Practice Test 1

A 22 year old female is having an asthma attack. She is 31 weeks pregnant. Which one of the following reasons explains why asthma might affect this patient more profoundly than a nonpregnant patient?

Pregnancy causes an increased blood volume Pregnancy increases the consumption of oxygen EXPLANATION A pregnant female uses oxygen at a faster rate than a nonpregnant female. An asthma attack and its subsequent decrease in minute volume could impact this patient more severely. Increased blood volume and cardiovascular pressure are changes that occur with pregnancy but have only a limited effect on the respiratory system. Gastric motility refers to digestion and also would have little effect on asthma. Pregnancy creates high pressures in the cardiovascular system Pregnancy causes slowed gastric motility

You are called to a school for an 8 year old with a nosebleed, which the school nurse is having trouble controlling. When packaging the patient for transport, what is the most appropriate way to position him?

Prone with the head turned to side Sitting up and leaning back Prone and flexed forward Sitting up and leaning forward EXPLANATION Sitting the patient up and leaning forward allows gravity to assist with slowing bleeding and drainage. By sitting forward the blood will not run back into the throat to cause either a potential obstruction or vomiting.

***Early signs of hypoperfusion in a pregnant female patient may be lost due the physiological changes caused by pregnancy. Which of the following vital signs is one such example of this?

Pulse oximetry Blood pressure EXPLANATION The amount of blood volume in a pregnant female increases by approximately 45%. Thus, in a shock state, a significant amount of blood may be lost before there is a reflection of this in the patient's vital signs. The heart rate can still increase as does the respiratory rate as a result of sympathetic discharge, and the pulse ox will maintain until peripheral perfusion pressure starts to diminish. Heart rate Respiratory rate

***While ventilating a patient with a bag-valve mask, you squeeze the bag in order to ventilate the patient. Now that the lungs have been filled, by what process does the air (oxygen) leave the lungs before the next ventilation is provided?

Reactive Active Contraction Passive EXPLANATION The process by which air leaves the lungs is considered passive because the patient does not assist. That is one of the reasons why there is a pause between breaths during artificial ventilation. The time between ventilations allows the air (oxygen) to leave the lungs.

***As you enter an apartment, you observe an alert but anxious woman in her 50s sitting in a chair working to breathe. You see accessory muscle use, shallow respirations, and pale skin. How would you classify this patient's respiratory status?

Respiratory failure Respiratory distress EXPLANATION Respiratory distress is increased work of breathing with shallow respirations, use of accessory muscles, and pale or cyanotic skin. The patient meets these criteria. Her alert mental status is an indication of this. With respiratory failure, respirations are inadequate to support life and will usually lead to respiratory arrest if untreated. Respiratory acidosis isn't easily determined in the field and is not appropriate here. Respiratory compromise is not a specific medical term. Respiratory compromise Respiratory acidosis

A 4 year old sustained an accidental impact to the chest and is conscious with some respiratory distress. While performing the physical assessment, you observe bruising on the chest. When palpating the chest bilaterally, no deformity is felt. Auscultation identifies diminished sound on one side. Based on the information from the assessment, which one of the following is most likely to have occurred?

Ruptured aorta Fractured ribs Abdominal bleeding Hemothorax EXPLANATION Based on the assessment, hemothorax seems most likely. The ribs of the very young are elastic and can bend with trauma, doing damage to underlying organs, as in this case (the lungs). Symmetry of the chest wall indicates that the ribs probably did not fracture. Diminished lung sounds mean something is affecting breathing on that one side. Bruising is seen only on the chest, which most likely rules out an abdominal injury. If the aorta had been ruptured, the patient would be unconscious.

***WRONG You are en route to a motor vehicle crash where you will back up an EMS unit already on scene. They advise you by radio that you will be picking up an unresponsive female patient with a head injury. They add that she is currently breathing spontaneously at 34/minute, pulses are present, all active bleeding has been managed, and the vitals are stable. Given this, what vital aspect of the primary survey did they not advise you of?

SAMPLE history and OPQRST findings Airway patency EXPLANATION Given the findings presented through the radio transmission, one missing aspect of the primary survey is the determination of airway patency. Although the patient's weight and ethnicity are often determined during the general assessment step of the primary, rarely will that information make a critical difference in the management of an unstable patient. Finally, an actual heart rate is less important to know during the primary - rather, just an estimation of the heart rate in general (too fast, normal, too slow, or absent) is sufficient to start treatment. Patient's weight and ethnicity Actual heart rate (WRONG)

A 66 year old male patient with a stoma is found in respiratory arrest. Which one of the following would be the most appropriate method for delivering positive pressure ventilations to this patient?

Seal the stoma and ventilate, using a traditional face mask. Use a pediatric mask to ventilate the stoma directly. EXPLANATION To deliver positive pressure ventilations to a patient with a stoma, a pediatric mask should be used to form a seal directly over the stoma. If this method is unsuccessful, then a traditional mask can be used to ventilate through the mouth. If this method is utilized, the stoma must be sealed. A traditional face mask would be very difficult to seal directly over the stoma. Use a traditional face mask to ventilate the stoma directly. Use a traditional face mask to ventilate, leaving the stoma open.

During the management of a patient with respiratory distress, you elect to assist in the administration of a metered dose inhaler (MDI). This drug causes smooth muscle relaxation at what level of the patient's respiratory tree?

Segmental bronchi Bronchioles EXPLANATION The respiratory tree is supported proximally with cartilaginous rings that progressively give way to cartilaginous plates, and eventually smooth muscle that encircles the conducting airways. The trachea, bronchi, and segmental bronchi are all supported by cartilage. The bronchioles, however, are supported by smooth muscle and this is the site where the MDI causes relaxation and allows better airflow to the alveoli. Alveoli Bronchi

You have been dispatched to a local college dormitory for an unresponsive male. Bystanders on scene state he was drinking alcohol heavily, passed out and fell to the floor. As you approach the patient you see large amounts of vomitus on his face and around his head. What clinical finding would you observe if you suspect the patient is aspirating the vomitus?

Sonorous airway sounds while attempting to breathe No breath sounds Stridorous airway sounds during inhalation Gurgling airway sounds with each breath EXPLANATION Whenever there is any kind of fluid (blood, vomit, heavy secretions, etc) in the airway of the spontaneously breathing patient, it will create a gurgling sound as the breaths try to pass by the obstruction. Not only will this lead to inadequate breathing, but it can also lead to aspiration of the vomitus which is very damaging to lung tissue. No breath sounds would be consistent with apnea. Stridorous sounds are due to severe blockage of the airway at the level of the vocal cords. Finally, sonorous sounds are consistent with the tongue that has fallen into the posterior pharynx and is blocking the airway.

A 43 year old male patient has been shot in the abdomen during a bar fight. Upon your arrival, he appears alert and oriented. You observe a small puncture wound to the LUQ with minimal bleeding and no exit wound. The airway is patent, breathing is rapid but adequate, the peripheral perfusion is intact with good radial pulses. Vitals are P 110, R 26/min, BP 122/86. Given these findings, how would you categorize his physiological status?

Stable Unstable Potentially unstable Stable, but potentially unstable EXPLANATION This patient would be categorized as "stable, but potentially unstable". Although he has no acute change in his mental status, nor disturbance in the airway, breathing, or circulatory components resulting in lost function, he does have an injury which may cause deterioration (hence he is not "stable"). Since it is virtually impossible to tell the course of the bullet, there may be additional internal injuries that are deteriorating the body's hemodynamic status that the compensatory mechanisms of the body are covering up. As such, this patient should be carefully but rapidly treated and transported to a Level I trauma center if possible. An unstable patient is one that has an acute loss of function in the airway, breathing, circulation, and/or mental status.

A 32 year old male has been stabbed in the upper right quadrant of his abdomen. The knife used was seven inches long. What is the organ most likely damaged by this wound?

Stomach Bladder Spleen Liver EXPLANATION The liver is found primarily within the boundaries of the upper right quadrant. The stomach and spleen are typically found in the upper left quadrant. The bladder is found on the midline between the lower two quadrants.

You are caring for a geriatric patient who is bedridden from a prior stroke and is being cared for by her family. Upon assessment, you note that she has bed sores, dirty underclothes, and the bed smells of dried urine. Upon your arrival at the hospital, what should you report?

The findings that are suggestive of abuse EXPLANATION The EMT will see all types of patients in all types of situations, and you'll see society at its best and its worst. Given this, there are times when you may have findings suggestive of abuse or neglect, whether it is purposeful or not. This patient, with bed sores, dirty clothing, and urine smells could probably be cared for better, but since the EMT does not know the whole story, the best thing to do is report those findings that are suggestive of potential abuse without actually saying or accusing anyone of the abuse. You personally witnessed abuse The patient is abused Just the normal assessment findings

Which one of the following best describes the pathophysiology of pericardial tamponade?

The sac surrounding the heart is ruptured, allowing the release of lubricating fluid. The sac surrounding the heart fills with blood and limits the heart's ability to fill. EXPLANATION Pericardial tamponade is caused by pressure building within the pericardial sac. This pressure squeezes the heart and prevents filling. Without filling, cardiac output drops. Bruising of the heart is called cardiac contusion. Contusions can be caused by compression-related injuries. The heart is bruised, causing swelling of myocardial tissue. The heart is compressed between the sternum and the spine leading to blunt-trauma injuries.

A 31 year old male jumped from a fourth-floor window and landed feet first onto the pavement below. Based on this mechanism of injury, you should suspect which one of the following areas to sustain the most damage?

Thoracic spine Lumbar spine EXPLANATION The lumbar spine bears the weight of the body. Feet-first impact often causes blow-out fractures of this area of the spine. Injuries are possible in all the areas listed, but most probable in the lumbar region. Cervical spine Sacral spine

You are departing the scene of a two-car MVC from which you are transporting a critical trauma patient. Your partner is in the back and you are going to drive the ambulance to the hospital. As you conceptualize the route you wish to take to the hospital, which of the factors below is LEAST important to the actual route you'll take?

Traffic patterns Freeway versus city road EXPLANATION One of the largest considerations when choosing a route to take is the anticipated travel time. The route must be safe, but it must also be expedient. The road surface is important because excessive bumps and potholes can disrupt care occurring in the rear of the ambulance. Traffic patterns must be considered as they can contribute to time delays and pose an increased risk of accidents. Whether or not the road chosen is a freeway or city road is irrelevant so long as the first three considerations are taken. Travel time Road surface

During a large-scale incident in your community where multiple people are injured, you have been designated by the Incident Commander to serve the role of EMS Branch Director. As you establish the units under your direction, which one will be responsible for organizing the positioning and flow of ground and air ambulances to and from the scene?

Treatment Unit Leader Triage Unit Leader Staging Unit Leader EXPLANATION The Staging Unit Leader is responsible for maintaining ambulances, helicopters, and other equipment until they are needed for a specific task. The Transport Unit Leader is the individual that arranges who is going aboard the ground or air vehicle for transport to a medical facility. The Triage Unit Leader performs the sorting of patients based on criticality, and the Treatment Unit Leader oversees on-scene treatment based upon patient criticality. Transport Unit Leader

A 45 year old female is complaining of trouble breathing. The patient is sitting in a tripod position, has nasal flaring, rapid breathing, accessory muscle use, and diminished alveolar breath sounds. Of these findings, which one is more indicative of difficulty breathing rather than heightened respiratory efforts due to the pulmonary problem?

Tripod positioning Nasal flaring Accessory muscle use Diminished alveolar sounds EXPLANATION Many of the findings consistent with dyspnea (troubled breathing) are actually changes due to the body working harder to breathe - not findings tied directly to one disturbance or another. Of the findings described, the only one that is truly representative of labored ventilations is the diminished alveolar breath sounds. The other findings are representative of the body working harder to breathe.

Injury to which of the following skeletal structures carries with it the highest likelihood of fatal complications?

Ulna Tibia Femur EXPLANATION Generally speaking, broken bones do not result in death. However, it is the associated damage which can be life-threatening. For example, fracture of the femur can result in significant bleeding should the femoral artery also be lacerated. In addition, large bones may hemorrhage from the medullary canal at the center of the bone. Given this, the femur carries with it the greatest complication for hemorrhage and possible death due to bleeding. Humerus

An insulin-dependent diabetic has completed a large meal and afterward reports that he is not feeling well. For the past few hours, he has been extremely thirsty with frequent urination. You notice that he is breathing rapidly and has breath that smells like acetone. During the SAMPLE history, he tells you that he has taken his insulin regularly. What is this patient's most likely underlying problem?

Urinary tract infection Hyperglycemia EXPLANATION The patient is an insulin-dependent diabetic who ate a large meal a few hours ago. He may not have taken enough insulin to compensate for the large meal. He is now showing signs of hyperglycemia-frequent urination and extreme thirst. Besides these symptoms, he has rapid breathing and acetone breath, which are consistent with hyperglycemia. If a blood glucose is obtained, expect the number to be high. MI and UTI are not reasonable choices given the symptoms. Myocardial infarction Hypoglycemia

***A patient has suffered significant blunt trauma to the chest, resulting in multiple rib fractures and a flail segment. Beyond the impaired ventilation due to thoracic instability, what is a common secondary injury seen with blunt thoracic trauma that can severely hamper normal respiratory efficiency?

Ventricular rupture Diaphragmatic hernia Pulmonary contusion EXPLANATION With blunt trauma to the chest, there may be fractured ribs causing a flail segment. In addition, this mechanism of injury can also cause bruising to the lung tissue (known as a pulmonary contusion), which causes edema within the lung tissue and severely hampers adequate gas transfer. Ventricular rupture is more often from an MI, not as much from blunt trauma. Diaphragmatic hernia occurs with blunt abdominal trauma. The thoracic vertebrae are actually rarely injured due to the stability provided by articulations with the ribs. Thoracic vertebral injury

A 58-year-old male was found confused and stumbling by his family. Which one of the following questions would be most important to ask as part of obtaining the patient's history?

When did the patient last eat? Does the patient have any past medical problems? EXPLANATION With this patient, you will need to determine the cause of the altered mental status. Past medical history can shed immediate light on the current condition. Medications and the last meal may also be important but would be secondary to medical problems that may relate to the current condition. Allergies may be causing the problem, but this question would only be immediately relevant if signs of anaphylaxis were present. Does the patient have any allergies? Does the patient take any medication?

A 17 year old was slashed in the abdomen during a knife fight. When you arrive, you observe that part of the patient's large intestine is eviscerated. Which one of the following is the most appropriate way to care for the protruding intestine?

Wrap the protruding section with dry sterile gauze dressing. Flush the wound with saline and then cover it with an occlusive dressing. Apply a moistened dressing and then an occlusive covering. EXPLANATION A protruding section of intestine should be covered with a sterile dressing moistened with sterile saline, and then it should be covered with an occlusive dressing. The protruding intestine should finally be covered with a bulky dressing to keep that section of the intestine warm. The intestine should not be touched or placed back into the abdominal cavity. Replace the protruding intestine in the abdomen.

A 25 year old male has been involved in a serious motor vehicle crash. During your rapid trauma assessment, you note crepitus when evaluating the pelvis. This finding indicates

a dislocation of the femur. a fracture of the pelvis. EXPLANATION Crepitus is the sound and feeling of broken bone ends rubbing together. Feeling this is a finding that indicates a fracture. A dislocation is typically indicated by deformity of the joint. Ecchymosis is bruising. A hematoma is bleeding under the skin. bruising of the skin. bleeding under the skin.

You are called to evaluate a 2 year old female who has fallen. On your appearance, the child begins to cry and refuses to speak to you. This behavior is

a sign of a potential brain injury. expected in a 2 year old and most likely indicates a normal mental status. EXPLANATION Stranger anxiety should be expected in a 2 year old. It is reasonable for her to cry and refuse to speak. You cannot rule out altered mental status, shock, or brain injury, but this behavior is not unexpected. Consult with the parent for an accurate assessment of mental status. a potential sign of shock. unusual for a 2 year old and may indicate altered mental status.

A 44 year old male tells you he is suicidal and plans to hang himself with the rope next to his bed. He does not wish to be transported to the hospital. You should

allow the patient to refuse care. speak to the patient calmly about why he is suicidal. await law enforcement and transport this patient against his will. EXPLANATION Suicidal patients can be dangerous to EMTs. In this case, it is best to await law enforcement assistance. Although a suicidal patient cannot refuse care, it would be better to involve the police than attempt to restrain the patient alone. Most states give the authority to order transport of patients against their will to the police. Speaking calmly is important, but transport is necessary. attempt to restrain this patient and transport him to the hospital.

Your partner tells you that after years of working as an EMT, he has begun to have nightmares. You also notice that he is quite irritable. These findings most likely indicate

an acute stress reaction. nothing, because this is normal for an experienced EMT. a cumulative stress reaction. EXPLANATION Nightmares and irritability indicate a cumulative stress reaction. An acute stress reaction would occur immediately after a major incident or stressor. Those signs are not normal for any EMT and must be recognized as an ongoing threat to wellbeing. Home life stress can certainly contribute but is not the most likely cause under the circumstances. an additional stressor in this EMT's home life.

A 69 year old female patient complains of difficulty speaking and an inability to move her right arm. She notes the symptoms came on about two hours ago but have since subsided. She is most likely suffering from

an acute stroke. a syncopal episode. a transient ischemic event. EXPLANATION The fact that the symptoms went away indicates that this is a TIA. If the signs and symptoms had continued, you would consider stroke. Both syncope and seizures can present with similar neurologic signs, but since the patient's symptoms persisted for two hours, syncope and seizures are unlikely. a seizure.

A 77 year old female resident of a nursing home complains of difficulty breathing. She has a history of mild dementia. The most appropriate way to evaluate the mental status of this patient would be to

ask her what day of the week it is. ask her who the president of the United States is. ask staff members what her baseline mental status is. EXPLANATION Determining the mental status of a dementia patient can be challenging. The best method would be to ask staff members what the patient's baseline mental status is. Often they are able to describe how the patient normally acts and how the behavior now compares to normal. Nursing home patients often have difficulty remembering the day of the week. A dementia patient may not know who the president is, even with normal mental status. perform a Cincinnati prehospital stroke examination.

A 74 year old COPD patient complains of difficulty breathing. She has an increased respiratory rate and you note cyanosis around her lips. After ensuring an open airway and adequate breathing, you should

assess her radial pulse. conduct a focused assessment of her chest. administer high concentration oxygen via non-rebreather mask. EXPLANATION The chief complaint and the findings of tachypnea and cyanosis indicate the need for high-concentration oxygen. It is important to immediately treat problems found in the primary assessment, so continuing on to assess the pulse, obtain a Glasgow Coma Score, or conduct a focused assessment prior to administering oxygen would be incorrect. assess her mental status using the Glascow Coma Score.

A 16 year old male has been struck by a car. He is confused and complains of abdominal pain. His vital signs are P 120, R 30, BP 100/72. A detailed assessment should be completed on this patient

before administering high-flow oxygen. only after transport has been initiated. EXPLANATION A secondary (detailed) assessment is important, but should not stand in the way of completing the primary assessment or initiating rapid transport. In this case, the detailed assessment should be completed en route to the hospital even if there are no other obvious injuries. High-flow oxygen would be a treatment identified as part of the primary assessment. only if there are obvious additional injuries. immediately following the primary assessment.

A 55 year old female complains of acute onset palpitations and chest pain. She is alert but pale and diaphoretic. Her vitals are P 220, R 28, BP 88/60. These findings most likely indicate

cardiogenic shock secondary to a cardiac dysrhythmia. EXPLANATION A heart rate of 220 most likely indicates a tachycardic dysrhythmia. It is possible for her to have hypovolemia, but the acute onset of symptoms and the lack of a likely cause make it improbable. Septic shock typically has a long, gradual onset. Anaphylaxis occurs suddenly, but usually is related to allergy-like symptoms. septic shock due to an infection. hypovolemic shock due to unknown internal bleeding. anaphylaxis due to an allergic reaction.

A 68 year old female complains of abdominal pain and vertigo. She notes a three-day history of dark, black stools. She is pale, slightly diaphoretic, and her vital signs are P 118, R 20, and BP 88/64. Those findings indicate

compensated shock caused by a bowel obstruction. diarrhea caused by food poisoning. pain caused by a GI infection. hypotensive shock caused by a GI bleed. EXPLANATION The low blood pressure indicates hypotensive shock. The history of black stool indicates a GI bleed. There would be little or no bowel movement with a bowel obstruction and although food poisoning and GI infection are possibilities, they are less relevant than the hypotensive shock.

***A 21 year old female states that she has taken 25 Librium capsules approximately 30 minutes ago. After completing a primary assessment and initiating transport, you should next

complete a detailed assessment. administer activated charcoal. contact poison control. EXPLANATION Poison control is a wealth of knowledge pertaining to toxicology. Contacting them early can help focus your treatment and provide critical information to the entire healthcare team. Inducing vomiting is an uncommon treatment. Activated charcoal may be appropriate later, but would likely be directed by poison control. A detailed assessment would be important, but only after making contact with poison control. induce vomiting.

A 32 year old male presents with an altered mental status. He is babbling and speaking incoherently. His family states he has a history of psychiatric problems. After ensuring scene safety, you should next

contact the patient's psychiatrist to obtain more information on this patient's particular problem. request law enforcement transport because this is a psychiatric issue only. explain to the family that there is nothing you can do for a purely psychiatric problem. complete a primary and secondary assessment to rule out medical causes of altered mental status. EXPLANATION Altered mental status can be the hallmark of a variety of serious medical conditions. You should never assume it to be resulting from only a psychiatric cause. Always rule out medical causes first. Psychiatric emergencies should be treated like any other emergency. Although your treatment may be limited, these patients deserve the care you would give to any other serious disorder. This is not just a law enforcement issue.

***WRONG A 15 year old male has been stabbed in the abdomen. As you examine his abdomen, you see a small loop of intestine protruding from the wound. After completing your patient assessment, you should next

cover the exposed intestine with moistened sterile dressing. (WRONG) initiate rapid transport. EXPLANATION Although an abdominal evisceration is a dramatic injury, you should not lose sight that this is a serious mechanism of injury and typically implies more significant internal injuries. As such, you should immediately initiate rapid transport. On the way to the hospital, the wound should be covered with moistened sterile dressings and then with an occlusive dressing. Remember that the main goal of trauma care must be to bring the patient to the operating room as soon as possible. push the intestine back into the wound. apply an occlusive dressing over the wound.

A 7 year old female complains of difficulty swallowing and chills. You notice the child is sitting bolt upright and will not tolerate leaning back. You also note drooling. These findings most likely indicate

croup. bronchiolitis. asthma. epiglottitis. EXPLANATION Difficulty swallowing, drooling, and a bolt upright position indicate epiglottitis. Croup typically presents with a barking cough. Asthma and bronchiolitis are commonly present with lower airway symptoms such as wheezing.

You are dispatched for a patient who has been assaulted. On arrival, you note a crowd gathered around two men fighting. One of the men has blood on his shirt. You should

enter the crowd and attempt to stop the fight. return to the ambulance and leave the scene immediately. ask bystanders to help separate the combatants. stage a safe distance away and await law enforcement. EXPLANATION Your scene size-up reveals a potentially unstable and dangerous scene. Law enforcement is needed. You should stay a safe distance away until police arrive. You should identify the danger before arriving at the scene so you shouldn't be there on foot at all (and therefore not have to leave). Entering the scene or engaging with bystanders is a dangerous option.

You respond to a serious motor vehicle crash where it is apparent that a young woman has been killed. Her family arrives on scene. When speaking with them, you should tell them

everything will be okay. crews are doing everything they can. their daughter has died. EXPLANATION Being honest is an important element of approaching a death and dying scenario. Clearly in this case everything will not be okay, and there is really nothing more the crews can do. Although you may know how they feel, often we have no idea what the family is going through and it is best to avoid statements to that effect. you know how they feel.

***A 19 year old patient has a traumatic brain injury and is unconscious. When laid supine, the patient stops breathing. This apnea is most likely caused by

foreign bodies present in the airway. swelling in the airway. poor airway muscle control. EXPLANATION The most common cause of airway obstruction is poor muscle control. This situation should be suspected in any patient with an altered mental status. Foreign bodies, secretions, and edema can obstruct an airway, but typically would not be limited to the supine position. secretions building up in the airway.

You are caring for an elderly female patient who has not been acting normally for the past few hours. The family reports she has been acting confused, forgetful, and she has trouble walking. Her medical history includes hypertension and thyroid problems. Vitals are P 86, R 18, and BP 168/78. The most likely medical problem to explain this presentation is

heart attack. stroke. EXPLANATION The patient most likely suffered a stroke. A heart attack would present with chest discomfort or respiratory distress and more cardiovascular findings rather than neurological. A hypertensive crisis can explain some of the findings, but not the fact the vitals are essentially unremarkable for an elderly patient. Finally, diabetic ketoacidosis has a more gradual onset and typically the blood pressure will start to drop. diabetic ketoacidosis. hypertensive crisis.

A 48 year old female was recently prescribed an antibiotic. Upon taking her first pill, she noted watery eyes, itching, and now complains of shortness of breath. She is alert, her skin is flushed, and you hear wheezes bilaterally. Her vital signs are P 110, R 30, and BP 112/74. You should first

identify the type of pill she took. arrange for ALS to meet you en route to the hospital. EXPLANATION Respiratory signs indicate anaphylaxis. Transport should be initiated immediately. ALS should be contacted because they can administer medications to counteract the anaphylactic reaction. Identifying the pill might be important, but not at the risk of delaying transport. A detailed assessment is appropriate but should be completed en route. Poison control could be helpful, but should not delay transport. contact poison control for further instructions. conduct a detailed assessment.

A 21 year old male has been involved in a serious motor vehicle crash. You begin your primary assessment in the vehicle as rescue crews prepare for mechanical extrication. After checking airway and breathing, you find spurting blood coming from a laceration on his leg. Your jump kit is outside the car. You should

immediately apply the tourniquet you carry in your pocket. wait for a crew member to bring you a sterile dressing. wait for the patient to be extricated to initiate bleeding control. use your gloved hand to initiate direct pressure. EXPLANATION In the event of severe bleeding, a gloved hand can be used to initiate direct pressure. This patient may not have time to wait for a sterile dressing and certainly does not have time to await extrication. A tourniquet may be reasonable, but should only be used if direct pressure fails.

***WRONG A 7 year old male has crashed his bicycle. He notes he was thrown over the handlebars and complains of only left shoulder pain. His vital signs are P 120, R 24, and BP 102/60. Given this presentation, you should first rule out

internal bleeding from a ruptured spleen. EXPLANATION Left shoulder pain is commonly referred from an injured spleen. His vital signs point to compensated shock. A Gallbladder injury is not likely to present with left shoulder pain. The child may have orthopedic injuries associated with the shoulder, but internal bleeding must be considered first. soft tissue damage in his shoulder. (WRONG) internal bleeding from a Gallbladder injury. a fractured left clavicle.

A two-car motor vehicle crash has occurred at the bottom of a steep hill. As you approach the crash site, you can see the severely damaged vehicles, but the ambulance begins to slide on the ice. You should

leave your partner at the top of the hill to warn traffic. continue on at a slower speed. stop the ambulance and proceed on foot. EXPLANATION Slippery road conditions are a significant safety hazard. If the icy road caused a collision already, you must take steps to avoid falling victim to the same hazard. In this case, you should stop the vehicle and proceed on foot. After stopping, you can contact the highway department to improve the road conditions. Although slower speeds can increase safety on icy roads, this strategy is too dangerous on a steep hill. Leaving your partner may warn other drivers, but it does not protect you against the icy conditions. contact the highway department so they can de-ice the road.

You are caring for a 19 year old female who is complaining of an acute onset of abdominal pain with dizziness. You find the patient to be tachypneic, tachycardic, nervous, and very scared. Skin is pale and diaphoretic. She admits to being sexually active, but "always" uses some type of prophylactic. Her last menstrual cycle was 25 days previously. Abdominal assessment is benign other than slight tenderness to palpation. The most likely reason for the patient's pain is

menstrual cramps. sexually transmitted disease. ectopic pregnancy. EXPLANATION Sudden onset of abdominal pain in a sexually active female should always be assumed as ectopic pregnancy, and the patient should be managed and transported expeditiously to the hospital. A patient with pelvic inflammatory disease or a sexually transmitted disease rarely has a sudden onset, and menstrual cramps have a typically slower onset. pelvic inflammatory disease.

You are called to assist another crew with lifting a heavy patient. After walking up the stairs to the patient's second-floor bedroom, you realize you do not have gloves. You should

not worry about gloves because you will not be providing care. be careful what you touch and assist in the lift. assist in the lift and be sure to wash your hand thoroughly afterward. return to the ambulance to retrieve a pair of gloves. EXPLANATION Even though you are not providing direct care, lifting and moving patients can be a biohazardous event. In this case, you should retrieve gloves before moving the patient. Washing your hands afterward is always a good idea, but gloves should be worn.

You and your partner are completing your pre-shift ambulance inspection. You notice that the driver's seat belt is not functioning. You should

not worry about it because you do not really need a seat belt. attach a nine-foot strap to the seat to replace the malfunctioning belt. take the ambulance out and make a maintenance appointment later. take the ambulance out of service and notify maintenance. EXPLANATION A seat belt is an essential piece of equipment on an ambulance. In this case, the ambulance must be taken out of service and the seat belt repaired. Using the ambulance prior to the repair creates a serious safety hazard. A nine-foot strap is not a safe replacement for a functioning seat belt.

A 31-year-old female has been found unconscious by the side of the road. Bystanders state that they do not know what happened. The patient does not appear to be breathing. After ensuring scene safety, you should next

open her airway using a jaw-thrust maneuver. interview bystanders for further information. obtain a blood glucose level. check her carotid pulse. EXPLANATION AHA guidelines indicate that a patient found not breathing and without signs of life should first receive a pulse check. This is the C - A - B approach. Airway is, of course, an important priority but is secondary unless multiple EMTs are present or the airway appears to have blood or vomit in it. It would be important to determine the history of the present illness by completing a physical exam, obtaining a blood glucose, and interviewing bystanders, but those are not more important than determining pulselessness and beginning CPR if necessary.

***Alveolar ventilation refers to the amount of

oxygen transferred to the blood from the alveoli each minute. air that does not reach the alveoli during normal inhalation. carbon dioxide transferred from the blood to the alveoli each minute. air moved in and out of the alveoli per minute. EXPLANATION Alveolar ventilation refers to the amount of air that is moved in and out of the alveoli per minute. The movement of carbon dioxide and oxygen are functions of this ventilation but do not apply to this specific definition. The amount of air that does not reach the alveoli during normal inhalation would refer to dead space air.

***WRONG A patient is found in his apartment sitting in a chair in the tripod position exhibiting noisy respirations, cyanosis around the lips, and restlessness. Vital signs are R 28 (working to breathe), P 100 (slightly irregular), and BP 140/90. Oxygen should be provided to this patient by way of

oxygen-powered ventilation device. nasal cannula. non-rebreather mask. EXPLANATION This patient is still controlling his own respirations, so the initial device that should be used is a non-rebreather. If the non-rebreather is not tolerated, then a nasal cannula should be used. If the patient can no longer support his own respirations adequately, then a bag valve mask should be used or, if appropriate, an oxygen-powered ventilation device. bag valve mask. (WRONG)

A 4 month old male is in respiratory arrest. Before initiating positive pressure ventilations, you should

pad behind his occiput to place him in the sniffing position. pad behind his shoulders to account for his large occiput. EXPLANATION The occipital regions in small children are often large. Having these children lie flat can actually occlude the airway by causing hyperflexion. Padding behind the occiput can exacerbate this problem. Hyperextension or flexion would be inappropriate and not open the airway. flex his neck to put him in the neutral position. hyperextend his neck to open the airway.

A 35 year old male police officer has been shot. His bulletproof vest stopped the bullet, but he now complains of pain in his left chest beneath where the bullet was stopped. You should suspect

potential internal injuries from the blunt force trauma. EXPLANATION Even though the bullet was stopped, the energy from the projectile may have caused significant blunt force trauma. Soft-tissue injuries are likely, but the larger concern would be internal injuries and bleeding. Assessment should always look for secondary wounds. Myocardial infarction is a possibility, but it is not as likely as blunt force trauma. a potential second bullet that actually penetrated. only soft-tissue injuries because the bullet did not penetrate. myocardial infarction caused by the stress of the incident.

A 55 year old male dropped a container at work and was sprayed with a dry powder that is burning him. The patient is now unconscious and you note that the powder still covers his chest and arms. His coworkers state that he complained of severe pain and burning before losing consciousness. You should

stage away from the patient until hazardous materials technicians arrive. EXPLANATION This patient's burns have been caused by a hazardous material that could harm you. It is best to stage away from the patient and await the arrival of hazardous material technicians. Any contact with the powder, including brushing, flushing, or covering, could expose you to the same harm that fell upon the patient. flush the wounds with copious amounts of water. brush away the powder and cover the wounds. cover the wounds with moistened sterile dressings.

You are transporting a 67 year old female patient who is complaining of chest pain. Your partner is driving in nonemergency mode while you are administering oxygen and monitoring vital signs. Suddenly the patient stops breathing and goes into cardiac arrest. You should next

stop the ambulance first and then attach the AED. EXPLANATION When the patient goes into cardiac arrest, you should stop the ambulance and attach the AED. In most cases, it is not appropriate to operate an AED in a moving ambulance, plus stopping the ambulance will allow your partner to assist you in resuscitative efforts. Continuing on, either in emergency mode or nonemergency mode, would limit resources available to the patient. ALS is important but your immediate actions will be most meaningful with regard to patient outcome. attach the AED and continue to transport in nonemergency mode. attach the AED and tell your partner to expedite transport. divert the ambulance to a rendezvous with the closest ALS.

A 22 year old, 38-week pregnant female requires transport to the hospital after a fall. There is no indication of spine injury. The most appropriate position to transport her in would be

supine. left lateral recumbent. EXPLANATION Left lateral recumbent would help prevent supine hypotension in a late-term pregnant female. Often times the supine and even the semi-Fowler's position can lead to a drop in blood pressure in this type of patient. The knee-chest position would be used only in specific complications related to pregnancy such as a prolapsed cord. semi-Fowler's position. knee-chest position.

You respond to a severe motor vehicle crash that requires technical extrication. Rescue crews have begun readying to use power tools. A rescue team member asks you to climb in the car and hold manual cervical immobilization while they extricate the patient. You do not have proper protective equipment. You should

tell him you cannot enter the car because you are not properly equipped. EXPLANATION Extrication requires specific personal protective equipment and if you do not have the appropriate level, you should not be involved with extrication. In this case, you should let the team know that you are not properly equipped and therefore cannot enter an unsafe environment. Just borrowing a helmet or a safety blanket is not enough. Teamwork is important on this type of scene, so it is always a better approach to be polite. tell him to get one of their guys to climb in the car because you are not doing it. borrow a helmet and climb in the car. ask for a protective blanket and climb in the car.

You and your partner are preparing to transport a 56 year old man with hand pain. The patient states he does not wish to sit on the stretcher and "just wants to sit on the bench." Your partner says, "Sure, that's fine." You should

tell your partner you are uncomfortable with transporting a patient on the bench seat. EXPLANATION The bench seat should not be used to routinely transport patients. The appropriate thing to do would be to discuss your concerns before initiating transport. Even if the bench has seat belts, the safest place to transport a patient is on the stretcher. be sure the bench seat has seatbelts and transport the patient. require the patient to lie flat on the bench seat and use multiple seat belts to secure him. transport the patient on the bench seat and discuss your concerns with your partner later.

You are about to transport a pediatric cardiac arrest. A police officer asks you if you would like an escort. You should

thank him but decline because an escort can cause a safety hazard. EXPLANATION Police escorts can create a safety hazard as often traffic responds erratically to two emergency vehicles. In this case, it would be best to thank him and decline his offer. Safe distances, whether the police vehicle is in front or back, are very difficult to maintain and often result in increased danger to both vehicles. accept the escort because it will shorten transport time. ask him to follow the ambulance to help prevent tailgating. accept the escort but tell him to make sure he maintains a good distance between the cruiser and the ambulance.

A closed soft tissue injury implies that

the soft tissue has not been broken or penetrated. EXPLANATION A closed injury is one in which the skin and soft tissue are intact. Although a closed injury may include broken bones and ruptured blood vessels, the skin must be intact. blood vessels beneath the skin are intact. the bone beneath has not been broken. a penetrating wound is no longer bleeding.

A 71 year old female presents with a new onset of right-sided facial droop and a lethargic mental status. As you load her onto a stair chair for extrication, she exhibits snoring respirations. You should

tilt her head forward to stop the snoring. stop movement and reposition her airway. EXPLANATION Snoring indicates a partially obstructed airway. In this case, the most likely cause is poor muscle control and position. The best remedy would be to stop and reposition her airway. Snoring is unlikely to be caused by secretions so suction is unnecessary. Tilting her head forward would likely fully occlude her airway. continue extrication but move quickly. immediately suction the airway.

A 59 year old male complains of acute onset chest pain. He is alert and diaphoretic. His vitals are P 110, R 24, and BP 188/80. The patient states he has a history of heart problems and takes nitroglycerin occasionally. The only other medication he takes is Viagra. You should

transport only. determine whether he has taken his Viagra before assisting with nitroglycerin. EXPLANATION This patient is demonstrating the signs of acute myocardial infarction and nitroglycerin is an important element of treating this disorder. However, erectile dysfunction medications can make nitroglycerin dangerous. In this case, you should determine if the patient is currently taking Viagra, and if so how long ago did he take it? This line of questioning might allow for the administration of nitroglycerin and would be preferred to foregoing the medication altogether. assist this patient with his nitroglycerin. administer only aspirin and oxygen because this patient cannot take nitroglycerin.

A 17 year old male has been stabbed in the groin. He presents with bright red, spurting blood. This bleeding is most likely from a(n)

underlying organ. capillary. artery. EXPLANATION Bright red, spurting blood is most likely caused by arterial bleeding. Venous bleeding is darker and typically does not spurt. Capillary bleeding oozes and commonly clots on its own. Organ system bleeding would typically be internal and not visible on the exterior body. vein.

After checking your ambulance, you notice your hands have been soiled by an unknown substance. The most effective way to protect yourself against disease would be to

wash your hands with warm soapy water. EXPLANATION Washing your hands with warm soapy water affords the best protection against disease. Alcohol-based hand cleaners are better than nothing, but in some cases they do not kill all the organisms that cause disease. Wiping away surface soil might be a good idea, but only if it is followed by washing. Ammonia and other solutions can be harmful. wipe off your hands with a dry towel. clean your hands with an alcohol-based hand cleaner. rinse off your hands with an ammonia solution.

You should begin multi-casualty procedures when

you have more than 10 patients. you have more than 20 patients. you have fewer ambulances than patients to be transported. the demands of the event overwhelm your available resources. EXPLANATION Multiple-casualty incident (MCI) procedures should be utilized anytime the demands of an event outstrip resources. Often this has nothing to do with the number of patients. It may have to do with the number of ambulances available, but it is common to use fewer ambulances to transport a larger number of patients.

A mother states her 7 week old infant has not been feeding well and may have had a fever over the last four days. The baby is listless, and when you examine his head, you notice his fontanels are sunken. What does this finding most likely indicate?

Rising intracranial pressure Meningitis Hypovolemia EXPLANATION Sunken fontanels most likely indicate hypovolemia, especially in the context of this history of the present illness. Meningitis, rising intracranial pressure, and traumatic brain injuries are typically associated with bulging fontanels. Traumatic brain injury

A 20 year old female complains of severe headache and photophobia. She notes she has had a fever and a stiff neck for the last two days. To manage this patient you should first

administer 324 mg aspirin. complete a Cincinnati Prehospital Stroke Scale. turn down the lights in the ambulance. don gloves and respiratory protection. EXPLANATION These symptoms indicate the potential for meningitis. In this case, personal protection takes precedence over treatment. Respiratory protection and gloves are the most important. Aspirin is very useful in treating cardiac patients, but not useful in this case. Turning down the lights would be appropriate but only after you protect yourself. It is reasonable to conduct a stroke assessment, but not before applying PPE.

***WRONG A 20 year old female has been involved in a minor motor vehicle crash. She is ambulatory on arrival and complains of difficulty breathing. She is alert and vitals are P 110, R 40, and BP 122/80. Her skin is flushed. Considering her respiratory status, you should

ask her to breathe into a paper bag. begin positive pressure ventilation. (WRONG) do nothing because her respiratory status is fine. apply a non-rebreather mask. EXPLANATION This patient is in respiratory distress and requires further assessment. Her normal mental status and flushed skin indicate that she is not in respiratory failure and therefore does not need positive pressure ventilation. Due to her distress, supplemental oxygen should be considered in the form of a non-rebreather mask. It is not appropriate to use a paper bag to treat hyperventilation.

Approaching the scene of a single-car crash, you observe smoke in the vicinity of the vehicle. You are concerned that there may be someone still inside. As the first emergency responder on scene, where should you position your vehicle?

100 feet upwind from the vehicle EXPLANATION The danger zone for this incident is within 100 feet of the vehicle fire. Your emergency vehicle should be parked upwind so the smoke does not come back into the path between EMS personnel and the scene. Parking downwind brings the smoke back onto the emergency vehicle and can visually obstruct the scene. Parking next to the burning vehicle could place emergency personnel in jeopardy in case there is a flare-up or explosion. 50 feet downwind from the vehicle Next to the crashed car for fast access to the patient Leave the area until the fire department arrives

***WRONG You and your partner are checking your ambulance prior to your shift. Which one of the following oxygen cylinder pressures would be the minimum safe residual pressure for operational use?

2000 psi 200 psi EXPLANATION The minimum safe residual pressure in an oxygen tank is 200 psi. Keep in mind that this is a minimum pressure and many systems require a change at higher pressures. Always follow service guidelines. 1000 psi (WRONG) 500 psi

You are assisting in the management of four injured patients in a remote area of the county. You have at your disposal one helicopter capable of transporting one critical patient, and two more ground ambulances that will handle the other three patients. Please select the patient below that you would elect to receive transport by the helicopter.

24 year old patient with penetrating lateral chest injury, breath sounds intact 39 year old patient with head injury, and signs of herniation EXPLANATION Air medical transport should be reserved for those patients who have a time-sensitive condition in which expedient transport to the hospital is essentially a required component for survivability. In this situation, the patient with the brain herniation should be flown. The patient in arrest should not be selected because survivability rates from a traumatic arrest are extremely poor. The open femur fracture and penetrating chest injury will both probably need surgery, but since they are otherwise asymptomatic, they can go by ground. 23 year old patient with open femur fracture, bleeding controlled 42 year old patient who just arrested due to traumatic injuries, resuscitation is ongoing

You are caring for a baby that was just delivered in the mother's home. After cutting the cord you complete your initial APGAR scoring. You find the baby displays a strong cry, has cyanotic hands and feet with a pink core, is actively moving, the heart rate is 140 per minute, and the newborn grimaces and cries with stimulation. What is the calculated APGAR score?

7 9 EXPLANATION The APGAR score is a numeric representation of the neonates physiological status, and can serve as an indication of the baby's overall condition. For this infant, the crying = 2 points, the acrocyanosis = 1 point, the active motion = 2 points, the heart rate = 2 points, and the grimacing = 2 points. This totals 9 points (out of a possible 10 points) which means the baby is vigorous and needs only routine care. 5 11

***Which one of the following best describes the National Incident Management System?

A command system in which several agencies work independently but cooperatively A system designed to be used by federal, state, and local governments to prepare for and manage emergencies in the United States EXPLANATION The National Incident Management System is designed to be used by federal, state, and local governments to prepare for and manage emergencies in the United States. A predefined set of instructions for emergency responders to use during a specific major incident would be a disaster plan. Unified command would be a system in which several agencies work independently but cooperatively. Incident command is a system designed to improve the span of control at major incidents. A predefined set of instructions for emergency responders to use during a specific major incident A command system designed to improve the span of control at a specific incident

Which one of the following medical-legal concepts would best apply to an EMT who chose to illegally perform a paramedic level skill?

Abandonment Libel Duty to act Scope of practice EXPLANATION Scope of practice defines the skills and level of care a specific provider can perform. Although the provider may have a duty to act, it does not limit the skills he can perform. Libel occurs due to injurious information in written form. Abandonment occurs when care is ended inappropriately.

You are caring for a 2 year old female patient with a recent history of bronchitis. The patient is being held by her mother, but you notice that the child seems very limp. The airway is patent, breathing is spontaneous but rapid and shallow. The pulse is rapid and the skin is ashen in color. Breath sounds are markedly diminished with both inspiratory and expiratory wheezing bilaterally. Given this situation, you should perform what intervention first?

Administer oxygen via non-rebreather. Insert an NPA Insert an OPA Initiate PPV with oxygen supplementation. EXPLANATION The patient in this situation is in decompensated respiratory failure as evidenced by the limp muscle tone, ashen skin, and diminished breath sounds. The intervention this patient needs first is PPV to better ventilate the alveoli and restore oxygenation. The use of an OPA or NPA is warranted only if the patient cannot maintain their own airway. Finally, due to the respiratory failure, use of oxygen via NRB will not help as the child requires ventilation.

Of the following traumatized patients, which one would most likely suffer critical injuries and require transport to a trauma center based on a significant mechanism of injury?

An adult who dropped a cement block on his foot and has severe pain A child who fell five feet from a fence top who had a loss of consciousness EXPLANATION Generally speaking, the mechanism of injury should not be the conclusive deciding factor as to whether or not a patient is transported to a trauma center. However, certain mechanisms coupled with clinical findings can become a deciding factor. A child who has fallen any height and suffered a loss of consciousness should be taken to a trauma center for evaluation and treatment. A stable MVC victim with no interior displacement, an isolated foot injury, or a fall victim with back pain may not be of sufficient significance to go to a trauma center versus a closer emergency department. A stable adult who wrecked his car with no interior displacement A child who fell while skateboarding, complaining of lower back pain

An adult patient who is extremely allergic to bee stings was attacked when he accidentally dislodged a beehive while cutting a tree down. He has multiple stings all over his body and currently presents with stridor, tachycardia, coarse bilateral wheezing, falling blood pressure, and unresponsiveness. Given the pathophysiologic changes in an anaphylactic reaction, which of the below would be the greatest contributor to the rapid death of this patient?

Bilateral wheezing Airway closure EXPLANATION An acute anaphylactic reaction actually results in three different pathophysiologic changes that could result in the death of the patient. They include airway swelling, severe bronchiole constriction impairing alveolar ventilation, and profound systemic hypotension from arteriolar vasodilation. Of these, airway closure (as evidenced by stridor) is the swelling shut of the glottic opening and can result in rapid airway occlusion and death of the patient. Tachycardia is an expected finding due to the peripheral vasodilation, but it is not the cause of death. Tachycardia Hypotension

A 26 year old, 36-week pregnant female has been involved in a car crash. She complains of tearing, steady abdominal pain and vaginal bleeding. She is alert and her vital signs are P 116, R 24, and BP 100/68. Given this presentation, what is her most likely problem?

Braxton Hicks contractions Imminent delivery Abruptio placentae EXPLANATION Tearing pain and vaginal bleeding are commonly associated with abruptio placentae. Placenta previa is not typically associated with severe pain. Delivery and Braxton Hicks contractions would most likely present with pain that comes and goes. Placenta previa

You arrive first on the scene of a car that has struck a tree. Moderate damage has occurred. You ensure the scene safety, don appropriate personal protective equipment, and request additional resources. You note the patient is not responding and you are unable to gain access through the front doors. What should you do next?

Break a window to access the patient. Attempt to open a rear door and enter the car. EXPLANATION Often when front doors are jammed, the rear doors are functional. Always start simple with vehicle extrication. Breaking, sawing, and prying are much more difficult than simply opening a door. Use a crowbar to pry open the driver's door. Use a hacksaw to remove the front windshield.

You arrive at the scene of a reported domestic dispute near your station. Due to the rapid response time you arrive before the police. As you cautiously approach the front door you hear loud shouting and what sounds like glass breaking coming from within. What should you do in this instance?

Cautiously peer in the windows to see what is going on. Return to ambulance and stage a few blocks away while waiting for police EXPLANATION In any situation where the EMT may be harmed, the best course of action is to retreat from the scene to a safe location, even if that is staging in your ambulance a few blocks away. Dangerous scenes, especially domestic disputes can easily "spill" into the streets and the EMT should not be anywhere near should more trouble erupt. Once the police have arrived and cleared the scene of hazards, the EMT can again cautiously approach. Stand to the side of the door and knock loudly. Clear the scene, return to the station, and wait for dispatch to resend you to the address after the police arrive.

***A 12 year old male is having an asthma attack. He appears tired and pale. During your primary assessment, you note his respiratory rate to be 40. However, you have difficulty hearing his lung sounds. What is the most likely reason for the difficulty in hearing lung sounds?

Children always have quiet respirations Fast breathing is difficult to hear Children require a different technique for lung sound evaluation There is little air moving EXPLANATION Asthma causes bronchoconstriction and although it may appear he is breathing rapidly, the narrowed air passages allow little air to move. Children may have quieter breathing and may require altered evaluation techniques, but in the case of an asthma attack, you must assume air is not moving.

You are addressing a person who is angry at you because his wife was pronounced dead on scene and he thinks you should have started treatment and transport. You are trying to gather specific patient information from him so you can contact appropriate authorities. During this exchange, what patient communication strategy could you possibly employ?

Confrontation Clarification Anger Reflection EXPLANATION Reflection is a technique where you paraphrase the patient's words to encourage more information and to build trust. Doing this with the husband may make him trust you more since you are listening and understanding his concerns first. The use of anger will only spawn more anger, and clarification or confrontation will not help the grieving husband grow to appreciate your genuine concern regarding the death of his wife.

During the management of a female trauma patient who is 8 months pregnant with her second child, you elect to immobilize her on a backboard for suspected spinal injury. When preparing for transport, what important treatment consideration must you provide regarding transport on a backboard?

Consider immobilizing the patient on her right side to improve fetal blood flow. Tilt the backboard to the left side to avoid potential hypotension. EXPLANATION With pregnant females needing immobilization or even regular transport on the cot, always tilt the patient to her left side. This helps to remove the weight of the gravid uterus off the inferior vena cava. Failure to do so may result in a condition called "supine hypotensive syndrome." This occurs secondary to poor cardiac filling when blood from the lower body is impeded when flowing back to the heart. The use of high flow oxygen is always warranted, and it does not harm the fetus. The use of PPV is only warranted if the patient has inadequate ventilation. Finally, placing the patient on her right side has no clinical benefit and should not be done. Do not apply high flow oxygen as it may harm the fetus. Automatically provide positive pressure ventilation to assist in breathing while supine.

While managing a patient with cardiac chest pain, you elect to assist them in the administration of their nitroglycerin. After two doses the chest pain is still not relieved. Per your clinical protocols, you must contact medical control prior to the administration of a third nitro. This is an example of what type of medical authorization?

Continuation of care protocols Online medical direction EXPLANATION Medical oversight is always required for the EMT to practice medicine. The situation in this question is referred to as "online" medical direction. Offline medical direction is when the EMT relies on a written document to guide care. Finally, all care should be patient-based and should be continuous in nature, but neither of these is a type of medical direction or clinical protocol. Offline medical direction Patient-based medical control

An 18 year old male diabetic patient has been sick for one week. His family states he has complained of nausea and vomiting but has been taking his insulin properly. Today they note he is "acting drunk." You note the patient is pale and diaphoretic and his vital signs are P 116, R 28, and BP 132/80. What is the most likely cause of his condition?

Dehydration Hyperglycemia Sepsis Hypoglycemia EXPLANATION Vomiting can quickly remove the necessary food that must be paired with the administration of insulin. With insulin in the system without glucose from food, hypoglycemia can rapidly develop. Dehydration and sepsis may be a concern, but you should first rule out hypoglycemia. Hyperglycemia would be unlikely as long as he has been taking his insulin.

You and your partner are on a lunch break when you hear a scream from across the room: "My child is choking!" You immediately go to help. The mother quickly tells you she thinks the 10 month old swallowed a coin. You note that the baby is cyanotic with no cough. What is the appropriate way to clear the obstruction?

Deliver abdominal thrusts and back blows. Immediately attempt artificial ventilation. Try a blind finger sweep to dislodge the coin. Use back slaps and chest thrusts. EXPLANATION For an infant (younger than one year of age), provide a set of five back slaps alternating with a set of five chest thrusts. If the object can be seen, then a finger sweep may be used to extract it. Do not perform a blind finger sweep. Abdominal thrusts should not be used until a patient is older than one year of age. Artificial ventilation and compressions should be performed and pulse assessed (basically performing CPR) if the child becomes unconscious before the object is removed.

***WRONG You are attempting to remove vomitus from the airway of a 3 year old female hit by a car. If you are planning on using a suction machine, what do you know regarding the length of time you should suction the oral cavity?

Do not suction pediatrics due to inherent dangers of oral trauma Do not exceed 30 seconds Suctioning should not exceed 15 seconds (WRONG) Suction less than 10 seconds EXPLANATION Suctioning of the pediatric oral cavity should be limited to 10 seconds when possible due to the concern of progressive hypoxemia and hypercapnia. The patient should be well oxygenated prior to and after the suctioning event. Adults are suctioned for 15 seconds. Ventilations should never be interrupted for more than 30 seconds to place an airway. Finally, there are no inherent dangers of suctioning anyone's airway so long as the EMT does the procedure correctly.

***A patient has a gastrointestinal bleed that is resulting in a drop in his circulating blood volume. In order for the body to try and compensate for this volume loss while attempting to maintain adequate peripheral perfusion, what might the negative feedback systems of the body employ?

Enhancing vasomotor tone EXPLANATION By increasing vasomotor tone (constricting blood vessels) the arterial "container" becomes smaller which in turn will elevate blood pressure and perfusion pressures. This is a normal negative feedback mechanism. Slowing the heart rate will only drop cardiac output, as will diuresis, as additional volume will be lost. Slowing of the heart rate Increasing diuresis through the kidneys Decreasing afterload on the left ventricle

Upon turning a patient over to hospital staff, a nurse advises you that your patient is a known injectable drug abuser. Of the numerous work practice controls to keep you safe from cross-contamination, which of the below is best in protecting your safety as an EMT?

Hand washing EXPLANATION The practice of good hand washing techniques is the single most preventative measure the EMT can employ to protect oneself from cross-contamination. The use of the other described PPE is warranted as the situation dictates, but they all should be complemented with hand washing both prior to and after the EMS call. Use of non-latex exam gloves Donning a moisture resistant gown Wearing protective eyewear

Given any type of cellular, digital, or radio communication between the EMS providers and dispatch, what is one consistent limitation across these technologies the EMT must be aware of and try to avoid in order to ensure smooth communication occurs?

High costs Language barriers Dead spots EXPLANATION Dead spots are those areas within an EMS community where communication technology that relies on transmission of data across frequencies is hampered due to geography, buildings, vastness, or other situations. It is important for the EMT to know these in order to avoid losing contact with dispatch whenever possible. Costs are something the EMS system has to consider as the system is designed and dead batteries are typically not a problem with ambulance-mounted chargers. Finally, language barriers can be minimized by EMS providers knowing the appropriate terms and codes the EMS system advocates. Dead batteries

A 21 year old patient collided with another player while playing soccer. Bystanders note he briefly lost consciousness. He is awake, but cannot remember where he is. He states he does not wish to be transported to the hospital. Which one of the following reasons best describes why this patient cannot refuse care?

His mental status is altered. EXPLANATION This patient is not competent to refuse care because he has altered mental status (can't remember where he is). A person 21 years of age is typically allowed to make healthcare decisions without a parent present, and the fact that he previously lost consciousness would not be significant if he now had a normal mental status. A parent is not on scene. He is only 21 years old. He previously lost consciousness.

You arrive on scene for a male patient in his mid-30s who, according to family, is acting strangely. As you enter the house you find the patient standing with his face to the corner with aluminum foil wrapped around the top of his head to keep the "evil radio waves" from entering his head. The patient is not aggressive, and allows you to complete your physical exam. Of the following conditions, which is most likely NOT his problem?

Hypoglycemic episode Psychiatric disorder Stroke or TIA Heart attack EXPLANATION A behavioral emergency can be caused by a myriad of psychological or physiological disturbances to include psychosis, stroke/TIA, and a hypoglycemic episode. They can also be from hypoxia, drug overdose or withdrawal, and acute stress. They are not commonly the result of myocardial infarction (heart attack).

A patient who has a history of oral and laryngeal cancer had his laryngeal structures surgically removed as part of the cancer treatment. In its place, a stoma tube has been inserted into the airway on the neck. Currently, this patient is breathing inadequately as evidenced by minimal chest wall movement and no basal breath sounds. Given the patient's history and presentation, what would be the best way to ensure adequate ventilation?

Initiate positive pressure ventilation with the face mask properly sealed over the mouth and nose. Provide positive pressure ventilation with a pediatric mask and adult bag over the stoma opening. EXPLANATION Patients who are breathing inadequately, regardless of oxygenation status, must be manually ventilated. The provision of oxygen via mask or cannula to patients inadequately breathing is of no use. Secondly, if the patient has had their laryngeal structures removed due to cancer, trauma, or other causes and have a stoma tube placed, this is the site where air enters and exits the lungs. As such, the most appropriate means to ventilate these patients is via a BVM with a pediatric mask placed over the stoma opening (due to the small size of the mask and the stoma). Ventilating over the mouth and nose on someone with no laryngeal structures is futile. Always utilize oxygen whenever you are manually ventilating a patient. Use a pediatric face mask over the stoma with high flow oxygen. Place a non-rebreather mask at 15 lpm over the stoma opening.

***What term is used to describe the exchange of respiratory gases between the alveoli and the pulmonary capillary bed?

Internal ventilation External respiration EXPLANATION External respiration refers to the process of moving air between the outside world and the alveoli. Internal respiration refers to the exchange of oxygen and carbon dioxide from the blood to the tissues. Cellular respiration and metabolism refer to the process of using oxygen and glucose to manufacture energy. Cellular ventilation Cellular metabolism

A 60 year old male complains of chest pain. You decide to use the acronym OPQRST to better investigate the chief complaint. When referring to the "S" of OPQRST, which one of the questions below would be the most appropriate?

Is the pain sustained? What is the severity on a 1-10 scale? EXPLANATION The "S" of OPQRST refers to severity. The best measurement of severity is to use a 1-10 scale. Sweatiness is clinically significant, but not as important as severity. O for "onset" will discuss whether the pain has been sustained, and Q for "quality" will describe whether the pain was sharp or dull. Does the pain cause you to be sweaty? Is the pain sharp or dull?

Which one of the following best describes why activated charcoal is administered to treat an ingested toxin?

It neutralizes acidic toxins It reverses the effects of many toxins It absorbs toxins in the stomach EXPLANATION Activated charcoal is very porous and absorbs toxins in the stomach. It is not an antidote and cannot reverse the effects of a toxin or remove a toxin from the blood once it has been absorbed. It does not neutralize acids. It removes toxins from the bloodstream

While obtaining a SAMPLE history from a 58 year old suspected cardiac patient with severe chest pain and diaphoresis, you are informed that the patient had open heart surgery three years ago. Under which "letter" of the acronym SAMPLE should this information be placed?

L P EXPLANATION P is the pertinent past history, such as previous open heart surgery. "L" is last oral intake. "S" stands for signs and symptoms the patient is having. "E" stands for events leading up to the problem, such as the patient's activity level when the symptoms started. The two letters not listed are "A," which stands for allergies, and "M," which is for medications the patient is currently taking. E S

***WRONG You are treating a 23 year old male for burns sustained when the lawn mower he was working on caught fire due to a gas spill. The patient has reddened skin and blistering to both hands, his right arm, and the anterior right thorax. Given the type and percentage of body surface area burned, how would these burns be categorized?

Moderate (WRONG) Fatal Mild Severe EXPLANATION These burns would be considered "severe" due to the involvement of both hands. Beyond the total body surface area burned, and even the type of burn, any burns that can potentially cause loss of function are immediately considered to be severe. Other types of severe burns are airway burns, burns to the genitalia, large thoracic/abdominal burns, circumferential burns and burns involving large muscle groups or major joints of the body.

While performing a scene size-up for a report of workers overcome in a factory, you see a diamond-shaped placard on the building with four numbers. Generally speaking, the higher the number in each quadrant, what can be inferred?

Numbers infer what the building is composed of The more dangerous the contents EXPLANATION The placard, which is color-coded for health (blue), fire (red), reactivity (yellow), or additional information (white) - use a series of numbers in each quadrant (0-4) to represent the status of the contents given those four criteria. Generally speaking, the higher the number, the more dangerous the contents. There is no relationship between the placards and the structural composition of the building. The less dangerous the contents There is no relationship between the numbers and the substances inside

A 17 year old male complains of lower quadrant abdominal pain. How should you properly assess his abdomen?

Palpate four quadrants and the affected area last EXPLANATION The painful area of an abdomen should be palpated last because this can cause an increase in pain and guarding. All four quadrants should be palpated to assess normal vs. abnormal. First palpate the affected area and then the other three quadrants. Palpate every quadrant except the affected area. Palpate only the affected area