JBL TestPrep Questions for NREMT

A. A gurgling sound during breathing Reason: Secretions in the upper airway of a patient with an intact gag reflex would normally stimulate coughing, gagging, or some other mechanism to clear the airway. If the unresponsive patient is gurgling, fluids are pooling in the airway and such a mechanism is absent; this clearly indicates a severely depressed or absent gag reflex. Stridor indicates narrowing or swelling of the upper airway; it tells you nothing as to the status of the patient's gag reflex. Slow, shallow breathing indicates that the patient's respiratory effort is inadequate; it does not give any indication as to the status of the gag reflex. Cyanosis is a clinical sign of significant hypoxia; it does not indicate the presence or absence of a gag reflex.

An unresponsive man is found lying supine in his bed. Which of the following assessment findings would indicate that his gag reflex is depressed or absent? A. A gurgling sound during breathing B. High-pitched inspiratory stridor C. Breathing that is slow and shallow D. Cyanosis to the face, neck, and chest

A. prevents a clot from getting larger. Reason: Early administration of baby aspirin (160 to 325 mg) to patients with acute coronary syndrome (ACS) has clearly been shown to reduce mortality and morbidity. Aspirin (acetylsalicylic acid [ASA]) prevents the clot in a coronary artery from getting larger by inhibiting platelet aggregation; in other words, it makes the platelets less sticky, which means that they will be less likely to clump together. Aspirin does not relieve the chest pain or discomfort associated with ACS, nor does it reduce blood pressure. Furthermore, aspirin does not remove the clot that is blocking a coronary artery; cardiac catheterization or fibrinolytic (clot-buster) drugs are required to do this.

Aspirin is beneficial to patients experiencing an acute coronary syndrome because it: A. prevents a clot from getting larger. B. effectively relieves their chest pain. C. decreases cardiac workload by lowering the BP. D. destroys the clot that is blocking a coronary artery.

C. A sling to support the left arm and swathes to secure the arm to the body Reason: Injuries to the shoulder are most effectively immobilized with the use of a sling and swathe. The sling will provide support and relieve pain to the shoulder, and the swathe will secure the arm to the body. The purpose of the swathe is not to facilitate traction. Patients with dislocated or fractured shoulders will not allow you to extend their arm, so any attempt to immobilize the injury in such a fashion will not be possible and could worsen the injury.

During a soccer game, a 20-year-old man collided shoulder-to-shoulder with another player. He has pain and a noticeable anterior bulge to the left shoulder. Which of the following is the MOST effective method of immobilizing this injury? A. An air-inflatable splint with the left arm immobilized in the flexed position B. A long board splint with the left arm immobilized in the extended position C. A sling to support the left arm and swathes to secure the arm to the body D. A sling to support the left arm and swathes to maintain downward traction

D. A large avulsion to the arm and an altered mental status Reason: During triage, patients with an altered mental status, who are in shock, or who have problems with their airway, breathing, or circulation are potentially salvageable and are given immediate priority. Patients who are pulseless and apneic have low priority in a mass-casualty situation. If you focus your efforts on cardiac arrest patients, who will most likely not survive anyway, patients who could have potentially been saved will die as well. Remember, the goal of triage is to provide the greatest good for the greatest number of patients.

During the triage process, which of the following injuries or conditions would classify a patient as a high priority? A. Pulselessness and apnea B. Unilateral femur fracture and tachycardia C. Partial-thickness burns with no respiratory difficulty D. A large avulsion to the arm and an altered mental status

B. Keep the baby warm and transport Reason: If the newborn has no signs of distress, has pink skin, and a heart rate greater than 100 beats/min, simply keep the baby warm and transport to the hospital. Re-suctioning the mouth and nose is not necessary if the newborn is breathing adequately. Bag-mask ventilation is indicated if the newborn is apneic or has gasping respirations, or if the heart rate is less than 100 beats/min. If the baby has central cyanosis—cyanosis to the face or trunk—administer free-flow oxygen by face mask or oxygen tubing.

Following delivery of a baby, the newborn has a strong cry and a heart rate of 130 beats/min. What should you do? A. Suction the baby's mouth and nose B. Keep the baby warm and transport C. Ventilate with a bag-mask device D. Administer free-flow oxygen by mask

A. the affected part could refreeze after rewarming. Reason: Frostbitten body parts should not be rewarmed if there is a chance that they could refreeze after you have rewarmed them. If an extremity thaws and then refreezes, the amount of tissue and cellular damage may be worse than the damage caused by the initial freezing. A delay in getting the patient to the emergency department warrants rewarming. If rewarmed, the extremity should be immersed in water that is 105 ºF to 112 ºF. Analgesia would certainly be a comfort to the patient, although its absence does not negate rewarming a frostbitten body part in the field.

In general, you should avoid rewarming a frostbitten body part in the field if: A. the affected part could refreeze after rewarming. B. a paramedic is not present to administer analgesia. C. you are unable to obtain water that is at least 120ºF. D. arrival at the emergency department will be delayed.

B. atherosclerosis. Reason: In most patients with acute coronary syndrome (ACS; eg, unstable angina, acute myocardial infarction), atherosclerosis is the underlying problem that causes heart disease. Atherosclerosis is a disorder in which calcium and a fatty material called cholesterol build up and form a plaque inside the walls of blood vessels, obstructing blood flow. ACS due to atherosclerosis usually occurs when a fragment of plaque ruptures and occludes a coronary artery; further occlusion occurs when platelets aggregate in the area and clump together. Less commonly, acute coronary artery spasm may result in ACS. The cause of acute coronary vasospasm is largely unknown. Rupture of a coronary artery is a rare cause of ACS. Atrial or ventricular damage is usually caused by, rather than the cause of, ACS.

In patients with heart disease, acute coronary syndrome is MOST often the result of: A. atrial damage. B. atherosclerosis. C. coronary artery spasm. D. coronary artery rupture.

D. The child's collapse was witnessed and sudden. Reason: If you are off duty or otherwise alone and witness the sudden collapse of a child (1 year of age to the onset of puberty [12 to 14 years of age]) who is pulseless and apneic, you should immediately call 9-1-1 and retrieve an AED, just as you would for an adult. The sudden collapse of a child is consistent with a primary cardiac problem, not respiratory failure (the most common cause of cardiac arrest in infants and children). Therefore, early defibrillation is crucial in this patient population. Children with respiratory failure typically get progressively sicker and then develop cardiac arrest; they usually do not collapse suddenly. If the suspected cause of the cardiac arrest is respiratory failure, or if the child's collapse was not witnessed and sudden, you should perform CPR for 2 minutes before calling 9-1-1 and retrieving the AED. In these cases, it should be assumed that respiratory failure is the underlying cause. Cardiac arrest secondary to an opioid overdose is the result of hypoxia; in these cases, CPR should be performed for 2 minutes before calling 9-1-1 and retrieving the AED. The child's medical history is not a f

In which of the following situations should the lone rescuer call 9-1-1 and retrieve an AED before initiating CPR on a pulseless and apneic child? A. The child is between 1 and 8 years of age. B. The child's past medical history is unknown. C. An opioid overdose is suspected or confirmed. D. The child's collapse was witnessed and sudden.

C. keeping the weight as close to you as possible. Reason: General guidelines for safe lifting and moving include keeping the weight as close to your body as possible; keeping your back in a straight, locked-in position; using the muscles of your thighs to lift; and avoiding twisting when moving a patient around a corner. Back injuries are the most common injury sustained by the EMT and can be easily avoided if proper lifting and moving techniques are observed.

Proper body mechanics when lifting and moving a patient include: A. maintaining a slight curvature of your back. B. using the muscles of your lower back to lift. C. keeping the weight as close to you as possible. D. twisting at the waist when moving around a corner.

A. an antidote may prevent liver failure if administered early enough. Reason: Acetaminophen (APAP), the active ingredient in Tylenol, is a safe drug if taken as directed. However, ingestion of more than 140 mg/kg in an adult can cause liver failure and death. Symptoms of APAP overdose do not present acutely; it can take up to a week before signs of liver failure are apparent. The antidote for acetaminophen poisoning is acetylcysteine (Acetadote, Mucomyst), which is given only at the hospital. However, it must be given promptly if liver failure is to be avoided. Activated charcoal can be given to patients with APAP overdose; however, it is effective only if the drug is still in the stomach. After 1 to 2 hours following ingestion, activated charcoal would likely be ineffective.

Rapid transport of a patient who ingested a large dose of Tylenol is important because: A. an antidote may prevent liver failure if administered early enough. B. activated charcoal cannot be given to patients who ingested Tylenol. C. it takes only a small dose of Tylenol to cause cardiopulmonary arrest. D. liver failure usually occurs within 6 hours following a Tylenol overdose.

B. upper airway obstruction by the tongue. Reason: In an unresponsive patient, the muscles of the tongue, which attach to the mandible, relax and fall back over the posterior pharynx; this causes a snoring sound when the patient breathes. The tongue the most common cause of airway obstruction in the unresponsive patient. Foreign body upper airway obstructions and upper airway swelling typically produce stridor, a high-pitched sound heard during inhalation. Collapsing of the trachea during breathing would present with marked respiratory distress and retractions.

Snoring respirations in an unresponsive patient are MOST often the result of: A. foreign body airway obstruction. B. upper airway obstruction by the tongue. C. collapse of the trachea during breathing. D. swelling of the upper airway structures.

A. Decreased blood pressure Reason: Because nitroglycerin is a vasodilator, you should expect that the patient's blood pressure will be lower when you reassess it. Some patients experience only a minor decrease in blood pressure; other patients may experience a more significant decrease (one of the many reasons to reassess your patient). Nitroglycerin typically does not increase anxiety; the fact that it relieves their chest pain, however, may actually decrease their anxiety. Nitroglycerin has no effect on oxygen saturation. Some patients may experience a burning sensation under their tongue; a burning sensation in the chest is not typical following nitroglycerin administration.

The EMT is treating a man with chest pain and has assisted him with his nitroglycerin. Which of the following should the EMT anticipate during reassessment of this patient? A. Decreased blood pressure B. Increased level of anxiety C. Increased oxygen saturation D. Burning sensation in the chest

A. effective handwashing. Reason: According to the Centers for Disease Control and Prevention (CDC), the most effective way of preventing the spread of disease is to frequently and effectively wash your hands, especially in between patients. The regular use of gloves with all patients and wearing a mask when managing a patient with a communicable disease (eg, tuberculosis) will decrease your chance of disease exposure. Keeping up-to-date with your immunizations will reduce your risk of contracting certain diseases if you are exposed to them.

The MOST effective means of preventing the spread of disease is: A. effective handwashing. B. up-to-date immunizations. C. wearing gloves with all patients. D. wearing a mask with all patients.

B. 15 compressions to 2 ventilations, compressing the sternum with the heel of your hand, and ventilating until visible chest rise occurs. Reason: When performing two-rescuer CPR on an infant (less than 1 year of age) or a child (1 year of age to the onset of puberty [12 to 14 years of age]), use a compression to ventilation ratio of 15:2. Compress the chest by one-third the depth of the chest (about 1.5 inches for infants; about 2 inches for children), at a rate of 100 to 120/min, and allow the chest to fully recoil in between compressions. Deliver each breath over 1 second, just enough to produce visible chest rise, and allow complete exhalation. For a child, use the heel of one or both hands to compress the chest, depending on the size of the child. For two-rescuer infant CPR, use the tips of your thumbs to compress the chest (two-thumb, encircling-hands technique); the two-finger technique may be used for one-rescuer infant CPR. A 30:2 compression to ventilation ratio is used for all adult and one-rescuer CPR.

The appropriate technique for performing two-rescuer CPR on a 4-year-old child includes: A. 30 compressions to 2 ventilations, compressing the chest one-third the depth of the chest, and delivering each breath over 1 second. B. 15 compressions to 2 ventilations, compressing the sternum with the heel of your hand, and ventilating until visible chest rise occurs. C. 30 compressions to 2 ventilations, compressing the sternum with the heel of both hands, and delivering each breath over 1 to 2 seconds. D. 15 compressions to 2 ventilations, compressing the sternum with your thumbs, and delivering 100 to 120 compressions per minute.

B. skin blistering. Reason: The primary route of exposure to blister agents, or vesicants, is the skin. If vesicants are left on the skin or clothing long enough, they produce vapors that can enter the respiratory tract. Vesicants cause burn-like blisters to form on the victim's skin as well as in the respiratory tract (if inhaled). Vesicant agents include sulfur mustard (H), Lewisite (L), and phosgene oxime (CX). The symbols H, L, and CX are military designations. Vesicants usually cause the most damage to damp or moist areas of the body, such as the armpits, groin, and respiratory tract.

The primary clinical feature associated with exposure to a vesicant agent is: A. tachycardia. B. skin blistering. C. vomiting blood. D. muscle twitching.

D. up to three doses of sublingual nitroglycerin. Reason: Treatment for patients with congestive heart failure (CHF) includes supplemental oxygen as needed to maintain an oxygen saturation equal to or greater than 94%, continuous positive airway pressure (CPAP), ventilatory assistance with a bag-mask device if needed (do NOT hyperventilate the patient), placing the patient in an upright or sitting position to facilitate breathing (a supine position will clearly make it more difficult to breathe), monitoring the patient's vital signs, and transporting to the hospital without delay. Suction the airway only if there are secretions in the mouth; prophylactic suctioning is not indicated. Nitroglycerin (NTG) may be of value if the patient is not hypotensive and he or she has the medication prescribed to him or her. As a vasodilator, NTG causes systemic venous pooling of blood, which reduces the amount of blood returned to the heart (preload) and, therefore, the amount of blood available to back up in the lungs. Follow your local protocols or contact medical control as needed regarding the use of NTG for patients with CHF.

Treatment for a patient with congestive heart failure and shortness of breath may include: A. prophylactic suctioning of the airway. B. hyperventilation with a bag-mask device. C. supine positioning and elevation of the legs. D. up to three doses of sublingual nitroglycerin.

B. material safety data sheet. Reason: All facilities that use or store chemicals are required by law to have a material safety data sheet (MSDS) on file for each chemical used or stored in the facility. Many sites, especially those that stock many different chemicals, may keep this information archived on a computer. The MSDS provides basic information about the chemical makeup of a substance, the potential hazards it presents, appropriate first aid in the event of an exposure, and other pertinent data for safe handling of the chemical. Shipping papers, called bills of lading (freight bills), are required whenever chemicals are being transported from one place to another. Drivers transporting chemicals are required by law to have a set of shipping papers on their person or within easy reach inside the cab at all times. The company's policy handbook is of no real value to the incident commander. The Emergency Response Guidebook (ERG) is a tool for emergency responders; it is typically not present at a chemical plant or similar site.

When arriving at a chemical plant fire, the incident commander should expect a plant representative to present a/an: A. bill of lading (freight bill). B. material safety data sheet. C. company policy handbook. D. Emergency Response Guidebook.

C. look for the presence of an exit wound. Reason: When assessing a patient who sustained a gunshot wound, you should routinely look for an exit wound, which may be difficult to find. Exit wounds can be a source of continued bleeding, both externally and internally. They may or may not follow the same path as the entrance wound. This is why it is important to conduct a thorough examination of the patient. Ice can be applied to the wound, but only after the wound has been covered by a sterile dressing and any bleeding has been controlled. Determining why the patient was shot is the responsibility of law enforcement, not the EMT. If the wound is close to an extremity, pulse, motor, and sensory function should be assessed distal to the wound.

When assessing and treating a patient with a gunshot wound, you should routinely: A. apply ice directly to the wound. B. determine why the patient was shot. C. look for the presence of an exit wound. D. evaluate the pulses proximal to the wound.

C. Electrical interference that can make diagnosis difficult Reason: Artifact refers to an ECG tracing that is the result of interference, such as patient movement, deep breathing, or muscle tremors, rather than the heart's electrical activity. Artifact can make diagnosis of the ECG difficult or impossible. To minimize artifact on the ECG, make sure the patient is lying supine; if the patient is experiencing respiratory distress, place him or her in a semi-Fowler's position. Ensure that the patient's arms are relaxed by his or her side and his or her feet are uncrossed.

With regard to the electrocardiogram (ECG), what is artifact? A. A significant abnormality discovered by the paramedic B. The complete absence of electrical activity on the ECG C. Electrical interference that can make diagnosis difficult D. Improper lead placement, resulting in misdiagnosis

B. ventilation. Reason: The patient overdosed on an opioid, which has suppressed his respiratory system and is preventing him from ventilating adequately. This failure of ventilation causes a ripple effect. If ventilation is inadequate, oxygen is not effectively drawn into the lungs and carbon dioxide cannot be effectively eliminated. Therefore, pulmonary respiration is negatively affected. If oxygen cannot be drawn into the lungs, it cannot be delivered to the cells; therefore, cellular respiration is negatively affected, which results in inadequate perfusion.

A patient overdosed on heroin and is unresponsive. He is cyanotic; he has slow, shallow breathing; and his oxygen saturation is 80%. The primary cause of this patient's condition is inadequate: A. perfusion. B. ventilation. C. respiration. D. oxygenation.

B. turn the patient onto his side. Reason: The patient's airway must be clear of foreign bodies or secretions before it can be assessed or managed. If the patient begins to vomit, he must first be rolled onto his side to allow for drainage of the vomitus. Use suction to remove secretions after you have positioned him on his side. After the airway is clear, you should insert an appropriate airway adjunct (oral or nasal airway) and ensure adequate ventilation and oxygenation. In this patient, this involves assisting his ventilations with a bag-mask device.

A patient overdosed on several drugs and is unresponsive with shallow breathing and facial cyanosis. As you continue your assessment, the patient suddenly vomits. You should: A. suction his oropharynx at once. B. turn the patient onto his side. C. insert an oropharyngeal airway. D. begin assisting his ventilations.

B. manually stabilize his head. Reason: When a trauma patient is found in a prone (face-down) position, especially if he or she is unresponsive, your first action should be to manually stabilize his or her head; this action is based on the assumption that the patient has a spinal injury. Next, log roll the patient to a supine position (while continuing to manually stabilize the head), open the airway with the jaw-thrust maneuver, clear the airway with suction if needed, and assess for breathing. It would be extremely difficult to adequately open the patient's airway while he or she is in a prone position. Depending on the patient's breathing effort, administer high-flow oxygen or ventilate using a bag-mask device.

A 42-year-old man was ejected from his car after it struck a bridge pillar at a high rate of speed. You find him in a prone position approximately 50 feet from his car. He is not moving and does not appear to be breathing. You should: A. assess his breathing effort. B. manually stabilize his head. C. administer high-flow oxygen. D. use the jaw-thrust maneuver.

C. carefully stabilize the shard of glass and allow him to suction his own mouth. Reason: It remains true that you should remove an impaled object if it compromises the airway or impedes your ability to manage the airway. However, neither is the case with this patient because he has an adequate airway, unimpaired breathing, and is conscious and alert with only minor bleeding in his mouth. The safest approach, and most practical given the situation, would be to carefully stabilize the shard of glass in place; consider wrapping the exposed glass with gauze to protect yourself from getting cut. Since the patient is conscious and alert and has only minor oral bleeding, it would not be unreasonable to hand him the suction catheter and allow him to use it as needed. Be sure to instruct the patient to use the suction and not to swallow any blood. Keep in mind that if you attempt to remove the shard of glass, you risk cutting yourself and causing further injury to the patient. Do not attempt to cut the glass shard in order to shorten it; this may cause further injury (including injury to yourself) and would likely only worsen the bleeding.

A 22-year-old man has a shard of glass impaled in his cheek. You look inside his mouth and see minor bleeding. The patient is conscious and alert with adequate breathing. You should: A. carefully remove the shard of glass in the same direction that it entered. B. cut the glass to shorten its length and then stabilize the remaining shard in place. C. carefully stabilize the shard of glass and allow him to suction his own mouth. D. remove the shard of glass and place gauze in his mouth to control the bleeding.

B. Ask the mother to hold an oxygen mask near the child's face. Reason: Do not assume that a child will simply allow you to administer oxygen to him or her as you would to an adult. The child in this scenario, who is in respiratory distress and is mildly hypoxemic (SpO₂ of 91%), should receive supplemental oxygen; however, it should be given in a nonthreatening manner. Agitating a sick or injured child causes an increase in oxygen consumption and demand, which may cause the child's condition to deteriorate. In this scenario, ask the child's mother to hold an oxygen mask near the child's face (blow-by oxygen). Small children are not as likely to tolerate a nasal cannula or nonrebreathing mask as an adult would. Closely monitor the child's condition and be prepared to assist her ventilations with a bag-mask device if she deteriorates. Allow the child to assume a position of comfort and transport.

A 3-year-old child presents with respiratory distress. She is conscious, crying, and clinging to her mother. She has mild intercostal retractions and an oxygen saturation of 91%. What should you do? A. Gently restrain the child and assist her ventilations. B. Ask the mother to hold an oxygen mask near the child's face. C. Apply a nasal cannula with the flow rate set to 6 L/min. D. Apply a non-rebreathing mask with the flow rate set to 12 L/min.

A. has severe hypoxia. Reason: A 3-year-old child typically is very attentive to his or her surroundings, especially when a stranger enters the environment. The fact that the child does not acknowledge your presence is an abnormal (and ominous) sign and indicates significant hypoxia. Therefore, you must treat aggressively (ie, ventilatory support) to prevent respiratory arrest and subsequent cardiac arrest.

A 3-year-old child presents with respiratory distress. The child is being held by her mother and does not react to your presence. This finding indicates that the child: A. has severe hypoxia. B. probably is sleeping. C. is afraid of your presence. D. is reacting normally for her age.

D. intravenous fluids and certain drugs may be given before he is freed. Reason: Crush syndrome occurs when a part of the body is pinned by a heavy object for more than 4 to 6 hours, although it can occur earlier. Since circulation distal to the crushed part of the body is minimal or absent, chemicals such as potassium and lactic acid can accumulate to dangerous levels. If the body part(s) is/are suddenly freed, these chemicals can be released into the bloodstream, potentially causing a fatal cardiac dysrhythmia. For this reason, the patient may need intravenous fluids and certain medications before being freed in order to prepare the body for the onslaught of these chemicals. In some cases, especially if the patient is hemodynamically unstable, a surgeon may respond to the scene to perform an emergency amputation. However, in this case, the patient is stable. It would not be advisable to heavily sedate the patient while he is still entrapped as this may cause airway compromise. Sedation may be indicated, however, after the patient has been freed.

A man's legs were pinned by a steel girder for 5 hours before he was found. He is conscious and alert with stable vital signs but cannot feel his legs. The EMT should anticipate that: A. a surgeon will respond to the scene and amputate the man's legs. B. he will be heavily sedated by paramedics to prevent further pain. C. he will be immediately freed and rapidly transported to the hospital. D. intravenous fluids and certain drugs may be given before he is freed.

B. awake and alert and has swallowed a commercial drain cleaner. Reason: Activated charcoal adsorbs (binds to) many ingested substances, preventing them from being absorbed into the body by the stomach or intestines. In some cases, you may give activated charcoal to patients who have ingested certain substances, if approved by medical control or local protocol. Activated charcoal is contraindicated for patients who have ingested an acid or alkali (ie, drain cleaner) or a petroleum product (ie, gasoline), who have a decreased level of consciousness and cannot protect their own airway, or who are unable to swallow.

Activated charcoal is contraindicated for a patient who is: A. emotionally upset and has ingested two bottles of aspirin. B. awake and alert and has swallowed a commercial drain cleaner. C. agitated and claims to have ingested a bottle of Tylenol. D. conscious and alert and has ingested a large amount of Motrin.

B. diffuse bronchoconstriction. Reason: Wheezing is a whistling sound that indicates constriction of the bronchioles in the lungs. It is commonly heard on exhalation, but may also occur during inhalation and exhalation. Wheezing occurs with asthma or bronchiolitis. Fluid in the lower airways produces breath sounds such as rales (crackles) or rhonchi. Laryngeal swelling would produce stridor, a high-pitched sound heard during inhalation. Infection of the lower airway, such as pneumonia, would be expected to present with a fever, productive cough, and diminished breath sounds over an isolated lung field.

Assessment of a 40-year-old patient reveals respiratory distress, tachycardia, audible expiratory wheezing, and an oxygen saturation of 88%. The EMT should suspect: A. fluid in the lower airways. B. diffuse bronchoconstriction. C. swelling in the laryngeal area. D. infection of the lower airway.

B. is manufacturer specific. Reason: A biphasic AED sends energy in two directions simultaneously. This is advantageous because it produces a more efficient defibrillation than monophasic defibrillation, which sends energy in only one direction, and uses a lower energy setting. The energy setting on a biphasic AED is device specific, but typically ranges from 120 to 200 joules. AEDs are preprogrammed by the manufacturer to deliver a specific amount of energy, which eliminates the need to manually set the energy level. Some biphasic AEDs deliver the same amount of energy for each shock; others may escalate the energy level for each shock. Refer to the manufacturer's documentation that accompanies the AED you use regarding the amount of biphasic energy it delivers.

The energy setting for a biphasic AED: A. is typically 360 joules. B. is manufacturer specific. C. must be manually set by the EMT. D. increases by 50 joules with each shock.

D. park upwind from the scene. Reason: At the scene of a potential or actual hazardous materials incident, you should park the ambulance in an area that is both upwind and uphill from the incident. However, you must be prepared to quickly relocate if the wind direction changes. Staying uphill is important because many hazardous materials collect in low-lying areas, such as valleys. After ensuring that you are in a safe place, attempt to identify the chemical involved by reading the placard on the tanker (with binoculars) and referencing the placard number in the Emergency Response Guidebook (ERG).

Upon arriving at a scene in which a tanker truck overturned and is spilling an unknown liquid on the ground, you should: A. quickly identify the material. B. stay downhill from the scene. C. turn off your warning lights. D. park upwind from the scene.

C. Inform him that the patients were transported to the hospital, but that you cannot disclose the extent of their injuries Reason: The BEST practice is to NOT talk to the media. Your department should have a public information officer (PIO), whose job is to do just that. If, for whatever reason, talking to the media is unavoidable, you should give the absolute minimum information. In this case, advise the reporter that the patients were transported to the hospital; however, you are not authorized to disclose any other information, including the extent of their injuries, their names, or their ages.

Upon returning to quarters after working a major car accident involving an entire family, a member of the press calls and requests information regarding the call. What should you do? A. Disclose the general extent of the patient's injuries, but avoid disclosing which facility they were transported to B. Disclose the ages of the patients and the facility to which they were transported, but avoid discussing their injuries C. Inform him that the patients were transported to the hospital, but that you cannot disclose the extent of their injuries D. Provide information requested on the patients who are not minors, but avoid disclosing your name or badge number

B. be brief, concise, and factual. Reason: A radio report should be brief, concise, and factual. It should include the patient's age and sex, his or her chief complaint, associated assessment findings, vital signs, treatment that you provided, and the patient's response to your treatment. Avoid speculative statements regarding the patient's condition; report only what you know to be fact. Longer radio reports should be broken into 30-second increments; after 30 seconds, pause and ensure the listener heard your previous traffic. The patient's name is not vital to your report; thus, there is no need to disclose it. Unless you are requesting medical direction, it is acceptable, and routine practice, to give your report to a registered nurse.

When calling in your radio report to the receiving hospital, you should: A. include the patient's name. B. be brief, concise, and factual. C. give your report only to a physician. D. break your report into 60-second increments.

D. Brachial Reason: You should assess the brachial pulse in infants younger than 1 year of age. The carotid or femoral pulse can be assessed in children older than 1 year of age. A carotid pulse is difficult to locate in infants because they have minimal space between their head and shoulders.

Which artery should you palpate when assessing for a pulse in an unresponsive 6-month-old infant? A. Radial B. Carotid C. Femoral D. Brachial

B. apply a proximal tourniquet. Reason: Major hemorrhage kills patients faster than a compromised airway, so in this case, bleeding control has the highest priority. The EMT should apply a proximal tourniquet and stop the bleeding immediately. Attention can then turn to the patient's airway and breathing status. As with any patient, treatment priorities must focus on injuries or conditions that will be the MOST immediately fatal.

A patient is unresponsive with snoring respirations. His arm is amputated just above the elbow and is bleeding heavily. The EMT should: A. open the patient's airway. B. apply a proximal tourniquet. C. administer high-flow oxygen. D. ventilate with a bag-mask device.

A. Ataxic Reason: Respirations that are irregular, ineffective, and do not have an identifiable pattern are called ataxic respirations. Patients with severe brain injury or other conditions that can cause increased intracranial pressure may have ataxic respirations. Eupnea is the term for normal breathing. Kussmaul respirations are characterized by a pattern of deep, rapid breathing; patients with ketoacidosis commonly present with Kussmaul respirations. Cheyne-Stokes respirations are characterized by an alternating pattern of deep irregular breathing, followed by shallow breathing, followed by periods of apnea.

A patient presents with ineffective breathing that has no identifiable pattern. What term is used to describe this type of breathing? A. Ataxic B. Eupnea C. Kussmaul D. Cheyne-Stokes

A. Lung sounds Reason: Auscultation of the patient's lung sounds is the most specific assessment of the options listed and would be the most likely to provide you with information regarding the possible cause of the patient's respiratory distress. Lung sounds can help you differentiate an upper from a lower airway problem; if they are normal, an upper airway problem should be suspected. If abnormal lung sounds are heard, however, you could further determine the possible underlying cause based on the type of abnormal lung sounds heard. For example, wheezing indicates bronchospasm (ie, wheezing), whereas crackles indicate pulmonary edema. Oxygen saturation is used to assess the patient's oxygenation status. If it is low (less than 94%), it indicates that the patient is hypoxemic; however, it does not tell you why. Abnormalities in heart rate and quality, as well as mental status, may be observed in patients with respiratory distress; however, they do not tell you why the patient is experiencing respiratory distress.

A 69-year-old man reports dyspnea that began 2 days ago and has gotten worse. Which of the following assessments would give you the MOST information regarding the possible cause of his dyspnea? A. Lung sounds B. Mental status C. Oxygen saturation D. Pulse rate and quality

C. advise the patient that she should be transported to the hospital because of the seriousness of the crash. Reason: The consequences of refusal should be explained to any patient who refuses EMS treatment and/or transport. After establishing that the patient can legally refuse treatment and transport (eg, he or she is of legal age AND has decision-making capacity), you must advise her that because of the significant mechanism of injury, the potential for critical injury cannot be ruled out in the field, even though she may feel fine now. It should also be explained, in a manner that the patient can understand, that a hidden significant injury could result in death if untreated. Once this is explained, and the patient understands and is willing to accept the possible consequences, obtain a signed refusal and ask an impartial person (eg, police officer) to witness the signed refusal.

A 30-year-old woman crashed her car into a tree at a high rate of speed. She is conscious and alert and has stable vital signs. She has some small lacerations and abrasions to her arms and face, but no obviously life-threatening injuries. As you are loading her into the ambulance, she tells you that she does not want to go to the hospital. You should: A. advise her that she is probably too emotionally upset to be able to refuse EMS treatment and transport. B. ask a law enforcement officer to administer a breathalyzer test to determine if she has been drinking alcohol. C. advise the patient that she should be transported to the hospital because of the seriousness of the crash. D. obtain a signed refusal from the patient and ask a law enforcement officer to transport her to the hospital.

B. Assist her with a third albuterol treatment, administer supplemental oxygen, and transport Reason: Despite two albuterol treatments, the patient is still experiencing respiratory distress and her oxygen saturation is 88%. Furthermore, the presence of wheezing indicates continued bronchospasm. Therefore, you should assist the patient with a third dose of her prescribed inhaler, administer oxygen in a concentration sufficient to maintain her oxygen saturation above 94%, and transport her to the hospital. EMTs are generally allowed to assist patients with up to three doses of their prescribed inhaler; follow your local protocols because you may be required to contact medical control first. Drugs such as albuterol (Proventil, Ventolin), metaproterenol (Alupent), and levalbuterol (Xopenex) stimulate beta-2 receptors in the lungs, resulting in bronchodilation. Humidified oxygen prevents drying out of the upper airway passages; it does not cause bronchodilation. A supine position would aggravate the patient's respiratory distress; transport her in a sitting position. Although the patient is experiencing respiratory distress, she does not require ventilation assistance at this point.

A 33-year-old woman with a history of asthma presents with acute respiratory distress. She is conscious and alert, but anxious. She took two puffs of her albuterol inhaler without relief. Her oxygen saturation is 88% and you hear diffuse wheezing while auscultating her lungs. What should you do? A. Position her supine to facilitate breathing, administer supplemental oxygen, and transport B. Assist her with a third albuterol treatment, administer supplemental oxygen, and transport C. Give humidified oxygen to cause bronchodilation, monitor her oxygen saturation, and transport D. Ventilate her with a bag-mask device and transport immediately to the closest appropriate hospital

B. transport him to the hospital in a position of comfort. Reason: Although the patient is likely experiencing the flu, there are other diseases, some of which are communicable, that can cause similar symptoms. The patient is requesting EMS transport; failure to comply constitutes abandonment. Although he is tachycardic, the remainder of his vital signs are stable; therefore, requesting an ALS ambulance to the scene to start an IV is not necessary. Simply transport him in a position of comfort and monitor him en route. If the patient is infected with HIV or hepatitis, he may choose to voluntarily disclose that information. However, to inquire about infection with such diseases is unethical.

A 39-year-old man asks you to take him to the hospital because has had a fever, headache, and diarrhea for the past 2 days. His blood pressure is 120/60 mm Hg, his pulse is 110 beats/min, and his respirations are 16 breaths/min. You should: A. ask him if he has a history of HIV infection or hepatitis. B. transport him to the hospital in a position of comfort. C. request an ALS ambulance to the scene to start an IV line. D. advise him that he can drive himself to his family physician.

A. open her airway with the jaw-thrust maneuver while manually stabilizing her head, suction her oropharynx, and assist her ventilations. Reason: In any semiconscious or unconscious patient with a head injury, you should manually stabilize the head and open the airway with the jaw-thrust maneuver. If there are any secretions in the mouth, suction the oropharynx. If possible, insert a simple airway adjunct. The patient in this scenario is semiconscious and likely has an intact gag reflex; therefore, you should not attempt to insert an oropharyngeal airway. Conversely, you should not insert a nasopharyngeal airway in patients with a head injury, especially if there is fluid or blood draining from the nose (a sign of a skull fracture). After ensuring a patent airway, you should turn your attention to the patient's breathing. Slow, irregular breathing will not provide adequate minute volume and should be treated with ventilatory assistance.

A 4-year-old girl fell from a third-story window and landed on her head. She is semiconscious with slow, irregular breathing and is bleeding from her mouth and nose. You should: A. open her airway with the jaw-thrust maneuver while manually stabilizing her head, suction her oropharynx, and assist her ventilations. B. open her airway by carefully tilting her head back, suction her oropharynx, and administer high-flow oxygen via non-rebreathing mask. C. manually stabilize her head, open her airway with the jaw-thrust maneuver, insert a nasopharyngeal airway, and suction her oropharynx. D. suction her oropharynx, open her airway with the jaw-thrust maneuver, insert an oropharyngeal airway, and assist her ventilations.

D. Ruptured esophageal varices Reason: Based on the patient's presentation and medical history, you should suspect ruptured esophageal varices. Esophageal varices occur when the amount of pressure within the blood vessels surrounding the esophagus increases, frequently as a result of liver failure. The esophageal blood vessels eventually drain their blood into the liver. If the liver is damaged and blood cannot flow through it easily, blood begins to back up into these portal vessels, dilating the vessels and causing the capillary network of the esophagus to begin leaking. If pressure continues to build, the vessel walls may fail, causing massive upper gastrointestinal bleeding and, quickly afterward, hematemesis (vomiting up blood). Severe gastric ulcer disease can cause hematemesis; however, difficulty swallowing (dysphagia) is not common. Neither acute pancreatitis nor ruptured aortic aneurysm commonly present with hematemesis.

A 40-year-old man reports difficulty swallowing and is vomiting bright red blood. His wife advises that he has diabetes and liver failure from years of alcohol abuse. What should you suspect? A. Acute pancreatitis B. Ruptured aortic aneurysm C. Severe gastric ulcer disease D. Ruptured esophageal varices

B. prompt transport with continuous monitoring en route. Reason: Patients who are at high risk for lethal cardiac dysrhythmias (ie, VF, VT) may have an automated implantable cardioverter/defibrillator (AICD). This small device is usually implanted in the upper left chest, just below the left clavicle. The AICD detects cardiac dysrhythmias and rapidly delivers a shock. When treating a patient whose AICD has fired, you should determine the number of times the device fired, assess vital signs, and transport to the hospital with continuous monitoring en route. Administer supplemental oxygen if the patient is experiencing respiratory distress and/or the oxygen saturation is less than 94%. Application of the AED is not indicated; however, if the patient develops cardiac arrest, you should use the AED as you normally would (remember to apply the pads at least 1 inch away from the implanted device). The pain that the patient is experiencing, which is reproducible and localized near his AICD, is likely musculoskeletal pain as the result of his AICD shocking him; therefore, nitroglycerin is not indicated. Because the AICD works so quickly (much faster than you can apply an AED), you should not ma

A 50-year-old man's implanted defibrillator has fired twice within the last hour. He is conscious and alert and reports a "sore chest." Further assessment reveals that his chest pain is reproducible to palpation and is localized to the area of his implanted defibrillator. Treatment for him should include: A. application of the AED and transport to the hospital. B. prompt transport with continuous monitoring en route. C. deactivating his defibrillator by running a magnet over it. D. up to three doses of nitroglycerin and prompt transport.

C. transport only with close monitoring. Reason: The patient is obviously experiencing an allergic reaction, but she is not in anaphylactic shock. Her breath sounds are clear to auscultation, she is breathing without difficulty, her oxygen saturation is above 94%, and her blood pressure is stable. She requires little more than transport to the hospital with continuous monitoring en route. Epinephrine is not indicated, nor is supplemental oxygen. Warm compresses would make her itching worse, not better. Consider applying cool packs for itch relief.

A 50-year-old woman reports a rash and itching to her trunk and arms that began a day after she started taking penicillin. Her breath sounds are clear to auscultation, she denies shortness of breath, her oxygen saturation is 96%, and her BP is 132/74 mm Hg. Treatment should include: A. high-flow oxygen and transport. B. epinephrine and rapid transport. C. transport only with close monitoring. D. warm compresses to relieve the itching.

C. begin CPR, starting with chest compressions. Reason: When you arrive on scene and determine that a patient is in cardiac arrest, you should immediately begin CPR, starting with chest compressions. Perform 30 chest compressions and then open the airway and deliver 2 rescue breaths. Chest compressions are a crucial part of cardiopulmonary resuscitation and must be started without delay. Apply the AED as soon as it is available. In the interest of this patient, whose arrest interval is short, you should begin resuscitative efforts immediately. In some cases, it is appropriate to inquire about the presence of a living will; however, this should be done after resuscitative efforts have begun.

A 56-year-old man is found to be pulseless and apneic. His wife states that he collapsed about 5 minutes ago. As your partner gets the AED from the ambulance, you should: A. provide rescue breaths until the AED is ready. B. open the airway and give 2 rescue breaths. C. begin CPR, starting with chest compressions. D. ask the wife if the patient has a living will.

B. manually open her airway. Reason: Before you can assess and manage a patient's breathing, you must first ensure that the airway is patent. Snoring respirations indicate partial obstruction of the airway by the tongue. Manually open her airway, using the head tilt-chin lift or jaw-thrust maneuver, and ensure that her airway is clear of secretions. Suction the oropharynx if needed. After manually opening her airway and removing any secretions with suction, insert an airway adjunct (eg, oral or nasal airway). Slow respirations and cyanosis in an unresponsive patient are obvious signs of inadequate breathing and significant hypoxemia; therefore, this patient would require assisted ventilation with a bag-mask device.

A 60-year-old woman is found unresponsive. She is cyanotic, is making a snoring sound, and has a slow respiratory rate. You should: A. insert an airway adjunct. B. manually open her airway. C. thoroughly suction her airway. D. ventilate her with a bag-mask device.

D. Stable angina pectoris Reason: Angina pectoris is the principle symptom of coronary artery disease (CAD). It occurs when the heart's demand for oxygen exceeds its supply, usually during periods of physical or emotional stress when the heart is working hard. When the increased oxygen demand goes away, the pain typically resolves. Some patients with angina may also experience shortness of breath, nausea, or diaphoresis. Angina is classified as being "stable" or "unstable." Stable angina is characterized by cardiac-related chest pain that resolves with rest and/or nitroglycerin. Unstable angina is characterized by cardiac-related chest pain that occurs in response to progressively less physical exertion (for example, during rest). Unstable angina is also referred to as pre-infarction angina because it indicates a more severe degree of CAD and can lead to acute myocardial infarction if untreated. In contrast to stable angina, unstable angina typically does not resolve with rest and/or nitroglycerin. Given the patient's medical history, his chest pain should not be assumed to have simply been of a musculoskeletal origin.

A 62-year-old man with a history of coronary artery disease began experiencing chest pain and nausea while on his daily jog. After sitting down and resting for 5 minutes, his pain and nausea resolve. Which of the following BEST describes this patient's condition? A. Musculoskeletal chest pain B. Acute myocardial infarction C. Unstable angina pectoris D. Stable angina pectoris

B. his cardiac output is reduced. Reason: Although the patient's pulse is slow and weak, it is present; this rules out ventricular fibrillation (V-Fib) because V-Fib does not produce a pulse. Without a 12-lead ECG and other advanced diagnostic tools, there is no way of knowing if the patient has a blocked coronary artery. An unresponsive patient with severe bradycardia; a weak pulse; and pale, cool skin likely has a BP that is less than 90 mm Hg. Therefore, the EMT should conclude from this patient's presentation that his cardiac output is reduced.

A 69-year-old man is unresponsive. He has a weak carotid pulse at 40 beats/min and his skin is cool and pale. From this information, the EMT should conclude that: A. he is in ventricular fibrillation. B. his cardiac output is reduced. C. he has a blocked coronary artery. D. his systolic BP is at least 90 mm Hg.

D. Scoop stretcher Reason: Of the options listed, the scoop stretcher, also called an orthopaedic stretcher or split litter, would be the most appropriate to use. The scoop stretcher is contoured and allows for the placement of straps to secure the patient; it also allows you to place padding around and under the patient. The long backboard, unlike the scoop stretcher, is flat; therefore, the patient can slide from side to side or top to bottom, even when straps are placed. The wheeled ambulance stretcher is top heavy and is not safe for patient movement down a flight of stairs or across rough terrain. Because the patient has a hip injury, the stair chair would not be appropriate to use.

A 72-year-old woman fell and has a hip injury. She is on the second floor of her home. Which of the following devices should you use to move her down the flight of stairs A. Stair chair B. Long backboard C. Wheeled stretcher D. Scoop stretcher

A. Heatstroke Reason: The patient's signs and symptoms are consistent with classic heatstroke. Unlike exertional heatstroke, which usually affects otherwise healthy people who exert themselves in the heat for long periods of time, classic heatstroke commonly affects children and older adults, and it typically occurs when the patient is in a hot, poorly ventilated space for a prolonged period of time. Significant underlying medical problems (eg, hypertension, diabetes, heart disease) increase the patient's risk for classic heatstroke. Both exertional and classic heatstroke present with hot, flushed skin; however, patients with exertional heatstroke may have moist skin, usually from residual perspiration, whereas patients with classic heatstroke typically have dry skin.

A 72-year-old woman is found unresponsive in her poorly ventilated home. Her skin is flushed, hot, and dry, and her respirations are rapid and shallow. She is wearing a medical alert bracelet that states she is a diabetic and is allergic to sulfa drugs. What should you suspect? A. Heatstroke B. Anaphylactic shock C. Acute ischemic stroke D. Diabetic complications

C. he is in shock and requires prompt transport. Reason: The patient is likely bleeding from his gastrointestinal (GI) tract. Although this is a serious condition, it is not a condition you can treat; internal bleeding cannot be controlled in the field. You can, however, treat his signs and symptoms of shock by administering high-flow oxygen and keeping him warm by covering him with a blanket. Therefore, this should be your most immediate concern. Furthermore, the patient requires prompt transport to the hospital where he can receive definitive care, which may or may not involve surgery. It is highly unlikely that his blood glucose level is too high; he does not have a history of diabetes.

A 73-year-old man presents with confusion; cool, pale, clammy skin; absent radial pulses; and a blood pressure of 70/40 mm Hg. The patient's wife tells you that he has had abdominal pain for a week and began vomiting a coffee-ground substance yesterday. His past medical history includes hypertension and gastric ulcer disease. Your MOST immediate concern should be that: A. his blood glucose level is probably too high. B. he is bleeding from his gastrointestinal tract. C. he is in shock and requires prompt transport. D. his condition requires surgery within 2 hours.

D. grasp the angles of the lower jaw and lift. Reason: It must be assumed that the man fell from the ladder and potentially injured his spine. Therefore, you should first open his airway with the jaw-thrust maneuver; this involves grasping the angles of the lower jaw and lifting forward without manipulating the head. After manually opening his airway, use suction to clear secretions from his oropharynx if indicated and then consider inserting a simple airway adjunct (eg, oral or nasal airway). The recovery position (patient is placed on his or her side) is appropriate for unresponsive patients who are breathing adequately and are not injured.

A man is found lying unresponsive at the base of a ladder. He has abrasions on his face. To establish a patent airway, you should first: A. position him on his side. B. insert an oropharyngeal airway. C. thoroughly suction his oropharynx. D. grasp the angles of the lower jaw and lift.

A. Liver laceration Reason: Anatomically speaking, the liver is protected by the lower right ribcage. The lungs are not as low in the thoracic cavity as some illustrations would suggest. The patient's unlabored breathing tends to point away from a pneumothorax or hemothorax. Although a diaphragmatic injury cannot be ruled out, one would expect a certain degree of respiratory distress. Based on the anatomic location of the injury, in addition to the patient's clinical presentation, a liver laceration is the most likely injury.

A man was stabbed in the lower right ribcage. He is diaphoretic; his pulse is rapid and weak; and his respirations are regular and unlabored at 24 breaths/min. Which of the following injuries should the EMT suspect? A. Liver laceration B. Ruptured diaphragm C. Massive hemothorax D. Tension pneumothorax

A. Remove the occlusive dressing. Reason: When placing an occlusive dressing over a sucking chest wound (open pneumothorax), it is important to remember that you have converted the injury to a closed pneumothorax. With no way for the air in the pleural space to escape, and depending on the size of the pneumothorax, the patient could develop excessive pleural tension that interferes with circulation (tension pneumothorax). You should suspect that this is what is happening to the patient in this scenario. Your most immediate action should be to remove the occlusive dressing and allow air to escape from the pleural space. Positive pressure ventilation (ie, bag-mask ventilation) in a patient whose open chest injury has been covered with an occlusive dressing may rapidly lead to a tension pneumothorax; therefore, if the patient must be ventilated, the occlusive dressing should be removed.

A patient has an open chest wound, which has been covered with an occlusive dressing. He is receiving oxygen at 12 L/min by nonrebreathing mask. During transport, the patient's heart rate increases, he becomes pale and diaphoretic, and his oxygen saturation falls. What should you do? A. Remove the occlusive dressing. B. Ventilate with a bag-mask device. C. Increase the oxygen to 15 L/min. D. Encourage him to take deep breaths.

D. anatomic obstruction. Reason: When a patient is unresponsive, the tongue falls back and partially occludes the airway, resulting in a snoring (sonorous) sound. Therefore, sonorous breathing indicates an anatomic airway obstruction. The presence of vomitus or other secretions in the airway produces a gurgling sound. Upper airway swelling, such as from burns or an infection, produces a characteristic high-pitched sound on inhalation called stridor. Reduced tidal volume would manifest with shallow rise of the chest during inhalation.

A patient is unresponsive and has sonorous breathing. This indicates: A. vomitus in the airway. B. upper airway swelling. C. reduced tidal volume. D. anatomic obstruction.

B. shallow respirations. Reason: Tidal volume, a measure of the depth of breathing, is the amount of air (in milliliters [mL]) that is moved into or out of the lungs during a single breath; in the average adult male, this is about 500 mL. Tidal volume cannot be quantified (that is, it cannot be assigned a numeric value) by the EMT; however, it can be estimated by observing the adequacy of chest rise during inhalation. A patient who is breathing with reduced tidal volume will have a shallow depth of breathing; his or her chest rises minimally during inhalation. If a patient is not breathing with adequate tidal volume, he or she will eventually become hypoxemic, which will cause the skin to become cool and clammy and pale or cyanotic. Conversely, a patient with a prolonged inhalation phase (eg, taking a deep breath) would experience an increase in tidal volume. Minute volume is the amount of air moved through the lungs each minute; it is calculated by multiplying tidal volume and respiratory rate. A respiratory rate of 14 breaths/min with adequate tidal volume would result in adequate minute volume. Minute volume is affected by tidal volume, respiratory rate, or both.

A patient who is breathing with reduced tidal volume would MOST likely have: A. warm, moist skin. B. shallow respirations. C. a prolonged inhalation phase. D. a respiratory rate of 14 breaths/min.

B. has chest pain or discomfort that does not change with each breath. Reason: The type of chest pain or discomfort associated with acute myocardial infarction (AMI) is the same that is experienced by patients with angina pectoris (eg, dull, crushing, pressure, heaviness); thus, you cannot distinguish AMI from angina pectoris based solely on the type or quality of pain. Furthermore, the pain associated with AMI, like that of angina, often radiates to the arm, jaw, back, or epigastrium. Relative to other causes of chest pain or discomfort (eg, pleurisy, pneumothorax), the pain associated with AMI and angina does not worsen or improve when the patient takes a breath. Rest and nitroglycerin often relieve the pain associated with stable angina, but are less likely to relieve the pain associated with unstable angina or AMI.

A patient who is experiencing an acute myocardial infarction: A. most often describes his or her chest pain as being sharp or tearing. B. has chest pain or discomfort that does not change with each breath. C. often experiences relief of his or her chest pain after taking nitroglycerin. D. often complains of a different type of pain than a patient with angina.

C. Pericardial tamponade Reason: The EMT should suspect pericardial tamponade. Signs of pericardial tamponade include a narrowing pulse pressure and jugular venous distention (JVD). The first pulse pressure recorded was 30 mm Hg; however, it narrowed to 16 mm Hg during reassessment. The pulse pressure narrows in pericardial tamponade because pressure against the heart prevents full relaxation and filling; as a result, the diastolic BP increases. Because of inadequate ventricular filling, cardiac output decreases; this causes a decrease in the systolic BP. JVD occurs because blood backs up into the systemic venous system. Massive hemothorax and traumatic aortic rupture would not be expected to cause JVD because there is simply not enough blood in the venous system to distend the jugular veins. Simple pneumothorax typically does not present with signs of shock; the patient usually complains of pleuritic chest pain and shortness of breath. However, in some cases, a simple pneumothorax can progress to a tension pneumothorax and cause hemodynamic compromise.

A patient with a chest injury has a BP of 100/70 mm Hg and a heart rate of 100 beats/min. Reassessment reveals a BP of 90/74 mm Hg, a pulse of 120 beats/min, and the development of jugular venous distention. What should you suspect? A. Massive hemothorax B. Simple pneumothorax C. Pericardial tamponade D. Traumatic aortic rupture

B. report to the staging area. Reason: Once you arrive at the scene of a mass-casualty incident where an incident command system has already been established, you should report to the staging area, the area designated for all incoming ambulances and resources. The staging officer will know where help is needed the most and will be able to direct your actions accordingly.

After arriving at a mass-casualty incident where other ambulances are already present, you should: A. repeat the triage process. B. report to the staging area. C. initiate care for the most critically injured patients. D. obtain information from the fire service commander.

B. Ventricular fibrillation Reason: Ventricular fibrillation (V-Fib) is the most common initial cardiac dysrhythmia in adult cardiac arrest patients. V-Fib is a chaotic quivering of the heart muscle that does not produce a pulse and is due to a massive, uncontrolled electrical discharge of the cardiac cells. The most effective treatment for V-Fib is defibrillation. Some patients are in ventricular tachycardia (V-Tach) without a pulse, which is also treated with defibrillation. Although asystole and pulseless electrical activity (PEA) do not produce a pulse, they are not treated with defibrillation.

After attaching the AED and pushing the analyze button on an adult patient in cardiac arrest, the AED states that a shock is advised. Which cardiac rhythm is the patient MOST likely in? A. Asystole B. Ventricular fibrillation C. Ventricular tachycardia D. Pulseless electrical activity

B. assess the patient's breathing effort. Reason: If return of spontaneous circulation (ROSC) occurs, your first action should be to reassess the patient's airway status and breathing effort. If the patient is still apneic or is breathing inadequately, continue ventilations and frequently reassess his or her pulse. If the patient is breathing adequately, administer oxygen as needed to maintain an oxygen saturation of greater than 94%. If the patient is still unresponsive, as is often the case, insert an appropriate airway adjunct (if not already done) to assist in maintaining airway patency. After reassessing airway and breathing, obtain the patient's blood pressure and treat hypotension if needed. Do not remove the AED pads from the patient's chest, even if ROSC has occurred. The risk of cardiac arrest is still high and the patient may need further defibrillation. You should, however, disconnect the pads from the AED or simply turn the AED off.

After defibrillating a man in cardiac arrest, you resume CPR. As you are about to reanalyze his cardiac rhythm 2 minutes later, your partner tells you she can definitely feel a strong carotid pulse. You should: A. continue with the rhythm analysis. B. assess the patient's breathing effort. C. ask her to obtain a blood pressure reading. D. remove the AED pads from the patient's chest.

D. prevent further body heat loss. Reason: After moving a hypothermic patient to a warmer area, your primary focus should be to prevent further body heat loss. Remove wet or damp clothing and cover the patient with blankets (passive rewarming). It is especially important to cover the patient's head; most heat is lost around the head and neck. You should not, however, try to actively rewarm the patient (ie, place heat on or into the body). Rewarming too quickly may induce a lethal cardiac dysrhythmia and cardiac arrest. For this reason, active rewarming should be done in the controlled setting of a hospital. In some areas, medical control may call for the administration of warm, humidified oxygen; follow your local protocols. Assessing a hypothermic patient's core body temperature requires a special hypothermia thermometer, which many EMS systems do not carry.

After moving a hypothermic patient to a warmer area, your primary focus should be to: A. provide rapid rewarming. B. give warm, humidified oxygen. C. assess his or her body temperature. D. prevent further body heat loss.

B. 100 feet past the crashed vehicle, on the same side of the highway Reason: Emergency operations on the highway can be especially dangerous, and it is important to position emergency vehicles in a manner that will ensure responder safety, while at the same time allowing efficient traffic control and flow around the crash scene. Do not park alongside the scene, as you may block the movement of other emergency vehicles. The first emergency vehicle to arrive on scene should park 100 feet before the scene on the same side of the road as the accident. The first vehicle should create a barrier between the scene and oncoming traffic. If other responders have not arrived on scene, the ambulance can be positioned to block the scene and prevent oncoming traffic from getting too close to the scene and emergency personnel. If fire apparatus or law enforcement officers are on scene, they should position their vehicles before the scene, while the ambulance is parked 100 feet beyond the scene. Park the ambulance on the same side of the highway as the crash; this will prevent personnel from crossing the road unnecessarily.

An ambulance and fire apparatus are the first to arrive at a motor vehicle crash on a three-lane highway. There is one vehicle involved and it is located in the far left-hand lane. Where should the ambulance be positioned? A. In between the fire apparatus and crashed motor vehicle B. 100 feet past the crashed vehicle, on the same side of the highway C. Alongside the crashed vehicle, in the middle lane of the highway D. 100 feet past the crashed vehicle, on the opposite side of the highway

A. severe peripheral vasoconstriction. Reason: A pulse oximeter measures the percentage of hemoglobin that is saturated with oxygen. Under normal conditions, a patient's oxygen saturation (SpO₂) ranges between 95% and 100% while breathing room air. Although no definitive threshold for normal SpO₂ values exists, an SpO₂ that is less than 95% in a nonsmoker may indicate hypoxemia. Of the factors listed, severe peripheral vasoconstriction (ie, hypothermia, cigarette smoking, chronic hypoxia) would be the most likely to produce an inaccurate SpO₂ reading. When the peripheral vasculature constricts, blood is shunted to the core of the body; in such cases, the pulse oximeter would likely yield a falsely low reading (or no reading at all). Other factors that can cause inaccurate readings include dark or metallic nail polish, dirty fingers, and abnormal hemoglobin binding (ie, carbon monoxide [CO] poisoning). It is important to note that the pulse oximeter is designed to detect gross abnormalities, not subtle changes, and should be used in conjunction with a thorough clinical assessment of the patient.

An inaccurate pulse oximetry reading may be caused by: A. severe peripheral vasoconstriction. B. excessive red blood cell production. C. heat illnesses, such as heatstroke. D. a heart rate greater than 100 beats/min.

B. Increased residual volume Reason: Pursed-lip breathing and a barrel-shaped chest are classic signs of emphysema, a type of chronic obstructive pulmonary disease (COPD). Emphysema is caused by destruction of the alveolar walls and a loss of pulmonary surfactant. As a result, the alveoli cannot easily expand and recoil and the process of pulmonary gas exchange is impaired. The patient with emphysema has chronic air trapping in the lungs due secondary to incomplete alveolar emptying; as a result, residual volume increases. Residual volume is the amount of air remaining in the lungs following a complete exhalation. Decreased tidal volume would manifest with shallow breathing; it would not explain the pursed-lip breathing and barrel-shaped chest. Vital capacity is the maximum amount of air one can exhale after a completion inhalation; in patients with emphysema, vital capacity would decrease, not increase. Widespread bronchospasm, such as what is seen in patients with asthma, would result in wheezing; it would not explain the pursed-lip breathing and barrel-shaped chest.

Assessment of an older man with respiratory distress reveals that his chest has a barrel-shaped appearance and he is exhaling through pursed lips. What is the pathophysiology of these findings? A. Decreased tidal volume B. Increased residual volume C. Increased vital capacity D. Widespread bronchodilation

D. apply a tourniquet proximal to the injury until the bleeding stops. Reason: You must control any and all external bleeding as soon as possible. In the case of arterial bleeding (ie, bright red blood is spurting from the wound), the patient will bleed to death if immediate action is not taken. In most cases, direct pressure will effectively control external bleeding. However, if the wound continues to bleed profusely despite direct pressure, you should apply a tourniquet proximal to the injury and tighten it until the bleeding stops. Packing additional dressings on a severe external hemorrhage will simply cause the patient to continue to bleed externally into the dressings. Locating and applying adequate pressure to a proximal arterial pressure point is often difficult and time-consuming.

Despite direct pressure, a large laceration continues to spurt large amounts of bright red blood. You should: A. elevate the extremity and apply a tight pressure dressing. B. apply pressure to the pulse point that is proximal to the injury. C. place additional dressings on the wound until the bleeding stops. D. apply a tourniquet proximal to the injury until the bleeding stops.

C. Rapid head-to-toe assessment Reason: During both the general impression and the primary assessment, you should assess for major bleeding. If there is no obvious bleeding, you should continue your assessment as usual. It is during the rapid head-to-toe assessment, when log rolling the patient to assess the posterior (back), that you would most likely find a small-caliber gunshot wound, especially if there is little or no bleeding. A secondary assessment should be performed, and focuses primarily on the patient's chief complaint; however, this may not be practical with a critically ill or injured patient. If a secondary assessment is performed on a critically ill or injured patient, it should occur en route to the hospital. All bleeding should have been controlled long before performing a secondary assessment.

During which part of your assessment would you MOST likely discover a small-caliber gunshot wound to the back with minimal bleeding? A. General impression B. Primary assessment C. Rapid head-to-toe assessment D. Detailed secondary assessment

C. high cholesterol in the blood. Reason: Numerous factors affect a person's ability to compensate for blood loss. The compensatory responses of tachycardia and peripheral vasoconstriction decrease as a person ages; thus, older patients are not able to compensate as effectively as younger patients. Furthermore, older patients commonly take medications to treat high blood pressure, such as beta-blockers; these drugs may blunt the body's release of the catecholamines necessary to increase the heart rate. The ability to compensate for blood loss is also related to how rapidly blood loss occurs. A normal, healthy adult can comfortably donate 1 unit (500 mL) of blood during a period of 10 to 20 minutes and adapts well to this decrease in blood volume. However, if a similar blood loss occurs in a much shorter period, the person's compensatory mechanisms may be overwhelmed, resulting in hypovolemic shock. Patients who take blood-thinning medications (eg, warfarin [Coumadin]) bleed longer than those not taking such medications; in these patients, bleeding from an otherwise minor injury can be significant. There is no known correlation between high cholesterol and a person's ability to compensat

Factors that affect a person's ability to compensate for internal or external blood loss include all of the following, EXCEPT: A. advanced age. B. the rate of blood loss. C. high cholesterol in the blood. D. blood-thinning medications.

D. focus any assessments on life-threatening conditions. Reason: As with any patient, your immediate assessment should focus on finding and treating immediately life-threatening injuries or conditions. Patients who were sexually assaulted may have evidence on (or in) them that could be crucial to bringing the perpetrator to justice. Therefore, you should discourage the patient from showering, urinating, or changing clothes. Again, your assessment should be focused on injuries that are life-threatening. Any articles of clothing that are removed should be placed in a paper bag; condensation can form in plastic bags and potentially destroy evidence. Documentation of the call should include information that is relevant to patient care; concise, detailed information regarding what happened will be gathered by law enforcement personnel.

When caring for a woman who was sexually assaulted, the EMT should: A. ask the patient if she wishes to change her clothes. B. obtain a concise, detailed account of what happened. C. place any articles of her clothing in a clean plastic bag. D. focus any assessments on life-threatening conditions.

D. glucose is rapidly taken out of the blood to fuel the cells. Reason: Insulin is a hormone that promotes the cellular uptake of glucose from the bloodstream. If insulin levels remain high, such as when a diabetic inadvertently takes too much insulin, glucose is rapidly taken out of the blood to fuel the cells. This leads to low circulating blood glucose levels (hypoglycemia) and a condition called insulin shock. By contrast, if insulin levels are too low, such as when a diabetic forgets to take his or her insulin, glucose cannot enter the cells and pools in the bloodstream (hyperglycemia). In the absence of glucose, the cells begin to metabolize fat, which produces ketoacids (diabetic ketoacidosis [DKA]). The respiratory system attempts to eliminate ketoacids from the blood with an increased rate and depth of breathing (Kussmaul respirations) that is accompanied by a fruity or acetone breath odor. Hyperglycemia causes the patient to eliminate excess water from the body through urination (diuresis), resulting in dehydration.

When insulin levels in the blood remain high: A. a fruity odor can be detected on the patient's breath. B. the cells starve for glucose and begin to metabolize fat. C. the patient urinates excessively and becomes dehydrated. D. glucose is rapidly taken out of the blood to fuel the cells.

A. transporting patients to the hospital. Reason: At the scene of a mass-casualty incident (MCI), you will be faced with many challenges, including ensuring your own safety, extrication, triage, and patient care. In the midst of all of these activities, however, you must never lose sight of your ultimate goal, which is to transport all patients to the appropriate hospital as soon as possible. At the scene of an MCI, patients who are pulseless and apneic are not treated.

When providing care to multiple patients at the scene of a mass-casualty incident, your goal should remain focused on: A. transporting patients to the hospital. B. immobilizing all patients at the scene. C. initiating CPR for those patients in cardiac arrest. D. keeping all bystanders at a safe distance.

D. ensure that there are no hazards and then try to open one of the doors. Reason: After ensuring your own safety, you should attempt simple means to gain access to the patient, trying to reach him or her as simply and quickly as possible without using any tools or breaking any glass. It may be necessary to use tools or other forcible entry methods, some of which may require specialized extrication equipment (eg, Jaws of Life). Many times, however, the patient can be accessed by just opening a door, even if the door is badly damaged. If the door is locked and the patient is responsive, ask him or her to unlock the door. Stabilizing the vehicle (eg, placing shoring blocks under the car) and disconnecting the car's battery cables are typical functions of the fire department.

When sizing up a motor vehicle crash in which a small passenger car struck a bridge pillar and sustained severe damage, you should: A. immediately approach the vehicle and determine if it is stable. B. break the driver's-side window and gain rapid access to the patient. C. disconnect the battery cables and then request heavy extrication tools. D. ensure that there are no hazards and then try to open one of the doors.

A. 1 second. Reason: When ventilating any apneic patient, each breath should be delivered over a period of 1 second--just enough to produce visible chest rise. Excessive ventilation duration and/or volume increases the likelihood of gastric distention, especially if the patient's airway is not secured with an advanced device (ie, ET tube, multilumen airway, supraglottic airway), and may result in increased intrathoracic pressure, decreased venous return to the heart, and decreased cardiac output.

When ventilating an apneic patient with a bag-mask device, each breath should be delivered over: A. 1 second. B. 2 seconds. C. 3 seconds. D. 4 seconds.

C. Palpable pain to the chest Reason: Signs and symptoms of cardiac compromise include non-reproducible pain, pressure, or discomfort in the chest or epigastric region; nausea; pale, cool, clammy (diaphoretic) skin; and an irregular pulse that is either fast or slow. Pain of cardiac origin typically is not reproducible by palpation. Palpable pain to the chest suggests a musculoskeletal problem, not a cardiac problem. However, because some patients with a cardiac problem present atypically, you should transport any patient with chest pain, pressure, or discomfort to the hospital.

Which of the following assessment findings is LEAST suggestive of a cardiac problem? A. Rapid, irregular heart rate B. Anxiety and pale, cool skin C. Palpable pain to the chest D. Nausea and epigastric pain

D. Poor muscle tone Reason: Of the findings listed, poor muscle tone (as a primary finding) would indicate dysfunction of the central nervous system. Children should be easily distracted, so an inability to distract the child would be abnormal. Nasal flaring indicates a primary respiratory problem and signals increased work of breathing. Pallor indicates poor peripheral blood flow; therefore, it would indicate a perfusion problem. When assessing an infant or child, the pediatric assessment triangle (PAT) will enable you to determine, by visual inspection, if the problem is neurologic, respiratory or circulatory in origin.

Which of the following assessment findings would indicate primary central nervous system dysfunction in an infant or small child? A. Nasal flaring B. Easily distracted C. Pale extremities D. Poor muscle tone

A. Stridor Reason: If a patient has ANY type of airway obstruction, you would expect him or her to be anxious and tachycardic, so these findings are not specific to a patient with poor air exchange. If the patient has adequate air exchange, he or she will be coughing forcefully, although you may hear wheezing (a whistling sound) in between coughs. The skin may be flushed and the patient's level of consciousness is not altered. Poor air exchange is characterized by a weak, ineffective cough; progressive respiratory distress; stridor (high-pitched sound heard during inhalation); cyanosis; and a decreasing level of consciousness.

Which of the following assessment findings would indicate that a patient with a foreign body airway obstruction has poor air exchange? A. Stridor B. Anxiety C. Wheezing D. Tachycardia

A. Cyanosis to the hands and feet Reason: Immediately following birth, and possibly for up to 12 to 24 hours, cyanosis to the hands and feet (acrocyanosis) is a common finding in newborns and usually resolves on its own. Cyanosis to the face and trunk, however, is not normal. Irregular breathing is normal in the newborn; shallow or gasping breaths, however, are not. A healthy newborn should have a heart rate greater than 100 beats/min. A heart rate less than 100 beats/min indicates hypoxia. Most newborns begin to breathe immediately or within the first 30 seconds following birth; apnea beyond 30 seconds is not normal.

Which of the following assessment findings would you expect to encounter in a newly born infant? A. Cyanosis to the hands and feet B. Shallow, irregular, gasping breaths C. Delayed apnea for up to 2 minutes D. Heart rate between 80 and 100 beats/min

B. Hyperglycemia Reason: Many factors can contribute to or result from a submersion injury (eg, drowning, near-drowning). It is not uncommon for a person to experience a spinal injury after diving head first into shallow water, especially if he or she is under the influence of alcohol. When a swimmer panics, he or she initially swallows large amounts of water, resulting in gastric distention. Gastric distention can cause aspiration if the patient regurgitates water during rescue breathing; protect the airway! During the panic phase, the victim expends a tremendous amount of energy (and glucose) by flailing around in the water, possibly resulting in hypoglycemia. Inhaling even a small amount of fresh or salt water can severely irritate the larynx, which sends the muscles of the larynx and vocal cords into spasm (laryngospasm), resulting in airway blockage and hypoxia.

Which of the following conditions would be the LEAST likely to be present in a patient who was submerged in water? A. Spinal injury B. Hyperglycemia C. Laryngospasm D. Gastric distention

B. Decreased ventilatory volume Reason: Gastric distention can be lethal if not detected and managed appropriately in any patient, but especially infants and children. As air insufflates the stomach, the diaphragm is pushed into the thoracic cavity, which decreases the amount of air that can fill the lungs. This results in decreased ventilatory volumes during artificial ventilation. Gastric distention also increases the risks of regurgitation and aspiration. You must be able to deliver adequate ventilations to the patient. Remember, respiratory failure is the most common cause of cardiopulmonary arrest in children.

Which of the following is the MOST detrimental effect of gastric distention in infants and children? A. Rupture of the trachea B. Decreased ventilatory volume C. Acute rupture of the diaphragm D. Less effective chest compressions

A. Compress the chest at least 2 inches, allow full recoil of the chest after each compression, minimize interruptions in chest compressions Reason: Effective chest compressions are essential for providing forward blood flow during CPR. To perform adequate chest compressions, the EMT should compress the chest of an adult at a rate of 100 to 120/min to a depth of at least 2 inches. A compression depth that is greater than 2.4 inches should be avoided, although this is not possible to accomplish without a CPR device the provides immediate feedback. When performing chest compressions on an infant or child, compress the chest at least one-third the depth of the chest (about 1.5 inches for infants, about 2 inches for children). Allow the chest to fully recoil after each compression, avoid leaning on the chest, and allow equal time for compression and relaxation. Minimize interruptions in CPR to 10 seconds or less. Obviously, chest compressions must be paused when using the AED to analyze the patient's cardiac rhythm or defibrillate and when assessing for a spontaneous pulse.

Which of the following describes the MOST appropriate method of performing chest compressions on an adult patient in cardiac arrest? A. Compress the chest at least 2 inches, allow full recoil of the chest after each compression, minimize interruptions in chest compressions B. Allow full recoil of the chest after each compression, compress the chest to a depth of 2 inches, deliver compressions at a rate of at least 80/min C. Do not interrupt chest compressions for any reason, compress the chest no more than 1½ inches, allow partial recoil of the chest after each compression D. Minimize interruptions in chest compressions, provide 70% compression time and 30% relaxation time, deliver compressions at a rate of 100/min

C. Recent pelvic inflammatory disease Reason: Pelvic inflammatory disease and scarring of the fallopian tubes are risk factors for ectopic pregnancy. There is no correlation between past Cesarean deliveries or spontaneous abortions and an increased risk of ectopic pregnancy. It is important to remember that acute abdominal pain in any female of childbearing age, especially with a missed menstrual period, is an ectopic pregnancy until proven otherwise.

Which of the following findings should make the EMT suspect an ectopic pregnancy in a woman who reports abdominal pain? A. Menstrual period began 3 days ago B. Spontaneous abortion 6 months ago C. Recent pelvic inflammatory disease D. Cesarean section scar on the abdomen

A. Distraction Reason: Injury to the cervical spine following a hanging occurs via distraction, or stretching, of the vertebrae and spinal cord. A subluxation is a partial or incomplete dislocation; it is an injury, not an injury mechanism. Injuries related to hyperextension mechanisms are common in patients who strike their head on the windshield during a motor vehicle crash. Axial loading is a mechanism of injury in which the spinal column is compressed vertically. Injuries caused by axial loading include cervical spine injuries after diving head first into shallow water and lumbar spine injuries after a fall from a significant height in which the patient lands feet first.

Which of the following injury mechanisms is associated with hangings? A. Distraction B. Subluxation C. Axial loading D. Hyperextension

C. Restless, diaphoresis, tachypnea, BP of 104/64 mm Hg Reason: In compensated shock, the nervous system is mounting a physiologic response to an underlying illness or injury in an attempt to maintain perfusion to vital organs such as the brain, heart, and kidneys. The patient with compensated shock is restless or anxious, has poor peripheral perfusion (eg, pallor), tachycardia, diaphoresis, and increased respirations (tachypnea). However, his or her blood pressure is maintained, usually above 90 to 100 mm Hg. In decompensated shock, the body's compensatory mechanisms fail, blood pressure begins to fall, and perfusion to vital organs decreases. Other signs of decompensated shock include a decreased level of consciousness, absent peripheral pulses (radial), and weak central pulses (carotid, femoral).

Which of the following is MOST indicative of compensated shock in an adult? A. Unresponsive, pallor, absent radial pulses, tachypnea B. Confusion, mottling, tachycardia, BP of 88/60 mm Hg C. Restless, diaphoresis, tachypnea, BP of 104/64 mm Hg D. Weak carotid pulse, cool skin, increased respiratory rate

C. The EMT informs a patient of the potential risks associated with his proposed treatment Reason: EMTs should obtain consent to assess and treat from every patient who is of legal age and has decision-making capacity. In order for consent to be informed, the patient must be informed of the EMT's proposed treatment plan, as well as the risks and benefits of said treatment. If this information is not disclosed to the patient, then consent is not informed. If a patient refuses EMS treatment, the EMT must inform him or her, in layman's terms, of the risks of refusing EMS treatment; this is called an informed refusal. Regardless of whether the patient accepts or refuses EMS treatment, he or she must be properly informed of risks and benefits. Treating an unresponsive patient based on the assumption that he or she would otherwise accept treatment is called implied consent.

Which of the following is an example of informed consent? A. Prior to starting treatment, the EMT asks a patient if he has permission to begin treatment B. The EMT informs a conscious patient of the risks of refusing EMS treatment and transport C. The EMT informs a patient of the potential risks associated with his proposed treatment D. EMTs treat an unresponsive patient under the assumption that he would consent if he was conscious

B. I don't know, but we will take good care of you. Reason: Patients experiencing chest pain often have a good idea about what is happening, so do not lie or offer false reassurance. Conversely, do not tell patients they are having a heart attack; EMTs are not trained to interpret the 12-lead ECG, and the 12-lead ECG is currently the only way a heart attack can be diagnosed in the prehospital setting. If asked, "Am I having a heart attack?", an appropriate response would be "I don't know for sure, but in case you are, we are going to take good care of you."

Which of the following is the MOST appropriate response when a patient with chest pain asks you if he or she is having a heart attack? A. Yes, so I recommend going to the hospital. B. I don't know, but we will take good care of you. C. Probably not, but we should transport you to be safe. D. I believe you are, but only a physician can tell for sure.

A. Pallor and shortness of breath Reason: Anemia is a deficiency of red blood cells (erythrocytes). Recall that red blood cells carry hemoglobin, which binds to oxygen, in order to deliver oxygen to the body's cells and tissues. You would expect the severely anemic patient to be pale (because of fewer red blood cells). In addition, because the patient's oxygen-carrying capacity is reduced, shortness of breath is also a common finding. In response to hypoxia, the patient would become tachycardic. Flushed (red) skin is not expected in anemic patients; you would expect flushing to occur if the patient had excessive red blood cell production (polycythemia). Jaundice (yellow skin) is observed in patients with liver disease or dysfunction, not anemia. Hematemesis and nosebleed may be observed in patients with low platelet levels (thrombocytopenia), not anemia.

Which of the following signs and symptoms should the EMT expect to encounter in a patient with severe anemia? A. Pallor and shortness of breath B. Flushed skin and a slow pulse C. Jaundice and abdominal pain D. Hematemesis and nosebleed

C. Hypothalamus Reason: The hypothalamus, which is located within the brain stem, regulates body temperature by acting as the body's thermostat. During a heat-related emergency, the hypothalamus can "reset" the body's normal temperature to a much higher temperature in response to the environment and the body's inability to eliminate heat.

Which of the following structures is responsible for regulating body temperature? A. Cerebrum B. Cerebellum C. Hypothalamus D. Medulla oblongata

B. the scene is potentially unsafe. Reason: The presence of law enforcement at the scene indicates, at a minimum, that the scene is potentially unsafe; otherwise, they would not have been summoned. While you are en route, you should make radio contact with the police officers at the scene to determine if it is safe for you to enter; you should also inquire about the severity of the patient's injuries. The more information you obtain before you arrive, the better. For all you know, you could arrive and find yourself in the middle of a firefight! The mere presence of law enforcement at the scene does NOT ensure a safe environment.

While en route to the scene of an injured person, dispatch advises you that law enforcement personnel are at the scene. This indicates that: A. a crime has been committed. B. the scene is potentially unsafe. C. the patient is critically injured. D. the scene is safe for you to enter.

B. Relieve pressure from the cord with your gloved fingers. Reason: The goal in treating a prolapsed umbilical cord is to maintain a pulsatile cord. Place your gloved fingers into the vagina and lift the presenting part of the baby off of the umbilical cord. Positioning the mother with her hips elevated may allow the baby to slide off of the umbilical cord. Continued pressure on the umbilical cord will cut off the baby's oxygen supply. In addition, you should keep the cord moist by covering it in saline-soaked dressings. Give the mother high-flow oxygen and provide rapid transport to the hospital. Uterine massage is only indicated AFTER delivery to control postpartum bleeding.

While performing a visual inspection of a 30-year-old woman in labor, you can see the umbilical cord at the vaginal opening. What should you do? A. Massage the uterus to facilitate delivery of the fetus. B. Relieve pressure from the cord with your gloved fingers. C. Place the mother on her left side and provide rapid transport. D. Elevate the mother's lower extremities and provide rapid transport.

B. is confused and disoriented. Reason: Most generalized tonic-clonic seizures are followed by a postictal phase, in which the patient is unresponsive at first and then gradually regains consciousness. In most cases, the postictal patient appears dazed, confused, or disoriented; in some cases, he or she is combative. The postictal phase typically lasts from 5 to 30 minutes. During the seizure, the patient is often not breathing or is breathing inadequately; however, when the seizure stops, breathing usually resumes. You will often find that postictal patients are tachycardic and hypertensive; this is the result of an adrenaline surge that occurs during the the seizure.

Witnesses state that a 49-year-old man had a seizure that lasted approximately 5 minutes. If the patient truly experienced a seizure, you would MOST likely find that he: A. has a slow heart rate. B. is confused and disoriented. C. is apneic and cyanotic. D. has a low blood pressure.

D. ensure that the strongest EMT is positioned at the head of the backboard. Reason: Since most of the patient's weight is distributed to the head end of a backboard, you should always ensure that the strongest EMT is at that position. This will reduce the risk of injury to less strong personnel as well as the risk of dropping the patient. The backboard should be lifted from the ends, not the sides; you have less control over the board if it is lifted from the sides. When lifting any patient, you should use the powerful muscles of your thighs, not your back, to lift. Keep your back straight and in a locked-in position.

You and your partner have secured a trauma patient to a long backboard and are preparing to lift the backboard onto the stretcher. When doing so, you should: A. lift the backboard from the sides instead of from the ends. B. be sure to lift the backboard with the powerful muscles of your back. C. recall that most of the patient's weight is at the foot end of the backboard. D. ensure that the strongest EMT is positioned at the head of the backboard.

C. 14 minutes Reason: The length of time you can use an oxygen cylinder depends on the type of cylinder you are using, the pressure in the cylinder, and the oxygen flow rate. A D cylinder is a small oxygen cylinder that is usually carried in the jump kit to the patient; it has a cylinder constant of 0.16. The following method can be used to calculate cylinder duration: gauge pressure (in psi) minus the safe residual pressure (200 psi) times the cylinder constant divided by flow rate in L/min. Using this formula, your D cylinder will become depleted in about 14 minutes, as follows: 1500 (psi) - 200 (safe residual pressure) x 0.16 (cylinder constant) / 15 (flow rate in L/min) = 13.86 (14 minutes). A full oxygen cylinder should contain 2000 psi. The safe residual pressure is the lowest acceptable cylinder pressure before it should be replaced; it is usually 200 psi, although some EMS systems use 500 psi as a safe residual pressure. Although you will switch to your on-board oxygen (M cylinder) source when you load the patient into the ambulance, you should always have at least one backup portable cylinder (preferably two) when administering oxygen to a patient at the scene, especially if yo

You are administering oxygen at 15 L/min to a patient with respiratory distress. If you are using a D cylinder (cylinder constant, 0.16), which reads 1500 psi, how long will it take before you need to replace the oxygen cylinder? A. 9 minutes B. 11 minutes C. 14 minutes D. 18 minutes

C. continue CPR until you have contacted medical control for guidance. Reason: Do not attempt resuscitation (DNAR) orders can be challenging for EMS providers. When presented with documentation, especially if it does not appear to be valid (in this case, an unsigned document), you should err on the side of patient care and continue resuscitative efforts until medical control orders you to stop.

You are called to a residence for a woman in cardiac arrest. Shortly after you start CPR, the patient's husband presents you with an unsigned document that states "do not attempt resuscitation." You should: A. stop all resuscitative efforts in accordance with the document. B. stop CPR until the document can be validated by a physician. C. continue CPR until you have contacted medical control for guidance. D. contact medical control prior to continuing any resuscitative efforts.

B. ventilate the patient with a bag-mask device. Reason: Vicodin is a combination of hydrocodone and acetaminophen (APAP), the active ingredient in Tylenol. Hydrocodone is a narcotic analgesic. When taken in excess, it can suppress the central nervous system and cause respiratory depression, bradycardia, and hypotension. Initial management of any patient who has overdosed on a medication of this type is to ensure a patent airway and support breathing. Because the patient is breathing inadequately (slow and shallow), immediate ventilation assistance is needed. If you carry naloxone (Narcan) and are authorized to administer it, do so. Naloxone binds to opiate receptor sites and reverses the effects of narcotic drugs. If you are not authorized to administer naloxone, consider requesting a paramedic intercept, especially if your transport time will be lengthy. The AED is not indicated for this patient; it is applied only to patients in cardiac arrest.

You are called to an assisted living center where an attendant found a 72-year-old man unresponsive. The patient had recent hip surgery and has been taking Vicodin for pain. His respirations are slow and shallow, and his pulse is slow and weak. You should: A. apply high-flow oxygen via a non-rebreathing mask. B. ventilate the patient with a bag-mask device. C. administer intranasal naloxone at 0.4 mg. D. apply the AED and analyze his cardiac rhythm.

B. request additional ambulances to respond to the scene. Reason: One of the most important aspects of the scene size-up is determining the need for additional resources. A single EMS unit and two EMTs cannot effectively manage three patients, especially if those patients are critically injured. Therefore, you must first request additional ambulances at the scene. After requesting additional resources, begin the processes of triage and treatment. Notify the local trauma center early, if possible, so personnel there can prepare to take care of the patients; however, your first priority is to maximize patient care at the scene by requesting additional ambulances.

You are the first ambulance to arrive at the scene of a motor vehicle crash. As you approach the scene, you see three patients: two have been ejected from their vehicles and the other is still in his vehicle. You should: A. begin triaging and treating the most critically injured patients. B. request additional ambulances to respond to the scene. C. call medical control and apprise him or her of the situation. D. notify the local trauma center so personnel there can prepare for the patients.

A. carefully inspect the environment in which the infant was found. Reason: When managing a case of sudden unexpected infant death (SUID), you will be faced with three tasks: assessment and management of the infant, communicating with and providing emotional support to the family, and assessing the scene. It is clear that the infant in this scenario is deceased; therefore, resuscitation (in any form) would be futile and therefore is not indicated. Be very clear (yet tactful and empathetic) when advising the parents or caregivers of this. When assessing the scene, you should note the position in which the infant was found, any signs that suggest the infant was recently ill (eg, medications, humidifiers), and the general condition of the house (ie, clean or dirty). Assessment of the scene is an important part of the overall investigation, along with a post-mortem and review of the infant's medical history, in attempting to determine the cause of death.

You receive a call for a 3-month-old infant who was found unresponsive by his mother when she woke up. The infant is pulseless and apneic and his skin is cold and pale. You should: A. carefully inspect the environment in which the infant was found. B. attempt full resuscitative measures, and transport the infant to the hospital. C. perform CPR for 10 minutes and then contact medical control for further direction. D. withhold chest compressions but apply the AED to analyze the infant's cardiac rhythm.

D. insert a nasopharyngeal airway. Reason: In the absence of trauma, open the patient's airway with the head tilt-chin lift maneuver. To help maintain airway patency, a nasopharyngeal airway should be inserted. Your patient is semiconscious, not unconscious, so she will likely gag if you attempt to insert an oropharyngeal airway; this may result in aspiration if she vomits. Remember, you must first open the patient's airway and, if needed, suction any secretions from the mouth. Next, insert an airway adjunct and assess respiratory effort. The method of oxygenation you provide depends on the adequacy of the patient's breathing.

You receive a call for a 49-year-old woman who passed out. No trauma was involved. The patient is semiconscious and has cyanosis to her lips. After opening her airway with the head tilt-chin lift maneuver, you should: A. assess her respiratory effort. B. begin ventilation assistance. C. insert an oropharyngeal airway. D. insert a nasopharyngeal airway.

D. administer supplemental oxygen at 12 to 15 L/min. Reason: Initial management of a patient with a severe allergic reaction is to ensure a patent airway and administer supplemental oxygen. Positive pressure ventilation may be required if the patient is breathing inadequately. After ensuring a patent airway and adequate ventilation and oxygenation, you should inquire whether the patient has a prescribed epinephrine auto-injector. If so, you should contact medical control and obtain permission (if required by local protocol) to assist the patient with the auto-injector.

You receive a call to a restaurant where a 34-year-old man is experiencing shortness of breath. When you arrive, you immediately note that the man has urticaria on his face and arms. He is conscious, but restless, and is in obvious respiratory distress. You should: A. ask the patient if he has an epinephrine auto-injector. B. remove the patient's shirt to inspect his chest for urticaria. C. obtain vital signs and a SAMPLE history. D. administer supplemental oxygen at 12 to 15 L/min.

B. Neurologic Reason: The Pediatric Assessment Triangle (PAT) is a structured assessment tool that allows you to rapidly form a general impression of the child's condition without touching him or her. This first glance assessment, which can be performed in less than 30 seconds, will help you identify the general category (neurologic, respiratory, or circulatory) of the patient's physical problem and establish urgency for treatment and/or transport. The PAT is comprised of three components: appearance, work of breathing, and skin circulation. Abnormal mentation and poor muscle tone suggest abnormal neurologic function, such as what caused by hypoglycemia, stroke, or other neurologic problems. A respiratory rate of 30 breaths/min is normal for a 2-year-old child, and considering that his breathing is not labored, a primary respiratory problem is unlikely. Pallor or mottled skin suggests a circulatory problem; however, the child's skin is pink.

Your assessment of a 2-year-old boy reveals that he has is not interacting normally and has poor muscle tone. His respirations are 30 breaths/min and unlabored and his skin is pink. These findings suggest a problem with which of the following body systems? A. Cardiac B. Neurologic C. Respiratory D. Circulatory

B. Position the mother with her hips elevated and administering high-flow oxygen. Reason: Limb presentations represent a dire emergency for the newborn and do not spontaneously deliver in the field. You should position the mother in a manner so that her hips are elevated in an attempt to slide the infant slightly back into the birth canal and remove pressure from the umbilical cord. Administer high-flow oxygen to the mother, cover the protruding limb with a sterile sheet (or any clean sheet, if a sterile sheet is not available), and transport immediately. Do NOT pull on the protruding limb, as this may cause injury to the newborn.

Your assessment of a mother in labor reveals that a fetal limb is protruding from the vagina. What should you do? A. Position the mother in a semi-Fowler position and administer oxygen. B. Position the mother with her hips elevated and administering high-flow oxygen. C. Apply gentle traction to the protruding limb to remove pressure of the fetus from the umbilical cord. D. Give the mother 100% oxygen, and attempt to manipulate the protruding limb so that delivery can occur.

A. The patient is being ventilated too fast. Reason: The patient is being ventilated twice as fast as she should be. You should ventilate an apneic adult at a rate of 10 breaths/min (one breath every 6 seconds). Ventilating too fast or with too much volume can cause a dangerous elevation in intrathoracic pressure; as a result, venous return to the heart can be compromised and cardiac output can fall. Of the choices listed, this is the most likely cause of the change in her vital signs. Reduced cardiac output (secondary to decreased venous return) is causing the drop in her systolic BP, and her heart rate is elevating in an attempt to compensate for the lowered blood pressure. Cocaine and other CNS stimulants would be expected to cause hypertension and tachycardia, and increased intracranial pressure would be expected to cause hypertension and bradycardia.

Your partner is ventilating an apneic woman at a rate of 20 breaths/min while you reassess her vital signs. You notice that her systolic BP has decreased by 20 mm Hg and her heart rate has increased by 25 beats/min. Which of the following is the MOST likely cause of these vital sign changes? A. The patient is being ventilated too fast. B. Too little volume is being given with ventilations. C. The patient has severe cocaine toxicity. D. The patient has increased intracranial pressure.