NREMT Review Exam 4

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

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

The first step in initiating a START triage would be to ask patients to get up and walk. assess the patient's respirations. assess the patient's pulse. open the patient's airway.

ask patients to get up and walk. RATIONALE START triage begins by asking patients to get up and walk to a collection point. Next, respirations are assessed and if the patient is not breathing, the airway is opened. Pulse is then assessed, followed by mental status.

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

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

You are preparing to assist with imminent childbirth. The most appropriate level of personal protection should be gloves and N-95 mask, and eye protection. gown. eye protection. gown, and eye protection.

gown, and eye protection. RATIONALE Childbirth has many biohazard threats. The most appropriate level of protection would be gloves, gown, and eye protection. Although protecting your mouth would be appropriate, an N-95 mask would not be necessary.

The spouse of a 72 year old female tells you she took a number of her oxycodone pills to try to kill herself. He tells you he cannot locate the pill bottle but knows they were definitely oxycodone. The patient denies taking the pills but presents with a slightly lethargic mental status. You should attempt to locate the pill bottle and then initiate transport. initiate immediate transport of this patient. leave the patient alone to further question her spouse. believe the patient because suicide is rare among older patients.

initiate immediate transport of this patient. RATIONALE The patient's mental status indicates that she likely took an overdose of medication and that the medication has begun to affect her. Because an overdose can cause rapid changes in patient status, you should immediately initiate transport. It is important to identify the medication; however, you could ask law enforcement or even the patient's spouse to attempt to find the bottle. Suicide rates are actually high among older patients and a suicidal patient should never be left alone.

A 17 year old male has been shot in the chest. He is unconscious and the bullet wound is bleeding. You should first apply high flow oxygen via non-rebreather mask. apply an occlusive dressing to the wound. apply direct pressure to the wound. open the airway using a jaw thrust.

open the airway using a jaw thrust. RATIONALE Although this patient has a bleeding wound that is potentially interfering with breathing, opening the airway is still the most important step. The wound can be bandaged appropriately after you ensure a patent airway. High flow supplemental oxygen may be necessary, but only if the patient is breathing adequately.

When evaluating blood pressure, the systolic measurement represents the pressure created by the ventricles contracting. constant pressure in distal arteries. pressure of venous blood returning to the heart. pressure created as the ventricles relax.

pressure created by the ventricles contracting. RATIONALE Systolic blood pressure represents the pressure created by the ventricles contracting. The pressure created as the ventricles relax is demonstrated as the diastolic pressure. There is no constant pressure in arteries as long as the heart continues to beat. Venous pressure is low and not evaluated by blood pressure assessment.

A 9 month old child has been found in the morning by her parents to be apneic and pulseless. Upon examination, you note rigor in the extremities and a cool body temperature. You should begin CPR. transport the baby, but do not begin resuscitation. complete one round of resuscitation on scene and pronounce death if not successful. pronounce death.

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

A geriatric patient summons EMS with the complaint that every time he stands up, he becomes very dizzy and lightheaded. Although he has not fallen, he wants to be checked out to see if anything is wrong. Which of the following reasons may be the greatest contributor to his postural hypotension? Muscle weakness and joint stiffness A drop in baroreceptor sensitivity An increase in blood viscosity Diminished proprioception ability

A drop in baroreceptor sensitivity RATIONALE Baroreceptors are special pressure receptors in the large blood vessels of the body that detect blood pressure. Should the pressure drop, they signal the brain to change cardiac output and vasomotor tone to counter the drop in pressure. In the geriatric patient, however, these pressure receptors begin to fail and cannot regulate blood pressure as efficiently or expediently. This can result in dizziness when quickly standing. Blood viscosity can change with aging, and this usually leads to hypertension, not postural hypotension. Proprioception and muscle weakness/stiffness can make standing difficult, but again these changes affect the body regardless of position - not just when standing.

You are providing external cardiac compressions to a patient in cardiac arrest. The maximum rate of compressions you are allowed to deliver is 60/minute. 100/minute. 80/minute. 120/minute.

120/minute. RATIONALE According to current AHA standards, the compressor should provide compressions at a rate of between 100-120/min and 2 inches depth on an adult (push hard, push fast). Rates slower than 100/min, faster than 120/min, or excessive interruptions in the compressions have all been associated with worse outcomes of survivability and hospital discharge rates.

A 5 year old male has burns that cover his entire back. Considering the rule of nines, what percentage of body surface area would these burns cover? 18% 36% 9% 7%

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

You have been instructed to report to the safe/cold zone of a highway motor vehicle crash. It is the middle of the night. Which one of the following components of personal protective equipment would be most important when entering this situation? An NFPA-approved helmet Eye protection A reflective safety vest Heavy-duty extrication gloves

A reflective safety vest RATIONALE The most immediate threat on a highway at night is oncoming traffic. For this reason, a high visibility reflective vest would be the most important element of personal protective equipment. Entering the cold zone implies that you will not be taking part in actual extrication and although the other elements certainly would be recommended, protection from oncoming traffic would be the highest priority.

A 33 year old male has been involved in a car vs. motorcycle crash. He has an open fracture of his right tibia and fibula. How should you properly splint this fracture? Do not splint an open fracture. Use only a bandage and dressing to care for this injury. Apply a sterile dressing over the open wound before splinting. Apply the splint directly over the open wound.

Apply a sterile dressing over the open wound before splinting. RATIONALE An open wound should be bandaged prior to applying a splint. This helps stop bleeding and prevents infection. A splint should definitely be used, but only after proper dressing of the wound.

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

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

What is the most appropriate administration site for an epinephrine auto-injector? Deltoid muscle Muscles of the abdomen Superior gluteal muscles Anterior lateral thigh muscle

Anterior lateral thigh muscle RATIONALE The anterior lateral thigh provides a well-perfused area of muscle for epinephrine injection. The gluteals and the deltoid are acceptable sites for intramuscular injections but are not as well perfused as the muscles of the thigh. The muscles of the abdomen are unreliable for intramuscular injection.

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

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

A bedridden special needs patient has an infection with a 104 F temperature and needs to be transported to the hospital. The patient is supported in bed with a number of extremely large cushions. When you touch her to move her to the gurney, she yells out. Which one of the following is the next appropriate step to take? Place her on a backboard in the left lateral recumbent position. Contact medical control for advice on how to handle the move. Ask the caregiver how a move is normally done. Place her on the gurney quickly and ignore the screams.

Ask the caregiver how a move is normally done. RATIONALE When moving a special needs patient who is bedridden and most likely has positions that are more comfortable than others, ask the family or caregiver how a move from the bed is normally handled. A backboard should not be used unless medically indicated and in this scenario there is no indication it is needed. There is no reason to cause unnecessary pain to any patient. Therefore, the input from the family or caregiver hopefully will facilitate moving without too much additional discomfort. There is no need to contact medical control to discuss a patient move.

The family states that your 55 year old female patient is acting strangely. She is unable to answer your questions. What is the most appropriate method of obtaining a patient history? Consult the patient's personal physician. Look for scene clues such as medicine bottles. Check the patient for medical identification jewelry. Ask the family questions about the patient.

Ask the family questions about the patient. RATIONALE In this case, the family is the best source of information. In particular, they can discuss the history of the present illness and the events leading up to your arrival. Scene clues and physical findings will certainly be important but will likely only enhance the information you obtain from family members. The patient's physician may be able to shed light on previous medical conditions, but would probably not have much information regarding the issue at hand.

You are assessing a conscious 9 month old infant. Which one of the following locations would be most appropriate to evaluate a pulse? Radial artery Femoral artery Carotid artery Brachial artery

Brachial artery RATIONALE The brachial artery is the best location to evaluate a pulse in infants. Other sites are possible, but certainly more difficult. A small neck makes finding a carotid pulse challenging. Small femoral and radial arteries make locating those pulses difficult as well.

A patient who is in respiratory arrest is being ventilated using a bag-valve mask. Of the following which one is the most reliable method for determining that ventilations are effective? Pupil size will dilate after a few breaths. Skin color improves immediately . Heart rate will increase immediately. Chest rises with each ventilation.

Chest rises with each ventilation. RATIONALE Ventilation is the process of getting air (oxygen) in and out of the lungs. When performing artificial ventilation with a bag-valve mask, observing the chest rise with each ventilation is the definitive way of determining if air is getting into the lungs effectively. Pupil size, skin color, and heart rate may change depending on the condition of the patient before initiating artificial ventilation, but none of those signs are more reliable in determining effective ventilation when using a bag-valve mask.

During your assessment of a geriatric patient they provide all information to you regarding your SAMPLE history. What is the best way to ensure that you transcribe information to the PCR correctly? Ask them repeatedly for information you forget. Consider writing information down on a piece of paper. Do not bother to ask them for all their meds or their complete medical history, just obtain the pertinent information. Do not document information if you've forgotten it, only document what you remember.

Consider writing information down on a piece of paper. RATIONALE It is professionally and legally appropriate for the EMT to correctly document patient information on the PCR. An easy way to ensure all information is listed accurately is to use a small notepad to document such information during the interviewing process. It is wrong for the EMT to purposely not document things they think irrelevant or purposely leave out patient information simply because they forgot it.

You have been appointed to a committee charged with preparing an MCI plan for a potential terrorist attack. Given this charge, what should be understood when considering the different methods a terrorist may utilize? Chemical agents, when deployed, usually take several hours before identification. Conventional explosives are most commonly used. Radiological agents carry the lowest amount of damage. Biological weapons are the easiest to recognize after deployment.

Conventional explosives are most commonly used. RATIONALE Conventional explosives are the most commonly used terrorist method. Radioactive agents cause widespread damage over time. Biological weapons may not be quickly or easily recognized. Chemical agents are usually recognized promptly.

You are caring for a front seat occupant of a single car motor vehicle collision (MVC). After your arrival, and during your primary survey, you start to smell a strong odor of gasoline. The patient's condition is critical and the Fire Department is just arriving. Should you decide to remove the patient from the auto, what type of patient movement technique should you employ? Urgent move Non-urgent move Immediate move Emergency move

Emergency move RATIONALE An emergency move should be employed when you have a patient who is critical and must be extricated prior to implementation of certain interventions, especially if there is a threat of further injury or harm to the providers or patient. Using an urgent move should be reserved for a patient who requires movement for treatment reasons, but not due to further threat of injury. Finally, non-urgent moves are for routine patient movement and handling.

A 6 year old male has been rescued from a pool and is now not breathing. You initiate positive pressure ventilation. What is the most appropriate tidal volume for this patient? 40 mL per kilogram Enough air to make the chest rise One full squeeze of a pediatric bag-valve mask 800 mL

Enough air to make the chest rise RATIONALE The universal volume for positive pressure ventilation is enough air to move the chest. Complex formulas that give you exact volumes are cumbersome and unnecessary in the emergency environment. Remember also that typical bag-valve masks deliver far more volume than necessary.

An EMT incorrectly administers oral glucose to a patient that was actually suffering a stroke, but it did not result in any additional harm to the patient. Given this situation, what could the EMS system do in the future to lower the likelihood of such an occurrence from happening again? Only allow EMTs to work with paramedics. Ensure the system protocols are clearly written. Disregard the situation as it didn't result in patient harm. Punish the EMT with 3 weeks off work.

Ensure the system protocols are clearly written. RATIONALE Accidental mistakes in patient care are of great concern to all of health care, including EMS. If the system objectively writes protocols with clear treatment modalities and indications for use, errors can be minimized. Punishing the EMT will not increase knowledge or understanding, nor will making them work strictly with paramedics. Finally, medical mistakes should never be ignored, even if it didn't result in harm to the patient.

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

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

A 3 year old male presents with a high fever, headache, stiff neck, rash on his abdomen, and sensitivity to light. What standard precautions should you take? Gown, eye protection, and gloves Gloves and a gown Eye protection, mask, and gloves Eye protection and gloves

Eye protection, mask, and gloves RATIONALE This patient is showing signs of meningitis, which is an airborne disease. It is important that EMS personnel wear a mask in addition to taking other standard precautions. At the end of this call, all EMS personnel involved should contact their designated infection control officer immediately for follow-up prophylactic treatment.

You initiate positive pressure ventilation on a 20 year old male who has been struck by a vehicle. As you ventilate, you note that a small section of the chest wall expands beyond the rib cage. What does this most likely indicate? Flail chest Pericardial tamponade Pneumothorax Traumatic asphyxia

Flail chest RATIONALE Two or more ribs broken in two or more places is the definition of a flail chest. Here, positive pressure ventilation pushes the flail segment out during the inhalation phase. A pneumothorax can possibly cause paradoxical chest expansion, but would typically involve an entire side of the chest wall. Pericardial tamponade and traumatic asphyxia would not necessarily involve paradoxical chest movements.

A 40 year old male has been involved in a front-end motor vehicle crash. Upon evaluation of the vehicle, you note that the windshield has been broken in a star pattern just above the steering wheel. Which one of the following injuries would be most likely given this mechanism? Blunt abdominal trauma Head and cervical spine injuries Chest and thoracic spine injuries Bilateral femur fractures

Head and cervical spine injuries RATIONALE Typically a starred windshield is caused by a strike from the patient's head. This mechanism commonly indicates head and neck injuries. Bilateral femur fractures and chest injuries also may be present, but the head and spine would be most likely. Usually, blunt abdominal trauma is caused by seat belts, but given that the patient hit the windshield, the use of a seat belt is not likely.

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

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

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

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

What term is used to describe the condition in which blood accumulates in the pleural space? Simple pneumothorax Hemothorax Tension pneumothorax Flail chest

Hemothorax RATIONALE A hemothorax occurs when blood accumulates in the pleural space. Both a simple and a tension pneumothorax occur as air builds up within the pleural space. A flail chest occurs when two or more ribs are broken in two or more places

You are treating an 81 year old male COPD patient for severe difficulty breathing. As you assist him with his prescribed inhaler, he loses consciousness and has a tonic-clonic seizure. What is the most likely cause of this seizure? Hypoglycemia Hypoxia Medication interaction Epilepsy

Hypoxia RATIONALE Given his difficulty breathing, the most likely cause is hypoxia. In fact, you should assume that to be the cause and concentrate your efforts on correcting his airway and breathing problems. Epilepsy could be an underlying complication, but hypoxia is a more proximate issue. Hypoglycemia could cause seizures and should be ruled out later. A medication reaction is possible, but unlikely if you are using a prescribed inhaler properly.

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

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

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

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

A 51 year old male complains of severe right flank pain. He notes he has had difficulty urinating over the last three days. The pain radiates from his flank to his groin. What is the most likely cause of this pain? Kidney stone Gastric reflux Acute myocardial infarction Abdominal aortic aneurism

Kidney stone RATIONALE Difficulty urinating and the nature of his pain make a kidney stone likely. Further assessment is necessary to rule out acute myocardial infarction and abdominal aortic aneurism, but both are less likely. Gastric reflux can have similar symptoms, but rarely results in urinary difficulty.

Which one of the following tissues connect bone to bone to form joints? Meninges Cartilage Ligaments Tendons

Ligaments RATIONALE Ligaments connect bone to bone to form joints. Tendons connect bone to muscle. Cartilage forms structure and can be found in discs inside joints. Meninges are fibrous layers that cover the brain and spinal cord.

A 9 year old male has fallen off the monkey bars at school. The child is alert and complains of pain across the upper two quadrants of his abdomen. Considering anatomy, which of the following organs should you be most concerned about in this child? Gall bladder and pancreas Liver and spleen Large intestine and appendix Small intestine and stomach

Liver and spleen RATIONALE The liver and spleen in children are far more exposed and vulnerable to injury than in adults. You should suspect liver and spleen damage with all upper quadrant abdominal injuries. The gall bladder and pancreas also are housed in the upper quadrants but are less vulnerable to injury. The intestines, stomach, and pancreas can be damaged but with less frequency than the liver and spleen.

A 17 year old male slipped and hit his head hard on a diving board prior to falling into the water. Upon your arrival, the patient has already been extricated by the Fire Department. You find him responsive on the cement. The patient has no movement from the shoulders down and is experiencing respiratory distress. Given this mechanism, at what level is the suspected spinal injury at? Low cervical High thoracic Low thoracic High cervical

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

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

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

A 50 year old male patient is complaining of severe abdominal pain that has been present the last week or so. The patient states he has not seen a doctor for several years and does not have any diagnosed GI problems. Given the patient findings below, which of the following is most suggestive that the patient has an upper GI tract bleed? Excessive vomiting Melena Diarrhea Hemoptysis

Melena RATIONALE Dark-tarry stools, known as melena, is a common finding in a patient with a GI bleed. The dark tarry stool represents the oxidation of the hemoglobin and iron in the blood by the ileum and colon. Diarrhea and vomiting are common findings for GI disturbances, but not necessarily a GI bleed. Finally, hemoptysis is the coughing up of red blood, which usually originates in the respiratory system, not the gastrointestinal system.

An 80 year old male complains of acute onset chest pressure radiating into his left shoulder. He is alert, pale, and diaphoretic. His vitals are P 120, R 24, and BP 190/90. Which one of the following best describes why high concentration oxygen would be important in this patient? Myocardial infarction causes heart tissue to be hypoxic. The heart is not pumping enough oxygenated blood. The patient's breathing is inefficient. This patient is in shock.

Myocardial infarction causes heart tissue to be hypoxic. RATIONALE Acute myocardial infarction causes cardiac tissue to be hypoxic. Supplemental oxygen maximizes the amount of oxygen circulating in the blood. This patient's respirations seem to be efficient. There is no sign of shock or inefficient cardiac output yet.

A 68 year old female complains of shortness of breath. She presents with severe respiratory distress and pink frothy sputum. If her respirations were adequate, which one of the following devices would be most appropriate to treat this patient? Bag-valve mask at 15 liters per minute Simple face mask at 8 liters per minute Nasal cannula at 4 liters per minute Nonrebreather mask at 12 liters per minute

Nonrebreather mask at 12 liters per minute RATIONALE This patient requires a non-rebreather mask at 12 liters per minute. A bag-valve mask may be useful, but if her respirations are adequate, a non-rebreather would be more appropriate. A nasal cannula should be used only if a mask is not tolerated. A simple face mask would not deliver a high enough oxygen concentration.

You are transporting a pediatric patient who has a stoma which is connected to a home mechanical ventilator. As you are preparing for transport, what is the best source of information readily available to the EMT regarding the operation of the mechanical ventilator? Hospital Equipment manufacturer EMS supervisor Parents

Parents RATIONALE When the EMT has to transport a patient on a ventilator, it is the best course of action to learn as much as reasonably possible about the technology before departing with the patient. The best source is often the child's parents who have been caring for the child on this technology. Often the hospital does not have someone on staff 24/7 to answer these questions, nor is the manufacturer always readily available. Your EMS Supervisor is probably not familiar with every piece of equipment out there.

You suspect that your 9 year old patient has been physically abused by her mother. Which one of the following would represent the most appropriate documentation of your findings? Patient has bilateral bruising on her upper arms. Mother states, "I think she fell." Patient has bruising that indicates abuse. The mother's story does not match the injuries. The patient has been abused by the mother. The bruises on the arm could not be caused by the fall the mother describes.

Patient has bilateral bruising on her upper arms. Mother states, "I think she fell." RATIONALE Documentation should be objective, particularly when describing sensitive issues such as potential abuse. Use descriptive statements and when possible document direct quotes. In this case, describing the injuries objectively and quoting the patient's mother would be the best practice. You should avoid making judgment statements such as "the mother's story does not match the injuries." You also should avoid subjective analysis such as "the bruises could not be caused by the fall."

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

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

What is the most common cause of respiratory failure in a muscular dystrophy patient? Upper airway edema Uncontrolled secretions in the airway Bronchoconstriction leading to poor air movement Poor nervous control of the respiratory mechanism

Poor nervous control of the respiratory mechanism RATIONALE Diseases like muscular dystrophy destroy the nervous control of the respiratory system and can lead to poor respiratory function and failure. Uncontrolled secretions, bronchoconstriction, and edema could all be possibilities but should be considered only after ensuring nervous function in this type of patient.

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

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

You are called to care for a patient who was injured by the explosion of a natural gas furnace. There is no fire present, and the patient is found in the corner of his basement where he was thrown. At the conclusion of your primary assessment, you discern that the patient has a pneumothorax. This injury may have been caused by what phase of the blast? Tertiary phase Primary phase Secondary phase Blunt traumatic injuries

Primary phase RATIONALE The primary phase of a blast (also known as the pressure wave), damages hollow gas-containing organs of the body such as the lungs, GI system, inner ears, and sinuses. The secondary phase causes blunt and penetration injuries from flying debris, and the tertiary phase injuries are sustained from the patient being thrown back and impacting something (wall, ground, etc.). Blunt traumatic injuries may occur from either the secondary or tertiary phases of the blast.

A patient presents with a history of bilateral pneumonia, respiratory distress, and a persistent cough. You note that the patient has mild wheezing with loud ronchi. The blood pressure is 168/90 with a heart rate of 120, and a respiratory rate of 28/min. The patient is still speaking full sentences. The pulse ox is reading 87% on room air and did not increase with the addition of high flow oxygen. Given this presentation, what is the most important finding of impaired oxygenation? Pulse oximetry reading of 87% Rapid respiratory rate with coughing Heart rate of 120/min Abnormal breath sounds

Pulse oximetry reading of 87% RATIONALE Whereas ventilatory adequacy is gauged by the quality of airflow in and out of the lungs, oxygenation and respiratory adequacy can be gauged by things like mental status, skin characteristics, and pulse oximetry. A pulse ox reading less than 90% is considered to be a sign of hypoxia by itself, and if it does not rise (or only minimally) after oxygen therapy, it can indicate poor oxygenation and respiration at the cellular level.

Which one of the following is classified as a sign when taking a patient history? Report of night sweats Description of pain Rash on the stomach Ringing in the ears

Rash on the stomach RATIONALE A sign is objective and can be observed by another person, such as a rash. A symptom cannot be observed and is subjective as reported by the patient or a third party (family member, bystander, or friend). A symptom cannot be verified, such as the degree of pain, having a problem before EMS arrives like night sweats, and what the patient states he hears.

A blood glucose evaluation is indicated for a 5 year old male. Which one of the following would be the proper technique for performing a potentially painful finger stick? Allow the child to examine the lancet before performing the procedure. Tell the child that the finger stick will not hurt. Ready all the equipment before mentioning the finger stick. Discuss the procedure with the child before you ready the equipment.

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

What type of respiratory bacterial infectious disease, communicated by airborne respiratory droplets, may the EMT encounter in a patient with signs and symptoms of a common cold? Tuberculosis Pulmonary abscess Lung cancer Pneumonia

Tuberculosis RATIONALE Tuberculosis is an infectious state of the lung tissue caused by a pathogenic bacterium (usually a strain of mycobacteria). It is highly contagious, and if left untreated it can cause death in about 50% of victims. Lung cancer has multiple etiologies, but it is not contagious. Likewise, pneumonia and pulmonary abscesses can both disrupt normal pulmonary functioning, but they are not communicated by airborne water droplets.

You are called for a female in active labor. Upon your arrival you find the patient lying on a bed, knees up, and the baby is already halfway out the birth canal. Given this information, what stage of labor would you say the patient is in? Second stage Fourth stage First stage Third stage

Second stage RATIONALE The hallmark finding in the second stage of labor is the complete delivery of the baby. The first stage occurs from the onset of true labor contractions until dilation and effacement of the cervix. The third stage occurs when the placenta delivers. There is no fourth stage of delivery.

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

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

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

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

Your patient has suffered an abdominal injury when he was accidentally kicked hard in the abdomen during a football game. The patient complains of immediate sharp and burning pain to the upper quadrants, and tenderness is noted with palpation. The patient is responsive and vitals are stable. Given this presentation of pain, what organ was most likely damaged? Small intestines Descending abdominal aorta Liver Pancreas

Small intestines RATIONALE There are three types of organs in the abdomen - solid, hollow, and vascular. When a solid organ is damaged, there is usually dull or diffuse pain, when a vascular organ is damaged, there may be sharp pain but the patient will display signs of internal hemorrhage. When hollow organs are damaged, they typically spill their contents into the abdomen. Since the pH of the small intestines is acidic, spillage of these contents creates sharp and immediate pain. Hollow organs do not hemorrhage extensively from trauma, so vitals are typically minimally affected.

While attempting to gather a patient history from an elderly male, what techniques should the EMT employ to best ensure the patient's understanding of the questions and comments the EMT is making? Utilize words or questions that are often used by other EMS providers in the area. Speak in terms the patient understands. Maximize the use of medical terms and phrases in speaking. Attempt to use the simplest terms and phrases possible.

Speak in terms the patient understands. RATIONALE The easiest way to gather information from a patient is by giving them the question in a form they can understand (which is not necessarily using the simplest terms possible). The use of medical jargon or questions employed by others in different situations will rarely help, in fact, they may hinder the interview process.

Of the following, which one is the proper procedural technique for suctioning with a Yankauer suction tip? Start to suction as the catheter is being removed. Suction when the tip is near the material to be removed. Suction only as the catheter moves from side to side. Start to suction as the catheter enters the mouth.

Start to suction as the catheter is being removed. RATIONALE The appropriate procedure is to place the suction tip - without suctioning - into the mouth as far as can be visualized. Do not lose sight of the end of the catheter. Once in place, start to suction as the Yankauer is withdrawn from the mouth. Intermittent suctioning or moving side to side is ineffective and can force material farther back into the airway.

A patient is suspected of having an abdominal aortic aneurysm (AAA). How might the patient describe the pain? Crushing Diffuse Intense Tearing

Tearing RATIONALE A tearing pain in the back is a common way a patient with an AAA will describe the sensation. Dull and diffuse pain (visceral) arises from the abdominal organs and intense focused pain from the lining of the abdominal cavities. Crushing pain may be caused by myocardial infarction.

After arriving at your EMS station, you learn of your ambulance assignment and start your checklist of tasks that must be done before your unit can go into service. Of the following tasks, which one is most important to ensure the safety of the crew during an emergency response? Checking fuel and oil levels Testing the emergency response lights Ensuring that horn, windows, and dash lights are fully functional Ensuring the heating and air conditioning systems are operable

Testing the emergency response lights RATIONALE There are multiple things the EMT must ensure are functioning properly on the ambulance prior to responding to an emergency. Some pertain to the operation of the vehicle (fuel and oil levels), some pertain to crew/patient comfort (heating and air conditioning), and finally, some pertain to the safe operation of the vehicle when responding to an emergency (lights and siren).

You are caring for a patient whose arm was traumatically amputated just proximal to the elbow in a construction accident. Upon your arrival, the stump of the arm is bleeding profusely. Following direct pressure at the site and application of trauma dressings, the bleeding is still severe. What would be the next step you should take in attempting to limit the bleeding? Use hemostats to clamp off the bleeding artery Application of cold Tourniquet application Raise arm above the heart

Tourniquet application RATIONALE Stopping a significant bleed is an important treatment priority during the primary survey, and assuring its cessation during transport is equally important for patient survival. As such, the management of the bleed must be aggressive and appropriate. Following direct pressure and trauma dressings, if bleeding is still severe, the EMT will place a tourniquet proximal to the injury site. The application of cold compresses or elevation may help with minor bleeds, but are much less effective with significant bleeds. Finally, the EMT should never attempt to clamp off a blood vessel as this can increase damage and complicate possible reimplantation of the severed limb.

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

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

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

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

A 23 year old male has been struck by a vehicle. You find him unconscious with gurgling respirations and note blood in his airway. Which one of the following best describes the method you should use to clear his airway? Use a rigid tip suction catheter and suction only as the catheter is removed. Immediately turn his head to the side so blood will run out of his mouth. Use a finger sweep with a towel to soak up blood. Use a rigid tip suction catheter and suction as the catheter is inserted.

Use a rigid tip suction catheter and suction only as the catheter is removed. RATIONALE When suctioning, apply suction only as the catheter is removed. Often gravity can be used as suction by turning the patient on his side, but you should never turn just a patient's head when dealing with a traumatic mechanism of injury. A finger sweep may be appropriate if a foreign body is identified, but in this case mechanical suction would be more appropriate.

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

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

A patient is suffering from a pulmonary embolus, which is blocking blood flow to a portion of the lungs for re-oxygenation. Given the nature of this medical emergency, what component of the life support chain will become deranged and result in patient deterioration? Patency of the patient's airway Transport of gases in the blood stream Ventilation/Perfusion ratio Blood vessel size and resistance (SVR)

Ventilation/Perfusion ratio RATIONALE The ventilation/perfusion ratio describes the dynamic relationship of alveolar ventilation and perfusion through the perialveolar capillary bed. With a pulmonary embolus, blood flow will not reach the alveoli to be oxygenated, thus this is the component disturbed. Patency of the airway and transport of the gases in the blood are irrelevant if the blood can't get to the alveoli. SVR deals with the afterload the left heart has to pump against to maintain adequate peripheral perfusion. PREVIOUS

You are managing a patient in extreme pain from a sickle cell crisis. The vitals are stable and the patient can communicate properly. Following oxygen administration and placing the patient in a position of comfort, what is the next best intervention an EMT can provide? Positive pressure ventilation Aspirin Verbal reassurance Placement of the AED

Verbal reassurance RATIONALE Sickle cell crisis occurs when an organ or muscle group is deprived of oxygen because of the diminished carrying capacity of the blood cells. This often results in severe pain, but usually not an acute deterioration. Following oxygen therapy and comfortable positioning, the next best thing the EMT can do is provide verbal reassurance en route to the receiving facility. Aspirin is not warranted for this type of pain, nor is the placement of the AED (the patient still has a pulse). Positive pressure ventilation is only utilized when this (or any patient's) ventilation becomes inadequate.

You are preparing to transfer a patient to a helicopter crew. The aircraft has landed and you are ready to move the patient. Which one of the following would be the most appropriate method of approaching the helicopter? Only approach helicopters after they have been shut down. Walk up to the helicopter to get the attention of the flight crew. Wait for a signal from the crew that it is safe to approach. Approach from the rear of the helicopter because that is where the patient will be loaded.

Wait for a signal from the crew that it is safe to approach. RATIONALE Proper communication with the flight crew is essential to staying safe while operating around aircraft. In this case, you should wait for a signal from the crew to approach the aircraft. You should never approach the helicopter without the awareness of the crew, and helicopters should never be approached from the rear because the tail rotor presents a serious safety hazard. Helicopters can be approached safely while they are under power, but safe procedures require teamwork.

A lone driver has crashed his car into a telephone pole on a rainy night. While caring for this patient during the extrication process, what can the EMT do that will greatly increase their visibility to other motorists passing by the scene? Wear a high visibility safety vest. Park the ambulance sideways in the road to stop traffic in both directions at all MVC scenes. Position themselves on the side of the wrecked car away from traffic flow. Don light blue non-latex gloves.

Wear a high visibility safety vest. RATIONALE The donning of an ANSI-approved reflective safety vest is perhaps the single most important precaution the EMT can take in order to increase their visibility to passing motorists. Donning light blue exam gloves will do no good as they are not light reflective. Positioning themselves on the opposite side of the wreck or positioning the ambulance across the road does not increase the visibility of the EMT.

You have responded to a residence where a 42 year old using a table saw amputated his left index finger. After controlling the bleeding and treating for shock, how should the finger be prepared for transport? Wrap it in a sterile dressing, place it in a plastic bag, and put the bag in cool water. Wrap it in a towel and place it in a saline ice bath. Place it in sterile saline and chill it with ice or cold bags. Wrap it in gauze, put it in a plastic bag, and keep it at room temperature.

Wrap it in a sterile dressing, place it in a plastic bag, and put the bag in cool water. RATIONALE An amputated part should be prepared for transport by wrapping it in a sterile dressing in order to minimize on any additional contamination. Next, the part should be put in a plastic bag, which should then be placed in cool water or ice packs. An amputated part should not be placed directly in water or saline. It should not be allowed to come into direct contact with ice because it could freeze.

You are dispatched to a motor vehicle crash. During extrication, the patient cuts his arm on a jagged piece of metal. Which one of the following reasons would best describe why your actions are not protected by Good Samaritan laws? You acted within your scope of practice. You operated within the standard of care. You had a duty to act. Your actions were grossly negligent.

You had a duty to act. RATIONALE Good Samaritan acts typically protect providers who have no duty to act. In this case, you were dispatched to the call and therefore did have a duty to act. Your actions were not grossly negligent, nor were they outside the scope of practice or standard of care.

A 77 year old female complains of shortness of breath. She has a history of COPD and is in moderate respiratory distress. She is alert, has a patent airway, and her respiratory rate is 38. You can hear wheezes as she exhales. Based on your assessment of her breathing, you should administer 6 liters per minute of oxygen via nasal cannula. ask the patient to breathe into a paper bag. administer 12 liters per minute of oxygen via non-rebreather mask. initiate immediate positive pressure ventilation.

administer 12 liters per minute of oxygen via non-rebreather mask. RATIONALE The respiratory assessment of this patient indicates respiratory distress but not respiratory failure. The immediate treatment necessary would be supplemental, high-concentration oxygen. A non-rebreather mask would be the most appropriate choice. A nasal cannula might be used if a mask could not be tolerated. Positive pressure ventilation would not be necessary yet. A paper bag should never be used to treat any respiratory condition

Three teenage patients have become ill after using a camp stove inside a closed tent. One patient is unconscious and the other two complain of nausea and headache. To treat the conscious patients, you should administer 324 mg of aspirin. administer high concentration oxygen. allow them to breathe fresh air. administer activated charcoal.

administer high concentration oxygen. RATIONALE These patients are most likely suffering from carbon monoxide poisoning. The most appropriate treatment for a conscious patient would be high concentration oxygen. Removing them from the source and into fresh air is important, but oxygen will speed the removal of CO from their systems. Aspirin or activated charcoal are not indicated in this situation.

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

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

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

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

A 25 year old male has been slashed in the neck by a small blade. He has a large, open wound on the right lateral aspect of his neck. He is alert, complaining of pain, and his vitals are P 110, R 20, and BP 130/72. After ensuring the scene is safe, you should next apply a bulky dressing to stop the bleeding. an occlusive dressing over the wound. manual cervical stabilization. a pressure dressing around his neck.

an occlusive dressing over the wound. RATIONALE Wounds to the great vessels of the neck pose a risk for air emboli. The wounds should be sealed as quickly as possible with an occlusive dressing. Direct pressure can be used to stop bleeding, but a bandage should never be placed around the neck. The risk of spine injury here is low. Immobilization is not necessarily wrong, but sealing the wound should come first.

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

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

You are first on the scene of a serious motor vehicle crash. Your patient's car has struck a tree and sustained significant damage. As you assess your patient, you notice the airbag has not deployed. You should turn off the ignition to cut power to the airbag. ask rescue personnel to disconnect the battery. not worry about the airbag; if it was going to deploy it would have already. place a blanket over the airbag.

ask rescue personnel to disconnect the battery. RATIONALE Airbags can be serious hazards to emergency crews. The safest way to handle this situation is to have the battery disconnected. Airbags can deploy when the car is not running and have been known to deploy unexpectedly.

A 33 year old female patient has just delivered a healthy child. While your partner cares for the baby, you assess the mother. You note postpartum bleeding to be heavy with no signs of slowing after the delivery of the placenta. You should pack the vagina with sterile pads. place the patient in a knee-chest position. begin fundal massage. apply direct pressure to the birth canal.

begin fundal massage. RATIONALE Fundal massage is used to stimulate the uterus to contract and may be necessary to stop postpartum hemorrhage. You should never pack the vagina and because the bleeding is occurring within the uterus, direct pressure externally will not help. A knee-chest position would do no good either.

You are treating a 59 year old female who is having a severe asthma attack. Upon reassessment, you note her respiratory rate has dropped from 48 to 32 and she appears to be falling asleep. You should increase the oxygen flow to her nonrebreather mask. monitor carefully, because your treatments seem to be improving the patient's condition. begin positive pressure ventilation. assist the patient with an additional dose of her prescribed inhaler.

begin positive pressure ventilation. RATIONALE A slowing respiratory rate in combination with a decline in mental status is an indication of respiratory failure. Positive pressure ventilation must be initiated immediately. At this point, increasing supplemental oxygen or assisting with an inhaler would not be enough.

After arriving at the scene of a "man down" you determine your patient is the victim of an assault. As you perform your interventions the assailant returns with a gun and orders you to quit treating the patient and leave. In this situation, you should comply with the wishes of the gunman and depart the scene. try to reason with the assailant so he relinquishes his gun. grab your portable radio and immediately notify dispatch about the gunman. attempt to move the patient with an "emergency move."

comply with the wishes of the gunman and depart the scene. RATIONALE When a scene becomes dangerous, especially when an EMT is confronted with someone wielding a gun, the best course of action is to listen to their demands, and comply with them to the best of your ability. If that means leaving the patient there unattended, so be it. It is always the highest priority for the EMT to protect his/her safety and that of their partner. After this, the patient's safety is next priority. If the EMT cannot assure their own safety, then the patient is not yet a concern.

You are driving with lights and siren and the vehicle in front of you does not yield. You should continue driving and be prepared for erratic maneuvers by the driver in front of you. choose an alternate route of response. attempt to force the driver to pull to the right by swerving into the oncoming lane. use your spotlight as an additional warning device in an attempt to get the driver's attention.

continue driving and be prepared for erratic maneuvers by the driver in front of you. RATIONALE Not all drivers can hear the siren. Quiet cars, car radios, and inattention all can result in drivers not noticing your visual and audible warnings. In this case, you should continue driving but be prepared for erratic behavior if the driver suddenly notices you. You should not attempt to force the driver to yield and you should not shine a spotlight at the driver. An alternative route would likely add time to your response and may not be necessary if you are patient.

The muscle tissue of the heart receives its blood supply from the oxygenated blood passing through it. coronary arteries. pulmonary artery. carotid arteries.

coronary arteries. RATIONALE Cardiac tissue is perfused by the coronary arteries. The carotid arteries help perfuse the brain. The pulmonary artery brings deoxygenated blood to the lungs.

A 17 year old multisystem trauma patient has been transferred into your ambulance. As you begin your assessment, you notice that the backboard has been placed on top of the stretcher straps that you would ordinarily use to secure a patient. You should delay transport long enough to get at least one strap on the patient. delay transport to free the straps and resume only after the patient has been secured. initiate rapid transport without the straps because this case is time sensitive. initiate transport and attempt to free the straps en route.

delay transport to free the straps and resume only after the patient has been secured. RATIONALE Proper patient packaging must balance expedience and function. That said, it is not appropriate to transport a patient who has not been properly secured. In this case, you should delay transport long enough to properly secure him. Securing en route or minimally securing the patient would be unsafe.

A 58 year old male is found with altered mental status, profuse sweating, and uncontrolled shaking. His friends note his only medical problem is chronic alcoholism. His vital signs are P 120, R 30, and BP 190/100. His blood glucose level is 84. These signs and symptoms most likely indicate delirium tremens. shock. hypoglycemia. hypoxia.

delirium tremens. RATIONALE Given his history of alcohol abuse, these signs indicate delirium tremens. Hypoglycemia can present this way, but his blood glucose is within normal limits. Hypoxia and shock must be ruled out, but there is no indication to point you in that direction yet.

A 15 year old male has injured his arm playing football. He presents alert and complaining of pain in his right shoulder. Upon examination, you note he is holding his right arm against his chest and when compared to the left shoulder, there appears to be a bulge in the anterior aspect of the right shoulder joint. Those findings most likely indicate a fractured clavicle. fractured humerus. dislocated shoulder. fractured scapula.

dislocated shoulder. RATIONALE Deformity around the joint capsule and immobility of the arm indicate a shoulder dislocation. A fractured humerus can present similarly, but deformity of the joint makes this choice less likely. A fractured clavicle is possible but would likely not show deformity in the joint. A fractured scapula typically presents with posterior deformity and pain.

The U.S. Department of Transportation's Emergency Response Guide is primarily used to design protocols and standard operating guidelines. outline emergency driving laws and statutes. determine the most appropriate medical treatment for specific illnesses. identify placards associated with hazardous materials.

identify placards associated with hazardous materials. RATIONALE The Emergency Response Guide is a useful resource for the identification of hazardous materials. Services develop standard operating guidelines. State and regional medical directors develop treatment protocols. Emergency driving guidelines are typically defined by state laws and statutes.

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

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

A 2 year old female has fallen out of her crib and landed on a small chair. She complains of pain in her belly. Her vital signs are P 140, R 30, and BP 90/62. After completing the primary assessment, you should complete a detailed assessment. initiate rapid transport. discuss a detailed medical history with the patient's mother. perform a focused assessment of the abdomen.

initiate rapid transport. RATIONALE This patient is in compensated shock and needs immediate transport. A focused exam, a detailed exam, and a medical history will be necessary, but should not delay transport.

You are assessing a 37 year old, 39-week pregnant woman in labor. As you assess her perineum for crowning, you note that the umbilical cord has prolapsed. You should insert a gloved hand into the vagina and gently move the baby's head off the prolapsed cord. apply direct pressure with a moistened sterile dressing. pull on the prolapsed cord to facilitate delivery. immediately clamp and cut the cord.

insert a gloved hand into the vagina and gently move the baby's head off the prolapsed cord. RATIONALE When an umbilical cord prolapses, blood flow through it is often compromised as the baby's head enters the birth canal. In this situation, you must place a gloved hand into the vagina to take pressure off the cord. You should never pull on an umbilical cord nor should you clamp and cut it prior to delivery. Direct pressure will do nothing to restore blood flow to the baby.

An 11 year old male has fallen from a tree onto the rails of a fence. He complains of abdominal pain but is ambulatory and otherwise uninjured. His vital signs are P 118, R 24, and BP 110/74. You should suspect internal bleeding and compensated shock. minor injuries and vital signs related to fear. a soft tissue injury in the abdomen. abdominal discomfort due to anxiety.

internal bleeding and compensated shock. RATIONALE This patient has a mechanism of injury, signs of an injury, and vital signs that demonstrate compensated shock. He has internal bleeding. Fear and anxiety can often mimic compensation, but you should always err on the side of shock. Although he may have a soft tissue injury, it is better to err on the side of the more serious problem.

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

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

Blood oxygenated in the lungs returns to the heart via the pulmonary vein and enters the right atrium. right ventricle. left atrium. left ventricle.

left atrium. RATIONALE Oxygenated blood from the lungs enters the left atrium, passes through the mitral valve, and then is pumped out to the body by the left ventricle.

You respond to an explosion. The patient you are assessing has been thrown onto some debris and as you examine his airway, you notice a piece of wood has impaled the soft tissue of his cheek. You should stabilize the object in place. pad the object from inside the patient's mouth. remove the object even if it is impaled into tissue beyond the cheek. remove the impaled object as long as only the cheek is involved.

remove the impaled object as long as only the cheek is involved. RATIONALE An impaled object that only involves the soft tissue of the cheek may be removed. If it were to be impaled deeper into oral structures it should be stabilized in place. In this case, it should be removed. Padding inside a patient's mouth would be difficult and may interfere with airway management.

You reassess an 88 year old female pneumonia patient. You have previously placed her on high concentration oxygen via non-rebreather mask to treat her respiratory distress. Now you notice that her respiratory rate has dropped from 48 to 28 and her oxygen saturation has dropped to 81%. Those findings most likely indicate normal variation for a patient in respiratory distress. the need for positive pressure ventilation. a need for increased oxygen flow to the mask. patient improvement.

the need for positive pressure ventilation. RATIONALE Your reassessment of this patient has revealed that she is no longer just in respiratory distress and now is in respiratory failure. Positive pressure ventilation is essential. This patient is not improving and those findings are not normal variations. Increased flow to the mask would not be an aggressive enough intervention under these circumstances.

A 6 year old female has injured her leg at school. A school nurse instructs you to transport the patient to the hospital. No parent is on the scene. You should ask the nurse to transport the patient. transport the patient because she has given you expressed consent. await the arrival of a parent. transport the patient because the nurse is acting in loco parentis.

transport the patient because the nurse is acting in loco parentis. RATIONALE The concept of in loco parentis allows the nurse to act on behalf of the parents. Awaiting the arrival of the parents would be unnecessary under those circumstances. A 6 year old patient is too young to grant expressed consent. The nurse transporting the patient would not be a viable option.

Delayed capillary refill in a hypovolemic shock patient is most likely caused by destruction of small capillaries as a result of trauma. blood pooling in the extremities due to shock. little to no blood flowing in the cardiovascular system. vasoconstriction of the peripheral blood vessels.

vasoconstriction of the peripheral blood vessels. RATIONALE Delayed capillary refill is most likely caused by vasoconstriction of peripheral blood vessels. In hypovolemic shock, blood is shunted to the core by narrowing blood vessels in the skin and nonessential organs. This causes poor peripheral blood flow. There may be little blood flowing in the cardiovascular system, but capillary refill can be delayed far before the patient reaches this point. Destruction of capillaries is not the cause, nor is pooling blood.

Asking about provocation in a patient with chest pain would refer to how severe the pain is. what makes the pain better or worse. the type of pain the patient would describe. what time the pain started.

what makes the pain better or worse. RATIONALE Provocation refers to what, if anything, makes the pain better or worse. In the acronym OPQRST, time would refer to when the pain started. Severity would refer to how severe it is and quality would refer to the type of pain the patient would describe.

Most laws regarding emergency driving refer to "due regard for the safety of others." This would mean other drivers have to be careful to avoid you as you drive. you need to account for other drivers as you drive the ambulance. you do not have to stop at red lights. you can drive as fast as you want to.

you need to account for other drivers as you drive the ambulance. RATIONALE Due regard to the safety of others means that although you may be exempt from traffic laws, your driving must account for the well being of other drivers. It means you cannot drive as fast as you want nor can you ignore red lights. Other drivers may be required to yield the right of way, but you still must drive in a manner that considers their safety.