pocket prep 1/2

Which of the following history-taking questions would be specific to a patient in a respiratory emergency?

-"Sir, when was the last time you used your metered-dose inhaler?" -History taking of patients in a respiratory emergency, as with all patients, should include patient demographics, a review of the chief complaint, additional subjective findings not previously discussed in the chief complaint, and pertinent positive and negative symptoms (i.e., OPQRST), allergies, current medications, last oral intake, and events leading up to the current condition. When discussing respiratory emergencies, symptoms (e.g., dyspnea, a sore throat, chest pain) and medications (e.g., home oxygen, a metered-dose inhaler, a nebulizer) that are pertinent to the condition are paramount. -A patient's medications, medical history, and review of their chief complaint are elements of history taking for all patients.

Which of the following would not be appropriate management of bystanders and unprotected workers at the scene of a suspected toxic gas leak? Select the three answer options which are correct.

-*In a hazmat situation involving a gas, the safe areas will be upwind, not downwind. It would not be safe to move bystanders to a building with no windows, as it may not be ventilated and the gas could be trapped. You would not contact poison control for isolation distances; instead, you would most likely consult the Emergency Response Guidebook (ERG) or ChemTrec. -The cold zone is an area identified by the hazmat team as safe and is the best location for bystanders and unprotected workers.

Which of the following is an example of a special reporting situation?

--A mass-casualty incident -Special reporting situations may include mass-casualty incidents, gunshot wounds, animal bites, specific infectious diseases, or suspected physical or sexual abuse. Local laws/protocols dictate which incidents require special reporting. -An error in documentation should be corrected by a single line through the error with dates and initials of the author and updated information.

Which of the following chest pain descriptions is most consistent with acute myocardial infarction

--Crushing chest pain radiating to the neck with shortness of breath -Acute myocardial infarction (AMI) is a medical emergency, as heart muscle can be permanently damaged within 30 minutes. Patients can present with chest pain/discomfort that is typically described as pressure or heaviness with radiation to the neck, back, jaw, or upper extremities; dyspnea; nausea/vomiting; syncope; and sweating without an obvious cause. Pain associated with AMI can last several hours. Aspirin (due to its platelet-aggregation inhibition), nitroglycerin (due to its vasodilating effects), and oxygen are all important prehospital treatments for suspected AMI. Pain may or may not be alleviated with nitroglycerin. -Pleuritic chest pain is a sharp pain that worsens with inspiration. It can be associated with conditions like pneumothoraces but is not commonly associated with AMI. -Burning chest pain (heartburn) is commonly due to gastroesophageal reflux disease (GERD). -Cardiac chest pain that is alleviated with rest is considered stable angina pectoris, which is due to temporary myocardial ischemia.

An elderly patient is in cardiac arrest, and a family member presents a do-not-resuscitate (DNR) order. Which of the following is commonly required for a DNR to be valid?

--List of medical problems -DNR orders instruct responders not to attempt resuscitation for a patient. In order to be valid, a DNR must articulate the following requirements:* clear statement of the patient's medical problem(s) signature of the patient or legal guardian signature of one or more physicians or other licensed healthcare providers valid expiration date if required by the state*

A 70-year-old male was trimming a tree branch when it broke and fell on him. His wife called because he seemed confused immediately after the incident, but he insisted that he felt fine and refused transport. Two days later, you are called to his home again, where he is clearly confused. During your assessment, he vomits once and then becomes somnolent. The patient's medical history includes a cardiac stent placed eight months ago. Ecchymosis at the site of the injury is noted, but no further ecchymosis is visible. Which of the following is most likely?

--Subdural hematoma -In addition to Subdural Hematoma (SDH), head trauma is a major cause of Epidural Hematoma (EDH), Subarachnoid Hemorrhage (SAH), cerebral contusion, diffuse brain swelling, and fractures. Any of these injuries may coexist in a patient following trauma, and their clinical manifestations can be difficult to distinguish. Patients with head trauma should be transported to a hospital with a dedicated trauma team, if feasible, to promote significantly better outcomes. -Subdural hematoma typically occurs with a sudden acceleration/deceleration injury, and tearing of the bridging veins of the dura, resulting in a hematoma between the dura mater and arachnoid. Because these are commonly venous injuries, they often present more slowly; acute symptoms usually develop gradually one to two days after the initial injury. Because of the mechanism of injury, however, they also typically have accompanying parenchymal damage. The elderly and alcoholics tend to have more extensive brain atrophy and are more susceptible to the development of acute SDH. Children under two years of age are also at increased risk. Immediate evaluation is critical, as the diagnosis is based on CT scan results. -An epidural hematoma results from a collection of blood in the potential space between the skull and the dura mater. Blunt trauma to the temporal or temporoparietal area with an associated skull fracture and disruption of the middle meningeal artery is the primary mechanism of injury. The classic presentation of EDH involves significant blunt trauma, with a loss of consciousness or altered mental status, followed by a "lucid interval" of indeterminate duration; the patient then quickly declines in status, with a rapid neurologic demise. High-pressure arterial bleeding can lead to herniation of the brain within hours after injury. While the "lucid interval" is regularly taught to healthcare practitioners, this presentation occurs in a minority of cases (<20%). -A basilar skull fracture is associated with high-energy trauma and occurs following diffuse impact to the head. Signs and symptoms include Cerebrospinal Fluid (CSF) draining from the ears, "raccoon eyes," or a Battle sign (ecchymosis behind one ear over the mastoid process). Patients with leaking CSF are at risk for bacterial meningitis. These symptoms may not occur until 24 hours after the incident. -A concussion is a mild traumatic brain injury, leading to impairment of brain function without overt hemorrhage or gross lesion and resulting in a GCS (Glasgow Coma Scale) score of 14 or 15. Signs and symptoms include confusion and alterations in consciousness. The patient may refer to the incident in terms of having their "bell rung" or "seeing stars." The presence of vomiting, a headache, loss of consciousness, focal neurologic deficit, or a dangerous mechanism of injury indicates an increased risk of serious injury.

A 36-year-old patient has a decreased level of consciousness. They also need suctioning due to excessive oral secretions blocking their airway. A suction catheter is measured from the corner of the mouth to the earlobe. During suctioning of the patient, how far should the rigid catheter be inserted?

--To the depth measured -A rigid catheter should be inserted to the depth measured. The catheter is measured prior to use from the corner of the mouth to the tip of the earlobe in a conscious or semiconscious patient. Catheter insertion in this setting may induce vomiting. Apply suction only while withdrawing the catheter.

Assuming the assessment of a patient's pulse and breathing are done simultaneously, what is the maximum time these assessments should take?

-10 seconds -After a patient is deemed unresponsive, assess for a pulse and breathing. These assessments can be done simultaneously and should take no longer than 10 seconds in total. A pulse assessment should occur at the carotid. If no pulse is palpable, CPR should be initiated, beginning with chest compressions.

If a patient has a stroke volume of 75 mL per beat and a heart rate of 75 beats per minute, what is their cardiac output

-5.6 L/min -Cardiac output is the estimation of the amount of blood pumped by the heart in one minute. It is found by multiplying stroke volume (in mL per beat) and heart rate (in beats per minute). -Stroke volume is the amount of blood ejected from the heart in one minute. The average stroke volume for an adult is 70 to 80 mL per beat. The average heart rate for an adult is 60 to 100 beats per minute. -For this patient: 75 mL per beat x 75 beats per minute = 5,625 mL per minute.

An unconscious adult patient has sustained a large laceration to the upper right thigh. Their skin is cool, clammy, and pale. The patient has a palpable carotid pulse but no palpable radial pulse. The patient's systolic blood pressure must be at least which of the following?

-70 mm Hg -Generally, if a patient has a palpable radial pulse, their systolic blood pressure will be at least 90 mm Hg. If a patient has a palpable femoral pulse, the systolic blood pressure will be at least 80 mm Hg. If a patient has a palpable carotid pulse, the systolic blood pressure will be at least 70 mm Hg.

For most adults, at what level must a patient's systolic blood pressure be in order to demonstrate a palpable radial pulse?

-90 mm Hg Generally, if an adult patient has a palpable radial pulse, the systolic blood pressure will be at least 90 mm Hg. If a patient has a palpable femoral pulse, the systolic blood pressure will be at least 80 mm Hg. If a patient has a palpable carotid pulse, the systolic blood pressure will be at least 70 mm Hg

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

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

What is the preferred method for defibrillation of an infant?

-A manual defibrillator -For an infant (age 1-12 months), a manual defibrillator is the preferred method of defibrillation. The manual method is preferred due to the low dose of energy required for defibrillation of an infant. If this is unavailable, an AED equipped with a pediatric dose attenuator is used. If neither is available, an adult-sized AED may be used. -For pediatric patients under eight years old, an AED equipped with a pediatric dose attenuator is preferred. If this is not available, an adult-sized AED may be used.

In which of the following scenarios is an automated external defibrillator (AED) indicated

-A patient who is unresponsive and apneic when you have difficulty palpating a pulse -An automatic external defibrillator (AED) is indicated for a pulseless and unresponsive patient. If you are having difficulty palpating a pulse in an unresponsive patient, assume there is no pulse and begin CPR, applying an AED as soon as possible.

Which of the following is true regarding suctioning for children?

-Aggressive suctioning can cause vagal stimulation- -Prolonged suctioning can actually obstruct an airway. Aggressive suctioning may cause vagal stimulation, especially in children, which may cause further hypoxia or bradycardia. It is recommended to limit suction attempts for patients of all ages to 10 seconds. Some textbooks may reflect 15 seconds, but the current recommended practice is 10 seconds. -A French (whistle-tip) catheter should be used for patients with a stoma, those whose teeth are clenched, or when suctioning of the nose is required. A tonsil-tip (Yankauer tip) catheter is the best option for infants and children, as the tips have a large diameter, are rigid, and therefore will not collapse. The tip of a suction catheter should be inserted only as far as can be visualized.

Identify which ambulance types are correctly described.

-Ambulance manufacturers must design ambulances based on current NFPA 1917 standards. The NFPA 1917 covers three types of basic ambulance designs. -A Type I ambulance is a conventional truck-cab chassis separated from the patient compartment. A Type II ambulance is a standard van chassis that is all one piece. A Type III ambulance is a van chassis separated from the patient compartment.

How can angina pectoris be distinguished from acute myocardial infarction (AMI) in a prehospital setting?

-Angina pectoris and AMI are indistinguishable in a prehospital setting. -Angina pectoris—temporary chest pain associated with acute coronary syndrome—and AMI cause similar signs and symptoms in a prehospital setting. Both conditions lead to chest pain/discomfort that is typically described as a feeling of pressure or heaviness, which can radiate to the jaw, arms, epigastrium, or back. Patients also develop shortness of breath, sweating, and nausea are also common. -Pain associated with angina pectoris typically resolves within minutes, while pain associated with AMI may last several hours. Pain from both conditions may or may not be resolved with rest and/or nitroglycerin. Since AMI is a more serious condition, AMI should be assumed for all nontraumatic patients with chest pain/discomfort until definitely ruled out by a physician. -Not all myocardial infarctions present with electrocardiogram changes. Physician evaluation and blood analysis are required to diagnose an AMI definitively.

A 21-year-old male marathon runner has sprained his right ankle. He is conscious, appears alert, and denies any other injury or illness. His skin is warm and dry with a pink, moist mucosa. The patient's pulse is 52 beats per minute, and his blood pressure is 116/65 mm Hg. He does not appear to be in acute distress. What is the most appropriate intervention in the management of this patient?

-Ask the patient what his normal pulse rate is -Athletes may have a slower resting heart rate (under 60 beats per minute) as a result of normal physiologic changes related to conditioning. -There is no indication that this patient requires oxygen or spinal immobilization; he is also not exhibiting signs of dehydration.

Which of the following is NOT a risk factor for a spontaneous pneumothorax?

-Blunt trauma to the chest *A pneumothorax is a partial or complete accumulation of air in the pleural space. A spontaneous pneumothorax has no identifiable cause but is associated with certain conditions. Patients with emphysema or asthma and tall, thin men are more susceptible to the development of a spontaneous pneumothorax. Dyspnea, pleuritic chest pain, and absent/decreased breath sounds on the affected side are common. *A spontaneous pneumothorax can progress to a life-threatening condition. *Blunt trauma to the chest is more likely to cause a tension pneumothorax resulting from a fractured rib that lacerates a lung or bronchus. A tension pneumothorax can be spontaneous, but this is rare. Chest pain, respiratory distress, decreased lung sounds, tachycardia, and signs of shock can affect patients with a tension pneumothorax.

An adult male was cleaning his garage where several bags of dry lime were stored. He is now covered with lime and in pain from the chemical burns to his hands and face. Which action should be done first?

-Brush the remaining dry chemical from the skin and clothing -Decontamination by properly trained personnel should be completed. -The potency, concentration, and duration of exposure to a toxic agent are the primary determinants of the degree of tissue damage from a chemical burn. Immediately begin treatment. The management of topical chemical burns generally consists of the following steps: *Ensure protection of rescuers and health care workers from exposure. Remove the patient from the area of exposure. Remove all clothing and jewelry. Brush any dry chemicals off the patient; any suitable instrument may be used (e.g., dry brush, towel).* -The most important component of active therapy is irrigation of all wounds and areas of exposure thoroughly with copious amounts of water. If done in the field, ensure that the patient is kept warm following irrigation to avoid hypothermia.

A 350-pound male patient requires transport from the fourth floor of his apartment building to the ambulance. There is no working elevator, but the staircase is wide and sturdy. Which of the following is the most appropriate first step?

-Call for additional rescuers to assist with the transfer -Any patient who weighs more than 250 lbs (114 kg) should be lifted by no fewer than four providers. Local protocols should include a method to summon additional support to help lift and carry such a patient or to provide and maintain necessary care in the field. These resources should be summoned upon arrival at the scene or assessment of the situation. -Enlisting non-EMS personnel to assist with lifting may put the patient and others in danger, as they may not be properly trained in lifting techniques. -A stair chair may be used for this patient, but not without additional personnel to assist. -A patient may be moved down a flight of stairs on a backboard, not on a stretcher.

Chemical suicides involve mixing common household substances in an enclosed space, resulting in the release of which of the following gases?

-Chemical suicide involves mixing common household substances like detergents and cleaning products in an enclosed space, resulting in the release of hydrogen cyanide* and hydrogen sulfide.* -Carbon monoxide is a result of combustion and would occur in suicides where an engine is left running in an enclosed space. Anhydrous ammonia is found in fertilizers and is used in the illegal manufacturing of methamphetamine.

When administering aspirin to a patient with cardiac chest pain in the field, how would an EMT instruct the patient to ingest the medication?

-Chew the tablet before swallowing it -Aspirin is an antipyretic (fever reducer), analgesic (pain reducer), anti-inflammatory (inflammation reducer), and platelet aggregation inhibitor (prevents clots from forming or growing in size). It is often used after an acute myocardial infarction (AMI) or regularly in cardiac patients to help prevent future AMIs. These patients must be able to chew the tablets prior to swallowing. -Aspirin may cause bleeding and/or stomach ulcers. Contraindications to aspirin include allergy (absolute), preexisting liver damage (absolute), bleeding disorders (relative), and asthma (relative). It also should not be given for pain caused by trauma or for fevers in children. -Aspirin is not to be swallowed whole or taken sublingually (under the tongue) or buccally (between the lips and gums).

Which of the following are indications for CPAP?

-Continuous Positive Airway Pressure (CPAP) is immensely beneficial for patients experiencing respiratory distress from acute pulmonary edema or COPD. General indications for CPAP use include: *an alert patient displaying moderate to severe respiratory distress from underlying pathology such as COPD -respiratory distress after a submersion incident -pulse oximetry below 90% despite supplemental oxygen -rapid breathing that affects minute volume* -These are general indications for CPAP use. Always follow protocols. Hypoventilation would be a contraindication to CPAP use.

An emergency medical technician (EMT) has been exposed to several serious trauma calls recently. They are irritable at home and work, and they cannot sleep well. From which of the following is the EMT most likely suffering?

-Cumulative stress reaction -Cumulative stress reactions manifest in response to prolonged or excessive stress. Symptoms can include fatigue, appetite changes, gastrointestinal problems, changes in sleep patterns, behavioral changes, or an inability to concentrate. Events that trigger incident stress include mass-casualty incidents, a serious injury or traumatic death of a child, crashes with injuries, or serious injury or death of a coworker in the line of duty. -Delayed stress reactions manifest after a stressful event. -Acute stress reactions manifest during a stressful event. -General adaptation syndrome is the three-stage response to stress, consisting of an alarm response, a reaction and resistance stage, and recovery. Exhaustion may substitute for recovery if the stress is prolonged.

Which of the following are forms of distributive shock?

-Distributive shock occurs when there is widespread dilation of blood vessels. The four most common types of distributive shock are septic, neurogenic, anaphylactic, and psychogenic. -Cardiogenic shock occurs when the heart is unable to circulate sufficient blood to maintain adequate oxygen delivery. It is not a form of distributive shock. Obstructive is not a form of distributive shock.

Ventricular tachycardia (VTACH) is a rapid heart rhythm that is life-threatening and requires rapid intervention. Which of the following are signs/symptoms of VTACH?

-During ventricular tachycardia, the heart beats too fast, not allowing adequate time for the ventricles to fill with blood. This results in a loss of blood pressure and inadequate circulating blood volume. -Signs and symptoms of ventricular tachycardia include a heart rate of 150-220 beats/min, lightheadedness or unresponsiveness, chest pain, and a weak or impalpable pulse.

Which of the following are treatments that an EMT could provide for a patient who is in respiratory distress?

-EMTs possess many skills and tools that can be used to treat a patient with respiratory distress. These include providing high flow supplemental oxygen, providing positive pressure ventilation with a bag-mask device, using airway adjuncts such as an oral or nasal airway, providing CPAP, positioning the patient upright, and assisting with respiratory medication prescribed to the patient such as an albuterol inhaler or a small volume nebulizer

Which of the following techniques would be an appropriate way to open a patient's airway if the mechanism of injury is unknown?

-Jaw-thrust maneuver -If the mechanism of injury is unknown, the jaw-thrust maneuver is completed to open the airway. The rescuer kneels above the patient's head with fingers behind the angles of the lower jaw. The jaw is then moved upward with the index and middle fingers, and the thumbs help position the lower jaw. -The head-tilt/chin-lift maneuver is performed to open the airway if no spinal trauma is suspected. The patient is placed in a supine position, and the rescuer is beside the patient's head. The heel of one hand is placed on the patient's forehead, and firm pressure is applied to tilt the patient's head back. The fingertips of the alternate hand are placed under the lower jaw, near the bony part of the chin; the chin is then lifted upward. The forehead is held to maintain the backward tilt.

The 5 major functional areas of the Incident Command System (ICS) include which of these?

-The Incident Command System (ICS) comprises five major functional areas: command, operations, planning, logistics, and finance/administration. -Medical or EMS would be a branch or division under the major function of operations

A 17-year-old male was struck on the side of the head. Police found him unconscious and called for EMS assistance. By the time they arrive, the patient has regained consciousness and states that he is fine. During the primary assessment, there is no obvious bleeding or airway compromise, and his breathing is fine. As EMS proceeds, he becomes obtunded and subsequently loses consciousness. What is the likely cause of this patient's sudden decline?

-Epidural hematoma -Intracranial hemorrhage is the accumulation of blood within the skull, increasing Intracranial Pressure (ICP). Bleeding can occur between the skull and the dura mater (epidural), between the dura mater and the brain (subdural), within the brain tissue (intracerebral), or in the subarachnoid space where the Cerebrospinal Fluid (CSF) circulates. -An epidural hematoma is nearly always the result of a temporal bone fracture from a blow to the side of the head. The middle meningeal artery will commonly bleed from this fracture and result in rapidly progressing symptoms. Patients commonly present with an immediate loss of consciousness followed by a brief period of consciousness (lucid interval) and later, lapse back to unconsciousness. ICP continues to increase, and the pupil on the affected side becomes fixed and dilated. Death is imminent if surgical interventions are not completed rapidly. -A subdural hematoma usually occurs after falls or injuries involving strong deceleration forces. They are more common than epidural hematomas and may or may not be associated with skull fractures. Patients commonly experience fluctuating levels of consciousness and slurred speech. -Hypovolemic shock (due to hemorrhage) is unlikely to occur from a closed head injury. The cranial vault cannot contain a volume of blood large enough to cause hypovolemia. Bleeding into the brain (subdural or subarachnoid) can cause loss of consciousness from direct damage to neurons or from the mass effect of the blood pushing against the brain, with the potential for a cerebral herniation. -A subarachnoid hemorrhage will cause bloody CSF and meningeal irritation (e.g., neck rigidity, headache). Trauma and ruptured aneurysms are common causes.

A trauma patient has sustained a blunt force injury to the costovertebral region. Which of the following would be most indicative of a kidney injury?

-Hematuria -Damage to the kidneys may not be evident on physical examination. Bruises or lacerations on the skin can be evident. If blood loss is significant, signs of shock can occur. Commonly, a kidney injury will involve hematuria (blood in the urine). -Hematemesis (blood in the vomit), melena (blood in the stool), and epistaxis (nosebleeding) are not indicative of kidney damage.

Which of the following are the results of hypoventilation?

-Hypercapnia (also known as hypercarbia) is high carbon dioxide (CO2) and results from ineffective removal of CO2 from the body by the lungs. Hypoventilation is the most common cause, which is a reduction in the respiratory rate and reduces minute volume. Minute volume is a patient's Respiratory Rate (RR) x their Tidal Volume (VT). Atelectasis is the collapse of the alveoli. Loss of surfactant and hypoventilation are common causes of atelectasis. -Hypocarbia (also known as hypocapnia) is caused by an excessive loss of carbon dioxide from hyperventilation.

Which of the following is not a common side effect of nitroglycerin?

-Hypertension -Common side effects of nitroglycerin include hypotension, headaches, and changes in heart rate (tachycardia or bradycardia).

Which of the following statements are false regarding partial airway obstructions in a responsive patient?

-If a possibly choking patient is coughing or can speak, they have a partial airway obstruction. If the patient is unable to speak and is not coughing, they have a complete airway obstruction. (encourage cough) -The abdominal thrust maneuver (Heimlich) is the most effective method of dislodging a complete airway obstruction in a conscious patient. However, do not attempt the Heimlich maneuver on a patient with a partial airway obstruction, as it can cause the object to shift down into the airway. The best treatment is to reassure the patient and encourage them to try to cough forcefully. Allowing the patient to drink something is not recommended.

A 62-year-old male complains of chest discomfort. During the evaluation, he suddenly becomes unconscious, pulseless, and apneic. You have an AED on hand. Which of the following is the appropriate first step?

-Immediately start CPR, place the AED, and analyze when compressions are paused -CPR should be initiated for any patient who does not have a palpable pulse. High-quality CPR and rapid defibrillation are important for survival. However, CPR should not be delayed for a defibrillator to be acquired and attached. -This patient will require assisted ventilation, as he is apneic; however, chest compressions are completed prior to ventilations in CPR.

Which of the following is considered a tertiary blast injury?

-Injuries from being hurled into a stationary object -Mechanisms of a blast injury are divided into five types. -Primary-type injuries are caused by the impact of a supersonic blast wave on the body, preferentially affecting hollow or gas-filled structures. Typical injuries include pulmonary barotrauma (blast lung), tympanic membrane rupture and middle ear damage, abdominal hemorrhage, and intestinal perforation. Eyeball rupture and mild traumatic brain injury (concussion) are also included in this category. -Secondary-type injuries result from the impact of blast debris striking the body, such as penetrating or blunt injuries and eye penetration (evident or occult). -Tertiary-type injuries result from being hurled by the blast onto environmental surfaces or other debris, causing fractures, traumatic amputations, and closed or open brain injury. Quaternary-type injuries do not overlap with primary, secondary, or tertiary blast injuries and result in burns, crush injuries with rhabdomyolysis and compartment syndrome, respiratory tract injury from inhaled toxicants, asthma, angina, or MI (Myocardial Infarction) triggered by the event. Quinary-type injuries result from toxic materials absorbed by the body from the blast. These materials can affect the immune system and autonomic nervous system, leading to an immediate hyperinflammatory state. A fever, diaphoresis, low central venous pressure, and tissue edema are typical of this category.

A 24-year-old male is found semi-conscious after an assault. Minimal external blood loss is noted, his skin is cool and clammy, and his heart rate is fast. Which of the following is the most likely cause of his symptoms?

-Internal bleeding -A high-energy mechanism of injury increases the likelihood of unseen injuries, such as internal bleeding; however, internal bleeding should always be suspected in cases of blunt trauma or penetrating injury. Because there is minimal external bleeding and the patient is exhibiting signs of shock (cool, clammy skin and tachycardia), internal bleeding is likely. -Acute respiratory distress syndrome (ARDS) is characterized by the development of acute dyspnea and hypoxemia within hours to days of an inciting event such as trauma, sepsis, or drug overdose, which is not a likely cause of this patient's hypotension. -While a spinal injury is possible, neurogenic shock (which can be associated with spinal injuries) results in a loss of sympathetic tone, leading to vascular dilation (relative hypovolemia), hypotension, and bradycardia. -There is no indication of head trauma provoking increased intracranial pressure. An increase in intracranial pressure is also associated with bradycardia. -Neurogenic shock is diagnosed with evidence of central nervous system injury and persistent hypotension despite adequate volume resuscitation.

Which chamber of the heart pumps oxygenated blood to the body?

-Left ventricle -The left ventricle pumps oxygenated blood from the heart to the body via the aorta. Deoxygenated blood returns to the right atrium via the superior and inferior vena cava. The deoxygenated blood then flows through the tricuspid valve to the right ventricle. The right ventricle pumps deoxygenated blood to the lungs via the pulmonary artery. -Oxygenated blood returns to the left atrium via the pulmonary vein. Oxygenated blood flows from the left atrium to the left ventricle through the mitral valve.

Which of the following are examples of personal safety precautions an EMT can take to reduce the risk of being harmed by violence against first responders?

-Light makes a good target, so holding a flashlight away from your body while illuminating an object can make your core body less of a target. Approach a vehicle that is on its wheels from behind. As you approach, stop at the B post to look for signs of weapons or other hazards. The front door of a residence can be a point of extreme danger. Always stand to the side of a doorway while knocking or announcing your presence. -Standing in front of windows makes you an easy target while an entry is being made and should be avoided.

Which of the following can be a cause of upper GI bleeding?

-Mallory-Weiss syndrome *is a partial tearing of the esophagus and frequently causes upper GI bleeding. Boerhaave syndrome is a complete rupture of the esophagus* (usually as a result of vomiting) and frequently causes upper GI bleeding. -Cholelithiasis is the presence of stones in the gallbladder and does not cause GI bleeding. Ulcerative colitis is caused by inflammation of the colon and can cause lower GI bleeding. -Hemorrhoids and polyps can be a cause of lower GI bleeding, though rare and present very slow if it occurs.

A 17-year-old male fell from a ladder approximately 30 feet onto concrete. He is semiconscious. After in-line C-spine stabilization is completed, which of the following is most important?

-Manage the airway -The airway of any patient (trauma or medical), along with C-spine stabilization, should always be a top priority in assessment and treatment. This patient will need spinal immobilization and rapid transport due to the significant mechanism of injury (greater than 20 feet). He may require oxygen; however, the airway takes precedence.

Which of the following are medications used in the management or treatment of asthma?

-Many medications are used to manage asthma. EMTs should recognize some of the most commonly prescribed medications used in asthma management. -These include: albuterol beclomethasone fluticasone ipratropium levalbuterol montelukast salmeterol Topiramate is an anti-seizure medication that is used to manage epilepsy. Lasix is a diuretic drug that prevents your body from absorbing too much salt. Digoxin is used to treat heart failure.

Which of the following is the most common cause of brain injury?

-Motor vehicle crashes -Brain injuries can be caused by penetrating objects (e.g., bullets, knives) or external forces on the skull. The most common cause of brain injuries in the US, motor vehicle collisions, accounts for approximately 50% of all traumatic brain injuries (TBIs). The most frequent type of trauma in TBIs from motor vehicle crashes is blunt force trauma. When a passenger hits their head on the windshield in a motor vehicle crash, the brain continues to move forward until it strikes the inside of the skull. This rapid deceleration results in a compression injury (bruising) to the anterior portion of the brain. -"Coup" (pronounced "koo") contusions occur at the area of direct impact to the skull because of the creation of negative pressure when the skull, distorted at the site of impact, returns to its normal shape. -"Contrecoup" (pronounced, "kontra-koo") contusions are similar to coup contusions but are located opposite the site of direct impact. Cavitation in the brain, from negative pressure due to translational acceleration impacts from inertial loading, may cause contrecoup contusions as the skull and dura matter start to accelerate before the brain on initial impact. Alternate reasons for brain injury include other traumatic causes (e.g., blast injuries), blood clots, and hemorrhages.

An adult female patient was involved in a motor vehicle crash with major compartment intrusion. She is conscious but disoriented with a current Glasgow Coma Scale score of nine. She is hypotensive and bradycardic with a thready, irregular carotid pulse. Her abdomen is flat and non-tender on palpation. Her extremities remain warm and dry, and she extends her legs when stimuli are applied. Which of the following types of shock is most likely causing these findings

-Neurogenic shock -Neurogenic shock is due to spinal cord damage. This can be from brain conditions, tumors, pressure on the spinal cord, or spina bifida. In neurogenic shock, the muscles in the walls of the blood vessels are cut off from the sympathetic nervous system and the impulses that cause them to contract. Below the level of the injury, vessels dilate, increasing the size and capacity of the vascular system and causing blood to pool. Some signs and symptoms of neurogenic shock include an absence of sweating below the level of injury, bradycardia, hypotension, and warm skin below the level of injury. -Hypovolemic shock is due to the loss of fluid or blood. A patient with hypovolemic shock will present with a rapid, weak pulse; hypotension; altered mental status; cyanosis; cool, clammy skin; and tachypnea. -Cardiogenic shock commonly causes chest pain, weak pulse, hypotension, cyanosis, rales, pulmonary edema, and cool, clammy skin. -Septic shock is a systemic inflammatory response during a severe infection. Fevers, tachycardia, and hypotension are common.

Which of the following would be the best question to get information about the "S" of the "OPQRST" mnemonic?

-Onset: "What were you doing when the symptoms began?" -Provocation/palliation: "Does anything make the symptoms better or worse?" -Quality: "What does the symptom feel like?" -Region/radiation: "Where do you feel the symptom? Does it move anywhere?" -Severity: "On a scale of zero to ten, how would you rate your symptom?" -Timing: "When did the symptom start? How long as has it been occurring? Has it been constant, or does it come and go?"

Which of the following is the earliest sign/symptom of compensated shock?

-Restlessness -Shock is an acute widespread reduction in effective tissue perfusion, leading to hypoxia. Restlessness, agitation, and anxiety are among the early signs of shock. Compensated shock is a state in which the body can compensate for blood loss. Symptoms of compensated shock include a feeling of impending doom; altered mental status; shallow, rapid breathing; shortness of breath; cool, clammy skin; pallor/cyanosis; nausea and vomiting; and marked thirst. Signs include a weak, rapid, or absent pulse, narrowing pulse pressures, and capillary refill greater than two seconds in infants and children. -Decompensated shock occurs when the body is unable to compensate. Signs and symptoms include falling blood pressure, labored or irregular breathing, thready or absent peripheral pulses, dull eyes and dilated pupils, ashen/mottled/cyanotic skin, and low urinary output.

An unresponsive and apneic 2-month-old has a palpable brachial pulse of 70 beats per minute but is not breathing. After a ventilation attempt, the child's chest does not adequately rise. If repositioning does not open the airway, which of the following actions would be most appropriate?

-Perform one cycle of chest compressions and attempt to visualize the obstruction -If the child has a severe airway obstruction and basic life support (BLS) maneuvers fail to dislodge the foreign body into the mouth (where it can be visualized and removed), and the patient loses consciousness, begin CPR compressions and look for the obstruction before delivering ventilation. If this still fails, use a two-person technique to deliver ventilation. For an unresponsive infant, a thorough scene size-up is important.Look for clues as to why the infant may have become unresponsive and apneic. Note any toxins nearby, high room temperature, or odors. Look for street drugs or any other medications and bring them to the ED. Be alert for signs of abuse.

A 23-year-old patient is found unresponsive at the bottom of a staircase with no obvious signs of trauma. Which of the following is the most appropriate next step?

-Perform the jaw-thrust maneuver while maintaining C-spine control -When determining the mechanism of injury for an unresponsive patient at the bottom of a staircase, you must assume trauma. A C-spine injury is considered present until it is ruled out at the hospital. As part of the ABCs of your primary assessment, check the airway and perform in-line C-spine stabilization. The jaw-thrust maneuver is used when a spinal injury is suspected. It is done by placing the fingers behind the angle of the jaw and lifting the jaw upward. -The head-tilt/chin-lift maneuver is contraindicated for patients with suspected spinal injury. While an oropharyngeal or nasopharyngeal airway adjunct may be indicated, the ABCs of your primary assessment indicate that the airway should be checked prior to breathing or circulation. Waiting for help to arrive to open a patient's airway is not appropriate management.

In an uninjured limb of a pediatric patient, capillary refill time may indicate which of the following?

-Perfusion -Hands-on cardiovascular assessment involves evaluating skin signs. Cool proximal extremities reflect poor perfusion and shunting of blood to the core. Capillary refill time (CRT) in a pediatric patient is determined by pressing firmly on the skin (e.g., thigh). CRT should be under 2-3 seconds in a child who is not cold. CRT indicates perfusion but does not adequately indicate blood return or blood pressure. -Although CRT is a good test of circulation in children, it must be interpreted in the context of overall signs of perfusion.

A 16-year-old football player collided with the goal post. His only complaint is pain on the left side of his chest. Inspection reveals a bruise on the left lateral chest wall. Mildly reduced breath sounds are heard on the left side, but he displays no shortness of breath. Which of the following is most likely?

-Pneumothorax -A pneumothorax occurs when there is an abnormal collection of air in the pleural cavity. There are three classifications of pneumothorax: Primary: No readily apparent cause and a lack of significant underlying lung disease. Secondary: Related to an underlying lung disease such as COPD (Chronic Obstructive Pulmonary Disease) or tuberculosis. Traumatic: Result of a traumatic injury. Based on the information provided, traumatic pneumothorax seems most likely. +Tension pneumothorax results from the progressive increase of air within the pleural space, usually due to a lung laceration which allows air to escape into the pleural space but not to return. The classic signs of tension pneumothorax are a deviation of the trachea away from the side with the tension, an increased percussion note, and a hyper-expanded chest that moves little with respiration. +A flail chest is when three or more ribs are fractured in two or more places. The sternum may also be fractured. The detached portion of the chest wall demonstrates paradoxical motion. Paradoxical motion is a late sign of a flail chest; the absence of paradoxical chest movement does not rule out a flail chest. +A spleen is highly susceptible to injury from blunt trauma. Injury can lead to internal bleeding, left upper quadrant pain, and a distended abdomen.

Positive pressure ventilation forces air into the lungs and is used for ineffective or absent breathing. Which of the following can result from positive pressure ventilation?

-Positive pressure ventilation, which can be delivered by bag-valve device or ventilator, increases intrathoracic pressure. This creates a pressure gradient that the heart must pump blood against, which causes an increase in afterload (pressure which the heart must pump against). -High intrathoracic pressure from positive pressure ventilation can squeeze the heart and vena cava, which will cause a decrease in venous blood returning to the heart (i.e., preload), blood pressure, and cardiac output.

Which of the following are signs/symptoms of preeclampsia?

-Preeclampsia is a condition that occurs in the second half of pregnancy. Signs and symptoms include new-onset hypertension, protein in the urine, swelling of the feet and hands, headaches, blurred vision, and altered mental status. It is life-threatening, and many patients diagnosed with preeclampsia are placed on bed rest to prevent progression to eclampsia. -Seizures indicate that preeclampsia has progressed to eclampsia.

A 50-year-old patient is found semi-conscious. They have a palpable carotid pulse of 120 beats per minute. They are breathing at a rate of 30 breaths per minute; the patient's respirations are shallow. Which of the following is the most appropriate way to provide assisted ventilation initially?

-Provide assisted ventilation at the same rate as the patient's and slowly adjust to a normal rate -Signs of inadequate breathing in an adult patient may include the following: irregular rhythm; noisy, diminished, or absent breath sounds; reduced flow of expired air; unequal or inadequate chest expansion; use of accessory muscles; shallow depth; skin that is pale, cyanotic, cool, or clammy; and retractions. -Assisted ventilation should be given to a conscious or semi-conscious patient initially at the same rate that the patient is breathing; after the initial five to 10 breaths, slowly adjust the rate to mimic a normal respiratory rate and be sure to deliver an appropriate tidal volume. The normal respiratory range is 12-20 breaths per minute for an adult, 15-30 breaths per minute for a child, and 25-50 breaths per minute for an infant.

What are the differences between the SALT and START triage methods?

-SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport) uses five categories, not four (Gray is used in SALT for patients who are alive but not likely to survive with the resources available), and SALT allows for limited interventions such as auto-injector use or tension pneumothorax decompression. -Both SALT and START (Simple Triage and Rapid Treatment) are used for adult patients. The triage method used for pediatric patients is JumpSTART. Both START and SALT methods direct the walking wounded to a treatment/collection area.

A patient has sustained a basilar skull fracture. Which of the following is NOT specific to a basilar skull fracture?

-Seizures -Basilar skull fractures are associated with high-energy trauma to the head (e.g., falls, motor vehicle crashes). A linear fracture can occur at the base of the skull; the diagnosis is made with a CT scan. General signs and symptoms of a head injury can occur (e.g., visible injury, altered mental status, widening pulse pressure, bradycardia, unreactive pupils, amnesia, seizures, numbness/tingling in the extremities, visual complaints, nausea/vomiting, posturing). -**Additionally, specific signs of a basilar skull fracture include cerebrospinal fluid drainage from the ears, raccoon eyes (ecchymosis under the eyes), and the Battle sign (ecchymosis behind one ear over the mastoid process). Depending on the severity of the injury, some specific signs may not appear until up to 24 hours after the injury. Treatment should be focused on supporting ABCs, spinal motion restriction, and rapid transport to a trauma center. -Seizures can occur in all types of head injuries

Which of the following are the signs/symptoms of a shoulder dislocation?

-Shoulder dislocations present with severe pain, a squared-off or flattened shoulder, guarding of the affected limb by holding it away from the torso, a numb patch on the outer aspect of the shoulder, or numbness of the hand (from nerve impairment). -Crepitus in the upper arm would be indicative of a humeral fracture, not a dislocation.

What are the signs of hyperglycemia?

-Signs of hyperglycemia include polyuria, polydipsia, and tachycardia. Patients also develop abdominal pain, deep and rapid breathing (Kussmaul respirations), and warm, dry skin. -Cool, moist skin is a sign of hypoglycemia.

Approximately how much blood is in an average adult's body?

-Six liters -In the calculation of total blood volume, blood represents about 7% of body mass. Gilcher's rule of fives is used for diffusion differences based on body habitus, as adipose and muscle distribute fluid differently. -The US population's average body mass has increased in recent years to ~88.8 kg/195.8 lb (male) and ~76.4 kg/168.4 lb (female). Given these parameters, the average volume is 6.2 L for men and 5.3 L for women. -Hypovolemic shock is the major contributor to early mortality from trauma (and the chief cause of death in those under 45 years of age). A 10% loss of blood volume can generally be well tolerated (resultant tachycardia). A 20-25% loss of volume typically results in a failure of compensatory mechanisms (hypotension, orthostasis, decreased cardiac output), and more than 40% blood loss is associated with overt shock (marked hypotension, decreased cardiac output, and lactic acidemia).

During a high school football game, a 15-year-old male was hit in the chest and abdomen during a hard tackle. Bystanders stated it took him a minute or two to get up, but he seemed fine for the remainder of the quarter. At halftime, the player complained of sharp, left upper quadrant pain in his abdomen that radiated to his left shoulder. Which of the following was the most likely cause of his pain?

-Splenic injury -Left upper quadrant abdominal pain can indicate a splenic injury. Occasionally, this pain radiates to the left shoulder. If the abdomen becomes rigid and/or distended, the spleen may be lacerated. Since the spleen is made of delicate tissue, it is particularly susceptible to injury. The spleen is highly vascular, and its injury may lead to severe internal bleeding. -Right shoulder pain coupled with a rigid, distended abdomen is indicative of a lacerated liver with internal bleeding. -Gallbladder injury generally causes pain in the right upper quadrant of the abdomen, just under the margin of the ribs. -A tension pneumothorax is a buildup of air in the pleural space. Symptoms typically include hypotension, shortness of breath, and tracheal deviation.

An adult patient in cardiac arrest is being transported. Medical direction indicates an analysis and an additional shock via an automated external defibrillator (AED) should be given en route. Which of the following is the correct procedure per medical direction?

-Stop the vehicle, analyze the rhythm, and deliver the shock if indicated -An AED cannot analyze a cardiac rhythm while a vehicle is in motion. It is unsafe to defibrillate a patient in a moving vehicle. Therefore, the vehicle must be stopped before the analysis of the cardiac rhythm and defibrillation. All rescuers must be clear of the patient during an analysis of the cardiac rhythm and defibrillation. CPR should be resumed during AED charging.

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

-Support Closed soft-tissue injuries are treated using methods summarized in the mnemonic **RICES (rest, ice, elevation, splinting). The patient and the injured area should be rested. Ice or a cold pack and compression (pressure over the injury) may help to slow bleeding and reduce swelling. If possible, the injured area should be elevated above the patient's heart and splinted appropriately.

An adult male was hit in the chest by a large steel beam while at work. He is now conscious and alert but struggling to breathe. He has unequal breath sounds and subcutaneous emphysema. Which of the following is the most likely cause of his symptoms?

-Tension pneumothorax -A pneumothorax is a partial or complete accumulation of air in the pleural space. There are three classifications of pneumothorax: Primary: No readily apparent cause and a lack of significant underlying lung disease. Secondary: Related to an underlying lung disease such as COPD (Chronic Obstructive Pulmonary Disease) or tuberculosis. Traumatic: Result of a traumatic injury. Based on the information provided, traumatic pneumothorax seems most likely. -A tension pneumothorax is commonly the result of trauma to the chest, more commonly a closed, blunt injury that causes a fractured rib to lacerate a lung or bronchus. Rarely, tension pneumothorax can be spontaneous. Chest pain, respiratory distress, decreased lung sounds, tachycardia, and signs of shock can develop. -Flail chest is the fracture of three or more ribs in two or more locations. Paradoxical motion, when an area of the chest moves in during inhalation and out during exhalation, is a telltale sign, along with dyspnea and hypoxia are other common signs. Maintenance of the airway and respiratory support are indicated. Pneumothoraces may be the result of a flail chest. -Traumatic asphyxiation results from a sudden, severe compression of the chest, producing a rapid increase in intrathoracic pressure. The common presentation will be that of distended neck veins, cyanosis in the face and neck, and hemorrhage in the sclera of the eye. An underlying injury to the heart and possibly pulmonary contusion are likely to accompany traumatic asphyxiation. Ventilatory support with supplemental oxygen and immediate transport is necessary. -An open pneumothorax is due to an open or penetrating wound to the chest wall. It is also known as a sucking chest wound because a sucking sound can be heard as the patient inhales.

Which of the following are part of the Department of Transportation (DOT) marking system for hazardous materials?

-The DOT marking system is an identification protocol characterized by labels, markings, and placards. -A waybill is carried by the conductor of a train and describes the materials being transported. It can be a useful source of information regarding the material involved in an incident, but it is not part of the DOT marking system.

Which of the following are common complications of providing artificial ventilation with a bag-mask device?

-The bag-mask device is the most common tool used to provide artificial ventilation to a patient who is apneic or has inadequate ventilation. Common complications include:* failure to maintain a good mask seal improper positioning of the patient's head over or under ventilation gastric distention (which can lead to vomiting and aspiration) barotrauma from too much pressure on the airways decreased cardiac output from increased intrathoracic pressure* Hyper-oxygenation results from a sustained, rapid ventilatory rate with high-flow oxygen and is a rare complication of bag-mask ventilation

A nearly full-term pregnant female called for assistance after discovering that her water broke. She is not experiencing contractions. Which of the following is true regarding this scenario?

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

Which of the following is the comparison of vital signs to previous values?

-Trending Trending is the comparison of previous and current vital signs. It is done to determine whether the patient's condition is unchanged, declining, or improving

What is the most appropriate way to clean blood off a stretcher's metal rails and mattress?

-Use a bleach-water solution to wipe the stretcher and mattress -Cleaning is an essential part of the prevention and control of communicable diseases. The ambulance and equipment should be cleaned after each run and on a daily basis. Cleaning is generally done with a bleach and water solution at a 1:10 dilution. Do not use alcohol or aerosol spray. Cleaning should be done quickly but completely to return to service as soon as possible. Ideally, cleaning should be done at the hospital. If cleaning is done at the station, adequate ventilation is a must. Any medical waste should be placed in a red biohazard bag and disposed of at the hospital. Contaminated equipment is placed in a red bag for transport and cleaning at the station. -Since the metal rails and mattress are not porous, they are not considered contaminated and can be cleaned using the solution above.

Which of the following signs/symptoms is not expected in a patient requiring albuterol via a metered-dose inhaler?

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

A two-month-old child is bleeding from the mouth. What is the maximum amount of time that the patient's mouth should be suctioned?

10 seconds

A patient has had skin contact with a poison. For how long should their skin be flooded with water?

15-20 minutes . If the chemical is dry, brush off the remaining chemical, flush with water for 15-20 minutes, and then wash with soap and water. Cases of liquid exposure should be flushed for 15 to 20 minutes. Ensure communication with hazardous materials teams and decontaminate after treating the patient.

Which of the following may cause erroneous pulse oximeter readings?

Bright ambient light may interfere with pulse oximeter function and can create an incorrect reading. Poor perfusion can prevent the pulse oximeter from sensing a pulse and generating a reading. Nail polish interferes with the sensor function and can prevent the pulse oximeter sensor from obtaining an accurate reading.

Which of the following symptoms characterize an allergic reaction?

Allergic reactions can present with a variety of symptoms, depending on the route of exposure. Common ones include: shortness of breath rapid, noisy respirations persistent, dry coughing tightness in the chest or throat red, flushed, warm skin urticaria on large areas of the body tachycardia altered mental status swelling of hands, feet, mouth, or other parts of the body hypotension (late sign)

With which of the following patients should a high-efficiency particle-absorbing (HEPA) respirator such as an N95 mask be used?

A 46-year-old homeless patient with a nonproductive cough of unknown cause High-efficiency particle-absorbing (HEPA) respirators should be worn during any aerosol-generating procedures, such as suctioning of airway secretions, performing CPR, or assisting with endotracheal intubation. HEPA respirators are also used in the presence of conditions spread via droplet transmission (e.g., tuberculosis). Pertussis is contagious and spread by droplets. Standard precautions with eye protection are appropriate for protection against pertussis. A HEPA respirator is not required for a bloodborne pathogen (e.g., HIV/AIDS); standard precautions are adequate with a face shield if blood splattering is possible. Standard precautions with eye protection are appropriate for potential bodily fluid contact.

Which of the following statements are correct regarding EMS helicopter landing zones?

An ideal helicopter landing zone is a level area of grass or hard surface that is 100 feet by 100 feet or larger. The landing zone should be free of debris such as gravel and litter or any materials that may become deadly airborne projectiles due to the helicopter's main rotor wash. The landing zone should also be free of overhead obstacles, such as power lines and trees. Secure the perimeter of the landing zone so that onlookers or vehicles cannot enter the area. All fire and EMS apparatus should be clear of the landing zone with their passenger doors, exterior compartment doors, trunks, hoods, and windows closed. The landing zone should be as close to the accident scene as possible without jeopardizing the safety of the personnel on the ground. There is no 200-foot minimum requirement for location in regard to the scene.

Which of the following are the correct steps for suctioning a patient's airway using a powered, portable suction unit?

Assemble the unit and turn on the power. Clamp the tubing and assure the unit generates a vacuum of more than 300 mmHg. Measure the catheter from the corner of the mouth to the earlobe or angle of the jaw. Turn the patient's head (if no C-spine injury is suspected) to the side, open the mouth, and insert the catheter to the predetermined depth. Apply suction in a circular motion while withdrawing the catheter. Avoid suctioning longer than 10 seconds. Some textbooks may reflect 15 seconds, but the current recommended practice is to limit suctioning in patients of all ages to 10 seconds.

If emergency care is given without consent, which of the following charges may apply?

Battery Battery is the unlawful touching of another person. This includes providing emergency care without consent. This crime may be criminal or civil. For criminal proceedings, proof of intent to harm is generally necessary. Assault is the unlawful placement of a person in fear of immediate bodily harm (e.g., threatening a patient with restraint in order to transport them). Abandonment is the termination of care by EMS without consent and without provision for continuation of care by a competent medical professional. Negligence is the failure to provide the same care that a person with similar training would provide in a similar situation. Emergency care should not be withheld if providing care is reasonable and a form of consent is obtained. Good Samaritan laws protect individuals who provide emergency medical care if the individual acted in good faith by rendering care, acted within their scope of practice, acted without gross negligence, and did not expect compensation.

Which of the following are signs or symptoms of beta-blocker toxicity?

Beta-blocker medications are used to treat conditions such as hypertension. Beta-blockers will interfere with the sympathetic nervous system and result in bradycardia, hypotension, and possibly coma. Hypoglycemia often occurs in beta-blocker toxicity, especially for pediatric patients.

Which of the following is the normal respiratory rate range for an 8-year-old patient at rest?

Correct answer: 12-20 breaths per minute -ages 0 to 12 months: 30 to 60 breaths per minute -ages 1 to 3 years: 24 to 40 breaths per minute -ages 4 to 5 years: 22 to 34 breaths per minute -ages 6 to 12 years: 18 to 30 breaths per minute -ages 13 to 18 years: 12 to 16 breaths per minute -ages 18 and up: 12 to 20 breaths per minute

An adult patient has a diabetic history. Which of the following findings would be expected for a patient suffering from hypoglycemia?

Diaphoresis A normal blood glucose level for an adult patient is between 80 and 120 mg/dL. Hypoglycemia will commonly cause a rapid onset of pale, cool, and moist skin (from sweating); a rapid, weak pulse; potential hypotension; shallow or ineffective breathing; and altered mental status if the blood glucose volume is too low. Oral glucose is the primary prehospital treatment for suspected hypoglycemia

Energy that is emitted from a radiological source can be categorized as which of the following?

Energy that is emitted from a radiological source can be categorized as alpha, beta, gamma (X-rays), or neutron radiation. Delta is not a form of energy emitted from a radiological source.

Which of the following is the most appropriate response to a patient who does not speak English?

Have a relative or friend translate If a patient does not speak English, a family member, friend, or smartphone application/website may be used for translation. Requesting a translator to respond to the scene may cause a delay in patient care and extended scene time. Using symbols or a translator app on your phone may help facilitate communication, but using a family member who speaks the patient's language is the most appropriate.

Which of the following are signs/symptoms of classic heat stroke?

Heatstroke signs and symptoms include: core body temperature of 104 °F (40 °C) or higher altered mental state or behavior alteration in sweating nausea and vomiting flushed skin tachypnea tachycardia headache

The Department of Transportation's (DOT) North American Emergency Response Guidebook (ERG) classifies Hazardous Materials into nine different groups. Identify the classes below that are matched correctly with the chemical family.

Here are the nine DOT classes of chemical waste recognized in the ERG: DOT Class 1: Explosives DOT Class 2: Gases DOT Class 3: Flammable/combustible liquids DOT Class 4: Flammable solids that are dangerous when wet or water-reactive DOT Class 5: Oxidizers and organic peroxides DOT Class 6: Toxic substances and infectious substances DOT Class 7: Radioactive DOT Class 8: Corrosive substances DOT Class 9: Miscellaneous hazards

indication of increased work of breathing in a pediatric patient?

Increased work of breathing in a pediatric patient can involve abnormal airway noises (grunting or wheezing), accessory muscle use, retractions, head bobbing, nasal flaring, tachypnea, or the tripod position

Which of the following are possible causes of tachycardia in an adult patient?

Tachycardia is a rapid beating of the heart at 100 beats per minute or higher. Some common causes of tachycardia in an adult patient include: hypoxia anxiety pain heart disease stimulant medications or stimulant use

Which of the following is a sign of increased intracranial pressure?

Non-reactive pupils An increase in intracranial pressure (ICP) is due to the accumulation of blood or swelling of the brain within the skull from trauma or a stroke. To perfuse the brain, arterial pressure (i.e., mean arterial pressure) must be greater than intracranial pressure. The Cushing reflex is a physiological response of the CNS to maintain perfusion, resulting in a triad of increased mean arterial blood pressure, irregular breathing, and bradycardia. This is an ominous sign of acute head injury that may indicate imminent brain herniation. Other signs of increased intracranial pressure are a headache, altered mental status (lethargy, obtundation, nonreactive pupils), decerebrate posturing, bradycardia, nausea, vomiting, and changes in respiration (Cheyne-Stokes, ataxic rhythms).

Which of the following patient behaviors suggests hypothermia?

Patients with hypothermia will often present with an altered mental status and seem withdrawn, confused, lethargic, or sleepy. Other signs and symptoms include tachypnea in early hypothermia, as well as bradycardia, bradypnea, a weak pulse, and unresponsiveness in later or more severe hypothermia. Rapid speech, extreme thirst, and headaches are not associated with hypothermia.

A 15-year-old female has profuse non-traumatic vaginal bleeding. Which of the following is the most appropriate method to control this patient's bleeding?

Place a sanitary pad on the external genitalia Vaginal bleeding can have many causes. If external injuries are present, treat the bleeding with local pressure and a diaper-type bandage to hold dressings in place. If the bleeding is non-traumatic, place a sanitary pad to absorb the blood. If any foreign bodies are present, stabilize them with bandages.

What are some complications of CPAP administration?

Some patients may find CPAP (Continuous Positive Airway Pressure Therapy) claustrophobic and will not tolerate the mask, complicating the ventilation process. Do not force the application for these patients; instead, choose another treatment. The pressure of CPAP is generally helpful but can lead to gastric distention. Although rare, CPAP may also increase intrathoracic pressure, which reduces preload available to the heart, resulting in hypotension. It is important to monitor blood pressure closely in patients who are receiving CPAP.

Which of the following represents the categories of blast injuries?

Primary injuries result from the impact of the blast wave. Secondary injuries result from two sources: fragmentation and shrapnel. Tertiary injuries result from the objects the patient is thrown into by the blast wave. Quaternary injuries result from the inhalation of superheated gasses from the detonation. Quinary injuries result from long-term damage from biological or radiological materials involved in a blast.

What factors should be assessed splinting?

Pulse, motor function, and sensation Any extremity that requires splinting (e.g., painful, swollen, deformed) requires an assessment of cardiovascular and neurological function before and after the application of a splint via distal pulses and motor and sensory functioning, respectively.

What is the major artery in the forearm?

Radial artery -The radial artery is the major artery in the forearm; it is palpable on the thumb side of the wrist. -The ulnar artery is located on the opposite side of the forearm from the radial artery. -The brachial artery is the major artery that supplies blood to the arm; it is located above the elbow. The brachial artery divides at the elbow into the radial and ulnar arteries.

Which of the following is the correct procedure for initiating high-flow oxygen therapy via a non-rebreather mask?

Select the correct mask size. Turn on the oxygen source. Adjust the flow of oxygen to 10 to 15 liters per minute. Ensure the reservoir bag is inflated by placing a finger over the bag outlet. Place the mask over the patient's face and adjust accordingly. -A properly fitting mask is extremely important, particularly in the pediatric population. The oxygen should be turned on, and the flow should be adjusted to 10 to 15 liters per minute. The reservoir bag should be inflated prior to placing the mask on the patient's face; this can be accomplished by placing a gloved finger over the reservoir bag outlet. Much like selecting an appropriately sized mask, fitting the mask to the patient after placement is important for adequate flow.

Which of the following are the signs of hypothermia? Select the 3 answer options which are correct.

Signs and symptoms of hypothermia include: core body temperature below 95 °F (35 °C) shivering that has stopped slurred speech or mumbling slow, shallow breathing a weak pulse clumsiness or lack of coordination drowsiness or very low energy confusion or memory loss loss of consciousness

Which of the following is correct regarding the difference between Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)?

The biggest differences between HHNS and DKA are blood glucose levels (higher in HHNS) and the presence of ketones (absent in HHNS). Changes in levels of consciousness occur in both DKA and HHS; if not corrected, both will lead to a comatose state. The pulse increases significantly in both DKA and HHNS, leading to tachycardia

Which of the following would be established by the first units that arrive at a mass-casualty incident (MCI)?

The first units to arrive at an MCI will need to establish an incident commander, begin triage, and establish treatment areas for the wounded. As mutual aid and more units arrive, staging and transportation groups with respective leaders will be established.f

You are an EMT assisting a paramedic with endotracheal intubation. The paramedic asks you to position the patient's head. Which of the following positions would not be beneficial for attempting endotracheal intubation in an adult patient?

The sniffing position is the most effective position for attempting intubation in an adult. It allows alignment of the three axes needed to visualize the airway.

When a patient is placed on a long backboard, which of the following areas is secured first?

Upper torso A long backboard can be used to provide spinal motion restriction for a supine patient. In-line stabilization is maintained, and extremity pulse, motor, and sensory functions are assessed throughout. A cervical collar should be applied prior to spinal motion restriction on a long backboard. The upper torso is the first area to be secured. Consider placing padding between the patient and the backboard to make transport more comfortable. Once the upper torso is secure, the pelvis and upper legs are secured. Finally, the head is secured. Cardiovascular and neurological functions are assessed after each step and periodically during transport. Follow local protocols regarding equipment to be used and indications for spinal motion restriction.