NREMT Practice Test

What would be an expected systolic BP in infants, toddlers, and preschool aged children? a. 50 mm Hg b. 60 mm Hg c. 70 mm Hg d. 80 mm Hg

d. 80 mm Hg Rationale: Infant 70-90, toddler 70-100, and preschool 80-110.

Which of the following is a rare cause of respiratory failure in children? a. Upper airway obstruction b. Epiglottitis c. Anaphylaxis d. Croup

d. Croup Rationale: Croup is a relatively common condition that affects about 15% of children at some point, most often between 6 months and 5-6 years of age. The other choices are dire emergencies that can lead to respiratory failure and require immediate care and transport.

What would a baby that had a cephalic presentation during birth be considered? a. An emergencyb. A reason for a c section c. Unlikely to be healthyd. Optimal for delivery

d. Optimal for delivery Rationale: Head first presentation is considered optimal for delivery of a baby through the vaginal opening.

During one person CPR you can assess ventilations by watching what? a. Bilateral rise and fall of the chest b. Their capillary refill c. Nostril flare d. The patient's blood pressure

a. Bilateral rise and fall of the chest Rationale: Watching rise and fall of the chest is the most reliable way of verifying ventilations among the choices.

Without any further information, what condition would you say the following patient is in? A 1-year-old male with a pulse rate of 110, breathing at 30 breaths per minute, with a systolic BP of 90. a. Good b. Poor c. Bad d. Moderate

a. Good Rationale: All vitals are within normal limits for a child of this age. 1-year-old is the dividing line between infancy and toddler age, and so both sets of vital sign ranges could apply to a 1-year-old. Treat the patient based on overall appearance and what the parents tell you is normal or abnormal.

Which of the following choices is not a route of drug administration? a. Nuchalb. Inhaledc. Intravenous d. Sublingual

a. NuchalRationale: Nuchal is not a route of medication administration.

The umbilical cord is wrapped tightly around the baby's neck and you have tried unsuccessfully to slip the cord over the head. What should your next course of action be? a. Push the baby's head into the vagina until the cord comes loose b. Clamp the cord in two places and cut it in the middle c. Support the head and suction the baby's nose and mouth d. Massage the uterus to stimulate harder contractions to free the baby

b. Clamp the cord in two places and cut it in the middle Rationale: Getting the baby's airway patent is the most important thing so cutting the cord appropriately would be the best decision at this point.

What should be done to a French tip catheter after suctioning a patient's airway? a. Throw it away b. Flush with sterile water in preparation for additional suctioning c. Put it in the sharps container d. Take it home for your kids to play with

b. Flush with sterile water in preparation for additional suctioning Rationale: Anticipating the need for additional suctioning should be followed by cleansing of the catheter with sterile water.

Who is responsible for developing protocols for an EMS system? a. Department of Transportation (DOT) b. Medical directorc. State EMS Controld. National EMS control

b. Medical director Rationale: The medical director is responsible for creating these written instructions for various medical conditions and injuries.

Unoxygenated blood travels into the lungs via the? a. Pulmonary valve b. Pulmonary artery c. Pulmonary vein d. Aortic arch

b. Pulmonary artery Rationale: Blood travels into the lungs from the pulmonary artery. This is the only artery in the body that carries unoxygenated blood.

In order to maneuver an ambulance efficiently around a turn, the driver should know the proper speed, _____________________________________, as well as understand the need to ____________________________________. a. The desired ending point of the turn / reach the apex of the turn earlyb. The current position and projected path / reach the apex late in the turnc. The caliper and approximate distance of the turn / begin turning early in the turnd. How tight the turn is / apply the breaks if the turn was entered with too much speed

b. The current position and projected path / reach the apex late in the turn Rationale: When making a turn it is best to reach the apex late in the turn as the vehicle will tend to stay on the inside and maintain the traffic lane. If the apex is reached early it has a tendency to push the vehicle to the outside of the lane as it exits the curve.

Anaphylaxis may involve more than one of the body's systems. Which of the following systems are involved? a. Reproductive and respiratory b. Reproductive and neurological c. Respiratory and neurological d. Reproductive and metabolic

c. Respiratory and neurological Rationale: While each answer contains a correct answer, the reproductive system is not involved in anaphylaxis.

The symptoms of a TIA usually last around ______. a. 1 minute b. An hour c. 24 hours d. 48 hours

a. 1 minute Rationale: The AHA (which is the source we will go by for the NREMT exam) states that most TIA's last less than 5 minutes with an average being only about 1 minute. The National Institute of Neurological Disorders and Stroke state that

Respirations in an adolescent would be considered normal at ________________. a. 16 breaths per minute b. 24 breaths per minute c. 32 breaths per minute d. 35 breaths per minute

a. 16 breaths per minute Rationale: According to the NES (National Education Standards) adolescence (13-18 years) begins at the onset of puberty until adulthood. The respiratory rate for this age group is 12-20 per minute.

Dispatch has just called you to Frontier Lake where a man's boat has capsized. The update is the patient is likely suffering from hypothermia and is breathing very shallow. You and your partner Sean arrive to find a man and a woman doing CPR on an approximately 48 year old male. When you and Sean begin CPR, what ratio and depth of compressions will you use? a. 30:2 / 2 to 2.4 inchesb. 15:2 / 1.5 to 2 inchesc. 30:15 / one third to one half the depth of the chest d. 15:2 / one third to one half the depth of the chest

a. 30:2 / 2 to 2.4 inches Rationale: AHA guidelines specify that for adult CPR a 30:2 ratio of compressions to breaths is to be used. Additionally, the depth of compressions should be at least 2 inches for adults but not more than 2.4 inches. This question is also used to demonstrate that often times, the call you receive from dispatch is not the call at which you arrive. Be prepared for anything.

A woman has fallen 20 ft. from a ski lift. You are the first medical unit on scene. She is conscious and breathing normally. C-spine is in place, you package her on a backboard with high flow O2 and begin transport. The patient is looking around the ambulance and begins using inappropriate words to describe things she is seeing. You have given her several requests to wiggle her toes but she does not respond. This woman has a GCS of what? a. 8 b. 9 c. 10 d. 11

a. 8Rationale: Using inappropriate words gets her 3 points, spontaneous eye movement gets her 4, and no motor response on request gets her 1 point, for a total of 8 points.

You arrive on scene with your partner Steve to a 1-vehicle accident. You are the 1st ambulance to arrive. Scene size up indicates there are 4 patients in the car. In the front is a 45 year old woman who is unconscious and wearing her seat belt, a 7 year old girl who is unrestrained and complaining of finger pain, an 8 year old boy who is unrestrained and has no signs or symptoms, and a 5 year old girl who is unrestrained and has no signs or symptoms. There is little to no damage to the car and it appears as if she just went off the road at a very slow rate of speed and bumped up against a fence. What could have likely been the cause of the woman's altered LOC? a. Diabetic reaction, alcohol, stroke, or seizureb. Poisoning, exhaust in the car, or head traumac. Coma, AMI, or GI bleedd. Carbon monoxide poisoning, anaphylaxis, or pneumothorax

a. Diabetic reaction, alcohol, stroke, or seizureRationale: Diabetes, alcohol, stroke, or seizure are all likely in this situation as no one in the car is injured. Her altered LOC could have been caused by any of the things listed above (they are more likely than any of the other answers).

Dispatch has reported there is a man passed out behind a supermarket who is not breathing. You arrive to find a male sitting alone up against a wall. His eyes are closed and he does not respond to your attempts to elicit an answer. He is breathing at 8 irregular breaths per minute with periods of apnea. There is a small plastic baggy with a white substance on the ground next to him. When you give him a sternal rub, he grabs his chest with his hand, but does not make any noise. What is this man's GCS and what is the best course of action? a. GCS of 7 / Assist ventilation via BVM b. GCS of 7 / Restrain the man to the gurney with the likelihood of drug ingestion c. GCS of 6 / Put him on high flow O2 via NRB and transport d. GCS of 6 / Insert a nasopharyngeal and prepare to suction

a. GCS of 7 / Assist ventilation via BVM Rationale: This man needs assistance breathing. With the low rate and periods of apnea he is not getting enough oxygen. He does not open his eyes to any stimulus, so that is 1 point. He will not answer any questions or talk, so that is also 1 point. Finally he localizes pain by grabbing his chest, that would give you 5, for a total of 7.

Name three medical conditions that often cause tachypnea? a. Hypoxia, CHF, shockb. Fibromyalgia, hypoxia, ischemiac. Hypoxia, congestive heart failure, opiate overdose d. Allergic reaction, shock, CHF

a. Hypoxia, CHF, shock Rationale: Hypoxia, congestive heart failure (CHF), and shock are correct for the following reasons. Hypoxia is a condition in which the body or region of the body is starved of oxygen supply which in turn causes the body to become acidodic. Tachypnea is often the result because it increases alveolar PO2 by raising the rate and depth of breathing. Congestive heart failure is where the ventricular myocardium becomes so damaged that it can no longer keep up with the return flow of blood from the atria. The lungs become congested with fluid once the heart fails to pump blood effectively. Blood then backs up in the pulmonary veins which leads to a decrease in oxygen exchange at the capillary level (Pulmonary Edema). The body tries to compensate by becoming tachypnic. Shock: Cardiovascular system fails to provide sufficient circulation for every body part to perform its function. Due to the poor perfusion, metabolic acidosis occurs early in the process. The body will then become tachypnic while trying to compensate for the metabolic acidosis and establish homeostasis.

Your 57-year-old patient was a chain smoker for 35 years and is pursing his lips during exhalation. How does this action assist the patient's respiratory effort? a. It creates a backpressure on collapsed alveoli b. It forces air out of the lungs faster c. It demonstrates his lung control d. It causes the patient to hyperventilate

a. It creates a backpressure on collapsed alveoli Rationale: Breathing with pursed lips is a sign that a chronic obstructive pulmonary disease (COPD) patient is trying to keep the alveoli open with backpressure on his/her lungs.

You and your partner arrive at a motel in response to a 911 call for an unconscious female. You find the woman pulseless and while your partner hooks up the AED, you begin delivering compressions. How many compressions per minute would you give this woman? a. 60-80 compressions per minute b. 100-120 compressions per minute c. 150 compressions per minute d. 90-100 compressions per minute

b. 100-120 compressions per minute Rationale: 100-120 compressions per minute is the current recommendation of the 2015 AHA CPR Guidelines.

How many compressions per minute would you give an adult patient who has no pulse? a. 80-100 compressions per minute b. 100-120 compressions per minute c. 60-80 compressions per minute d. 30-2 compressions per minute

b. 100-120 compressions per minute Rationale: 2015 AHA guidelines now require at least 100 compressions per minute but no more than 120 compressions per minute.

You arrive on scene with your partner to find a 7 year old boy unconscious after being dragged from the water. He is not breathing and has no pulse. CPR in this case should include________________. a. 30:2 compression to ventilation ratio b. 15:2 compression to ventilation ratio c. 5:1 compression to ventilation ratio d. 30:1 compression to ventilation ratio

b. 15:2 compression to ventilation ratio Rationale: AHA CPR Guidelines specify that for two person CPR on a child you should use a 15:2 ratio. It would be 30:2 if you were alone and did not have your partner.

Your patient is a 69 year old female who has a history of diabetes. She is breathing very deeply and very rapidly in a state of respiratory acidosis. Her husband said he woke up to her breathing like this and she would not wake up. You know that this woman is most likely in? a. Respiratory rebound stage b. A diabetic coma c. Diabetic shock d. Respiratory alkalosis

b. A diabetic coma Rationale: A diabetic coma will often present with the patient breathing deeply and rapidly. The body is trying to blow off the build up of ketones(acids).

A 6 year old child has fallen from the monkey bars at the local park. What are the components of the pediatric assessment triangle (PAT) that you would use to rapidly assess this patient? a. Airway, Breathing, and Circulation b. Appearance, Work of breathing, Circulation c. Mentation, Reaction, Distress level d. General impression, Distress level, Transport priority level

b. Appearance, Work of breathing, Circulation Rationale: The pediatric assessment triangle (PAT) is utilized to rapidly assess and form a general impression of the child's condition. Their Appearance (mental status and muscle tone), Work of breathing or visually determining their respiratory status, and assessing Circulation of their skin, will give you a good idea of their distress level.

You arrive on scene with your partner Leonard to the report of a child appearing lethargic. Upon entering the house, you see a 9-year-old girl lying on the couch. Her father says she has been breathing strangely and began vomiting about 45 minutes ago. During your assessment, you determine she needs to be transported to the ER immediately. Which of the following sets of vitals would lead you to believe this girl is in need of immediate transport? a. BP 104/60, respirations of 24 per minute and a pulse of 82 b. BP 100/58, respirations of 14 per minute and a pulse of 130 c. BP 108/64, respirations of 20 per minute and a pulse of 100 d. BP 116/70, respirations of 27 per minute and a pulse of 96

b. BP 100/58, respirations of 14 per minute and a pulse of 130 Rationale: The second answer is the set of vitals that would warrant immediate transport. The respirations are too slow and the pulse is too fast. All other options fall within the normal range for this age of patient.

A fierce winter storm has left hundreds of people stranded along a stretch of highway for a few days. You have been dispatched with the National Guard to help care for anyone suffering from exposure. As you prepare your equipment what things should you carry extra of and why? a. Blankets; Any patients you meet will need aggressive warming and blankets are part of that b. Drinking water; Dehydration is a very likely problem c. Warm IV fluids; The patients will need warm IV fluids to help combat the hypothermia you will likely encounter d. Oral glucose; If patients have not had food for a few days they may have low blood glucose levels

b. Drinking water; Dehydration is a very likely problem Rationale: While warming methods and glucose are good, drinking water is probably the most important. This is due to the fact that cold weather decreases our thirst mechanism and so we don't drink. However, a lot of moisture is lost during the respiratory cycle in cold air. This is compounded by not feeling thirsty, and a person becomes dehydrated very quickly and doesn't realize it. It is important to encourage patients of exposure to take fluids either hot or cold.

You and your partner Abraham arrive on scene to a one-car collision with a cow. Your patient was driving about 45 MPH around a corner when the cow leaped from the roadside in front of the car. After doing your initial scene size up, which of the following would you proceed to? a. Baseline vitals b. Get a general impression of the patient c. Perform a detailed physical examination d. C spine and SAMPLE history with focused physical examination

b. Get a general impression of the patient Rationale: According to the NREMT assessment skill sheets after the scene size up you should move to the primary survey/assessment, which begins with the general impression of the patient.

You and your partner Greg are called to a hockey arena where a fan was struck in the side of the chest with a hockey puck that was hit over the protective glass and into the crowd. The man is having a painful time breathing at about 16 a minute. He says his ribs really hurt. What should your treatment include? a. A chest compression wrap while having the patient maintain his exhaled state b. High flow O2 via NRB and rapid transport c. Bag valve mask with oxygen attached d. Sweeping the tongue out of the way to look for airway obstructions

b. High flow O2 via NRB and rapid transport Rationale: As long as the patient is able to talk and keep their respirations within range, then high flow O2 and transport would be your best choice.

You are dispatched on a medical call to a 45 year old male who is exhibiting signs of a stroke. His wife told dispatch that her husband's speech is slurred and he appears to be having seizures. When you arrive on scene, the man is sweating profusely in a postictal state and breathing at 16 breaths a minute with adequate volume and regularity. What elements of the assessment would likely be the most useful right now? a. Glascow coma scale and pulse rateb. History and blood glucose measurementc. Patent airway established and blood pressure d. Baseline vitals and a rapid physical exam

b. History and blood glucose measurement Rationale: This patient, while exhibiting signs of stroke, is also exhibiting signs of hypoglycemia. Requesting some history from the wife may uncover that the man is a diabetic. A glucose measurement can confirm or disprove the hypoglycemia and allow you to further your differential diagnoses. The other answers each contain assessment elements and tools that would also be utilized, but none would be more useful than answer 2.

A 6 year old girl was found outside in her yard unconscious. She is breathing 6 breaths a minute and her pulse is 58 bpm with poor systematic perfusion. What should you do? a. Assist ventilations with high flow O2 and transport rapidly b. Initiate chest compressions and assist ventilations with high flow O2 c. Use an epinephrine auto injector to increase her heart rate d. Transport with high flow O2 and assist respirations if needed

b. Initiate chest compressions and assist ventilations with high flow O2 Rationale: AHA Guidelines for BLS include compressions for children with a pulse rate of less than 60 bpm who are perfusing poorly. Symptomatic bradycardia is a common terminal rhythm in infants and children. Don't wait for pulseless arrest to begin compressions.

Meconium is: a. A sign of a lower GI bleed. Dark colored stool as the result of digested blood. b. Often found in amniotic fluid when the fetus has voided in the womb. c. A natural lubricant produced in the uterus to aid in delivery of the fetus. d. Is an alternative to Nitro and should only be used if local protocols allow.

b. Often found in amniotic fluid when the fetus has voided in the womb. Rationale: Meconium is the first stools of a newborn. It is a dark green tarry stool composed of water, amniotic fluid, mucus, and other materials ingested while the infant is still in the uterus. Stress and other factors can cause a fetus to have it's first bowel movement in the womb. Though nearly sterile and odorless, it can cause airway and delivery problems if not managed correctly. Bowel movements of meconium may continue for a few days after birth as the child finishes digesting.

A 26 year old woman has called the ambulance because she has begun delivery of her baby. Dispatch says the mother stated the baby's foot was sticking out of the vaginal opening. You should be prepared to? a. High flow 02 on the mother, rapid transport, and gently maneuver the baby's foot back into the vagina b. Place patient into a knee to chest position and rapid transport c. Ask the mother to push and assist with the rest of the delivery d. Gently pull the rest of the baby out by the foot sticking out

b. Place patient into a knee to chest position and rapid transport Rationale: Allow gravity to assist you in keeping the child in the canal until definitive care.

You and your partner Duval arrive on scene to find a woman who has suffered a blunt trauma to the chest from a swing on a carnival ride. She is having difficulty breathing and upon auscultation you hear nothing on the right side. This woman likely has a______________________ and would be suffering from_____________________as the collapsed lung is incapable of oxygenating any blood. a. Flail chest / hyperventilation b. Pneumothorax / hypoxia c. Hemoptysis / hypoventilation d. Broken jaw /severe pain

b. Pneumothorax / hypoxia Rationale: No breath sounds on one side is characteristic of a pneumothorax or collapsed lung. This condition would make oxygenation of the blood difficult at half capacity and cause the patient to be hypoxic.

Without knowing anything else, what condition would you say the following patient is in? A 30 year old male with a pulse rate of 40, breathing at 10 breaths per minute, and a systolic BP of 90. a. Goodb. Poorc. Faird. Moderate

b. PoorRationale: A patient who has bradycardia (HR less than 60), slow respirations (below 12), and a systolic BP of less than 100 would most likely be in a very poor condition.

Which of the following is a high priority condition? a. Child birth b. Severe pain c. Controlled bleeding of the wrists d. An adult breathing at 20 a minute

b. Severe pain Rationale: Uncomplicated childbirth is not a high priority condition. Severe pain anywhere is high priority.

You arrive on scene with your partner Elija to a multiple vehicle accident where you are the 2nd ambulance to arrive. Scene size up indicates there are 7 patients in 3 cars all requiring extrication. In the first car is a 27 year old woman who is 32 weeks pregnant, conscious, and crying, a 12 year old girl who is screaming and complaining of back pain, and an 8 year old boy who has a facial laceration and open fracture of the tibia who is also conscious but breathing very shallow. In the second car is an 86 year old man who is slumped against the steering wheel with no pulse and has a piece of metal impaled through his head. In the third car are 3 teenagers 17 years of age. The two in the front seat are complaining of neck pain and appear to have an altered level of consciousness. Neither of them were wearing a seatbelt and both have contusions on their foreheads. In the back seat is the last occupant, a girl who said she was having a seizure and vomiting earlier so her friends were taking her to the hospital. She was wearing her seat belt and has no sign of injury. Who should be receiving treatment first? a. The pregnant woman b. The 8 year old boyc. The 86 year old man d. The vomiting teenager

b. The 8 year old boyRationale: The 86 year old man shows signs that resuscitation would be futile. The eight year old boy has similar injuries to the other patients, but is the only one having breathing difficulties.

Question 10: Why does the NHTSA require use of lights and sirens during response and transportation? a. The safety of EMS providers and public is the driving force of the NHTSA b. The NHTSA does NOT require use of lights and sirens during response and transportation c. NHTSA research has shown that every second counts in the outcome of patients d. High visibility decreases the likelihood of a vehicle accident

b. The NHTSA does NOT require use of lights and sirens during response and transportation Rationale: Lights and sirens can be used at the responder's discretion to move through traffic more efficiently in order to speed up transport in a safe manner. They can be used for alerting people to your presence, but may also cause anxiety in patients as well as drivers around you, causing them to do stu.... unintelligent things (the drivers not the patients!). The NHTSA does NOT require the use of lights and sirens during response and transport. Each EMS call has a priority and local systems may opt to run 'non-code' for many types of calls and transports.

If a person has dyspnea what is happening? a. They are vomitingb. They are having trouble breathing c. They cannot breathd. They are incontinent

b. They are having trouble breathingRationale: Problems breathing is termed dyspnea. Dys refers to difficulty and pnea refers to breathing.

You are preparing to suction secretions from your patient's airway, when would you engage the suction action in the catheter? a. When inserting the catheter and while suctioning secretionsb. While suctioning secretions and withdrawing the catheterc. From the time the catheter tip passes the lips going in, until it passes the lips coming out d. For no more than 10 seconds

b. While suctioning secretions and withdrawing the catheter Rationale: You should only apply suction once you have the tip in the visible secretions and then continue suctioning on the way out. You should make a good effort to remove all secretions and try to limit your suctioning time to 10 or 15 seconds. If your patient's airway is completely full of secretions it may take a little longer. Remember that you need to clear the airway before ventilation begins to prevent aspiration, but also any suctioning you are doing is removing air from the patients airway as well.

Your patient has been kicked in the chest by a horse and is having trouble breathing. Lung sounds are non existent on the right side where she was kicked and you believe she has a tension pneumothorax. During inhalation, her ______ ______________ impeding ventilation. When she exhales, her ________________ __________________. a. blood pressure rises / blood pressure returns to normal b. mediastinum moves left / mediastinum shifts, distorting the vena cava which results in poor venous return c. lung on the affected side takes in air from the pleural space / lung passes that air back into the pleural space which increases intrathorasic pressure d. ribs over the injured area move outward / ribs move inward over the non injured side

b. mediastinum moves left / mediastinum shifts, distorting the vena cava which results in poor venous return Rationale: With a tension pneumothorax, you would expect the blood pressure to drop, not rise, as venous return is inhibited by the shifting of the mediastinum and distoration of the vena cava. During a pneumothorax, the pleural space fills with air from a hole in the lungs. Not the other way around.

You have been unsuccessful in starting an IV on a 2 year old child that is in cardiac arrest. Your medical direction indicates you should consider initiating IO access to administer medications. As you prepare this procedure what are the anatomical landmarks you are looking for, and what are the complication risks with this procedure? a. distal tibia / fracture of the tibia b. proximal tibia / pulmonary embolism c. distal fibula / compartment syndrome d. proximal fibula / severe pain

b. proximal tibia / pulmonary embolism Rationale: The proximal tibia is the usual site to establish an IO catheter in a pediatric patient. All of the above mentioned complication risks are correct. Fracture of the tibia, pulmonary embolism, compartment syndrome, and severe pain upon infusion of fluids can be possible when initiating IO access.

You arrive on scene with your partner Zelda to a restaurant where a woman is apparently having a reaction to the seafood from the buffet. She is having trouble breathing and her lips are swollen. Zelda hands you an adult EPI pen and you inject the patient into the thigh and hold it there for about 3 seconds. How long will the injection likely be effective? a. 30-60 minutes b. 1-2 hours c. 10-20 minutes d. 24 hours

c. 10-20 minutes Rationale: Plan for it lasting only 10-20 minutes. Having additional dosages on hand during transport is a necessity.

You have an unconscious patient. What do you do? a. Start CPR immediatelyb. Baseline vitals, primary assessment, and secondary assessment c. ABCs, History taking, Rapid full body scand. ABC, Baseline vitals, Transport decision

c. ABCs, History taking, Rapid full body scan Rationale: According to the NES, the ABCs are part of the primary survey, which is then followed by history taking, and then the secondary assessment. A rapid full body scan is the first step of the secondary assessment. The rapid full body scan may be incorporated into the primary survey in order to determine life threats. You would not start CPR as the patient is only unconscious. They may be breathing with a pulse. Baseline vitals come after the primary and secondary assessments. Transport decision also comes before vital signs.

A DNR is? a. A dual lumen airway device b. Not legal to use in all states c. An advanced directive d. Only valid if notarized

c. An advanced directive Rationale: Do Not Resuscitate. This is a legal document directing medical care (or refusing interventions) should the patient stop breathing or go into cardiac arrest.

You are dispatched to a daycare where a child is having difficulty breathing. The caregiver called 911 and reported that the 5-year-old went down for a nap. When she went to check on him 30 minutes later he did not appear to be breathing normally. En route to this call, what are the most important things to remember? a. Sunken fontanelles can indicate dehydration or possible allergic reaction. Wheezing respirations with red skin may also indicate swelling in the throat.b. Daycare providers are often involved with child abuse. Remember to look for odd shaped bruising or burns on the child. Note if the caregiver is acting oddly or has difficulty making eye contact with you.c. Because of the size of a child's head you may need additional padding under the shoulders to align the airway. Flexion and hyperextension can obstruct the airway.d. Caregivers may be reluctant to give additional information about the cause of the child's respiratory difficulty out of fear of blame. Call law enforcement if you suspect abuse.

c. Because of the size of a child's head you may need additional padding under the shoulders to align the airway. Flexion and hyperextension can obstruct the airway. Rationale: You are being called for breathing difficulty. The most important initial considerations should revolve around making sure the child's airway is open. Understanding the anatomical differences in a child is necessary to ensure that the intervention of physically opening the airway is done properly. Properly dealing with the airway issue is your primary concern. You can deal with any possible legal issues after taking care of the patient.

You are dispatched to an amusement park where a 16-month-old boy is reported to have something wedged in his throat. Dispatch says that the child is breathing, but it sounds very noisy like a whistle. Upon arrival you can see that the child is breathing with stridor, is pale, and is beginning to turn blue around the lips. What is the best treatment plan for this patient? a. Try to see the object in the child's throat and remove with your fingers if possible. Call for additional help if unable to remove the object.b. Give the child 3 back slaps and 3 abdominal thrusts. If the object does not dislodge, begin transport with non-reabreather mask and O2. c. Begin transport while giving blow-by oxygen. Continue to monitor the status of the child's airway en route to the hospital. d. Perform pediatric Heimlich thrusts with an upward motion slightly lower than those used on adults.

c. Begin transport while giving blow-by oxygen. Continue to monitor the status of the child's airway en route to the hospital. Rationale: The best choice is to begin transport while giving blow-by oxygen. As the child's airway is not completely occluded and he is still exchanging air, you should begin moving toward definitive care while providing additional oxygen. Using a mask to provide oxygen to a patient with a foreign body airway obstruction is contraindicated.

A 73 year old female was in her backyard gardening when she collapsed to the ground. Her husband told 911 that "she is breathing very fast and will not talk to me." You arrive to find the woman lying on her side in the grass. She is breathing at 7 breaths per minute and her pulse is irregular and very thready. Her lungs also present with crackles upon auscultation As you are taking a blood pressure (88/66) the husband tells you that the woman has been having jaw pain and some weakness for approximately 3 days. What is the most likely cause of this woman's condition and how would you treat her? a. Hypoperfusion, High flow O2, and transport in Fowler's positionb. Cardiac arrest, Treat for shock, and rapid transportc. Cardiogenic shock, Assist ventilations, and transportd. Septic shock, Transport in a position of comfort with high flow O2 via NRB

c. Cardiogenic shock, Assist ventilations, and transport Rationale: This woman is likely experiencing pump failure and she is hypoperfusing. Her poor respiration rate necessitates assisted ventilations. Transporting in the Fowler's would not be appropriate as it would increase the work load on the heart. Gravity increases the difficulty of pumping blood to the brain when the head and chest are elevated.

You and your partner Ebstein have been summoned to a residence where a 53 yr old woman has had a syncopic episode. You arrive to find her sitting on the couch sipping a glass of water. She states that she is feeling perfectly fine now. At this time a teenage girl enters the room with a monster mask in her hand. She tells you that she frightened her mother while wearing the mask. After administering oxygen to this patient, what would be the best course of action?_________________What was most likely the cause of this woman's hypoperfusion?____________ a. Do a focused physical exam on whatever injuries she has. Neurogenic shock is caused by pump failure to properly oxygenate the brainb. Have her lay down for a while until her blood pressure is back to normal. Increased vasoconstriction during the fight or flight response causes the body to shunt blood away from the brainc. Do a rapid trauma assessment to make sure she was not injured in the fall. Her sympathetic nervous system caused widespread vasodilationd. Help her to the ambulance for transport and evaluation at the hospital. Her nervous system reacted to the scare by increasing vascular pressure, impairing oxygen transport

c. Do a rapid trauma assessment to make sure she was not injured in the fall. Her sympathetic nervous system caused widespread vasodilation Rationale: The woman is most likely fine and recovering from a case of psychogenic shock resulting from her daughter's prank. Lying supine for a short time is often all that is necessary to treat this condition. Doing a rapid trauma assessment would be appropriate in order to verify she was not hurt in the fall. The fainting spell is caused by the sympathic response to the scare. Blood is shunted from the lower priority organs and there is widespread vasodilation resulting in the hypoperfusion to the brain.

What is the area of hazardous contamination known as? a. Green zone b. Yellow zone c. Hot zoned. Black zone

c. Hot zoneRationale: An area of contamination is referred to as the hot zone.

A 45 year old male patient is complaining of headaches and fatigue. He has had a fever of over 102 degrees for 3 days now and he says his neck hurts when he moves his head around. These signs and symptoms make you consider that this man is suffering from? a. A mild stroke b. Migraine headache c. Meningitis d. Cerebral aneurism

c. Meningitis Rationale: Persistent headache, fatigue, fever, and neck pain are all classic signs of meningitis.

You are dispatched to a boat fire with multiple victims in the water. You are the only provider on scene. Upon arrival you find patient #1 shivering uncontrollably, but able to answer questions appropriately. Patient #2 is on a boat across the bay with another EMS unit. That unit relates that the patient is mildly hypothermic and doesn't want to be transported. Both patients indicate that a third person was with them and that he was burned badly. On scene command confirms that this patient is still in the water. Which is the most critical patient, and why? a. Patient #1, because she is in severe hypothermia.b. Patient #2, because he can't reason properly.c. Patient #3, because he will require the most care when he is removed from the water. d. Patient #1, because she is in hypogenic shock.

c. Patient #3, because he will require the most care when he is removed from the water. Rationale: Patient #3 is triaged as the most critical, even though you haven't seen him. Patient #1 is in mild hypothermia, and can be treated at the BLS level with warming measures. Patient #2 has been assessed and is refusing transport, so he is not your concern. There is no such thing as hypogenic shock.

You arrive on scene with your partner Stuart to a multi-car collision involving at least 6 patients. You have called for additional units to help you out with the scene. What should you do next? a. Perform a detailed history on the patientsb. Begin treating the patients immediatelyc. Prioritize and triage the patientsd. Check to see who the youngest is and treat them

c. Prioritize and triage the patientsRationale: With more patients than you can manage, you need to prioritize and triage based on who has the worst injuries.

You arrive on scene with your partner Emilio to find a woman who is having problems breathing. She is speaking in 1 or 2 word bursts and is on oxygen at 3 liters per minute. There is an ashtray next to her bed loaded with cigarette butts. She says her care taker called the ambulance and she does not want you there. She says she will allow you to take her vitals but then you have to leave. Her BP is 100/60 her pulse is 48 and her respirations are 18. She says she is 89 years old and has a pacemaker and is on high blood pressure medication. "I just want to be old, please leave", she says. What should you do? a. Transport her to the ER. Her vitals dictate that you mustb. Tell the care giver to quit calling and giving false alarmsc. Respect her wishes and leave, asking her to please call if she needs medical attention d. Prepare to bag her and transport when she eventually passes out

c. Respect her wishes and leave, asking her to please call if she needs medical attentionRationale: As long as the patient is of sound mind you must respect their request to be left alone. Reminding her that you are a phone call away is not a bad idea.

Question 46: The patient is a 6 year old girl whose mother says has been sick for a few days and then started having breathing problems this morning. Upon assessment, you notice the child is flaring her nostrils and has a hoarse voice when talking. What is she most likely suffering from and what should you do? a. She could have croup and needs to be transported with a nasal cannula at 4 lpmb. She could have tonsillitis and will require transport to the hospital in a position of comfort c. She could have epiglottitis and needs to be transported with high flow O2 on an NRBd. She could have SARS and should be transported wearing a HEPA mask

c. She could have epiglottitis and needs to be transported with high flow O2 on an NRBRationale: Epiglottitis is known to strike children in this age group. Croup is usually in younger children. Transporting with airway support is the best answer.

What is the first stage of labor? a. The baby crowns b. The baby is in the birth canal c. The cervix is dilating d. The placenta is delivered

c. The cervix is dilating Rationale: The cervix dilates and thins during the 1st stage of labor. During the 2nd stage the baby enters the birth canal. From delivery of the infant on to delivering of the placenta is the 3rd stage.

You are transporting a 27-year-old female who was the driver in a single car MVA on a remote logging road. She is on oxygen at 12LPM and had an actively bleeding laceration on her scalp that has been controlled with pressure. Her pulse is 100 with respirations of 12 a minute and her blood pressure is 110/70. You are still 30 to 40 minutes from the hospital. According to the NREMT trauma management skill sheet, which of the following answer choices contains the best treatment for this patient given the circumstances. a. Put a C-collar on her and re-assess vitals every 15 minutes en routeb. Perform a secondary assessment of the laceration to make sure bleeding has stopped c. Assess airway, breathing, and circulation every 5 minutes until arrival at the hospitald. Reassess and treat any conditions that present

d. Reassess and treat any conditions that presentRationale: The patient has been treated, packaged, and baseline vital signs have been taken. The final step on the NREMT Trauma Assessment Skill sheet would be the reassessment and ongoing treatment of the patient.

You are transporting a 6-year-old child that had a seizure. She is in the postictal state. How would you best describe this patient? a. The patient is sleeping comfortably and is easy to rouse b. The patient has weakness on one side of the body and acts as if they have had a stroke c. The patient is unresponsive with deep and rapid respirations d. The patient is combative and wants to fight you

c. The patient is unresponsive with deep and rapid respirations Rationale: The state at the end of a seizure where the patient is no longer having active seizures is called postictal. During the postictal state the patient's muscles relax and the breathing becomes deep and rapid in an attempt to compensate for the buildup of acids in the body. The patient usually begins breathing normally after several minutes as the body pH goes back to normal. Most commonly, the patient is lethargic, confused, or unresponsive. While not as common, a patient may exhibit one-sided weakness like a stroke. However, unlike a stroke, this usually resolves rather quickly. Patients can become combative as they begin to regain consciousness and their minds try to determine where they are and what has happened. Always be prepared for this possibility. If your patient doesn't improve and remains unresponsive or lethargic for a long time, you might want to consider some other possible underlying problems like hypoglycemia or a system infection of some kind.

You arrive on scene at a single-car accident involving a moose. Your patient was driving about 50 MPH when she hit the moose. After completing your scene size up, to which of the following would you proceed? a. Baseline vitals and oxygen b. Detailed physical examination c. The patient's chief complaint d. SAMPLE history with focused physical examination on c-spine

c. The patient's chief complaint Rationale: According to the NREMT Patient Assessment /Management - Trauma Skill sheet, you would want to proceed with the primary survey. This begins with verbalizing a general impression of the patient, determining level of consciousness, and determining the chief complaint and apparant life threats. Baseline vital signs would not be taken until after the secondary assessment. A detailed physical exam (secondary assessment) would not be completed until the primary survey is finished. A SAMPLE history would not be taken until the primary survey is completed and a transport decision was made.

An adult with a respiration rate of ______per minute would be considered within normal limits. A child aged 3-5 with a respiration rate of_______per minute would be considered within normal limits and an infant who is breathing at________per minute would be considered within normal limits. a. 22, 32, 42 b. 11, 6, 15 c. 20, 40, 60 d. 16, 25, 40

d. 16, 25, 40 Rationale: According to NES guidelines normal adult respiratory rates are from 16-20 - preschool aged children (3-5)children are 20-30 and infants are 40-60 initially and drop to 30-40 after a few minutes.

An ice storm has caused a 10 car pile up on a nearby interstate. Incident command has instructed you to take over triage of the patients. Patient 1 is a woman who has a broken arm and a back injury with suspected spinal cord damage. Patient 2 is male and has a broken femur and is showing signs of shock. Patient 3 is an elderly woman who has a laceration on her forehead and pain in her wrist. Patient 4 is a male, breathing at 6 breaths a minute with a head injury. What color triage tag should each of these patients receive? a. 1Red, 2Red, 3Black, 4Red b. 1Yellow, 2Yellow, 3Green, 4Black c. 1Green, 2Red, 3Black, 4Red d. 1Yellow, 2Red, 3Green, 4Red

d. 1Yellow, 2Red, 3Green, 4Red Rationale: The first patient with the back injury is yellow tagged, even with the suspected spinal cord injury, their transport is delayed. Patient number 2 is a red tagged because of the signs of shock, they require immediate transport. Patient number 3 has only minor injuries, therefore, she gets a green tag and is transported last. Patient number 4 is having problems breathing, so it is priority one or red tag.

You and your partner Tom arrive on scene of a gang shooting where the police have secured the area. There are two patients in their teens with multiple gunshot wounds to the arms, legs, and chest. You would immediately? a. Treat the most critical patient while Tom watches your back b. Make sure the police have secured the scene and get a SAMPLE c. Call for backup and put both patients in the back of your ambulance d. Apply 3-sided dressing to the chest wounds and assess breathing while your partner treats the other patient

d. Apply 3-sided dressing to the chest wounds and assess breathing while your partner treats the other patient Rationale: A gunshot wound to the chest is a life threatening injury and should be treated immediately with a 3-sided dressing as long as the scene is safe (the scenario said it was). The other answers may have things that should be done but not immediately.

You are called to the scene of a man down. Dispatch reports the man is pulseless and bystanders are doing CPR. According to the NREMT Cardiac Arrest Management/AED skill sheet, which of the following sequences is appropriate? a. Check for responsiveness, Assess for breathing, Check carotid pulse , put your gloves onb. Question the bystanders, direct them to stop CPR , check for pulse and then attach the AED, Begin chest compressionsc. Turn on power to AED, open the patient's airway, insert an adjunct and then analyze the rhythmd. Complete one cycle of CPR, Attach the AED, Have everyone stand clear during rhythm check

d. Complete one cycle of CPR, Attach the AED, Have everyone stand clear during rhythm checkRationale: Your gloves should be on! According to the NREMT skill sheet one cycle of CPR should be performed prior to attaching AED. Inserting an adjunct is not listed on this NREMT Skill Sheet.

Which of the following would not be considered an early sign of respiratory depression in a 7 year old girl? a. Bobbing of the headb. Retraction of the intercostals c. Rapid respirationsd. Cyanosis of the lips

d. Cyanosis of the lips Rationale: All of the answer choices are EARLY signs of breathing problems in a child with the exception of Cyanosis. Cyanosis is a LATE sign.

Which of the following statements is correct regarding the operation of an emergency vehicle: a. Emergency vehicles have certain limited privileges in every state which protects them from liability in a collision b. Emergency vehicles should only pass school buses when they have stopped to load childrenc. Pedestrians and drivers in all states are required to give emergency vehicles the right of wayd. Emergency vehicles must always be operated with due regard for the safety of others

d. Emergency vehicles must always be operated with due regard for the safety of others Rationale: Even with limited privileges the driver of an emergency vehicle may still be held liable in a collision. You should never pass a school bus that is stopped to load or unload children. Emergency vehicles operating with lights and sirens are requesting the right of way from pedestrians and other drivers. Each state has different laws with regard to right of way privileges. Drivers and pedestrians in all states are not required to give the right of way to emergency vehicles.

You arrive at a restaurant to a call of a woman choking. You find her sitting in a chair, very pale, and sweating. She states in a very hush tone that she has a piece of steak caught in her throat. You should immediately? a. Give her the Heimlich and pop the chunk of steak out b. Tell her she should not take such big bites c. Wait until she passes out and then give her abdominal compressions on the ground d. Encourage her to cough as it is likely high enough in the airway to expel it

d. Encourage her to cough as it is likely high enough in the airway to expel it Rationale: Unless her airway is completely blocked you should not attempt Heimlich thrusts. If she can speak there is a chance she can work the obstruction out herself.

An ambulance unit or fire department that makes an uncoordinated, independent decision during an incident is said to be: a. Soloingb. Spear Heading c. Bird Dogging d. Freelancing

d. Freelancing Rationale: Any individual, unit, or agency that is making decisions outside of the ICS system is considered to be freelancing. This type of behavior can lead to chaos, injury, and even death. It is vital that all responders at a scene understand the role of Incident Command and follow the direction of the Incident Commander.

You are standing by at a local sporting event when a mother rushes up to you with a 3-year-old boy in her arms. " He was playing with my car keys and then just started gagging and coughing!", she tells you in a panic. The child is having difficulty breathing and crying along with audible inspiratory stridor. What should you do? a. Give three quick abdominal thrusts to dislodge the FBAO. b. Visualize the FBAO and do a finger sweep to remove it.c. Turn the child upside down and give 3 quick back slaps.d. Give blow by oxygen and carefully monitor during transport.

d. Give blow by oxygen and carefully monitor during transport. Rationale: As long as the child is able to pass an adequate amount of air, which this child appears to be doing, then supportive care, transport, and oxygen therapy is all that should be done. Complete occlusion of the airway would obviously necessitate different measures.

Your patient is a 14-year-old girl who is complaining of vaginal pain after falling onto the center post of her bike. She is alone and very scared. She has called the accident in on her cell phone and stated that she is bleeding very badly and feeling faint. Besides treating for shock, what other things should you consider with this patient? a. Transporting in the fowler's position and O2 on nasal canula at 6 lpm b. Parental release and advice about bike riding c. If she is having her period and are her parents home d. Having a female EMT respond for the patient's modesty

d. Having a female EMT respond for the patient's modesty Rationale: Having a female EMT respond out of concern for the patient's modesty would be a good consideration. Unfortunately, having a female EMT is not always possible.

You and your partner Amy arrive on scene to find a woman with hives over much of her body. She is wheezing and complaining of difficulty breathing. Her husband says she was stung by a hornet and has no prior history of allergies. What would be the best course of action? a. Use an autoinject epinephrine pen and administer to the patient's thigh. Obtain signed transport refusal.b. Make sure blood pressure is above 100 mmHg and inject her with epinephrine 1/1000.c. Get her BP, pulse, and respirations and then inject her with epinephrine only if her vitals are within normal limits. d. High flow O2 and rapid transportation if the patient appears to be going into anaphylaxis.

d. High flow O2 and rapid transportation if the patient appears to be going into anaphylaxis. Rationale: Tending to the patient's ABC's and monitoring vitals is important in determining the onset of an anaphylactic reaction. If you administer epinephrine you would not have the patient sign a transport refusal. If you administer care, the patient needs to be transported. You do not need to make sure her BP is over 100 mmHg (that is for nitro). Having vital signs within normal limits is not a necessary criteria for giving epinephrine.

Your patient has a distended abdomen which you know can disrupt proper movement of the diaphragm and lead to? a. Hyperventilation b. Hyperglycemia c. Pleurisy d. Hypoventilation

d. Hypoventilation Rationale: If the diaphragm cannot move very well it inhibits breathing and poor breathing will lead to low oxygen levels or hypoxia.

Which type of shock would you expect to find in a patient who has vomiting, urinating, and diarrhea? a. Anaphylactic shock b. Neurogenic shock c. Septic shockd. Hypovolemic shock

d. Hypovolemic shock Rationale: Hypovolemic shock can result from excessive vomiting, urination, and diarrhea as the body voids much of the fluids that are needed to balance itself. This may also cause changes in the body's metabolic balance and be the reason for additional care to balance the metabolic system as well.

In order to speed delivery of the placenta the EMS provider should? a. Gently pull on the umbilical cord until it delivers b. Massage the cervixc. Position the mother in a prone positiond. Let the placenta deliver on its own

d. Let the placenta deliver on its own Rationale: None of the above is recommended and all of the other answers can be dangerous. Letting the placenta deliver in it's own time is recommended (usually in 30 minutes).

Question 29: You assess a young man who has yellow colored sclera. You would suspect he is suffering from? a. Kidney disease b. Hephaltic failure c. Pancreatic maltosis d. Liver failure

d. Liver failure Rationale: Liver problems often manifest themselves as a yellowing of the sclera. As seen with jaundice.

An Incident Command System is designed to: a. Notify emergency personnel about the level of triage to expect b. Stabilize patients of a mass casualty c. Define the roles and responsibilities of an EMS system d. Manage and control emergency responders and resources

d. Manage and control emergency responders and resources Rationale: Incident Command Systems are utilized to manage resources and responders and are very useful in mass casualty events and scenes that contain hazardous materials.

GI bleeding can be caused by all of the following except? a. Inflammation b. Infectionc. Obstruction d. Obtunded

d. Obtunded Rationale: Gl bleeding causes include disease processes, inflamation, infection obstruction to the upper or lower GI tract and more. Obtunded is a term to describe a persons level of consciousness. It is a mental blunting with a mild to moderate reduction in alertness and a dullness to sensation.

The primary survey is used to: a. Get a rapid understanding of the sceneb. Gather vital signs and discover injuriesc. Gather history of the eventd. Rapidly identify critical patients and life threatening conditions

d. Rapidly identify critical patients and life threatening conditions Rationale: The primary survey is used to quickly identify any life threatening injuries or conditions that the patient may have. This includes your general impression of the patient, the patient's level of consciousness, the patient's chief complaint or obvious life threats, the quality of the patient's airway, breathing, and circulation, and a transport decision. All of the other answer choices happen either prior to the primary survey or after primary survey.

Your patient was the restrained passenger in a vehicle accident. She is complaining of back pain and shortness of breath. The proper way to remove this patient from the car is? a. Using a seated immobilization device and then moving her to a backboard b. Rapid extrication while maintaining c-spine precautions c. With 2 EMTs in the car and 2 outside the car d. Splinting any fractures and transitioning her out on a backboard

a. Using a seated immobilization device and then moving her to a backboard Rationale: Using a KED or similar device with a seated patient and then transferring them to a backboard is the proper method of packaging this patient, provided there is no scene safety issues. You should provide high-flow oxygen to this patient and monitor her airway as well.

You and your partner Obi have been dispatched to a home for breathing difficulties. You arrive to find a 50 year old man in bed with labored breathing. His respiration rate is 20 with only very slight chest rise. His color is slightly pale and his pulse is weak. Family members tell you that the man has AIDS. When this history is presented Obi says, " I am sorry, but I don't want to catch AIDS. I can't help". Obi then leaves the house. What has just occurred? a. Obi has abandoned the patient by refusing to administer care. He has a duty to actb. A breakdown in communication between you and Obi has compromised the trust of the family and patient in EMS c. Obi has correctly determined that the scene is not safe and removed himself from the environmentd. Obi has caused psychological damage to the family. Physical harm to the patient is likely without his assistance

a. Obi has abandoned the patient by refusing to administer care. He has a duty to act Rationale: Denying care to this patient would be considered abandonment, even if Obi believed the man posed an infectious risk. His action can also be a violation of the Americans with Disabilities Act and possibly constitute negligence if the other 4 base criteria are met. There was no breakdown in communication from his statement. The family and patient may not be happy about Obi's statement, but it is a stretch to say that he has compromised the family and patient's trust in EMS. It is also not likely that you could determine on scene, that the family has suffered psychological damage as a result of the statement.

ou and your partner Genovese suspect a significant MOI to a patient who has been in a high-speed front end collision. In what order should you do your assessment? a. Primary survey - SAMPLE history - Secondary assessment b. SAMPLE history - Rapid trauma assessment - Focused physical c. Vital signs - SAMPLE history - Secondary survey d. Focused trauma - SAMPLE - Baseline vitals

a. Primary survey - SAMPLE history - Secondary assessment Rationale: According to the newest NREMT trauma assessment skill sheet, a primary survey should be followed by history taking and then a secondary assessment.

You are assessing a patient who is complaining of severe chest pain. The patient is sweating and has a BP of 96/55. You have the patient's medications with you including a prescription for nitroglycerin. You contact medical control and are ordered to give the patient 1 nitro tablet sublingually. What would you do? a. Repeat the blood pressure and ask again what you should dob. Give the patient 1 nitro tablet as instructedc. Instruct medical control to get out the protocol books and look under contraindications for nitro administration d. Repeat the blood pressure and administer 1 nitro tablet

a. Repeat the blood pressure and ask again what you should do Rationale: Giving nitroglycerin to someone who has a systolic blood pressure below 100 is likely to cause the blood pressure to go dangerously low and is not advised. Assuming responsibility and liability for your decision to decline is another issue for you to think about.

Which of the following would be a sign that CPR may not be necessary? a. Stiff neck and jawb. Core cyanosisc. No pulse or respirationsd. The patient is unconscious

a. Stiff neck and jaw Rationale: A stiff neck and jaw may be a sign of rigor mortis and CPR would not be initiated if the patient were pulseless and apneic as well as having rigor mortis. Remember to assess for rigor mortis in at least 2 joints. The other answer choices would all be indications of a possible need to begin CPR.

You and your partner Larry are dispatched for a call to a man with severe stomach pain. When you arrive on scene you find him lying on the floor of the kitchen in the fetal position. There is vomit on his face and he says he is going to throw up again. He denies falling and says the only thing wrong is that his stomach is killing him. Assessing his abdomen you find it to be very tender to the touch and he moans when you palpate his stomach. He is also breathing very fast at 30 a minute. What other signs and symptoms might you find with this patient? a. Tachycardia - hypotension - fever b. Bottle of poison, cyanosis, and crepitus c. Broken ribs, hypertension, and deep, rapid breathing d. Rebound tenderness - metabolic acidosis

a. Tachycardia - hypotension - fever Rationale: The patient is not likely to have crepitus, having no pain and denying that they fell. A person with broken ribs is unlikely to be breathing fast and deep and if a person has been vomiting copious amounts it is likely they would be in metabolic alkalosis rather than acidosis.

You and your partner Zoe arrive on scene to find an 8 year old girl who was struck by an ice cream truck while crossing the street. She is unresponsive and has an abrasion on her forehead and an abrasion on her right side. She is breathing at 20 breaths per minute with adequate depth. What would be the most appropriate action to take at this point? a. Take C-spine precautions and Administer O2 via nasal canula at 6 LPMb. Do a rapid trauma assessment and call law enforcementc. Start positive pressure ventilations with a BVM at 12-20 breaths per minuted. Give her a sternal rub to check for responsiveness and bandage the abrasions

a. Take C-spine precautions and Administer O2 via nasal canula at 6 LPMRationale: Her respirations are within range and she was just struck by a car. C-spine precautions and oxygen would be the best choice of those given.

You and your partner Grimes are called to the scene of a stabbing. There are two patients reported. A woman with a stab wound to the URQ and a man with a stab wound to the LRQ. The woman with the wound in the URQ is having problems breathing, has a pulse of 103, respirations of 35, and they are shallow. The patient with the stab wound to the LRQ is complaining of severe abdominal pain and has a pulse of 48 and a respiration rate of 24. Which patient is most likely to have a low blood pressure? Why? a. The man, because of the nature and location of the injury, he may be losing blood internally. His pulse is too slow as wellb. The woman, because if she cannot breathe well her BP will dropc. The man, because a respiration rate of 24 is indicative of low blood pressure d. Neither will have a low blood pressure, they will both be high

a. The man, because of the nature and location of the injury, he may be losing blood internally. His pulse is too slow as well Rationale: The man with the pulse of 48 and a knife wound to the lower right quadrant suggests internal bleeding which would lower the blood pressure.

The body's first physiological response to a deep laceration is ____________________. a. To stop it by chemical means and vasoconstriction (hemostasis) b. To stop it by means of slowing the heart and respirationsc. Psychogenic shockd. Decorticate posturing

a. To stop it by chemical means and vasoconstriction (hemostasis) Rationale: Localized constriction of the vessels, formation of a platelet plug, and coagulation are the initial steps the body takes to stop the bleeding.

You are treating a female patient who is complaining of chest pain. She is diaphoretic with a blood pressure of 98/50. You have her medications on board which includes a prescription for nitroglycerin. Medical control has instructed you to administer 1 nitroglycerin tablet sublingually. How would you respond? a. Respectfully disagree and state that you feel it is in the best interest of the patient with a blood pressure so low to not lower it any further by administering nitroglycerinb. Administer 1 nitroglycerin tablet as instructedc. Instruct medical control to get out the protocol books and look under contraindications for nitroglycerin administrationd. Repeat the vital signs to medical control and ask if they still wish to have you administer the nitroglycerin with the blood pressure that low

d. Repeat the vital signs to medical control and ask if they still wish to have you administer the nitroglycerin with the blood pressure that low Rationale: Administering nitroglycerin is contraindicated in patients with a blood pressure of less than 100 (Systolic). However it is always the best option to repeat the information to medical control if they give an order you think might be dangerous. Many doctors would have no problem with administering nitroglycerin to a patient who has a borderline BP, but you want to make sure they understand your concern. Ultimately you are an extension of the medical direction and unless you are sure the prescribed treatment will cause harm, you should follow the directions after clarifying the information. You should never blindly follow orders. You need to make informed and educated treatment decisions.

You and your partner Stacy are called to an apartment complex for a 17 year old female complaining of abdominal pain. Upon entering the residence you see the patient looking pale and lying on the couch. Her abdomen is completely distended and she has a towel in her lap with traces of blood on it. Her respirations are at 20 breaths per minute and her pulse is 114. She denies any trauma and tells you she has a small amount of vaginal bleeding. After applying high flow O2 and moving her to the ambulance, you discover a loop of tissue protruding from the patients vagina. What is likely happening with this patient and how would you treat her? a. She has preeclampsia with placenta abruptio. She should be transported in a left lateral recumbent position and treated for shock. Initiate IV therapy if scope of practice allows. b. She is giving birth and has a nucal cord. Transport with the patient's head and torso down while monitoring vitals in route. Initiate IV therapy if scope of practice allows. If ETA is more than 30 minutes gently maneuver the cord back into the vagina. c. She has an acute lower GI bleed and should be transported in a position of comfort and treated for shock. Establish IV if scope of practice allows. d. She has a prolapsed cord. Insert a gloved hand into the vagina and check for pulsations in the cord. Gently lift child's head off of the cord and transport in a supine position with the hips elevated. Treat for shock and establish IV en route if scope of practice allows.

d. She has a prolapsed cord. Insert a gloved hand into the vagina and check for pulsations in the cord. Gently lift child's head off of the cord and transport in a supine position with the hips elevated. Treat for shock and establish IV en route if scope of practice allows. Rationale: This patient is most likely delivering a child and has a prolapsed cord. A loop of umbilical cord emerges from the vagina first prior to any part of the baby. The danger is that the cord can become compressed between the baby's head and the mothers pelvis interfering with blood flow to the baby. If the cord is pulsing, it is a good sign. Do not, at anytime, push the protruding part back into the vagina. Use a warm and moist sterile towel to cover the umbilical cord.

A call has come in for a possible drowning. You and your partner respond to a public swimming pool a few blocks from the station. A 9-year-old boy apparently slipped while running, hit his head on the edge of the pool, and fell in. He has no pulse and he is not breathing. What would be your best choice of action? a. Apply a cervical collar and begin respirations and compressions at a 30:2 ratio. Deliver breaths with a BVM at 12-20 breaths per minute.b. Insert an oropharyngeal measured from the corner of his mouth to his earlobe and begin assisting ventilations at 15-30 breaths per minute.c. Take mechanical c-spine precautions and begin CPR delivering 5-6 breaths per minute while giving 100 compressions in that same time period.d. Take manual stabilization of the boy's head and neck while additional rescuers ventilate at about 13 breaths per minute and provide at least 100 compressions per minute.

d. Take manual stabilization of the boy's head and neck while additional rescuers ventilate at about 13 breaths per minute and provide at least 100 compressions per minute. Rationale: AHA Guidelines state that two person health care provider CPR performed on a child should be done at a 15:2 ratio. This means you will deliver about 13 breaths a minute instead of the 5-6 delivered for an adult. Additionally, if a c-spine injury is suspected, as in this case, manual c-spine stabilization is now advised as mechanical/cervical may interfere with CPR. Answer 2 does not address the absence of pulse and artificial ventilations are being delivered too fast.

You are about to begin CPR on a patient .You go to open their airway when you realize that CPR will probably not be advised. Which of the following answers could be a reason not to administer CPR? a. The patient is unconscious and not breathing b. The patient has hot, dry skin c. The patient has no pulse or respirations d. The patient has a stiff neck and jaw

d. The patient has a stiff neck and jaw Rationale: A stiff neck and jaw may be a sign of rigor mortis and CPR would prove futile.

You and your partner Steve arrive at an apartment building where you are greeted outside by a very upset woman. She says her husband is upstairs and needs help. He is a 57 year old and was a chain smoker for 35 years. As you enter the apartment, the man is sitting in a tripod position and pursing his lips while exhaling. Why is this patient pursing his lips? a. So he won't hyperventilate b. To exhale air quicker c. He just ate something hot d. To keep alveoli open with back pressure

d. To keep alveoli open with back pressure Rationale: Breathing with pursed lips is a sign that a COPD patient is trying to keep the alveoli open by creating back pressure on their lungs.

Your local Emergency Medical System is regulated by: a. The National Registry of Emergency Medical Technicians. b. Your medical director.c. The National Highway Traffic Safety Administration.d. Your state EMS office.

d. Your state EMS office. Rationale: All Emergency Medical Systems are regulated by the state EMS office.