EMT

A patient is complaining of stomach pain. She says she has a history of peptic ulcers. In which region of the abdomen is the stomach located?

Correct answer: Left upper quadrant The left upper quadrant contains the stomach, spleen, and a portion of the pancreas. The right upper quadrant contains the liver, gallbladder, duodenum of the small intestines, and a portion of the pancreas. The left lower quadrant contains the large and small intestines; of the large intestines, the left lower quadrant contains the descending and left half of the transverse colon. The right lower quadrant contains the large and small intestines; of the large intestines, the right lower quadrant contains the ascending, the right half of the transverse colon, and the appendix.

Which of the following obstetrical situations requires hospital intervention to correct? Meconium in the amniotic fluid Crowning Limb presentation Multiple births

Correct answer: Limb presentation A limb presentation, in which an arm or leg presents, cannot be delivered in the field and requires surgical intervention. Prolapsed cord, in which the umbilical cord is the first presenting part during delivery, is another emergency that requires hospital intervention. Meconium in the amniotic fluid may lead to aspiration by the baby during delivery; the receiving hospital should be informed of the presence of meconium in the amniotic fluid. Multiple births does not necessarily require hospital intervention for delivery. Crowning, in which the head is present at the vagina, means that delivery is imminent; consider delivering the baby prior to transporting.

Which of the following patients is most likely to deliver her baby on scene before transport?

Correct answer: Multigravida 24-year-old patient with visible crowning and contractions that are two minutes apart lasting 60 seconds Delivery at the scene should be considered when delivery is imminent (i.e., crowning is present) or if transport is delayed by external factors (e.g., natural disaster, inclement weather). Additionally, multigravida (previous pregnancy/pregnancies) patients are more likely to have shorter labor than those who are primigravida (first pregnancy). A patient without an urge to push or who had a recent water breaking or bloody show is unlikely to have an imminent delivery. A patient who had a recent water breaking/bloody show is likely in the first stage of labor (before full dilation of the cervix).

An adult male who took an overdose of drugs in a suicide attempt, per 911 dispatch, is unconscious with shallow breathing and a slow pulse. He is exhibiting constricted pupils and cyanosis. Which of the following medications is the most likely cause of this patient's overdose? Sympathomimetic Benzodiazepines Antihistamine Narcotic

Correct answer: Narcotics Recognition of the agent behind an overdose is important. Signs and symptoms may help differentiate possible causes. Opiate/opioid or narcotics (e.g., morphine, codeine, oxycodone, methadone, heroin) overdoses typically present with hypoventilation/respiratory arrest, hypotension, pinpoint/constricted pupils, and sedation/coma, as in this scenario. The patient's cyanosis is likely secondary to the hypoventilation. Anticholinergic and anitihistamines (e.g., diphenhydramine, atropine, chlorpheniramine, doxylamine) overdose will present with tachycardia, hypertension, hyperthermia, dilated pupils, dry skin/mucous membranes, decreased bowel sounds, and sedation/coma. Sympathomimetic (e.g., epinephrine, albuterol, cocaine, [meth]amphetamine) overdose will present with tachycardia, hypertension, hyperthermia, dilated pupils, and agitation or seizures. Benzodiazepines (e.g., diazepam, secobarbital, flunitrazepam, midazolam) overdose will present with hypoventilation, hypotension, slurred speech and sedation/coma. Sedative-hypnotics generally do not affect pupil diameter.

A 19-year-old is complaining of general malaise and shortness of breath. She is sweaty, breathing very shallowly, and has pinpoint pupils. Which of the following is the most likely cause of her signs and symptoms? Sympathomimetic overdose Tension pneumothorax Opioid overdose Sedative overdose

Correct answer: Opioid overdose Opioid overdose typically presents with sedation/unconsciousness, bradypnea, cyanosis and pinpoint pupils. As respirations continue to decrease in opioid overdose, respiratory and subsequent cardiac arrest are possible. Adequate airway and ventilation are paramount. Naloxone is an antidote that reverses the effects of opioid overdose; it is given intravenously, intramuscularly, or intranasally. As naloxone begins to work, the patient may regain levels of consciousness and will no longer be able to tolerate an oropharyngeal airway, if used. Sedative-hypnotic drugs (e.g., barbiturates, benzodiazepine, muscle relaxers, lithium) are sedating substances. Common presentation includes slurred speech, sedation or coma, hypoventilation, and hypotension. Sympathomimetics (e.g., cocaine, MDMA, PCP, amphetamine/methamphetamine) are central nervous system stimulants that mimic the sympathetic nervous system (fight-or-flight). Common signs and symptoms of use include tachycardia, hypertension, and dilated pupils. A tension pneumothorax is caused by damage to the lung tissue. The damage allows air normally held within the lung to escape into the chest cavity. The lung subsequently collapses and air can begin to apply pressure to the structures in the mediastinum (e.g., heart, great vessels). The patient will present with a trachea that deviates toward the unaffected side, along with tachycardia, tachypnea, dyspnea, anxiety, and decreased breath sounds. The onset of a tension pneumothorax is slower than that of a spontaneous pneumothorax.

An unresponsive patient has slow, shallow respirations and pinpoint pupils. Which of the following is the most likely cause?

Correct answer: Opioid overdose Opioid overdose typically presents with sedation/unconsciousness, bradypnea, cyanosis and pinpoint pupils. As respirations continue to decrease in opioid overdose, respiratory and subsequent cardiac arrest is possible. Adequate airway and ventilation is paramount. Naloxone is an antidote that reverses the effects of opioid overdose; it is given intravenously, intramuscularly, or intranasally. As naloxone begins to work, the patient may regain levels of consciousness and will no longer be able to tolerate an oropharyngeal airway, if used. Sympathomimetics (e.g., cocaine, MDMA, PCP, amphetamine/methamphetamine) are central nervous system stimulants that mimic the sympathetic nervous system (fight-or-flight). Common signs and symptoms of use include tachycardia, hypertension and dilated pupils. Hyperglycemia may present with intense thirst/hunger, abdominal pain, sweet, fruity breath (in the case of diabetic ketoacidosis), rapid/weak/thready pulse, restlessness, abnormal/slurred speech, unsteady gait, or unconsciousness. An acute myocardial infarction may present with chest pain/discomfort, described as pressure or heaviness that can radiate to the jaw, arms, back abdomen or neck; sudden weakness; nausea/vomiting; irregular heartbeat; syncope; dyspnea; and/or pink, frothy sputum.

An 18-year-old patient is showing signs and symptoms of amphetamine use. Which of the following symptoms is not likely to be present?

Correct answer: Pinpoint pupils Sympathomimetics (e.g., cocaine, amphetamine/methamphetamine, epinephrine, albuterol) are stimulants that mimic the effects of the sympathetic nervous system. Common signs and symptoms of use/overdose include hypertension, tachycardia, dilated pupils, agitation, seizures, and hyperthermia. It should be noted that anticholinergics (e.g., atropine, diphenhydramine) have similar signs and symptoms. Pinpoint pupils are commonly seen in opiate use, but not in sympathomimetic use.

Which of the following is a common cause of seizures in adults?

Correct answer: Poisoning Common causes of seizures include epilepsy, tumors, infections, head injury or scar tissue from a previous head injury, stroke, hypoxia, hypoglycemia, poisoning, drug overdose, withdrawal or fever.

Which of the following is not commonly seen in new-onset type 1 diabetes mellitus?

Correct answer: Polypharmacy Type 1 diabetes mellitus is an autoimmune disorder where antibodies are created against pancreatic beta cells. Insulin is subsequently inadequate or absent in these patients. Common signs and symptoms for new-onset type 1 diabetes mellitus include polyuria (increased urination), polydipsia (increased fluid intake due to thirst), polyphagia (increased food intake due to hunger), fatigue, and weight loss. External insulin use (injectable insulin) is required for survival in patients who have autoimmune diabetes mellitus. Polypharmacy is the use of multiple medications by a patient. Polypharmacy is not necessarily associated with new-onset type 1 diabetes mellitus.

Which of the following is not a cause of vaginal bleeding in pregnancy?

Correct answer: Preeclampsia Preeclampsia is a possible complication during pregnancy, typically found in primigravada patients. It usually develops after the 20th week of gestation and is characterized by severe hypertension, proteinuria, headaches, visual abnormalities, edema, and anxiety. Ectopic pregnacy (when an embryo develops outside of the uterus), spontaneous abortion (miscarriage), and abruptio placentae (the placenta separates prematurely from the uterine wall) are all potential causes of bleeding during pregnancy.

Which of the following is not a common cause of altered mental status?

Correct answer: Pregnancy Pregnancy is not a common cause of altered mental status. The mnemonic AEIOU-TIPS is often helpful to remember the possible causes of altered mental status. Alcohol Epilepsy, endocrine disorders, electrolyte imbalance Insulin (i.e., hypoglycemia) Opiates and other drugs Uremia (kidney failure) Trauma (particularly head trauma), temperature (hypothermia/hyperthermia) Infection Poisoning, psychogenic causes Shock, stroke, seizure, syncope, space-occupying lesions, subarachnoid hemorrhage

What does amniotic fluid with a greenish color indicate?

Correct answer: Presence of meconium Meconium (fetal stool) may be seen after the amniotic fluid is released ("water breaking"). If the amniotic fluid is greenish, meconium is likely present. Newborn distress is possible if the fetus aspirates meconium during delivery.

Which of the following measures is appropriate emergency care for an adult with an early, localized cold injury?

Correct answer: Protecting the affected body parts from further cold exposure A patient with a localized cold injury should be removed from the cold area to prevent further exposure. The affected area should be handled gently and any wet or restrictive clothing should be removed to protect the area from further injury. The area should be splinted and covered with a dry, sterile dressing. It is not appropriate to place heating pads directly on a localized cold injury. Drinking warm fluids is a treatment option for mild hypothermia, assuming the patient has no altered sensorium and is able to swallow without difficulty.

A two-year-old child is postictal. His mother states that she witnessed a tonic-clonic seizure that lasted about 45 seconds. She says he has been ill for several days. Today, he has a fever that has not been well controlled with over-the-counter medications. His temperature is 102°F (38.9°C). Which of the following is the most appropriate treatment option for this child?

Correct answer: Provide oxygen via blow-by, remove his clothes, cool him with damp towels, and provide transport Febrile seizures are common in children between six months and six years of age. These seizures commonly occur on the first day of febrile illness, but may occur at any time. Febrile seizures are characterized by generalized tonic-clonic seizure, do not last longer than 15 minutes, and have a short or absent postictal phase. Assessment and treatment of ABCs, cooling measures (e.g., clothing removal, use of damp towels), and rapid transport are appropriate. Children often refuse an oxygen mask, so responders/guardians may have to hold the mask in front of the child's face (blow-by method). An anticonvulsant is not part of the pretreatment for a child who has experienced a febrile seizure.

A 20-year-old asthmatic patient is experiencing shortness of breath. On scene, the patient advises he has a meter-dosed inhaler in his backpack but needs assistance in getting it. What is the mechanism of action of albuterol via a metered-dose inhaler?

Correct answer: Relaxes bronchial smooth muscle Albuterol, administered via a metered-dose inhaler, is a bronchodilator, which works through relaxation of the smooth muscles of the bronchioles. It is often used for asthmatics to counteract an inflamed or swollen airway or excessive mucus production. Bronchodilators do not provide moisture to the lungs or affect alveolar blood flow or overall lung compliance.

Which of the following would be considered a serious complication of a severe allergic reaction?

Correct answer: Respiratory distress Anaphylaxis is defined as a severe medical emergency, a potentially life-threatening, allergic (hypersensitivity) reaction that occurs within seconds to a few hours after allergen exposure, most commonly food, medication, or an insect sting. Manifestations include sudden onset of respiratory distress, bronchospasm, angioedema, urticaria, nausea and vomiting, abdominal pain, tachycardia, and hypotension. Because of variability of presentation, predicting the severity of an episode is difficult. Accordingly, management depends on prompt recognition and treatment. Prehospital patients with symptoms of severe anaphylaxis should first receive standard interventions. Interventions include high-flow oxygen, cardiac monitoring, and intravenous (IV) access. For the initial assessment, check the airway closely. If needed, establish and maintain an airway and/or provide ventilatory assistance. Hypertension is not a life-threatening component of anaphylaxis.

A patient has taken a large dose of heroin. He is supine and semiconscious, and begins to vomit. Which of the following is the most appropriate intervention?

Correct answer: Roll the patient onto his left side If nausea or vomiting occurs in a patient, the patient should be placed on his or her left side to prevent aspiration of vomitus. Suctioning may be required, but should be done after the patient is done vomiting. Oropharyngeal airways are contraindicated in conscious or semiconscious patients. Inserting an oropharyngeal airway may further induce vomiting. Assisted ventilations are indicated in patients with severe respiratory distress/failure; assisted ventilations may also induce further vomiting. A patient who may have an altered level of consciousness for whatever reason is likely to aspirate when vomiting if he is not assisted by placing him on his side. The left lateral recumbent position is preferred, but either side is acceptable.

In which trimester does rapid uterine growth occur?

Correct answer: Second trimester Rapid uterine growth occurs during the second trimester. As the uterus increases in size, it displaces the diaphragm from its normal position; a subsequent decrease in tidal volume occurs, causing an adaptation of increased respiratory rate. Additionally, the metabolic demand for oxygen and workload increase occurs to support the developing fetus.

Which of the following is most likely to occur in young children who experience a sudden spike in their body temperature?

Correct answer: Seizures Febrile seizures are frequently seen in children between the ages of six months and six years old. These seizures typically occur on the first day of the febrile illness. Seizures generally last less than 15 minutes and have a short postictal phase, if the phase occurs. Shock, hives and cardiac arrest are not commonly associated with fevers in children.

Which of the following is not a sign or symptom of preeclampsia? Severe hypertension Edema Visual abnormalities Seizures

Correct answer: Seizures Preeclampsia is a possible complication during pregnancy, typically found in primigravida patients. It can develop after the twentieth week of gestation and is characterized by severe hypertension, headaches, visual abnormalities, edema, and anxiety. The condition can progress into eclampsia, which is defined by the onset of seizures due to hypertension. Any pregnant patient should be rapidly transported in a postictal state.

When using the OPQRST mnemonic to obtain information regarding a patient's chief complaint, what does the "S" stand for?

Correct answer: Severity The OPQRST mnemonic is useful for gathering background information on a patient's chief complaint. OPQRST stands for Onset, Provocation/palliation, Quality, Region/radiation, Severity, and Timing. Common questions for each are listed below. Onset: "What were you doing when the symptoms began?" Provocation/palliation: "Does anything make the symptoms better or worse?" Quality: "What does the symptom feel like?" Region/radiation: "Where do you feel the symptom? Does it move anywhere?" Severity: "On a scale of zero to ten, how would you rate your symptom?" Timing: "When did the symptom start? How long as has it been occurring? Has it been constant or does it come and go?"

What is the average length of the first stage of labor in a primigravida patient?

Correct answer: Sixteen hours The average length of the first stage of labor (the dilation of the cervix) in a primigravida patient is sixteen hours. Typically a patient in the first stage of labor, regardless of the number of prior pregnancies, will not deliver prior to transport.

Which of the following is not a method of gauging a patient's responsiveness to painful stimuli?

Correct answer: Slap the patient's cheek When assessing a patient's level of consciousness, if they are not responsive to verbal stimuli, it is appropriate to move on to painful stimuli. Appropriate painful stimuli include gently but firmly pinching the patient's ear lobe, pressing on the bone above the eye, and gently but firmly pinching the muscles of the neck. Striking a patient is inappropriate.

You arrive at a home and are guided to a 31-year-old woman, G2P1, at 35 weeks gestation, lying in a pool of blood, with active bleeding from the vagina. She is drowsy but responds to questions. Peripheral pulses are weak, bilaterally.Which of the following would be increased?

Correct answer: Systemic vascular resistance Loss of intravascular volume decreases cardiac preload, resulting in decreased cardiac output and decreased systemic blood pressure. The sympathetic nervous system responds with an increased heart rate and peripheral vasoconstriction (systemic vascular resistance) as a means to maintain cardiac output and redirect blood flow to the vital organs (brain, heart, kidneys)

Which of the following signs and symptoms would most likely indicate compensated shock in a child?

Correct answer: Tachycardia Hypovolemia is the most common cause of shock in children in the out-of-hospital setting. Vomiting/diarrhea from illness or bleeding from falls/injuries are the most common causes. Shock is a physiologic state characterized by inadequate oxygen and nutrient delivery to meet tissue demands. In children, losses of more than 5% of body weight result in compensation through adjustments in cardiovascular physiology (i.e., 1L of blood weighs slightly more than 2.2 pounds; a 40-pound child losing 1L of blood will go into compensated shock). In compensated shock, the body maintains perfusion to vital organs. Tachycardia is often the most sensitive vital sign change. Decompensated shock occurs when the child's resilience is overcome and presents as poor perfusion (extreme pallor and cold, mottling of skin), tachypnea, extreme tachycardia, hypotension, altered mental status, and oliguria/anuria (renal failure). Hypotension is a profound and ominous sign of decompensated shock in children.

A 34-year-old male patient is agitated and confused. Which of the following signs would help indicate cocaine use?

Correct answer: Tachycardia Sympathomimetics (e.g., cocaine, amphetamine/methamphetamine, epinephrine, albuterol) are stimulants that mimic the effects of the sympathetic nervous system. Common signs and symptoms of use/overdose include hypertension, tachycardia, dilated pupils, agitation, seizures and hyperthermia. It should be noted that anticholinergics (e.g., atropine, diphenhydramine) have similar signs and symptoms. Pinpoint pupils are generally only seen with opiate (e.g., morphine, heroin, methadone, oxycodone) use/overdose. Hypotension and sedation may be seen with opiate or sedative-hypnotic (e.g., diazepam) use.

An unresponsive diabetic patient has deep respirations at a rate of 32 breaths per minute. Blood glucometry determines a blood glucose level of 464 mg/dL. Which of the following statements regarding the patient's ventilatory status is true? The patient is hyperventilating, likely due to metabolic acidosis The patient is hyperventilating, likely due to metabolic alkalosis The patient is hyperventilating to increase carbon dioxide levels in the blood The patient is hyperventilating to reduce the blood glucose level

Correct answer: The patient is hyperventilating, likely due to metabolic acidosis Kussmaul respirations (deep, rapid respirations) are commonly seen in patients with metabolic acidosis due to hyperglycemia (diabetic ketoacidosis). Hyperventilation occurs as an attempt by the body to reduce the acidity by releasing more carbon dioxide (i.e., decreasing carbon dioxide levels within the body). Kussmaul respirations do not affect blood glucose level and are a response to correct acidic conditions, as stated above.

Which of the following factors is most likely to result in a rapid onset of altered mental status in a diabetic patient?

Correct answer: The patient skips a meal Rapid onset of an altered mental status in a diabetic patient is likely due to hypoglycemia. Symptomatic hypoglycemia can occur for many reasons. More common reasons include a routine change (e.g., increased exercise, skipping a meal, waiting to eat), an increased amount of insulin use, insufficient eating, and an acute illness. A decrease in insulin or a juice drink will likely lead to hyperglycemia. Altered mental status due to hyperglycemia has a more insidious onset.

A 70-year-old male awoke to find that he could not move the left side of his body. This patient has most likely suffered a cerebrovascular accident (CVA). Which area of the brain has most likely suffered insult in this scenario?

Correct answer: The right hemisphere of the cerebrum A cerebrovascular accident (CVA), or stroke, is an interruption of blood flow to an area of the brain, causing loss of function. Symptoms vary by the area of the brain that is affected. Unilateral visual disturbances, facial drooping, and loss of motor function are common. The cerebrum (gray matter) is broken down into four lobes: frontal, parietal, temporal, and occipital. The brain can be divided into left and right hemispheres, each lobe having a section of each hemisphere. The frontal lobe is involved in voluntary muscle control and storage of memories. The left hemisphere portion of the frontal lobe controls the right side of the body, and the right hemisphere portion of the frontal lobe controls the left side of the body. Therefore, if the right hemisphere is injured, the left side of the body is affected. The brain stem is made of up the midbrain, the pons, and the medulla oblongata. The midbrain is involved in maintaining a level of consciousness, muscle tone, and posture. The pons is responsible for respiratory patterning and depth. The medulla oblongata functions to maintain an appropriate pulse, blood pressure, and respiratory rate.

Which of the following is an absolute contraindication to injectable epinephrine use in a life-saving allergic situation?

Correct answer: There are no contraindications There are no absolute contraindications to the use of injectable epinephrine in a life-threatening allergic situation. Some products include the following contraindications: hypersensitivity to sympathomimetic amines; narrow-angle glaucoma; non-anaphylactic shock; thyrotoxicosis, in obstetrics when maternal blood pressure is in excess of 130/80 mm Hg and in hypertension and other cardiovascular disorders. Injectable epinephrine may aggravate angina or induce cardiac arrhythmias. Caution is suggested, particularly in patients receiving drugs that sensitize the myocardium. Peripheral constriction and cardiac stimulation may occur, inducing pulmonary edema; and decreased urine output may occur in patients with renal compromise.

A nearly full-term pregnant female called for assistance after discovering that her water broke, but she wasn't experiencing contractions. Which of the following is true regarding this scenario?

Correct answer: This may be a normal progression of labor The rupture of the amniotic sac (water breaking) or blood-streaked mucus (bloody show) may occur near the first contraction or early in the first stage of labor. The onset of labor starts with uterine contractions; in true labor, frequency and intensity of contractions increase with time. A patient who is not near full-term may experience premature rupture of the amniotic sac; this requires supportive care and transport to the hospital. In this scenario, there is no indication that the baby is in any life-threatening danger. The first stage of labor ends and the second stage of labor begins when the fetus enters the birth canal. Vaginal bleeding in early pregnancy may be an indication of a miscarriage.

A 66-year-old has sudden-onset unilateral facial droop, slurred speech, unequal pupils, and right-sided neurological deficits. Suspecting an ischemic stroke, within what time period is it best to begin medication treatments?

Correct answer: Three hours An ischemic stroke is the most common type of stroke, accounting for more than 80% of all strokes. A blockage (blood clot/thrombosis, embolus, or plaque) does not allow blood flow to a specific area. Atherosclerosis is a calcium and cholesterol buildup that forms plaque inside the walls of a blood vessel. Blood clots or plaque buildups may occur elsewhere in the body, break off, and then be carried to the brain. Rapid transport for treatment is crucial. Medication treatments for ischemic strokes are best when administered in a hospital setting within three hours of onset. Some mechanical treatment options are effective up to six hours after onset.

A full-term pregnant patient is in active labor. As the baby's head delivers, the umbilical cord is observed to be around the baby's neck. Which of the following is the most appropriate next step?

Correct answer: Try to slip the cord over the baby's head A nuchal cord is the wrapping of the umbilical cord around a baby's neck. This should be assessed for when the head is delivered. If wound tightly enough, a nuchal cord could strangle the fetus, so removal of the cord should be immediate. Typically, the cord is not wound tightly and can be slipped gently over the head. If the cord is too tight to slip over the head, it should be cut by placing two clamps about two inches apart and cutting between the clamps. If the cord is wrapped multiple times, only one cut is required. The cord should be handled very gently. It is never appropriate to push the head back into the vagina once it has presented.

How many bones are in each foot?

Correct answer: Twenty-six There are twenty-six bones in each foot: seven tarsal bones (including the talus and calcaneus), five metatarsal bones, and fourteen phalanges in the toes (two in the great toe and three in each of the smaller toes).

Which of the following signs/symptoms is not likely to be seen in a patient requiring albuterol via a metered-dose inhaler? Retractions Vesicular breath sounds Cyanosis Cough

Correct answer: Vesicular breath sounds Vesicular breath sounds are normal breath sounds and do not need treatment. Albuterol, a bronchodilator, is used in asthmatic patients. Common signs/symptoms of asthma are wheezing, retractions, cough, dyspnea, and cyanosis (in late stages).

Which of the following is a common sign/symptom of hyperglycemia, but not of hypoglycemia?

Correct answer: Vomiting Two of the most common, life-threatening conditions associated with diabetes are hyper- and hypoglycemia. Both are emergencies and require immediate intervention, so recognition is critical. Presentation can appear similar in both, presenting with hypotension, weak/rapid pulse, and altered mental status. Hyperglycemia is the most common symptom of diabetes mellitus. While mild hyperglycemia is often asymptomatic, more significant hyperglycemia causes increased urine glucose levels and osmotic diuresis, presenting symptomatically as increased urinary frequency, polyuria, and polydipsia, possibly leading to orthostatic hypotension and dehydration. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the most serious acute complications of diabetes; DKA is characterized by ketoacidosis and hyperglycemia, while HHS usually has more severe hyperglycemia without ketoacidosis. The most common precipitating factor in the development of DKA and HHS is infection. Precipitating factors also include discontinuation of insulin, pancreatitis, myocardial infarction, cerebrovascular accident, and drugs (e.g., corticosteroids, thiazides, antipsychotics). HHS usually evolves over several days to weeks, and DKA can present in less than 24 hours. Symptoms and signs of diabetic ketoacidosis include symptoms of hyperglycemia with the addition of nausea, vomiting, and, in children, abdominal pain. Lethargy and somnolence are symptoms of more severe decompensation. Patients may be hypotensive and tachycardic due to dehydration and acidosis; they may breathe rapidly and deeply to compensate for acidemia (Kussmaul respirations). They may also have fruity breath due to exhaled acetone. In the absence of timely treatment, DKA progresses to coma and death. Hypoglycemia typically has a rapid onset and an almost immediate response to treatment. Symptoms are nonspecific and include tremor, palpitations, anxiety/arousal, sweating, hunger, paresthesias, seizure, coma, and cognitive, behavioral, or psychomotor changes.

A 9-year-old boy had a single, brief seizure at home and is now postictal. His mother is upset and reports that he has experienced a seizure once before, but it was different than this episode. Which of the following is not a critical step to achieving the best patient outcome? Patient position Waiting for the patient to regain consciousness before assessment Clearing the airway of secretions Preventing aspirations

Correct answer: Waiting for the patient to regain consciousness before assessment The postictal state is an altered state of consciousness following seizure. It commonly lasts from 5 to 30 minutes; it is characterized by lethargy, drowsiness, confusion, nausea, hypertension, headache, and signs of disorientation. Most seizure-affected patients will be in a postictal state upon EMS arrival. Ensuring a patent airway via patient positioning, clearing of secretions, and prevention of aspirations is vital to obtaining the best patient outcome.

When is the correct time to perform a secondary assessment in an unstable patient?

Correct answer:While en route to the hospital, only after life threats are managed If a patient is stable and has an isolated chief complaint, the secondary assessment and detailed physical exam may be performed at the scene. If the patient is unstable and therefore requires rapid transport, the secondary assessment may be performed while en route to the hospital. Depending on the hospital location or the severity of any life-threatening conditions, the secondary assessment may not be completed. The secondary assessment is either a systematic head-to-toe secondary examination or an assessment that focuses on the body system of illness or area of injury; circumstances dictate which type of exam is appropriate. As above, an unstable patient will require rapid transport; thus, a quick assessment and treatment of life-threatening conditions along with a set of baseline vitals is taken at the scene, and the patient is loaded into the ambulance for transport before any further assessment/interventions are performed. Scene size-up is done upon arrival at the scene, prior to any assessment of or intervention on the patient. A detailed medical exam is performed while en route to the hospital to find any injuries/ailments that may have been missed in the initial assessment. This can be accomplished in a couple of minutes while en route to the hospital after more important issues are dealt with, such as life threat and stabilization. There is no reason for an EMT to waste time on-scene conducting a detailed physical exam that can be accomplished while en route to the hospital on a seriously ill or injured patient. This is a more in-depth assessment that builds on the focused physical exam. Many patients may not require a detailed physical exam because it is either irrelevant or there is not enough time to complete it. This assessment will only be performed while en route to the hospital or if there is time on-scene while waiting for an ambulance to arrive. Patients who will have this assessment performed are those with significant mechanism of injury, or those who are unconscious, confused, or unable to adequately relate their chief complaint. The detailed physical exam does not follow the initial baseline vital assessment on the scene. If needed, it can be done later, after stabilization and while en route to the hospital. It would never be appropriate to perform a detailed physical exam on initial contact with a patient. The initial assessment is the primary assessment and is designed to find immediate life-threatening conditions. The detailed physical exam is best suited for critical patients while en route to the hospital with time permitting.

A nearly full-term pregnant female called for assistance after discovering that her water broke; she noted green fluid in the discharge at that time. Which of the following is the most likely cause?

Meconium is fetal stool, seen as green fluid during the rupture of the amniotic sac. If aspirated, it may result in respiratory distress, obstruction, or fetal death. Post-term deliveries are at a higher risk of meconium. If meconium is seen and the newborn is not adequately breathing, consider quickly suctioning the mouth then nose before providing assisted ventilations. The receiving hospital should be notified of the presence of meconium. A nuchal cord (umbilical cord wrapped around a baby's neck on delivery) is a possible birth complication. If the cord is wrapped too tightly, the baby could be strangled. Preeclampsia is a possible complication during pregnancy, typically found in primigravida patients. It can develop after the twentieth week of gestation and is characterized by severe hypertension, headaches, visual abnormalities, edema, and anxiety. The condition can progress into eclampsia, which is defined by the onset of seizures due to hypertension. The amniotic sac will commonly rupture at the beginning of labor, due to contractions. If the amniotic sac remains unruptured, it will present as a fluid-filled sac (like a water balloon) emerging from the vagina prior to crowning.

what to do when treating patients

Preschool-age children (three to six years) are able to use simple language effectively. Children this age have a vivid imagination, so interventions should be explained simply and directly before they are done to ensure the child has no time to develop frightening fantasies. It is inappropriate to ignore any patient who is able to understand directions. It is also inappropriate to lie to any patient, particularly preschool-age children, as their trust may be hard to regain.

What happens after a seizure?

a patient will be in postical state. This indiciated the person has altered mental status the muscles will relax even to the extent they become (flaccid or floppy) and they have labored breathing to compensate for acidosis. the patient may experience hemiparesis which means weakness on one side of the body. even though the patients might respond to painful stimuli but they will be in a state of confusion that they may not be aware of place and time. It's rare for patients after seizure to experience anxiety or restlessness afterward

Hypoglycemia symptoms and treatment

altered mental status/pale/cool/moist skin/ hypotension. rapid weak pulse/ possible shallow respiration. give them oral glucose if the patient has patent airway

tonic-clonic seizure

generalized seizure in which the patient loses consciousness and has jerking movements of paired muscle groups

what should you do to patients experiencing hypothermia?

give them warm fluids assuming the patients don't have altered sensorium and are able to swallow without any difficulty.

symptoms of heat exhaustion

hot, dry skin dizziness, weakness, alternated mental status/syncope, vomiting/nausea, headache, muscle/abdominal cramping, dry tongue and thirst. Skin change can occur, but it's dependent upon the level of exposure the patient experience. if the patient is unable to regulate their core temperature then their skin will be hot, dry, and moist. if the patient is experiencing excessive fluid and salt loss then their skin will be moist/pale/ and cool.

Dsyphagia

inability or difficulty in swallowing and shouldn't be given anything to ingest bc they have risk of aspiration

Preeclampsia

is a possible complication during pregnancy, typically found in primigravada patients. It can develop after the twentieth week of gestation and is characterized by severe hypertension, headaches, visual abnormalities, edema and anxiety. The condition can progress into eclampsia, which is defined by the onset of seizures due to hypertension.

what happens if the PNS is overstimulated?

patient will expereince increase salivation/ bronchrrohea/ brochospam/ sweating/ abdominal pain/ diarrhea/ miosis (excessive constriction of the pupil) muscle paralysis/ bradycardia and eventually the patient will die from asytole.

what to do if a patient experience cold injury?

protect the affected body parts from the cold exposure to prevent futher injury. Any wet or restrictive clothig should be removed to protect the areas and the affected region should be splinted and covered with dry/sterile dressing.

What is a febrile seizure?

A seizure brought on in infants and young children caused by high fever. This seizure doesn't last more than 15 mins and they have a short postical phase. treatment: perform ABC then provide oxygen by blow-by. remove his clothes and cool him with a damp towel. Also, provide transportation

What is Ectopic pregnancy

An ectopic pregnancy is a pregnancy that occurs outside the uterus, most commonly in the fallopian tube. Risk factors include a history of pelvic inflammatory disease, tubal ligation, or previous ectopic pregnancies. Patients with an ectopic pregnancy may suffer internal bleeding. A common symptom is sudden, severe unilateral lower abdominal pain. An ectopic pregnancy is a medical emergency and should be evaluated in a hospital setting.

A seven-day-old newborn has cyanosis on his face and chest and a palpable pulse of 90 beats per minute. Which of the following is an appropriate respiratory rate for this child?

Correct answer: 36 breaths per minute An appropriate respiratory rate for an infant (under one year of age) is 30-60 breaths per minute. As the patient continues to age, the respiratory rate will decline. As with all patients, if a patient does not have adequate respirations, assisted ventilations should be provided. An increased work of breathing in infants may include grunting/wheezing, accessory muscle use, retractions, head bobbing, nasal flaring, and tachypnea. Normal respiratory ranges for other children is listed below: Toddler (one to three years old): 24 to 40 breaths per minute Preschool-age (four to five years old): 22 to 34 breaths per minute School-age (six to twelve years old): 18 to 30 breaths per minute Adolescent (thirteen to eighteen years old): 12 to 16 breaths per minute

In which scenario is activated charcoal most appropriate?

Correct answer: A 2-year-old child who has ingested blood pressure medication Activated charcoal is given to absorb ingested (oral route) poisons. It is inappropriate to use in cases where a patient has ingested an acid, alkali, or petroleum product. The typical dose of activated charcoal is 1-2 grams of medication per kilogram of body weight. A patient bitten by an unknown insect may develop an allergic reaction; activated charcoal would not be beneficial in this scenario. A patient who has inhaled carbon monoxide gas requires high-flow oxygenation, not activated charcoal.

In which of the following scenarios is oral glucose most appropriate?

Correct answer: A 58-year-old male behaving as if he is intoxicated and whose son states that his father takes injectable insulin A patient with a history of diabetes and an altered mental status should increase the suspicion of hypoglycemia. Oral glucose may be given to a conscious patient with suspected hypoglycemia, pending medical direction. The only contraindication to oral glucose is an inability to swallow and unconsciousness, as aspiration can occur. A conscious patient who does not really need glucose will not be harmed by it; however, a patient with a suspected diabetic emergency is a more appropriate scenario for the use of oral glucose. An altered mental status is a common sign of a recent head injury; a patient who has hit his/her head may exhibit this sign and be treated as a head injury patient. Trauma patients should not be given anything by mouth.

Which of the following diabetic situations would likely benefit from the administration of oral glucose?

Correct answer: A confused patient who is cool and clammy with a patent airway Oral glucose is indicated for patients with hypoglycemia. A patient who does not require oral glucose will not be harmed by it, so it should be given if hypoglycemia is suspected. Hypoglycemia often presents as a rapid onset of altered mental status, particularly in a patient with a history of diabetes. Other signs and symptoms include pale, cool, moist skin; hypotension; rapid, weak pulse; and possible shallow respirations if the hypoglycemia is severe. Oral glucose should not be given to an unresponsive/unconscious patient or a patient without a gag reflex, due to the risk of aspiration. Dysphagia is difficulty swallowing or inability to swallow; therefore, this patient is at risk for aspiration of the medication. Hot, dry skin is not a common sign and symptom of hypoglycemia; this patient will not likely benefit from oral glucose administration.

Which of the following statements is true regarding the pathophysiology of abruptio placentae?

Correct answer: Abruptio placentae may result in shock Abruptio placentae is the premature separation of the placenta from the uterine wall. The most common causes are hypertension and trauma. Severe pain is common; the degree of vaginal bleeding is dependent upon the severity of the separation. If blood loss is severe, the patient may exhibit signs of shock (e.g., weak, rapid pulse and pale, cool, diaphoretic skin). Placenta previa is when the placenta develops over and covers the cervical opening. Patients may experience heavy vaginal bleeding, often without pain. Supine hypotensive syndrome occurs when a pregnant patient lies supine and the pregnant uterus compresses the inferior vena cava. The blood return to the heart is decreased and results in subsequent hypotension of the mother. Because of this risk, any patient in the third trimester of pregnancy should be positioned on her left side during transport.

A 35-year-old has been recently diagnosed with diabetes. Bystanders state that her blood sugar was 60 mg/dL approximately ten minutes ago. The patient complains of lightheadedness but denies alternate symptoms. Which of the following is the most appropriate next step?

Correct answer: Administer oral glucose Hypoglycemia (low blood glucose level) is often caused by normal insulin dosing with a change in routine (e.g., increased exercise, delayed/skipped/inadequately-sized meal), increased insulin use, or the presence of an acute illness. Onset is typically rapid. Pale, cool, clammy skin; shallow breathing; hypotension; rapid, weak pulse; and altered mental status are common. Oral glucose is a mainstay treatment for suspected hypoglycemia. Contraindications to oral glucose use are unconsciousness and an inability to swallow. A normal blood glucose value is between 80 and 120 mg/dL; as this patient is symptomatic, treatment is appropriate. Oxygen may be beneficial for this patient, but it will not address her hypoglycemia.

Which of the following would be most appropriate when treating a 30-year-old hypoglycemic diabetic who is conscious but somewhat confused to person, place, and time?

Correct answer: Administer oral glucose, as long as he has an intact gag reflex Oral glucose is indicated for patients with hypoglycemia. A patient who does not require oral glucose will not be harmed by it, so it should be given if hypoglycemia is suspected. Hypoglycemia will often present as a rapid onset of altered mental status, particularly in a patient with a history of diabetes. Other signs and symptoms include pale, cool, moist skin; hypotension; rapid, weak pulse; and possible shallow respirations if the hypoglycemia is severe. Oral glucose should not be given to an unresponsive/unconscious patient, or a patient without a gag reflex, due to the risk of aspiration. Insulin would only serve to worsen the hypoglycemia. This patient will require high-flow oxygen and rapid transport; however, administration of oral glucose will improve symptoms quickly. Waiting for an ALS may delay care and subsequent transport

A 14-year-old male complains of lower abdominal pain. His blood pressure is 120/80 mmHg, his pulse is 130 beats per minute, respirations are 28 breaths per minute, and temperature is 104.8°F (40.4°C). The pain is located in the right lower quadrant. The patient has recent contacts with gastroenteritis. Which of the following is the most appropriate treatment? Do not transport, as gastroenteritis is not life-threatening Advise acetaminophen for fever and ask the parents to follow up with the patient's pediatrician Administer oxygen and transport Advise acetaminophen for fever and reassess in fifteen minutes

Correct answer: Administer oxygen and transport Despite the likelihood of gastroenteritis, this patient's symptoms are also those of appendicitis. In addition to right lower abdominal pain and fever, nausea/vomiting, anorexia, chills, and rebound tenderness are common. The patient also may have a ruptured appendix, which requires surgical intervention as well. Therefore, transport is paramount.

When is it appropriate to cut the umbilical cord after assisting a new mother to deliver her baby?

Correct answer: After the cord stops pulsating After delivery, the baby should be placed on the mother's abdomen to initiate skin-to-skin contact and help keep the newborn warm. Prior to cutting the umbilical cord, assess and treat the newborn for any signs of respiratory distress (e.g., gurgling). Once the newborn's airway is patent and he or she is breathing adequately, the cord may be cut after the pulsations in the cord stop. To cut the umbilical cord, place a clamp on it and milk the blood from a section of the cord on the placental side. Place a second clamp two to three inches away from the first and cut between the two clamps. Placental delivery should follow within thirty minutes. Never pull on the umbilical cord in an attempt to speed placental delivery.

Which of the following is an early sign of respiratory distress in a pediatric patient?

Correct answer: Agitation Early signs of respiratory distress in a child include changes in the patient's behavior like combativeness, restlessness or agitation, and anxiety. Additionally, an increased work of breathing may be present (e.g., nasal flaring, abnormal breath sounds, accessory muscle use, or the tripod position). Cyanosis, bradycardia and a decreased level of consciousness may occur if respiratory distress is not treated.

Which of the following conditions is not a common cause of an altered mental status? Allergic reaction Hypoglycemia Traumatic brain injury Hypoxia

Correct answer: Allergic reaction An altered mental status may arise from sudden illness, traumatic brain injury, seizure disorders, drug/alcohol abuse/overdose/withdrawal, diseases of the brain (e.g., Alzheimer's or meningitis), hypoglycemia, hypoxia, impaired cerebral blood flow, hyperthermia/hypothermia, or a psychiatric disorder. It is unlikely that an allergic reaction will cause an altered mental status.

An 11-year-old patient complains of chest tightness and itchy, red skin. He has rapid, labored breathing and a rapid heart rate. Which of the following conditions is most likely?

Correct answer: Allergic reaction Chest tightness, tachycardia, rapid/labored breathing and itchy, red skin are all common signs of an allergic reaction. Sneezing, rhinorrhea, dyspnea, persistent cough, hoarseness, wheezing/stridor, hypotension, flushing, cyanosis/pallor, tingling sensations, altered mental status, anxiety, gastrointestinal complaints, headache, itchy/watery eyes, and dizziness are all signs/symptoms of allergic reaction. Acute coronary syndrome may present with chest tightness, tachycardia and dyspnea, but is not likely to present with itchy, red skin and is uncommon in pediatric patients. Injuries to the head typically present with altered mental status/level of consciousness; they can also present with pupillary changes and neurological deficits. A patient in a postictal state will typically be unconscious, with flaccid muscles and labored breathing.

Which of the following is not appropriate after labor has begun? Administer oxygen, if indicated Ensure the legs are not held together Allow the patient to use the bathroom, if needed Contact medical direction if needed for guidance

Correct answer: Allow the patient to use the bathroom, if needed Once labor has begun, it cannot be slowed or stopped. It is inappropriate to hold a patient's legs together to attempt to slow or stop labor. Do not allow the delivering mother to use the bathroom; she should be reassured that the sensation of needing to move her bowels is normal. If at any time the situation is beyond a rescuer's training, medical direction should be contacted for further guidance. Oxygen may be administered during delivery, but is not required unless medically indicated.

What is the definition of hypoglycemia?

Correct answer: An abnormally low blood glucose level Hypoglycemia is an abnormally low blood glucose level. Hyperglycemia is an abnormally high blood glucose level. Type 1 diabetes is an autoimmune disorder in which the immune system produces antibodies to the pancreatic beta cells, decreasing insulin production by the pancreas. Type 2 diabetes is an acquired disorder in which insulin resistance develops in response to increased blood glucose levels.

In which of the following situations would the administration of albuterol via a metered-dose inhaler (MDI) be the most beneficial? An alert 6-year-old male with an active upper-respiratory infection, who has respirations of 24 breaths per minute but no respiratory complaints An alert 16-year-old female with history of asthma, who has respirations of 24 breaths per minute and is wheezing An alert 64-year-old male with history of emphysema, who complains of difficulty breathing and has access to an inhaler that was prescribed for his son An unresponsive 52-year-old female with a history of severe asthma, respirations of 28 breaths per minute and is wheezing

Correct answer: An alert 16-year-old female with history of asthma, who has respirations of 24 breaths per minute and is wheezing Albuterol via a metered-dose inhaler (MDI) may be used for acute asthma / chronic obstructive pulmonary disease (COPD) exacerbation or bronchitis. The 16-year-old is likely suffering from an asthma exacerbation as she has a history of asthma and her respirations are elevated (above 20 breaths per minute) and she is wheezing. Contraindications to MDI use include a patient who is unable to help coordinate inhalation with depression of the trigger (i.e., confused, unconscious) or a patient who has already had the maximum prescribed dose. A patient who has an active upper-respiratory infection (e.g., bronchitis) may not necessarily need albuterol via an MDI if no respiratory complaints are present. An MDI may be used only if the "six rights," including right patient, are assessed and accurate.

A 30-year-old female was stung by a bee. On arrival, the patient is complaining of steadily increasing shortness of breath and urticaria, and feels as if her throat or tongue is swelling. Which of the following is the most likely cause of her signs and symptoms? Heat exhaustion Anaphylactic shock Asthma Syncope

Correct answer: Anaphylactic shock Anaphylaxis, or anaphylactic shock, is a violent reaction to an allergen. Common causes of anaphylaxis include injections (e.g., tetanus antitoxin, penicillin), stings from insects, ingestion of foods, and inhalation of particles (e.g., dust, pollen, mold). It may develop within seconds or minutes of contact with the allergen. A repeat phase 1-8 hours after exposure is possible. Flushed, itchy skin, urticaria (hives), edema, pallor, cyanosis, hypotension, weak or almost impalpable pulse, sneezing, stridor/airway obstruction, chest tightness, dyspnea, cough, wheezing, respiratory arrest, abdominal cramping, nausea/vomiting, altered mental status, dizziness, syncope, and coma are possible. Asthma is an acute spasm of bronchioles associated with excessive mucus production and swelling of the respiratory mucosal lining. Wheezing, dyspnea, cyanosis, and respiratory arrest may occur. Urticaria is not commonly associated with asthma. Syncope is fainting not associated with a postictal state. Heat exhaustion is the most common heat emergency. It is caused by heat exposure, stress, and fatigue. Hypovolemia is common, due to the loss of water and electrolytes via sweating. Dizziness, weakness, syncope, muscle cramping, dry tongue/thirst, and tachycardia are common.

A 27-year-old man with an extensive psychiatric history calmly explains that his thoughts are controlling the whole universe and he does not know what to do. His body language and speech are gentle and nonthreatening. Which of the following options is most appropriate?

Correct answer: Be clam, direct, and straightforward In cases of acute psychosis, it is important to remain calm and speak to the patient in a respectful, direct, and straightforward manner. Maintain an emotional distance. Explain procedures. Involve people that the patient trusts. Do not agree or disagree with the patient's delusions. Do not patronize, argue with the patient, or challenge the validity of his/her perception. Since this patient is not combative, restraints are not appropriate.

An 11-year-old female complains of an allergic reaction. Upon arrival, her mother presents an epinephrine auto-injector. Which of the following is the most appropriate next step? Direct the mother to administer the epinephrine auto-injector Begin the primary assessment Administer the epinephrine auto-injector Contact the physician who prescribed the epinephrine auto-injector

Correct answer: Begin the primary assessment At the very least, a primary assessment must be conducted prior to performing any intervention, including the use of an epinephrine auto-injector. The general impression, formal assessment (i.e., vital signs, DCAP-BTLS) and the determination of the priority of the patient are all involved in the primary assessment. Administering treatment prior to evaluation is negligent. As above, interventions (whether by EMS personnel, patients, family members or bystanders) should be completed after a primary assessment is done. In this scenario, there is no reason to contact a prescribing provider.

You arrive on scene to find an unresponsive six-month-old. Which pulse point is best for assessing the presence of a pulse in an unresponsive infant?

Correct answer: Brachial pulse A brachial pulse is assessed in an infant to determine pulse rate. CPR should be initiated on an infant without a palpable pulse or a pulse of fewer than 60 beats per minute. A carotid or a femoral pulse are not typically palpable in a child less than one year of age. The radial pulse is not used to assess the need for CPR in any age group.

A woman is giving birth in the prehospital setting. As the baby's head is being delivered, the umbilical cord is noted to be wrapped tightly around the baby's neck; the cord cannot be slipped over the baby's head. Which of the following is the most appropriate next step?

Correct answer: Clamp the cord about two inches apart and cut between the clamps A nuchal cord (umbilical cord wrapped around a baby's neck on delivery) is a possible birth complication. If the cord is wrapped too tightly, the baby could be strangled. Typically, the cord can be gently slipped over the baby's head. If the cord is wrapped tightly around the infant's neck, the cord should be clamped in two places, about two inches apart, and cut between the clamps. Delivery must be expedited as the baby will no longer be receiving oxygen from the delivering mother.

Which of the following is the cause of supine hypotensive syndrome?

Correct answer: Compression of the inferior vena cava by the uterus Supine hypotensive syndrome occurs when a pregnant patient lies supine and the pregnant uterus compresses the inferior vena cava. The blood return to the heart is decreased, resulting in subsequent hypotension. Because of this risk, any patient in the third trimester of pregnancy should be positioned on her left side during transport. It may present with pallor, tachycardia, sweating, nausea, and dizziness. The uterus does not compress the vagus nerve. Fetal hypertension does not cause maternal hypotension. Placenta previa is when the placenta develops over and covers the cervical opening. Patients may experience heavy vaginal bleeding, often without pain.

Which of the following signs or symptoms can be expected from the early adverse effects of hypothermia?

Correct answer: Confusion Confusion is a possible sign of hypothermia. The severity of altered mental status often is dependent upon the severity of the hypothermia. Other early signs of hypothermia include shivering and tachypnea. Treatment should include covering the patient in dry blankets and placing the patient in a warm environment. Warm fluids may be given if allowed by local protocol for a conscious patient who is able to swallow without difficulty. Decreased mucus production, blood-tinged sputum, and peripheral edema are not signs of hypothermia.

A 32-year-old man is hypothermic after swimming in an icy river. Although he came out of the river within a few minutes, he is showing a diminished level of consciousness. Which of the following is the most appropriate next step?

Correct answer: Cover the patient with blankets and increase the heat in the patient compartment of the ambulance Passive rewarming is an appropriate first step when dealing with a patient who has mild hypothermia. Passive rewarming includes placing the patient in a warm environment (e.g., the patient compartment with the heat turned up), removing wet clothing, applying heat packs/hot water bottles to the groin, axillary, and cervical regions, placing dry blankets over and under the patient, and giving warm, humidified oxygen. Heat packs/hot water bottles should not be applied directly to the skin, to avoid burns. Stimulants such as coffee, tea, soda, or tobacco products should be avoided, as they are vasoconstrictors which may further impair circulation. Patients should be discouraged from walking, in order to not further damage the feet. Massaging the extremities or handling the patient roughly is inappropriate.

Which of the following is considered a sign of hypothermia?

Correct answer: Cyanosis with rapid respirations Hypothermia is defined as a core body temperature of less than 95°F (35°C). Early signs and symptoms include shivering, rapid breathing, and redness or cyanosis. If hypothermia progresses, loss of coordination, muscle stiffness, a slowing of respirations and pulse, confusion/lethargy, coma/unresponsiveness, weak pulse, dysrhythmias, very slow respirations and cardiac arrest can occur. A strong pulse is a normal pulse. Hypertension is not commonly seen in hypothermia.

Which of the following medications blocks the effects of histamine and is taken for allergic reactions?

Correct answer: Diphenhydramine Diphenhydramine is a medication indicated for allergic reactions. It blocks the effects of histamine. It can lead to drowsiness and increased pressure of the fluid within the eye. Asthma is a relative contraindication for diphenhydramine as it can worsen lower airway constriction. Activated charcoal is a very fine powder in a premixed suspension that is used to help absorb ingested poisons. Aspirin is an antipyretic (reduces fever), analgesic (reduces pain), anti-inflammatory (reduces inflammation), and platelet aggregation inhibitor (prevents clot formation and enlargement). It is often used by patients who are at risk for coronary artery disease. Naloxone is an intramuscular or intranasal medication used to reverse the effects of opioid overdose.

A breathing newborn was delivered in the prehospital setting. He has a pink body, a pulse of 108 beats per minute, and good muscle tone. The infant is crying lustily. Which of the following is the most appropriate next step? Dry off and completely wrap the newborn, exposing no areas to ensure warmth Provide assisted ventilations Immediately cut the umbilical cord Dry the infant and place the newborn on the mother's abdomen to begin skin-to-skin contact

Correct answer: Dry the infant and place the newborn on the mother's abdomen to begin skin-to-skin contact Assuming there are no life-threatening conditions, skin-to-skin contact should be initiated as soon as possible upon delivery. The mother may hold the newborn, or the newborn may be placed on the mother's chest or abdomen; this contact helps keep the newborn warm and may improve perfusion. If skin-to-skin contact is not an option, the newborn should be dried and wrapped in a clean blanket/towel leaving the face exposed. Sterile gauze should be used to wipe the newborn's mouth/nose as needed. An APGAR check is completed at one and five minutes after birth. After delivery, the umbilical cord may be cut once it has stopped pulsating; the cord is clamped in two places, approximately six inches (15 cm) from the newborn and another two to four inches (5-10 cm) away from the first clamp and is cut between the clamps.

A 7-year-old patient has a history of severe allergic reactions. He is currently experiencing facial swelling, urticaria, and inspiratory/expiratory wheezing equally bilaterally. If available, which listed intervention would be the most appropriate to initiate first?

Correct answer: Epinephrine auto-injector This patient is showing signs of a severe allergic reaction with multiple system involvement—anaphylaxis—which is consistent with his past medical history. Anaphylaxis may present with bronchospasms, wheezing, chest tightness, coughing, dyspnea, hypotension, anxiety, and gastrointestinal complaints. Epinephrine is a hormone given intramuscularly to treat anaphylaxis. Auto-injectors are given at doses of 0.3 mg for patients three years and older and 0.15 mg for patients under three years of age.

A patient is determined to be unstable. How often should vital signs be assessed?

Correct answer: Every 5 minutes An unstable patient should have his or her vital signs reassessed every five minutes. A stable patient may have his or her vital signs reassessed every fifteen minutes. Examples of unstable patients are those who are in shock, have consumed lethal amounts of poisonous substances, are suspected of having internal bleeding, have excessive external bleeding (including vaginal bleeding), have serious abdominal injuries, exhibit a decline in consciousness, or were involved in drowning or diving emergencies. Any change in condition should signal a reassessment of vital signs.

Which of the following is not a common side effect seen with metered-dose inhalers that contain epinephrine?

Correct answer: Fatigue Epinephrine via metered-dose inhaler can cause tachycardia, hypertension, and restlessness. Albuterol and metaproterenol are alternatives to inhalers of epinephrine with fewer side effects, and are more commonly used. Fatigue is a result of the effort to breathe during respiratory distress.

A two-year-old is in a postictal state. His mother says he has been ill for several days and had a fever just before becoming unconscious and experiencing the seizure, which lasted less than a minute. She denies any medical history. The child is lethargic but acknowledges his mother's presence. Which of the following has most likely occurred?

Correct answer: Febrile seizure Febrile seizures are common in children between six months and six years of age. These seizures commonly occur on the first day of febrile illness. Febrile seizures are characterized by generalized tonic-clonic seizure, do not last longer than 15 minutes, and have a short or absent postictal phase. Assessment of ABCs, cooling measures, and rapid transport are appropriate. Epilepsy is a congenital seizure disorder. The first seizure can occur at any time throughout life. As this patient recently had a fever and has not had a seizure in the past, epilepsy is not as likely as a febrile seizure. A patient with severe hypoglycemia may experience a seizure; there is no indication that this patient has hypoglycemia or a history of diabetes. Partial seizures occur in only one part of the brain. Simple partial seizures are not associated with a change in the level of consciousness.

How long after birth should a newborn infant start to breathe spontaneously? Fifteen to thirty seconds Immediately Ten to fifteen seconds One minute

Correct answer: Fifteen to thirty seconds An infant should begin breathing spontaneously within fifteen to thirty seconds after birth. If respirations are not observed (or crying is not heard), gently tap or flick the soles of the newborn's feet or rub the back to stimulate breathing.

A patient was accidentally sprayed in the eyes with a liquid insecticide. Which of the following would be the most appropriate treatment?

Correct answer: Flood the eyes with a constant gentle stream of water When a chemical burn occurs within the eye, the eye should be flooded with a gentle stream of water for 15-20 minutes. The eyes are flushed from the inside corners to the outside to prevent cross-contamination. If only one eye has been affected, the head should be turned to the affected side prior to flushing. If both eyes are affected, a nasal cannula may be used to direct water or saline to both eyes simultaneously; the prongs should not physically touch the eye. Activated charcoal is used for the ingestion of poisons or an overdose of medication; it is only used orally. Sterile gauze should be placed over burned eyes but after irrigation is completed; dressings are also used for injured eyes or those with impaled objects.

For which of the following patients would the administration of oral glucose be indicated?

Correct answer: Forty-two-year-old man with a history of diabetes and a sudden-onset altered mental status Oral glucose is indicated for patients with hypoglycemia. A patient who does not require oral glucose will not be harmed by it, so it should be given if hypoglycemia is suspected. Hypoglycemia will often present as a rapid onset of altered mental status, particularly in a patient with a history of diabetes. Other signs and symptoms include pale, cool, moist skin; hypotension; rapid, weak pulse; and possible shallow respirations, if the hypoglycemia is severe. Oral glucose should not be given to an unresponsive patient, or a patient without a gag reflex, due to the risk of aspiration. The forty-one-year-old likely has altered mental status due to the injury to his head and therefore does not require oral glucose at this time, and should not be given anything by mouth. Hemiplegia is not a common sign or symptom of hypoglcyemia. Stroke patients should not be given anything by mouth. The twenty-eight-year-old woman is unresponsive; as above, unresponsiveness is a contraindication to oral glucose. An unresponsive patient should not be given anything by mouth.

While assisting a full-term pregnant female in delivering her baby, what may be required to deliver the lower (second) shoulder?

Correct answer: Guide the head up slightly After the head is delivered, it will rotate to one side on its own. At the next contraction, the upper shoulder should be visible. Guide the head down slightly by applying gentle downward traction to help the upper shoulder deliver. Support the head and upper body as the shoulders deliver. Guiding the head up slightly to help deliver the lower shoulder may be required. Massage of the uterus in a firm, circular, kneading motion can help slow bleeding. Do not apply resistance to the head or attempt to slow the delivery in any way.

A 10-year-old male has non-traumatic epistaxis. He is visibly upset and crying. Which of the following is the most appropriate step to control his bleeding?

Correct answer: Have the patient sit leaning forward with the head tilted forward, and apply direct pressure for at least 15 minutes Epistaxis, or nosebleed, is a common occurrence. Blood loss, even if unseen, may be great enough to cause shock. Typically, a nosebleed may be treated by having the patient sit leaning forward with the head tilted forward and applying direct pressure for at least 15 minutes by pinching the fleshy part of the nostrils together. The patient may apply this pressure. Other treatment options include applying ice over the nose or placing gauze between the upper lip and gum and having the patient stretch the upper lip tightly, pushing it up into and against the nose. Blood from a nosebleed may be swallowed, so it is appropriate to monitor for nausea and vomiting. Placing the patient in a supine position or where the head is tilted backward may cause blood to be swallowed or possibly aspirated into the lungs. Nasal packing, often saturated with epinephrine, is considered a medical procedure indicated for overt or suspected epistaxis after direct pressure, topical agents, or silver nitrate cauterization, and is out of scope of practice for an EMT.

On a hot summer afternoon, a 64-year-old obese male, with no discernible medical history, complains of weakness and muscle cramps; he has a rapid heartbeat. Which of the following is most likely?

Correct answer: Heat exhaustion Dizziness, weakness, syncope, altered mental status, nausea, vomiting, headache, and muscle cramping are common in heat exhaustion. If the onset is in a hot, humid, or poorly ventilated area, the suspicion of heat-related issues should be increased. Because of the current weather conditions, the patient's age, and the signs and symptoms, you should suspect hyperthermia until proven otherwise. Respiratory distress will most commonly present with dyspnea, which is not present in this scenario. An acute abdomen is, by definition, the sudden onset of abdominal pain associated with a severe, progressive problem. Acute coronary syndrome may present with weakness and tachycardia, but is commonly seen with chest pain/discomfort and dyspnea.

A 66-year-old patient complains of right upper quadrant pain and general malaise, and has a yellowish tint to his skin and the sclera of his eyes. Which of the following is the most likely cause of his complaints and findings?

Correct answer: Hepatitis Hepatitis (inflammation of the liver) or liver insult/injury will most commonly cause right upper quadrant pain and jaundice (yellowing of the skin and sclera). Liver insult may be caused by gallstones/gallbladder insult, viral hepatitis, or drug and alcohol use. Chronic renal failure may present with lethargy, nausea, headaches, cramps, and extremity edema if untreated. It may progress to seizures or coma in later stages. Pancreatitis, which may also be caused by gallstones, is an inflammation of the pancreas. Other causes include alcohol abuse and other diseases. Common signs and symptoms include upper left quadrant pain, nausea, vomiting, abdominal distension, and tenderness. Pneumonia typically presents with a cough, fever, and dyspnea and may occasionally cause pain that radiates to the upper abdomen.

Which of the following signs or symptoms is most likely to be associated with a heat-related emergency?

Correct answer: Hot, dry skin Heat exhaustion is the most common heat emergency. Hypovolemia, as a result of loss of water and electrolytes from heavy sweating, is a common cause. Typical signs and symptoms include dizziness, weakness, altered mental status/syncope, nausea/vomiting, headache, muscle/abdominal cramping, dry tongue, and thirst. Slightly elevated temperature, rapid, weak pulse and low diastolic blood pressure are possible. Skin changes are likely, but they are dependent upon the level of exposure. Moist, pale, cool skin indicates excessive fluid and salt loss. Hot, moist skin and hot, dry skin indicates the body's inability to regulate core temperature.

An adult took an overdose of diazepam, a benzodiazepine. Which of the following symptoms would one expect to encounter during the physical examination?

Correct answer: Hypersomnolence Isolated benzodiazepine overdose, as described in the vignette, classically presents with CNS depression and normal vital signs. Many patients are arousable and able to provide an adequate history. However, most intentional ingestions of a benzodiazepine involve other drugs, the most common being alcohol and opioids, in which case, respiratory compromise is a possibility. Overdose is usually suspected on the basis of history and the clinical scenario. Any number of sedative-hypnotic medications share clinical features with benzodiazepines in overdose, including alcohol, barbiturates, GHB, and chloral hydrate. Patients with a clinically obvious ingestion manifest slurred speech, ataxia, and altered mental status (drowsiness). Ensure that the patient has a patent airway and transport.

An adult patient reports that he is on a newly prescribed opioid pain medication that he feels may be causing his complaints. Which of the following is not a feature of opioid use/overdose?

Correct answer: Hypertension Opioid overdose typically presents with sedation/unconsciousness, bradypnea, cyanosis, hypotension, and pinpoint pupils. As respirations continue to decrease in opioid overdose, respiratory and subsequent cardiac arrest are possible. Adequate airway and ventilation are paramount. Naloxone is an antidote that reverses the effects of opioid overdose; it is given intravenously, intramuscularly, or intranasally. As naloxone begins to work, the patient may regain levels of consciousness and will no longer be able to tolerate an oropharyngeal airway, if used.

A 25-year-old female has an altered mental status. Bystanders state the patient was acting fine until her mental status changed suddenly. They go on to say the patient is diabetic and has not eaten since taking her insulin earlier today. Which of the following is the most likely cause of her altered mental status?

Correct answer: Hypoglycemia Hypoglycemia (low blood glucose level) is often caused by normal insulin dosing with a change in routine (e.g., increased exercise, delayed/skipped/inadequately-sized meal), increased insulin use, or the presence of an acute illness. Onset is typically rapid. Pale, cool, clammy skin, shallow breathing, hypotension, rapid, weak pulse, and altered mental status are common. Oral glucose is a mainstay treatment with suspected hypoglycemia. Contraindications to oral glucose use are unconsciousness and an inability to swallow. Hyperglycemia (high blood glucose level) has a more gradual onset of signs and symptoms than hypoglycemia. An intense thirst and hunger; increased urination (polyuria); abdominal pain; vomiting; rapid, weak, thready pulse; restlessness with progression to coma; slurred speech; and an unsteady gait are typical signs and symptoms. Sweet fruity breath and rapid, deep (Kussmaul) respirations are possible in the setting of diabetic ketoacidosis. Since head injury was not mentioned by the bystanders, it is unlikely to be the cause. Dementia is not commonly in seen younger patients, and is therefore unlikely.

A five-year-old is unconscious, and breathing inadequately. When inserting an oropharyngeal airway, which of the following is true?

Correct answer: If the airway is too large, it may obstruct the larynx An oropharyngeal is designed to keep the tongue from blocking the airway and allows for easier suctioning. An oropharyngeal airway is indicated in patients who are unconscious and do not have an intact gag reflex. Oropharyngeal airways are contraindicated in patients who may have ingested caustic or petroleum-based products, as the airway may induce vomiting. One should begin by measuring for an appropriately sized airway in children by placing the flange at the central incisor, with the bite block segment parallel to the hard palate; the tip of the airway should reach the angle of the jaw. Alternatively, length-based resuscitation tape (Broselow tape) may be used to appropriately size an airway. After choosing an appropriately sized oropharyngeal airway, position the patient's airway via the head-tilt/chin-lift or jaw-thrust maneuver, depending on the scenario. In children, avoid hyperextension of the neck. Depress the tongue with either a tongue blade or the airway tip, and slowly insert the airway. Rotate the airway into position, following the curve of the tongue. The flange should rest against the lips. Reassess the airway after it is in place. If the airway is too small, the tongue may obstruct the airway; if the airway is too large, the airway may obstruct the larynx.

In infants and children, what does drawing in of the intercostal or substernal muscles during inspiration commonly indicate?

Correct answer: Increased work of breathing In children, increased work of breathing may present as grunting/wheezing, accessory muscle use, retractions (drawing in of the intercostal or substernal muscles during inspiration), head bobbing, nasal flaring, tachypnea, or the tripod position. Ensure a patent airway and supplemental oxygen or assisted ventilation, as indicated, in these patients. This breathing is not adequate but is not shallow either. Apnea is the absence of spontaneous breathing.

A 70-year-old female began showing signs of confusion, facial droop, nausea/vomiting, and right-sided weakness while watching TV, per her family. Prior to EMS arrival, the patient became unconscious. She is breathing at a rate of 16 breaths per minute with snoring respirations. She has a pulse rate of 100 beats per minute with a blood pressure of 190/120 mmHg. Her gag reflex is intact. She is beginning to show signs of hypoxia. Which of the following interventions would be most appropriate after opening her airway?

Correct answer: Insert a nasal airway, apply high-flow oxygen, and initiate a safe transport. Management of a stroke begins with the assessment and treatment of ABCs and rapid transport to a stroke center. Suction may be required if patients are having difficulty swallowing. Oxygen should be administered to maintain an oxygen saturation of at least 94%. Routine use of oxygen is not recommended unless the patient is showing signs of hypoxia. Rapid transport is appropriate. As this patient has snoring respirations, an airway adjunct is appropriate. A nasopharyngeal airway is used in a patient who is semiconscious or has an intact gag reflex or patients who will not otherwise tolerate an oropharyngeal airway. Severe head injury with blood draining from the nose and a history of a fractured nasal bone are contraindications for use. An oropharyngeal airway is contraindicated in patients who are conscious or have an intact gag reflex. The main purpose of the oropharyngeal airway is to prevent the tongue of an unconscious patient, without a gag reflex, from blocking the upper airway. There is no indication that the patient is apneic or having respiratory distress/failure; therefore assisted ventilations are not indicated at this time.

In which of the following routes is an auto-injectable syringe of epinephrine administered?

Correct answer: Intramuscular Epinephrine is a hormone that controls the fight-or-flight response. It is used in the setting of anaphylaxis (a severe allergic reaction). There are no contraindications in a life-threatening emergency; however, medical direction should be contacted if the patient has a history of heart disease or acute coronary syndrome. Epinephrine is given via an auto-injectable syringe intramuscularly; the thigh is a common site for administration. An EpiPen delivers 0.3 mg of epinephrine, while an EpiPen Jr (for patients under three years of age) delivers 0.15 mg of epinephrine. Side effects include tachycardia, sweating, pale skin, dizziness, headache, and palpitations.

The neighbor of a 65-year-old woman calls EMS after seeing that her friend received multiple wasp stings while she was working in her garden. She is in respiratory distress with wheezing and is confused, able to follow only simple commands. The skin is flushed, and urticaria is noted. Physical examination reveals diffuse bilateral expiratory wheezes, tachycardia, and extremities that are cool to the touch. Which of the following is the appropriate treatment?

Correct answer: Intramuscular epinephrine Anaphylaxis is defined as a severe, potentially life-threatening allergic or hypersensitivity reaction that occurs within seconds to a few hours of allergen exposure, most commonly food, medication, or an insect sting. Anaphylaxis involves multiple organ systems following exposure to a known or suspected allergen; skin or mucosal involvement is present in 85% of affected patients. Signs and symptoms include the following: Skin-mucosal tissue involvement (hives, itching, swollen lips or tongue) Respiratory compromise (dyspnea, wheezing, stridor, hypoxemia) Hypotension or signs of hypoperfusion (syncope, weakness) Gastrointestinal involvement (cramping abdominal pain, vomiting) The patient in this vignette presents with hypotension, bronchospasm, and urticaria, which are characteristic of a severe anaphylactic reaction. Intramuscular epinephrine is the drug of choice for anaphylaxis. Antihistamines (diphenhydramine and ranitidine) do not treat the life-threatening manifestations of anaphylaxis. There is no evidence that glucocorticoids (hydrocortisone) are effective in the treatment of anaphylaxis.

Which of the following drugs is a commonly abused hallucinogen?

Correct answer: Ketamine Hallucinogens can be classified into two subcategories: the classic hallucinogens and the dissociative drugs. Classic hallucinogens typically produce visual and auditory hallucinations and may result in an altered sense of time and heightened sensory experiences. Dissociative drugs produce feelings of detachment, such as derealization (the feeling that one is detached from reality or that things are not real) and depersonalization (the feeling that one is detached from one's own physical body). Classic hallucinogens include LSD, psilocybin (mushrooms), peyote, and DMT. Dissociative drugs include PCP and ketamine. Cocaine (sympathomimetic), alcohol (sedative/hypnotic), and amphetamines (sympathomimetic) are not classified as hallucinogens.

Which of the following is not part of the SAMPLE mnemonic?

Correct answer: Last occurrence of similar injury/illness Examples for each letter are listed below. Signs and symptoms: signs/symptoms that occurred before or during onset, or are actively occurring; OPQRST for pain Allergies: allergies to medication, food, or other substances; reactions to allergens Medications: medication; dosing; frequency; last time taken Pertinent past medical history: previous medical, surgical, or traumatic occurrences that pertain to current injury/illness Last oral intake: what and when last time patient ate or drank; drug or alcohol use Events leading up to injury/illness: time of onset; activities performed at onset