EMT Pass/LC Ready

A 24 year old female has a peanut allergy. Friends call you because she is weak and they think she may have been exposed to peanut oil. When you arrive she has an EpiPen in her hand but she has not used it yet. What would you say to her? "Are you certain you've been exposed to peanut oil?" "Why haven't you injected yourself yet?" "Do you want me to administer the EpiPen?" "Do you think you're going into anaphylactic shock?"

"Do you want me to administer the EpiPen?"

While working a shift as an EMT, your EMT student intern asks you about how a nasopharyngeal airway works in opening the airway. Which of the descriptions below provides the best answer? "The placement through the nasal cavity allows airflow through the nose." "When properly placed, the tip of the NPA is in the trachea so air can flow in and out of the lungs." "Its external shape is designed to help hold the tongue off the posterior pharynx." "The NPA has a hole in its center that air flows through."

"Its external shape is designed to help hold the tongue off the posterior pharynx." The benefit of the NPA in opening the airway comes from its external shape and design, not the fact it has a hole through its center. The hole just allows the walls of the device to be thin and flexible which promotes smoother insertion through the nasal cavity. Upon proper placement, it is the external design that helps elevate the tongue off the posterior pharynx. This is similar to how the OPA works when placed in the oral cavity.

When assessing breath sounds with a stethoscope, which of the below best describes how you should instruct the patient to breathe during your assessment? "Take some deep breaths in and out. Keep your mouth closed". "Breath normally with your mouth open" "Take a deep breath in and out with your mouth open." "Breathe normally with your mouth closed."

"Take a deep breath in and out with your mouth open." By directing your patient to take a deep breath with their mouth open, you are allowing a maximum of airflow to occur in and out of the respiratory tree, as well as ensuring full alveolar ventilation. Normal quiet breathing does not regularly inflate all distal alveoli.

When suctioning with a rigid tip, the patient begins to gag and vomit. You should: withdraw the suction catheter to a depth that does not cause vomiting. insert the catheter deeper as that will minimize the gag reflex. increase the suction pressure to clear any additional vomit. turn the patient on his side and continue suctioning.

withdraw the suction catheter to a depth that does not cause vomiting. Occasionally suctioning will cause stimulation of the gag reflex and vomiting. In this case you should withdraw the suction catheter to a depth that does not cause stimulation of the gag reflex. Inserting the catheter deeper will only cause increased stimulation. Continue suctioning and turn the patient on his side if necessary, but first you must adjust your catheter position.

You are caring for a patient who was ejected 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, the systolic blood pressure is 96 mmHg, and the heart rate is 110. Based on this information, the patient's computed Revised Trauma Score would be: 11 7 9 5

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

During the management of a toddler, you note that the child screams uncontrollably when you attempt to move him from his mother's arms to the ambulance cot. This separation anxiety will initially become prevalent with what age of toddlers? 12 months 30 months 24 months 18 months

18 months Starting around 18 months of age for most children, they will develop a very real and serious emotional and physical response to being separated from their parents (or primary care providers). This is best managed by trying to enlist the help of the parents as well as trying to keep the parent and child together for as long as you reasonably can given safety concerns for all.

A five-year-old male has burns that cover his entire back. Considering the rule of nines, what percentage of body surface area would these burns cover? 9% 36% 7% 18%

18% The rule of nines states that a child's back represents 18% of his body surface area. The front and back of both legs each represent 7%, and both a child's anterior and posterior torso would represent 36%. The upper back of an adult would represent 9%.

You should transport patients to trauma centers who fall greater than 19 feet as adults or 12 feet as children. 15 feet as adults or 9 feet as children. 10 feet as adults or 10 feet as children. 26 feet as adults or 16 feet as children.

26 feet as adults or 16 feet as children.

An adult female patient was cooking when there was a flare up that resulted in burns to the following areas: 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? 18% 27% 36% 45%

27% 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.

You are called for a female in active labor. Upon your arrival you find the patient lying on a bed, knees up, and the baby is already half way out the birth canal. Given this information, what stage of labor would you say the patient is in? 2nd stage 1st stage 3rd stage 4th stage

2nd stage The hallmark finding in the second stage of labor is the complete delivery of the baby. The first stage occurs from onset of true labor contractions till dilation and effacement of the uterus. The third stage occurs when the placenta delivers. There is no fourth stage of delivery.

You would expect the blood sugar of a diabetic patient who is acting intoxicated to be near 105 mg/dL. 60 mg/dL. 30 mg/dL. 230 mg/dL.

60 mg/dL.

Which of the patients below is most likely suffering from left-sided heart failure? A 72 year old female who has crackles in the dependent lung fields. A 56 year old who experiences a drop in systolic pressure of greater than 20 mmHg on inspiration. An 86 year old female with swelling in her ankles and fingers. A 42 year old who has a systolic pressure of 140 on the left arm and 110 on his right arm.

A 72 year old female who has crackles in the dependent lung fields.

Which of the signs below, present in a neonate, is most concerning to you immediately following delivery? Cyanosis Facial grimace Presence of meconium Slow pulse rate

Slow pulse rate

The difference between a contusion and a hematoma is the Location on the body Force used to cause the injury The proximity of bone to the skin Amount of blood loss

Amount of blood loss A hematoma is a deeper injury than a contusion and results in greater blood loss.

Your Medical Director has advised all personnel to administer oxygen based on pulse oximetry readings and patient presentation. Based on this statement, which of the following patient scenarios has oxygen administered appropriately? An alert 56-year-old man with chest tightness and oxygen saturation of 98% receiving oxygen at 4 lpm via cannula An alert 12-year-old patient with a fractured arm and oxygen saturation of 99% receiving 15 lpm via non-rebreather mask An alert 78-year-old male COPD patient with slight distress and oxygen saturation of 96% receiving oxygen at 15 lpm by non-rebreather mask A 24-year-old male patient who is unresponsive and breathing shallowly receiving oxygen via non-rebreather mask at 12 lpm

An alert 56-year-old man with chest tightness and oxygen saturation of 98% receiving oxygen at 4 lpm via cannula Oxygen is a drug and as such should be administered appropriately. In some cases (e.g. MI or stroke) too much oxygen may actually be harmful. Oxygen should be based on saturation and patient complaint/presentation. In this question the COPD patient and the child with the isolated fracture didn't need high flow oxygen. The Unresponsive 24-year-old was breathing shallowly and required ventilation. The chest tightness patient had adequate saturation and a cannula was appropriate.

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 pulse 130, respiration 38, blood pressure 60/44. What is the most appropriate method to splint her pelvis? Place a pillow beneath her knees Place pillows on either side of her pelvis Apply and inflate the pneumatic anti-shock garment (PASG). Use straps to fixate her legs together

Apply and inflate the pneumatic anti-shock garment (PASG). 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 as the PASG.

How can the EMT help minimize the amount of gastric pressure that may occur secondary to providing positive pressure ventilation to a patient who is not breathing? Apply cricoid pressure Insert an OPA Use a jaw-thrust Lay the patient laterally during ventilations

Apply cricoid pressure The application of cricoid pressure, or displacing the cricoid ring posteriorly with fingertip pressure so as to prevent the esophagus from opening easily, is a common technique to prevent both gastric insufflation and gastric regurgitation. The use of an OPA or jaw-thrust will help assure an open airway, but does not reduce gastric pressure during ventilations. Finally, the patient should be placed in a supine, not lateral, position while PPV is being applied.

You are assessing a 94-year-old woman complaining of shoulder pain. You notice that she often asks you to repeat your questions. What is the best approach to obtaining a history with this patient? Write out questions and answers on a pad of paper. Speak louder when you ask questions. Speak only to family members because history from the patient will be unreliable. Ask if she has a hearing aid with which you could assist

Ask if she has a hearing aid with which you could assist Often patients will have devices such as hearing aids or glasses that will make your assessment easier. Taking time out early on to obtain such devices is a best practice and will improve your ability to obtain accurate information. You may speak in louder tones, but with the proper assisting devices, this may be unnecessary. Writing questions and answers may be your only option, but is very slow. Family may be a good source of information, but certainly not better than the patient herself.

A 23-year-old male has been involved in a serious motor-vehicle crash. He is trapped in the vehicle and responds only to painful stimuli. His respiratory rate is irregular at a rate of 8 and he is bleeding profusely from a wound on his upper arm. While awaiting extrication, what should you do first? Administer high-concentration oxygen via nonrebreather mask. Apply direct pressure to the arm wound. Perform a rapid trauma assessment to identify additional injuries. Begin positive pressure ventilation.

Begin positive pressure ventilation. This patient has a multitude of problems, but the most immediate problem is his respiratory failure. Positive pressure ventilations should be initiated immediately. Bleeding might take precedence if it was a spurting arterial wound, but there is no indication of that. Oxygen will not help inadequate respirations. Trauma assessment will need to wait until primary assessment issues are dealt with

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? Alpha 2 Beta 1 Beta 2 Alpha 1

Beta 1 Epinephrine is the drug of choice for acute allergic reactions due to its ability to reverse some of the bronchoconstriction (beta 2 effect), and airway swelling and systemic hypotension (alpha 1 and alpha 2 effects). However, the beta 1 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.

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? Circulation Mental status Airway Breathing

Breathing 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 positioning.

A 14-year-old lacrosse player was struck in the chest with a ball. He collapsed immediately and now is in cardiac arrest. What is the most likely cause of this cardiac arrest? Tension pneumothorax Commotio cordis Pericardial tamponade Cardiac contusion

Commotio cordis Commotio cordis occurs when a powerful blunt force interrupts the normal depolarization of the heart. In this case cardiac arrest was caused by commotio cordis. A tension pneumothorax or pericardial tamponade could cause cardiac arrest, but it would be unlikely to happen this fast. A cardiac contusion also would be unlikely to cause immediate cardiac arrest, especially with the mechanism of injury that is described.

A four-year-old female complains of nausea and vomiting. Her mother states she has not been able to keep anything down for the last three days. She presents lethargic, pale, and her vital signs are: pulse 130, respiration 30, blood pressure 94/60. What is this patient's most significant problem? Compensated shock GI infection Electrolyte imbalance Probable appendicitis

Compensated shock Vomiting and diarrhea can cause severe dehydration in children. This patient's mental status, pulse, and skin color all point to hypovolemic shock. An electrolyte imbalance is also likely, but is not nearly as life threatening as the presenting shock. A GI infection is possible as is appendicitis, but both are less immediate concerns.

Serious chest injury patients will usually be placed supine and immobilized. Placing the patient in this position is important for immobilization, but it may actually hamper the patient's respiratory efforts. Why is this true? Diminished diaphragm motion Worsening of alveolar edema Drop in preload arriving at the heart Decreased oxygen saturation

Diminished diaphragm motion When a patient is placed supine, the weight of the abdominal contents (and any abdominal adipose tissue present) will start to push on the diaphragm due to gravity. This will impede the ability of the diaphragm to move and worsen the already diminished respiratory effort. Oxygen saturation and alveolar edema is minimally affected, if at all, and although preload may diminish in a supine position, it will not change the patient's ventilatory efficiency.

You are at the bedside of a hospice patient who has terminal cancer that has metastasized to the bones, lungs, and brain. The patient slipped into a coma and the family became scared and called EMS. Shortly after your arrival, the Hospice worker also arrives. Given this situation, what is the best course of action? Care for, but do not transport the patient Discuss the best course of action with the Hospice worker Do not care for the patient Initiate care, but if the patient arrests, discontinue all care

Discuss the best course of action with the Hospice worker Hospice patients are difficult situations for the EMT since the EMT's goal is to prevent death. Sometimes the patient's family calls EMS rather than hospice as directed, and now the EMT has a duty to the patient. The best course of action is to discuss the situation with the Hospice worker. If they are not available contact medical control. The EMT should remember however, that the patient in hospice care not wanting resuscitation does not mean they don't want comfort and compassion.

Which of the following might lead you to consider obstructive shock over hypovolemic shock? Indication of abdominal injury Distended neck veins Suspicion of significant closed head injury Widening pulse pressure

Distended neck veins Increased pressure in the thoracic cavity (e.g. tension pneumothorax) or cardiac tamponade prevents blood return from the head to the thoracic cavity resulting in distended neck veins. The pulse pressure is more likely to narrow. Abdominal injury would cause bleeding and hypovolemic shock. Head injuries do not cause shock because blood loss into the brain in minimal. The increasing pressure is the main problem in closed head injuries with bleeding.

Shock from anaphylaxis is best described by which mechanism? Cardiogenic Hypovolemic Distributive Obstructive

Distributive Anaphylaxis causes distributive shock by loss of vascular tone.

During the assessment and management of a musculoskeletal injury, you note an absence of pulses distal to the injury. With what type of injury is the EMT allowed to manipulate the shape/direction of the site in order to try to restore perfusion? Elbow injury Ulnar injury Humerus injury Tibial injury

Elbow injury With joint injuries, there is a complication of nerve or vascular trauma because these structures are not well protected by muscle or fascia around the joints. As such, a joint injury may result in a compression injury to a blood vessel, eliminating distal blood flow. The EMT may consider attempting one range of motion with the injured joint, although it may cause more pain, in an attempt to restore perfusion distally. If it fails after one attempt, the EMT should immobilize the joint in the new position and begin transport. With long bones, the injury is realigned only if necessary for immobilization purposes.

Which of the signs below would cause you concern that a patient might be having a hypertensive crisis? Nystagmus Ecchymosis Ptosis Epistaxis

Epistaxis

A patient with a diagnosis of CHF is complaining of dyspnea. You suspect that they are developing pulmonary edema. As this emergency progresses, what aspect of respiration will falter first and lead to continued patient deterioration? External respiration Cellular respiration Internal respiration Cellular metabolism

External respiration Pulmonary edema is a condition where fluid starts to fill the alveoli and cause alveolar dysfunction due to a failing left ventricle. As the alveoli become damaged from excess fluid, it impairs gas exchange with the capillary bed surrounding the alveoli. This will first alter external respiration (between alveoli and the blood stream), and eventually internal respiration (between blood and capillary beds). Cellular respiration and metabolism will subsequently fail.

When considering a systems approach to patients that have experienced multisystem trauma, which of the following considerations on the part of the EMT will have the greatest impact on ultimate patient survival? Focus on airway, breathing, and circulatory support Initiate care on those patients screaming in pain first as the quiet ones are either stable or dead Delivering the trauma patient directly into the surgical suite of the hospital Transport the patient as soon as possible, even before treatment begins

Focus on airway, breathing, and circulatory support Trauma is a common emergency seen by the EMT that in many situations cannot be definitively treated until arrival in the hospital. In these instances, the best thing the EMT can do is support lost function of the airway, breathing and circulatory components. Failure to support these three vital functions will almost certainly result in death of the patient. Following this initial management, the patient should be transported to the most appropriate facility for evaluation by a physician in the emergency department. Finally, always assess all victims present, loud or quiet, as the quiet ones may be that way due to a change in mental status or some other life-threatening condition.

Pediatric anatomy and physiology can present as a challenge to certain interventions the EMT may perform. Which of the below changes could complicate the EMT's management of the airway in a pediatric patient? Thorax more pliable Larger jaw Nasal cavity size Head size

Head size Pediatric patients have a larger occipital region of the skull. The younger the patient, the more prominent the problem is. This can complicate airway management because when the patient is placed supine, the neck will flex and contribute to airway closure. This is mediated by placing towels under the shoulder blades to realign the vertebrae into normal anatomical position which eliminates the flexion. The jaw in pediatric patients is actually smaller comparatively, and the nasal cavity does not pose any unusual problems itself. Finally, the thorax is more pliable which reduces the ability to ensure ventilations when dyspneic, but it does not complicate the airway.

Your 83-year-old female patient awoke with a severe stomach ache and nausea. She reports that she got out of bed and then experienced two episodes of emesis in which there were "large amounts of blood and blood clots". She now is light headed, has cool, moist skin, and her conjunctiva is pale. Which of the vital signs below would probably be the least reliable in demonstrating hemodynamic changes due to this blood loss? Pulse oximeter Respiratory rate Heart rate Blood pressure

Heart rate In the geriatric patient there is a general decline in the heart's ability to change cardiac output by altering rate. As such, *they rarely are able to achieve tachycardic rates seen in younger patients with volume loss*. Therefore heart rate would be the least reliable indicator. Pulse oximetry will drop as peripheral perfusion drops, and the respiratory rate will increase secondary to the sympathetic discharge from the shock state. Finally, blood pressure will change later in the course of the syndrome, but it will in fact drop (*often the EMT may note narrowing of the pulse pressure before frank systolic hypotension occurs*).

A patient has sustained an injury in which blood vessel damage beneath the surface of the skin has resulted in the formation of a palpable "lump" at the surface. This is known as what type of soft tissue injury? Crush injury Vascular deformity Contusion Hematoma

Hematoma Trauma can result in damage to blood vessels found in the body. As these damaged vessels begin to bleed, the mass of blood may be great enough to create a "lump" that is visible or palpable on the surface of the skin. These are known as hematomas. A contusion occurs when the capillary bed is damaged, and blood seeps to the skin surface and creates what is commonly known as a "bruise". A crush injury can cause a hematoma, but is much more damaging and can result in organ rupture and skeletal trauma. Finally, vascular deformity is what occurs to the vessel after injury, but it is not a type of soft tissue trauma.

A 30-year-old female tells you she has ingested some rat poison in an attempt to commit suicide. She is currently alert and her vital signs are pulse 110, respiration 20, blood pressure 98/50. Which one of the following would be the most important question to ask as you complete the patient history? Do you take any medications? Is there any chance you could be pregnant? How long ago did you ingest the poison? Do you have any medical problems?

How long ago did you ingest the poison? Ingested poisons are absorbed in the digestive tract slowly. Determining the timing of ingestion will help guide treatment and predict decompensation. Knowing about medical problems, medications, and pregnancy are important, but not as important as timing.

While providing positive pressure ventilation to a patient who is not breathing but has a pulse, you elect to initiate ventilations at 10 per minute with 15 lpm of supplemental oxygen. Should you decide to hyperoxygenate the patient prior to suctioning, how would this be best accomplished? Increase the oxygen delivered via the reservoir bag Increase the ventilation rate to 20/min Increase the ventilation rate to 18/min Increase the depth of ventilations by squeezing the BVM more completely

Increase the depth of ventilations by squeezing the BVM more completely Blood flow returns to the heart partially due to the negative intrathoracic pressure created during inspiration. If the patient is not breathing, the provision of PPV never allows an instance of negative pressure in the chest to facilitate blood return. In fact, *the higher the ventilatory rate, the worse the return of blood to the heart and the worse the subsequent cardiac output*. To minimize this, consider delivering a slightly larger tidal volume per breath rather than over-ventilating by increasing the ventilatory rate (which will drop cardiac output). Increasing the liter flow to the BVM is less helpful as the reservoir never fully depletes itself of oxygen during the BVM refilling.

Which one of the following is a sign of Cushing's triad (Cushing's reflex) that occurs with traumatic brain injury? Increased blood pressure Labored, regular respirations Pinpoint pupils Increased pulse rate

Increased blood pressure Cushing's triad, also referred to as Cushing's reflex, is a set of vital signs seen with an increased intracranial pressure from a traumatic brain injury (TBI). The vital signs are an *increased blood pressure, slowing pulse rate, and irregular respirations* (classically seen as Cheyne-Stokes). As the intracranial pressure increases, one or both pupils can dilate and become less responsive to constricting to light.

What manual airway technique should be employed on a patient that is unresponsive, found lying beside his bed with sonorous breathing? Cross-finger technique Head tilt-chin lift Head tilt-neck lift Jaw thrust

Jaw thrust There are two primary ways to manually open the airway in an unresponsive patient. The first is the head tilt, chin lift technique and the second is the jaw thrust. Since the patient has an unclear history as to an associated fall, the EMT should employ the jaw thrust technique in conjunction with spinal immobilization. The head tilt-neck lift is no longer utilized. The cross-finger technique is used to open the mouth, not the airway.

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? Cervical vertebrae Trachea Mandible Larynx

Larynx 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.

A 17-year-old male patient was swimming with his girlfriend one afternoon. She reports that he was trying a fancy dive off the diving board when he slipped and hit his head hard on the diving board prior to falling into the water. Upon your arrival the patient has already been extricated by the Fire Department. You find him responsive on the cement. The patient has no movement from the shoulders down and is experiencing respiratory distress. Given this mechanism, at what level is the suspected spinal injury at? Low cervical High thoracic Low thoracic High cervical

Low cervical If a patient cannot move from the shoulders down, the suspected spinal cord injury is likely in the low cervical region. Since the phrenic nerve that innervates the diaphragm is still intact, as evidenced by spontaneous breathing, that means the cord injury is below C3-C5 (which is where the phrenic nerve originates). If the patient had a thoracic injury, there would still be some intercostal innervation to assist with breathing.

You are caring for a bus driver for the local transit authority. Upon your arrival at the patient's side, you find the patient looks ashen in color, is complaining of chest pain and respiratory distress, and tells you that he has a "really bad heart" and "bad lungs". The patient has prescribed nitro and an MDI. He states that he does not know if he has any allergies. You hear inspiratory rales, the pulse ox reads 92% on room air, and the vitals are as follows: Heart rate is 102, respirations are 16, and the blood pressure in a sitting position is 98/60. Given this presentation, which of the following medications would you NOT administer to the patient? Nitroglycerin MDI Oxygen Aspirin

MDI Given the patient's presentation, the EMT should arrive at a field impression of an acute coronary event. As such, the administration of oxygen, aspirin, and nitro is warranted (provided the blood pressure allows). The MDI would not be used as this is for bronchoconstriction from a pulmonary pathology, which is not consistent with the patient's presentation.

In which abnormal birth situation should the EMT avoid warming, positioning, and stimulating the infant until other more pressing care occurs? Premature birth Meconium staining Multiple births Precipitous delivery

Meconium staining Meconium staining occurs when the fetus is in extreme distress during delivery. This stress causes the fetus to release its bowels. This stool matter (meconium) is very thick and can easily occlude the airway. In instances of meconium staining, the infant should be delivered and aggressively suctioned prior to the infant starting to breathe. Premature deliveries, precipitous deliveries, and multiple births all should benefit from normal and routine care.

You are treating an elderly male patient who fell on the sidewalk outside his home, striking his head hard. It was a witnessed fall by family members who called EMS immediately. Although he was initially responsive, by the time EMS arrives the patient responds to painful stimuli with muscular extension, pupils are becoming unequal but are still sluggish to respond, and he displays an elevated blood pressure, wide pulse pressure, and bradycardia. Given these findings, what level of brainstem involvement is suspected? Upper brain stem Middle brain stem Total brain stem involvement Lower brain stem/medulla

Middle brain stem With head injuries that result in hemorrhage or edema that increases intracranial pressure (ICP), the brainstem can begin herniating through the foramen magnum of the skull. As pressure increases, the brainstem is damaged from the top down. With middle brain stem involvement, the patient will typically have a wide pulse pressure with bradycardia, unreactive or sluggish pupils, central neurogenic hyperventilation, and will display abnormal motor extension (decerebrate posturing) with noxious stimuli.

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 may the EMT wish to administer? MDI Activated Charcoal Nitroglycerin Aspirin

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

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 Oral trauma Tracheal collapse Under-ventilation

Occlusion of the airway 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.

A patient is found unresponsive in his home. Upon gaining access to the patient you rapidly identify sonorous airway sounds and rapid breathing. Family members report the patient is diabetic. After completing the scene-size up, what initial intervention should you perform during the primary survey? Initiate positive pressure ventilation with oxygen Open the mouth Insert a nasopharyngeal airway Insert an oropharyngeal airway

Open the mouth During patient management, the EMT should first assure the adequacy of the airway. The first step in doing so is to open the mouth and inspect the oral cavity. This is best accomplished with the "cross-finger" technique. Following opening the mouth and inspecting the airway, the EMT can then progress with manual, simple mechanical, or suctioning techniques as the situation warrants.

Which one of the following best describes the responsibilities of the staging supervisor at a multiple-casualty incident? Overseeing ambulances and personnel Evaluating and prioritizing patients Communicating with hospitals and managing transport of injured patients Overall direction and supervision

Overseeing ambulances and personnel The staging supervisor manages ambulances and personnel at a multiple-casualty incident. The incident commander assumes overall direction and supervision. The triage supervisor evaluates and prioritizes patients and the transportation. The loading supervisor is in charge of communicating with hospitals and managing transport of injured patients.

For which one of the following patients is it most appropriate to use a pulse oximeter? Patient rescued from a house fire Patient with signs of decompensated shock Patient in her residence with chest pain Patient rescued in winter from a car

Patient in her residence with chest pain The best results with a pulse oximeter come when used with a patient who has good circulation to the extremity where the probe is placed. A pulse oximeter will give a falsely high reading with a patient that has carbon monoxide poisoning such as might be seen with someone rescued from a house fire. Cold and poor circulation to the extremity where the pulse oximeter is placed, such as for a patient with decompensated shock, will also result in an inaccurate reading.

A factory explosion on the outskirts of your EMS response area has injured between 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? Heart rate, mental status, blood pressure Perfusion status, respiratory status, mental status Mental status, blood pressure, respiratory status Heart rate, respiratory rate, mental status, blood pressure

Perfusion status, respiratory status, mental status 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.

Arriving at the scene of an "underground party" where there is a reported overdose, you find a patient with a depressed level of consciousness and respiratory depression. A bystander tells you the patient injected heroin. If that is true, then upon examination how would you expect the patient's pupils to appear? Unequal Normal Dilated Pinpoint

Pinpoint Narcotics can cause pupil size to become pinpoint. Dilation may occur with the use of amphetamines or hallucinogens. Unequal pupils are seen in traumatic brain injury with herniation.

A patient is on home oxygen for a chronic lung condition. They currently must wear a nasal cannula at 3 lpm. Should this patient start to experience respiratory distress from exacerbation of their lung condition, the EMT should improve the delivered oxygen by which of the following procedures? Increase the liter flow of the cannula to 6 lpm Increase the liter flow of the cannula to 4 lpm Place a non-rebreather mask running at 15 lpm Place a partial rebreather face mask running at 12 lpm

Place a non-rebreather mask running at 15 lpm When trying to improve oxygenation, the EMT should consider maximizing the inspired oxygen by placing a non rebreather on the patient at 15 lpm. With a properly fitting mask, this maximizes the inspired oxygen on a spontaneously and adequately breathing patient. Although the liter flows for the nasal cannula and partial rebreather mask are appropriate, none of them will afford a higher concentration of delivered oxygen to the patient than the non rebreather will.

An elderly patient has fallen and is found on the floor of her kitchen by a neighbor. When you assess the patient, you observe one leg rotated inward, the hip flexed, and knee bent. What type of injury do you suspect is most likely? Hip fracture Posterior hip dislocation Anterior hip dislocation Fractured femur

Posterior hip dislocation With a *posterior hip dislocation the leg is commonly rotated inward, the hip is flexed, and the knee is bent. In addition, the foot of the injured leg may be hanging loose. With an anterior hip dislocation the lower part of the leg is rotated outward and the hip usually is flexed. With a hip fracture, the foot on the injured side usually turns outward. With a femur fracture (closed), the leg may appear to be shortened as a result of muscle contractions*.

A blood glucose evaluation is indicated for a five-year-old male. Which one of the following would be the proper technique for performing a potentially painful finger stick? Allow the child to examine the lancet before performing the procedure. Discuss the procedure with the child before you ready the equipment. Ready all the equipment before mentioning the finger stick. Tell the child that the finger stick will not hurt.

Ready all the equipment before mentioning the finger stick. When a potentially painful procedure must be completed, it is best to ready all your equipment before mentioning it to the child. Discussing the procedure or showing him the equipment beforehand typically increases anxiety because he anticipates the pain. Never lie to a child. A finger stick does hurt.

You are treating a patient who was found with an altered mental status and minimal respiratory effort. After completing on-scene care how would you carry this patient from the second floor to the exterior of the residence? Urgent move Stair chair Reeves stretcher Wheeled stretcher

Reeves stretcher The patient would be moved in the Reeves stretcher. The patient's altered mental status and inadequate breathing would prevent the use of the stair chair--the device commonly used for alert, breathing patients in respiratory distress. The wheeled stretcher would be prohibitively heavy and difficult to maneuver.

You are obtaining a patient history from a 90-year-old female complaining of abdominal pain. What is the most appropriate method of accomplishing that goal? Refer to the patient by name and use the title "Ms." Use terms of endearment such as "granny" or "honey." Speak loudly because older patients have difficulty hearing Position yourself very close to the patient because she may have vision problems

Refer to the patient by name and use the title "Ms." A courteous and professional demeanor is always the best strategy. Using proper titles and names is the best approach. Remember that not all older persons have vision or hearing deficits. You should avoid violating personal space and using demeaning terms such as "honey."

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? Heart rate 172/minute Respiratory rate 64/minute Cyanotic extremities with pink core APGAR score of 6

Respiratory rate 64/minute Although the assessment of the baby and determination of clinical status should take into consideration multiple measures, there are some clinical finings that are so significant they can individually infer that the baby's status is critical. In this situation, the respiratory rate >60/min is such 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.

The acronym STEMI stands for start treating emergency myocardial infarctions. standard treatment encompassing myocardial infarction. ST-segment elevation myocardial infarction. standardized treatments for emergency myocardial infarctions.

ST-segment elevation myocardial infarction.

During a health fair at a local shopping mall, your EMS service has set up a booth where attendees with diagnosed hypertension can have their blood pressure checked for free as a public service. Given the role of EMS in public health, this would be considered what kind of health prevention and promotion strategy? Primary prevention Tertiary prevention Health screenings Secondary prevention

Secondary prevention Primary prevention strategies are designed to prevent illness or injuries (e.g. helmet safety classes). Secondary prevention strategies are designed to monitor and prevent progression of diseases already present, as in this example of hypertension. Health screenings are designed to determine if a disease state exists in a population of people, and tertiary prevention is not an actual type of health prevention and promotion strategy.

You and your EMT partner arrive at the scene of a stabbing, which has been secured by the police. When you get to the patient, you determine that there is a single stab wound to the lower left chest just above the diaphragm. There a minor amount of external bleeding is observed. Of the following which one is the first intervention for providing care for this patient? Treat for shock. Seal the chest wound. Provide oxygen. Secure the airway.

Secure the airway. The first intervention (in all but the cardiac arrest patient) is to secure the airway. The exception might be if there is significant external bleeding that needs to be controlled. In this case the external bleeding is minor. After the airway is secure, breathing is assessed and oxygen provided. Circulation can be handled next, including treatment for shock. This patient should have immediate life threats, including sealing the wound, treated on scene in ABC order and then packaged for immediate transport.

You are caring for a 79-year-old female that has fallen down the steps of her porch and into the yard. The patient states that she "slipped" on the last step, and now her ankle hurts. The site of injury is swollen and painful to the touch. Her airway is patent, breathing is adequate, and peripheral perfusion is intact. Her vitals are: heart rate 102, respirations 20/min, blood pressure 168/90 mmHg. Given the findings thus far, how would you categorize her physiological status? Potentially unstable Stable Stable, but potentially unstable Unstable

Stable This patient would be categorized as "stable". She has no acute change in mental status nor disturbance in the airway, breathing, or circulatory components. There was no "high risk" mechanism of injury, and no findings to suggest acute deterioration. A patient who is stable but potentially unstable is one who may acutely deteriorate from the illness/injury although they haven't yet, and an unstable patient is one who is already deteriorating.

You are caring for a patient who is post-cardiac arrest. According to bystanders, the patient clenched his chest and dropped to the ground. An AED was quickly brought to the patient's side and delivered one countershock. After 1-2 minutes of CPR the patient regained a pulse and started to wake up. Currently the patient has an intact airway with spontaneous breathing and a peripheral pulse. Vitals are all stable and the mental status of the patient is improving. Given this information, how would you categorize the patient's physiologic status? Stable Unstable Potentially unstable Stable, but potentially unstable

Stable, but potentially unstable This patient would be categorized as "stable, but potentially unstable". Since he did experience cardiac arrest that was corrected with AED and CPR, the nature of illness was significant. Or in other words, whatever put the patient into cardiac arrest, may occur a second time and again put the patient into arrest. So despite his relatively "stable" appearance (i.e. airway, breathing, circulation, mental status are all intact), he could again re-arrest which obviously makes the patient potentially unstable.

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 pressure to the distal radial artery pressure point. Straighten and splint the arm. Apply an ice pack to the wound. Place an occlusive dressing over the wound.

Straighten and splint the arm. 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 anyways. 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.

You are called to the scene of a violent psychiatric patient. The patient is conscious and NOT suspected of having any underlying urgent medical problems. But he must be restrained. In what position should he be placed on the stretcher? Prone Supine Fowler's Left lateral recumbent

Supine For best controlling the patient the position that is *the safest is supine. In this position the airway can be monitored and it is easier to communicate with the patient*. It is difficult to monitor the patient when placed in the prone position and if he is struggling, there can be more of a risk for positional asphyxia. The patient should never be hog tied. The left recumbent position is difficult because it can be a challenge to restrain the arm on the bottom, including possibly compromising the circulation. *Fowler's position gives the patient more leverage if he is fighting the restraints*.

A skateboarder was attempting to "grind" his board down a steel stair railing at a park when he fell from the skateboard and down the cement steps. Upon your arrival you assess the patient and suspect a spinal injury causing spinal shock. Which of the below vital sign changes is NOT consistent with spinal shock? Tachycardia Bradycardia Tachypnea Hypotension

Tachycardia With spinal cord injuries, if the injury is high enough (above the thoracic spinal nerves), the patient may still be able to breathe due to the phrenic nerve, but they will lose sympathetic stimulation as this exits the cord in the thoracic and lumbar regions of the spinal cord. As such, blood vessels dilate causing hypotension but the heart rate cannot increase due to the lack of sympathetic tone. So unlike other forms of hypoperfusion, spinal shock typically does not have a tachycardic pulse rate.

In order to assure that the blood pressure reading provided by the non-invasive blood pressure (NIBP) machine is correct, what should the EMT always do? Only use the NIBP machine on adult patients Take a manual blood pressure occasionally and compare it to the NIBP Ensure that the machine has new batteries Make sure the correct cuff is positioned on the patient's arm

Take a manual blood pressure occasionally and compare it to the NIBP Although the use of medical diagnostic tools enhances what the EMT does, they do not replace what the EMT does. Medical equipment is subject to malfunction, breakage, and may need calibration periodically. As such, the EMT should always obtain at least one quality manual blood pressure with a cuff and stethoscope during each patient encounter.

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 continues to climb, 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 Cardiac tamponade Atelectasis Flail segment

Tension pneumothorax 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 ventilations, 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 injuries.

A 16-year-old male has been shot in the upper right quadrant of his abdomen. He is alert, pale, diaphoretic, and complains of difficulty breathing. You note he has jugular vein distention (JVD). While assessing the patient, he loses consciousness and you have a difficult time finding his radial pulse. What is the most likely cause of this deterioration? Tension pneumothorax Perforated diaphragm Internal bleeding Ruptured spleen

Tension pneumothorax The mechanism of injury, anatomic location of the wound, and the presence of JVD indicate a tension pneumothorax. Injuries around the diaphragm should be considered potential chest and abdominal injuries. Additionally, the bullet may end up in either cavity. JVD would be unlikely with internal bleeding or a ruptured spleen. Diaphragmatic perforation might explain his difficulty breathing, but not his shock.

Which of the following is true regarding the vital signs of a patient in shock? The pulse will decrease and the respirations will decrease. The pulse will increase and the respirations will decrease. The pulse will decrease and the respirations will increase. The pulse will increase and the respirations will increase.

The pulse will increase and the respirations will increase. In shock the pulse and respirations both increase. This is an attempt to increase cardiac output and maximize the amount of circulating oxygen.

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

The upper part of the trachea is funnel shaped. 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.

During an MCI event, your EMS service as well as the local police, fire, and emergency responders on scene through mutual aid agreements are utilizing radio communications to organize and execute the MCI plan. What is the recommended form of verbal communication during this time? The use of plain English words The use of standardized MCI codes and plain English The use of standardized MCI codes and signals The use of organization specific codes and signals

The use of plain English words It is not uncommon for some degree of confusion to be present during an MCI. The communication system should be designed to minimize this confusion. In an attempt to do this, the use of plain English words are recommended for all verbal face-to-face and radio dialogue. This minimizes the confusion of not remembering specific codes, codes that are different between organizations, misuse of codes or other forms of miscommunication.

Considering the two ventilation measures that comprise "minute ventilation", which one most often becomes deranged and contributes to inadequate breathing? Tidal volume Residual volume Respiratory rate Dead space ventilation

Tidal volume The respiratory rate and tidal volume when multiplied together, comprise the "minute ventilation" of the patient. In most situations of illness or disease, the respiratory rate is expected to go up due to the pulmonary deficiency. However the increased respiratory rate is often a result of the drop in tidal volume with diminishment of alveolar ventilation. The residual volume is not a component of the minute ventilation, and dead space ventilation (while part of tidal volume), does not usually diminish as this is the first part of the lung to be filled during inhalation - alveolar ventilation only occurs after dead space has been filled.

You are called to the home of an infant who recently came home from the hospital with an apnea monitor. The family became scared when the alarm started to sound, so they summoned EMS. Upon your arrival, they are holding the infant who is awake and alert - in no apparent distress. What would be the best course of action regarding assessment and treatment of this patient? Since the patient is stable, reset the monitor and leave the scene Immediately initiate positive pressure ventilation should the patient stop breathing again Tell the parents the monitor probably malfunctioned and to call the medical equipment company in the morning Transport the patient to the hospital, explaining the infant should still be assessed to ensure they are OK

Transport the patient to the hospital, explaining the infant should still be assessed to ensure they are OK Apnea monitors are used for patients (typically neonates and infants) that due to a medical problem may become apneic at night while sleeping. Often when these machines alert, whether it was a real incident or it alarmed incorrectly, the parents become scared and want their child assessed. It is always the best course of action to provide assessment and transport to the hospital so the ED staff can perform other diagnostic examinations to ensure the patient's condition is stable enough to return home. The EMT should not attempt to determine the operation or malfunction of any home technology.

A fire erupts at a child daycare center, resulting in initiation of the MCI plan since multiple children have been burned and killed from the fire. During the MCI, a few care providers became overwhelmed by the stress of the incident. Which of the below strategies should be employed for a co-worker overcome with the stress induced by an MCI? Transport them to the hospital for evaluation. Send them home and follow up with them the next day. Remove them from the scene until they calm down. Have the incident commander speak with them personally.

Transport them to the hospital for evaluation. It is an unfortunate but real occurrence: emergency personnel can become disabled both mentally and physically due to the stress imposed upon them from an MCI event. In these situations the person should be relieved of their duties and transported to the hospital for evaluation. Removing them from service till they calm down is only a short term fix, and sending them home without any help is unacceptable. Finally, occupying the Incident Commander's time with this will detract him/her of their primary duty of overseeing the event.

Your EMS unit is dispatched to a college fraternity party at 0245 hrs. Bystanders take you to the patient who was drinking alcohol heavily and was found unresponsive lying on the bathroom floor. You note the toilet is full of vomit with splattering on the floor around it. Your primary survey reveals the airway to be intact and maintained by the patient, breathing is fast and deep at 30/minute, and peripheral pulses are present at 108/minute and regular. The skin is warm and dry, and no evidence of trauma is noted. Given your findings from the primary survey, how would you classify this patient's physiologic status? Stable Stable, but potentially unstable Unstable Potentially unstable

Unstable This patient's physiologic status would be classified as "unstable". Although the patient is able to maintain their own airway, breathing is intact and adequate, and peripheral perfusion is intact - the patient has suffered an acute change in mental status. Presumably it is from the alcohol, but the EMT cannot rule out trauma, drugs, or other medical conditions as of yet to explain the mental status. As such, the patient should be rapidly assessed, expediently treated, and taken to the emergency department as soon as possible.

A 290-pound man complains of chest pain while walking in the park. He must be transferred 500 feet across rough terrain to the ambulance. Which one of the following techniques would be most appropriate to move this patient? Use a blanket drag with two heavy-duty blankets and providers at the front and back. Assist the patient with walking the 500 feet. Use a wheeled stretcher raised only half way with a provider on each corner. Use a scoop stretcher with providers at each corner.

Use a wheeled stretcher raised only half way with a provider on each corner. The safest policy is to avoid lifting when possible. In this case a wheeled stretcher would be most appropriate. It should be raised only half way to keep the center of gravity low and to avoid tipping on the uneven ground. This patient should certainly not walk.

In a 21 year old male who has a severe allergic reaction, anaphylactic shock will first be assessed when he has hypotension. a thready distal pulse. a narrow pulse pressure. laryngospasm.

a narrow pulse pressure.

A 4 year old male has blank staring periods that last 15 seconds. The disruption in full consciousness begins and ends suddenly. You should suspect focal motor seizures. hypotonic seizures. absence seizures. Jacksonian seizures.

absence seizures.

A 61-year-old male is found seizing. His wife states he became ill and collapsed after handling some fertilizer from the garden. The most likely route of this poisoning would be: inhalation absorption ingestion injection

absorption Handling the fertilizer implies an absorbed toxin. Inhalation may be possible, but less likely as the event occurred as the patient was handling the fertilizer. An injected toxin would enter the body through a sting or a needle. Ingested toxins are swallowed.

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: complete a detailed assessment to look for potential injuries administer a tube of oral glucose. apply high-concentration oxygen via nonrebreather mask. initiate rapid transport

administer a tube of oral glucose. 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.

A 36 year old male injected himself with an EpiPen 5 minutes ago. When you arrive he speaks with a hoarse voice, has increased respiratory effort and flushed skin. His vitals are B/P 102/84, P 96, R 18. His SpO2 is 94% on room air. You should first administer another dose if available. lay him flat and elevate his legs. administer oxygen by non-rebreather mask. rapidly transport him to the hospital.

administer another dose if available.

A 55-year-old male is found in the break room at his factory by coworkers. He is very confused and appears to be intoxicated. Coworkers state there is no possibility that he has been drinking. The patient tells you he is diabetic and you find a medic identification bracelet on his wrist that confirms this. You do not have access to a glucometer. You should: administer fluids by mouth because this patient is hyperglycemic conduct the Cincinnati Prehospital Stroke Scale because this patient is having a stroke administer oral glucose because this patient is hypoglycemic contact law enforcement because this patient has been drinking.

administer oral glucose because this patient is hypoglycemic In the event it is unclear whether a diabetic patient with altered mental status is hyperglycemic or hypoglycemic, oral glucose should be administered. It will not harm the patient if the blood glucose ends up being high. A stroke is possible, but given the diabetic history, it is less probable than a diabetic emergency. Alcohol intoxication is possible, but unlikely

As you approach an unconscious male you see his face is cyanotic. When you watch his chest his inspirations are moving little tidal volume and only on occasion. You should suspect agonal breathing. Biot's breathing. CNS depression. dyspnea.

agonal breathing.

Your third call after graduating from EMT class is a pediatric cardiac arrest. Three hours after completing the call, you notice that you are having a difficult time concentrating and cannot seem to pay attention to what you are doing. This type of behavior is characterized as: an acute stress reaction a cumulative stress reaction unacceptable behavior for an EMT a delayed stress reaction

an acute stress reaction A tragic call affects each provider differently. Because the effects occurred immediately, consider this behavior an acute stress reaction. A delayed reaction would present much later. A pediatric call could add to a cumulative stress reaction, but given that this was one of the responder's first calls, it is unlikely. Physiologic symptoms to stressful situations are absolutely acceptable. The key point now is to work through the stress in an appropriate manner.

An 11-year-old male was stung on the arm by a bee. His mother notes he is allergic to bees. The patient complains of pain and has swelling and redness at the site of the sting. You note no hives or further rashes and his vital signs are pulse 104, respiration 24, blood pressure 108/70. You should: apply a cold pack to the site of the sting and monitor the patient place the patient in the shock position and initiate rapid transport assist the patient with his epinephrine auto-injector apply a tourniquet above the site of the sting

apply a cold pack to the site of the sting and monitor the patient Although this patient has a known allergy, there is no evidence of anaphylaxis and therefore epinephrine is not indicated. The best course of action would be to apply a cold pack and monitor the patient. Rapid transport is not yet indicated and certainly the shock position is not necessary. Tourniquets would do little good under the circumstances. Monitor him carefully in the event signs and symptoms progress

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 apply a pressure bandage cut away clothing to expose the wound

apply direct pressure with a clean dressing Direct pressure is the place to start. Unless clothing directly interfered 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 27-year-old male has been involved in a serious motor-vehicle crash. You find him slumped forward over the steering wheel and he is not responsive. After taking appropriate safety precautions, you should first: apply manual stabilization to the cervical spine remove the patient using a rapid extrication open the airway with a jaw thrust begin positive pressure ventilation

apply manual stabilization to the cervical spine Airway is very important in this patient, but cervical-spine stabilization should be achieved first. It may even be necessary to do this prior to airway management, simply to gain access to the airway. A jaw thrust should be applied next, followed by positive pressure ventilation, if necessary, and then rapid extrication when resources are available

The most appropriate strategy to protect yourself in a terrorist chemical attack would be to: wear a level A suit with SCBA. apply time, distance, and shielding. wear a level B suit with HEPA mask. use cover and concealment.

apply time, distance, and shielding. Although there are a number of specific personal protective measures, the universal protective measure is time, distance, and shielding. Personal protective equipment such as level A and B suits require specialized training and still put providers in the hot zone. Cover and concealment might help prevent a direct attack, but offer little help after the attack has been launched.

A 59-year-old male is found semiconscious by his wife. She tells you the patient has a left ventricular assist device. You note that the device appears to be running, but you cannot feel a carotid pulse. You should: begin CPR. attach an AED. ask his wife what the normal findings should be. disconnect the device and reassess.

ask his wife what the normal findings should be. In many cases a left ventricular assist device (LVAD) will not produce a palpable pulse. Here, as with a new or unusual home medical appliance, you should consult with the patient's family to determine what the baseline findings should be. CPR may not be indicated and an AED may not be needed. You should not disconnect the device because it is likely the only means for this patient to pump blood.

The girlfriend of your patient wishes to accompany the patient in the ambulance. In response to this request, you should: seat her on the bench seat next to the patient and apply a seat belt. attempt to find an alternate means of transport for the girlfriend. allow her to sit in the captain's chair at the head of the stretcher if she wears a seat belt. deny her request.

attempt to find an alternate means of transport for the girlfriend. It is most appropriate to find alternative transportation for the girlfriend. Civilians should not ride in the ambulance unless no other alternative is possible. If this is the case, the girlfriend should ride in the front passenger seat because it is the safest position. She should not be placed in the patient compartment.

You are delivering a baby. As the head presents at the perineum, you notice the umbilical cord to be encircled around the baby's neck. You should: insert a gloved hand into the vagina to create a channel of air for the baby attempt to slip the cord up and over the baby's head immediately clamp and cut the cord gently push the baby's head back toward the birth canal to take pressure off the cord.

attempt to slip the cord up and over the baby's head Most nuchal cords can be relieved by simply slipping the cord over the baby's head. You should always try this before clamping and cutting the cord. Never attempt to move the baby backwards. A gloved hand will do no good if the cord is strangling the baby.

An 80-year-old woman has fallen and now complains of right hip pain. She is alert and her vitals are pulse 64, respiration 28, blood pressure 140/90. After completing your primary assessment, you should: apply a pelvic binder. begin a secondary assessment on scene. initiate rapid transport. apply a traction splint.

begin a secondary assessment on scene. Your primary assessment has revealed no major life threats, so there is no need to initiate a rapid transport. However, that does not mean that no life threats exist. At this point you should begin a secondary assessment to be sure you have not missed any serious problems. *Application of splinting devices can begin after your secondary assessment has been completed*

You are ventilating and oxygenating a 1 year old who is cyanotic with clammy skin. His pulse rate is 48 bpm. You should increase the percentage of oxygen. increase your ventilations. begin chest compressions. attach an AED.

begin chest compressions.

A five-year-old female presents with severe respiratory distress. On examination you note retractions and nasal flaring. Her mother states the child has pneumonia, but is much worse today. She tells you EMS was called when her daughter started acting very sleepy. You should: apply 6 Lpm oxygen via nasal cannula. apply 12 Lpm oxygen via nonrebreather mask. administer oxygen via the blow-by technique. begin positive pressure ventilations.

begin positive pressure ventilations. Respiratory distress and an altered mental status indicate inadequate breathing. Positive pressure ventilations should be initiated immediately. Supplemental oxygen in any other form simply would not be enough for this patient.

Melena refers to...

black tarry stools, which usually occurs as a result of upper gastrointestinal bleeding. It has a characteristic tarry colour and offensive smell, and is often difficult to flush away, which is due to the alteration and degradation of blood by intestinal enzymes.

You are transporting a 58 year old male with chest pain who is on a non-rebreather mask at 12 Lpm. En route his SpO2 rises to 96%. You should reduce the liter flow to the non-rebreather mask to 3 Lpm. change his oxygen administration to a nasal cannula. assist his ventilations with a bag-valve-mask device. reduce the liter flow to the non-rebreather mask to 8 Lpm.

change his oxygen administration to a nasal cannula.

An allergic person has signs and symptoms of compensated shock because his body detects the presence of the antigen in the blood stream. an IgE coupling at a receptor within the sympathetic nervous system. hypersensitivity to antibodies present in the white blood cells. changes in intravascular blood pressure detected by baroreceptors.

changes in intravascular blood pressure detected by baroreceptors.

The most common cause of a cerebral aneurysm that can lead to stroke is aging. hypertension. congenital. tobacco.

congenital.

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: attempt to identify the hazardous-materials placards on the tank truck. attempt to visualize and count any injured patients. begin evacuation of vehicles downwind from the accident. contact dispatch to warn other responders of the hazard.

contact dispatch to warn other responders of the hazard. 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 have delivered a shock with an AED to a 5 year old girl. You should next give two rescue breaths. check for a pulse. continue chest compressions. re-analyze her rhythm.

continue chest compressions.

Altered mental status in hyperglycemia is caused by: too much glucose in the brain cells. too little sugar in the brain cells. dehydration of the brain cells. hypoxia of the brain cells

dehydration of the brain cells. Hyperglycemia is caused by an accumulation of sugar in the bloodstream due to a lack of insulin. Because brain cells do not require insulin for transport of glucose, in this condition they have plenty of sugar. The main cause of altered mental status in hyperglycemia is the massive fluid shift that robs brain cells of precious water. Hypoxia may be a secondary problem, but typically only contributes to the existing problem of dehydration.

You arrive first on scene at a motor-vehicle crash. You identify downed electrical wires that stretch across both sides of the two-lane road. You position the ambulance to block traffic in the approaching south bound lane. You should next: request power company resources to shut down electricity to the lines. deploy flares to warn traffic in the opposite north bound lane. request fire department resources to begin extrication procedures. begin triage and evaluate the need for additional ambulances.

deploy flares to warn traffic in the opposite north bound lane. In this situation, you must consider the hazard to both approaches to the accident scene. Deploying warning devices in both lanes will protect traffic in both directions. The power company will need to be contacted as will the fire department, but not before protecting oncoming traffic. Triage also will be a secondary priority.

You have just delivered a baby. The neonate is active and pink. After suctioning the mouth and nose, you should next: dry the baby off and keep him warm. clamp and cut the umbilical cord stimulate the baby by flicking his feet determine the baby's APGAR score

dry the baby off and keep him warm. Keeping the neonate warm is the most important priority. Cutting the umbilical cord is actually a low priority. This baby is active so there is no need to further stimulate it and although scoring is important, it is not more important than preventing heat loss.

The barking cough commonly associated with croup is most likely caused by foreign bodies present in the airway poor airway muscle control edema below the vocal cords. secretions building up in the airway

edema below the vocal cords. Croup is a common infection that affects the upper airway. The barking cough is most likely caused by edema below the vocal cords. Foreign bodies and secretions can cause coughing, but are unlikely in a croup situation. Some croup patients can become hypoxic enough to lose airway control, but this would not likely be the cause of coughing.

You are the first arriving responder on the scene of a major explosion. You can see that many people have been injured. Before entering the scene, you should first: establish command. don appropriate personal protective equipment ensure the scene is safe request appropriate resources

establish command. Establishing command early is essential to framing a functioning incident command system. Although ensuring safety is always a priority, here defining command is a first step which ensures safety for all providers, not just you. Personal protective equipment is important, but can be donned after establishing command and before entering the scene. Additional resources will be necessary and the incident command system will provide a structure upon which to build.

A 71-year-old female has fallen and complains of left hip pain. On examination you note her left foot is rotated laterally. This finding most likely indicates a(n): pelvic fracture. femur fracture. knee dislocation. ankle fracture.

femur fracture. A rotated foot in the context of hip pain typically indicates a femur fracture at the level of the hip joint. A pelvic fracture would not commonly affect the foot. A knee dislocation or an ankle fracture could rotate the foot, but in this case the pain is centered at the hip.

A 19-year-old male has fallen off a two-story roof. He has abdominal pain and an angulated fracture of his right femur. After completing a patient assessment, you should: use two padded boards to immobilize the leg. apply a traction splint to the leg. immobilize the patient on a long board. apply the PASG.

immobilize the patient on a long board. The fractured femur may be the most obvious injury, but this patient's mechanism of injury indicates the potential for many other problems. In this case you should immobilize the patient to a long backboard to account for any potential spine injuries. Splinting of the leg can be accomplished immediately afterward or en route to the hospital.

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 detailed physical exam. complete a rapid trauma assessment. initiate a focused examination of the patient's knee.

initiate a focused examination of the patient's knee. 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 on 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.

You are dispatched for a patient choking. Upon arrival you find a 40-year-old male standing over a table coughing and gasping for air. You should: initiate rapid transport. initiate back blows and chest thrusts. begin abdominal thrusts open his airway with a jaw thrust

initiate rapid transport. The fact that he is still coughing means his airway is at least partially open. The best practice would be to allow him to continue to cough and initiate rapid transport. Back blows and chest thrusts are not done on adult patients and abdominal thrusts would be indicated only in the case of a more severe or complete obstruction. If he is conscious, there likely would be no reason to initiate a jaw thrust.

A route of medication delivery that may be used in unresponsive patients which involves absorption through mucous membranes is autoinjector intranasal subcutaneous sublingual

intranasal The intranasal route involves administering atomized medications into the nose. One of the most common medications used via this route is naloxone (Narcan) for opiate overdose. Other medications may be administered through this route. The sublingual route involves absorption through the oral mucosa but it should not be used in an unresponsive patient. The auto injector and subcutaneous route both involve injections and not mucous membranes.

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

joint above and below the fracture. Proper splinting technique requires immobilization of the fracture site plus the joint above and below the site of the injury. Because 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.

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

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.

The reason hyperglycemic hyperosmolar nonketotic syndrome diabetic patients are thirsty is because the kidneys need water to flush out the ketone acid. brain is not metabolizing sugar properly. brain becomes dehydrated with urinary frequency. kidneys need fluids to wash out the glucose.

kidneys need fluids to wash out the glucose.

You and your partner are attempting to transfer a very heavy patient from your ambulance stretcher to a hospital bed. The most appropriate way to move this patient safely and prevent injury would be to: bend from the side and use your waist to pivot the patient. lean over and pull the patient onto the bed. extend your arms and lift with your elbows. kneel and push the patient onto the bed.

kneel and push the patient onto the bed. Safe lifting practices are an important part of wellness. EMTs should always push rather than pull and keep the weight close to the body. Bending, twisting, and extending are methods that lead to injury.

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

laryngeal edema. 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.

You have assessed and treated a trauma patient with an open chest wound. When reassessing this patient you should focus on: exposing the patient to identify additional injuries. listening to lung sounds to identify a pneumothorax. checking for pulse oximetry changes. assessing for changes in blood pressure.

listening to lung sounds to identify a pneumothorax. An open chest wound can rapidly turn into a tension pneumothorax. Lung sound changes are important warning signs that can indicate an impending problem. Exposing the patient is important, but not central to the main problem. Blood pressure and pulse oximetry will be late findings if a tension pneumothorax occurs.

A 49-year-old male has an internally implanted defibrillator that has fired three times in the last 10 minutes. On your arrival, the patient is conscious and in pain. His vital signs are pulse 100, respirations 24, blood pressure 100/68. As you are assessing him, the patient loses consciousness only to have his defibrillator fire again. You should: monitor the patient and prepare to resuscitate. begin CPR. attach an AED. not touch the patient because you might be shocked.

monitor the patient and prepare to resuscitate. In this case the implanted defibrillator is likely doing its job. You should monitor the patient and prepare to assist in CPR and airway management if necessary. As long as the implanted defibrillator is working, an AED is not necessary. *If the patient becomes pulseless, then CPR should be initiated.* Implanted defibrillators are not dangerous to providers and patients can be handled safely.

The first signs you will observe regarding an injected poison will be seen after the dependent muscle is affected. after the poison circulates to the heart. when the poison reaches peak effect. most often at the injection site.

most often at the injection site.

An 81-year-old COPD female 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: nasal canula at 4 Lpm. Venturi mask at 6 Lpm partial rebreather mask at 15 Lpm. nonrebreather mask at 12 Lpm

nonrebreather mask at 12 Lpm This patient is hypoxic as evidenced by the difficulty breathing and cyanosis. She needs supplemental oxygen. A nonrebreather 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.

In order for a patient to progress to status asthmaticus he must continue to wheeze over lower lobes for over 2 hours. not improve with medications when suffering an acute attack. continue to wheeze after being medicated and then become hypoxic. not improve through regular use of prescribed medications for 2 months.

not improve with medications when suffering an acute attack.

The draw of fluids into the venous side of the capillary bed occurs because of hydrostatic pressure. diastolic pressure. systolic pressure. oncotic pressure.

oncotic pressure.

You successfully used an AED on a 61 year old male. After 20 seconds of CPR he began to move his hands toward your chest compressions. You palpate a pulse and his blood pressure is now 94/82. You should hyperventilate him for 30 seconds. continue chest compressions. place the patient in the recovery position. leave the AED in place.

place the patient in the recovery position.

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

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

A nine-month-old child has been found in the morning by her parents to be apneic and pulseless. Upon examination you note rigor in the extremities and a cool body temperature. You should: begin CPR complete one round of resuscitation on scene and pronounce death if not successful. transport the baby, but do not begin resuscitation. pronounce death.

pronounce death. This baby is obviously dead. Rigor mortis and a cold body temperature suggest that resuscitation will be futile. In this circumstance you should not begin resuscitation. Transporting the baby will be ill advised especially if there is any reason to believe the situation could be a crime scene.

A 56 year old male complains of severe abdominal pain that began 30 minutes ago. He is lying in a fetal position and will not allow you to examine his abdomen. He grimaces when you auscultate his abdomen. Hit vital signs are B/P 134/84, P 94, R 20. You should suspect small bowel perforation because of the rapid onset of pain. position he is lying in pain. presence of acute peritonitis. interpretation of his vital signs.

rapid onset of pain.

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

rapidly assess the likelihood of acute stroke 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 arrive first on 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: notify the local trauma center triage the four minivan patients begin treating the most injured patient request extrication resources

request extrication resources 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.

After informing a patient's mother that her 10-year-old son has died, she refuses to believe you and attempts to strike you with a vase. You should: have her arrested immediately by law enforcement. physically restrain her until she calms down. attempt to de-escalate the situation by using calm tones. retreat to safety until she calms down.

retreat to safety until she calms down. Although denial and anger may be expected reactions to death and dying, this person poses a very real safety threat. The best strategy here would be to retreat. Physically restraining her would not be advisable and having her arrested is most likely unnecessary. De-escalation is always a good practice, but when faced with imminent physical harm, retreating is the better option.

A seven-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: remove the stinger with tweezers scrape the stinger away with a credit card. administer an epinephrine auto-injector apply a cold pack on top of the sting.

scrape the stinger away with a credit card. 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 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: suction the airway perform a finger sweep begin positive pressure ventilations open the airway with a jaw thrust

suction the airway 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.

Complications within the lungs of a drowning victim occur primarily due to collapse of the alveoli. perfusion pressure changes. surfactant levels. laryngospasms.

surfactant levels.

A 41-year-old female has sustained multisystem trauma from a severe motor vehicle crash. You have extricated her and initiated transport. The primary assessment and initial vital signs are complete. You should next: apply bandages to the minor soft-tissue injuries. reassess distal circulatory, motor, and sensory function. complete a detailed assessment. take steps to maintain the patient's body temperature

take steps to maintain the patient's body temperature Body temperature is an important element of trauma care. Remember that exposure, diaphoresis, and the surface they are on are all drawing heat from the patient. Early steps to maintain warmth will interrupt the movement toward hypothermia. Continued assessments and ongoing treatments are important but may not be as important as temperature regulation.

Hemoptysis, also spelled haemoptysis, is...

the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. This can occur with lung cancer, infections such as tuberculosis, bronchitis, or pneumonia, and certain cardiovascular conditions.

A 61 year old male is complaining of a headache for the past two hours. He has no signs of a neurological deficit. His vitals are B/P 180/96, P 92, R 14. You should transport and monitor him. have him hold his breath and bear down. determine if he takes nitroglycerin. administer oxygen by non-rebreather mask.

transport and monitor him.

A 62 year old male collapsed at a family member's funeral. He complains of shortness of breath and a sudden onset of sharp chest pain. His skin is ashen. Vital signs are B/P 96/82, P 108, R 16. His SpO2 is 85% on room air. You should ventilate him with a bag-valve-mask hooked to 100% oxygen. lay him flat and determine if he takes nitroglycerin for chest pain. transport rapidly and prepare for cardiorespiratory arrest. have him cough frequently to dislodge any blood clots in his lungs.

transport rapidly and prepare for cardiorespiratory arrest.

A 50-year-old female presents with upper right quadrant abdominal pain. She states the pain is a 7 on a 1-10 scale and notes it came on shortly after dinner. After completing a primary assessment, you should: measure the patient's temperature transport the patient in a position of comfort transport the patient in a shock position administer 324 mg of aspirin.

transport the patient in a position of comfort Severe abdominal pain typically indicates transport in a position of comfort. In this patient the shock position would likely make the pain worse. Acute myocardial infarction is a concern, but you should not administer aspirin without further indication of MI or medical direction approval. Temperature can be assessed en route.

A 62 year old male has had hematemesis for the past 2 hours. He appears scared. His skin is cool and clammy. He does not have any abdominal pain. His vitals are B/P 108/82, P 106, R 16. His SpO2 is 94% on room air. You should administer 100% oxygen. calm him down. treat for shock. provide supportive care.

treat for shock.