning the nose of an infant in respiratory distress?

Infants rely upon their nose to breathe more than do adults.

Which one of the following uses negative pressure to move air?

Inhalation

What detrimental side effect occurs at the cellular level when the body's metabolism shifts from aerobic to anaerobic metabolism?

Lactic acid production

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?

Larynx

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?

Perfusion status, respiratory status, mental status

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

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

Pulmonary edema

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

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?

Quality

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?

Remove the OPA.

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?

Respiratory rate 64/minute

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?

Straighten and splint the ar

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

The primary goal is to learn how to always arrive safely at your destination.

Which one of the following best describes why blind finger sweeps should be avoided in pediatric obstructed airway procedures?

The upper part of the trachea is funnel-shaped in pediatric patients.

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?

Unstable

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 uphill

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 initially on exhalation. Eventually the wheezing will be heard on inhalation and exhalation.

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.

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

administer a tube of oral glucose.

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

agitated delirium.

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.

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

ask the patient's parents to assist you with suctioning the tracheostomy tube.

A 72 year old patient has a severe nosebleed. The patient begins to cough and choke. This airway compromise is possible because

blood is passing through the nasopharynx.

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

discuss with the patient your concerns based on your scene size-up.

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

hypoxia.

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.

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

infection.

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 a focused examination of the patient's knee.

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

initiate transport immediately.

During your pre-shift ambulance inspection, you notice that one of the box warning flashers has burned out. You should

keep the ambulance in service and make an appointment with maintenance as soon as possible.

Disruption of upper airway patency in severe anaphylaxis is most likely caused by

laryngeal edema

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

non-rebreather mask at 12 Lpm.

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.

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

partial thickness burn.

The most important benefit of a unified command would be

preventing more than one set of tactics at a single incident.

Your patient has just finished actively seizing after a grand mal seizure. You should

protect the airway.

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.

The Cincinnati Prehospital Stroke Scale is used to

rapidly assess the likelihood of acute stroke.

You notice that a series of difficult calls has produced an abnormal amount of work-related stress. You should

reach out to a supervisor and discuss your concerns.

You are working at a multiple casualty incident. Your assignment is secondary triage. Your responsibilities would likely include

reassessing previously triaged patients to account for patient deterioration.

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

request extrication resources.

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

scrape the stinger away with a credit card.

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.

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.

An EMT applies a traction splint upside down. By doing this he has violated his

standard of 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

start resuscitative efforts.