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What is the side effect of positive pressure ventilation when properly delivered? An increase in minute volume A drop in blood pressure An increase in perfusion A decrease in oxygenation

- a drop in blood pressure Positive pressure ventilation impedes venous return and causes a drop in blood pressure. It could also increase minute volume if the patient has not been breathing improperly; but that is not a side effect. It won't increase perfusion if it drops blood pressure. And it will have no effect on oxygenation if the patient is not perfusing; oxygen increases oxygenation when a patient is perfusing adequately.

The signs that are present when a diabetic has a hypoglycemic reaction are due to chemoreceptor stimulation. a sympathetic response. anaerobic metabolism. RAS hypoglycemia.

- a sympathetic response Remember hypoglycemia is often called "insulin shock." So the answer is a sympathetic response; that's the response present in shock states (except septic shock). The skin becomes pale and clammy and the pulse may elevate. RAS hypoglycemia is a made up distractor; never pick something you've never heard of or read about. The same is true for chemoreceptor stimulation which does occur in normal physiology when the CO2 levels of the blood increase or decrease. Anaerobic metabolism happens in shock states where hypoperfusion is present for longer periods of time.

Which of the following is the best example of how to communicate with a patient? "Can you describe the type of pain you are feeling?" "I am here to help and everything will be OK." "Can you tell me why you ate that food?" "I think you have cholecystitis."

-"Can you describe the type of pain you are feeling?" "Can you describe the type of pain you are feeling?" is an open-ended question that allows the patient to describe their answer in their own words. That is the best example of therapeutic communication in this question. Providing a false sense of security isn't helpful. Accusing words like "why" a patient did something cuts off communication. And using medical terms like cholecystitis confuses patients and doesn't impress them. Use common words and therapeutic communication.

A 9 year old boy says he is sick and complains of abdominal pain. His Mom called you because he won't sit up and is lying in a fetal position in bed. He is hot to touch. As you begin to assess him, you should say "Does it hurt when I push here?" This is as you push over his RLQ. "Can you tell me if the pain increases or decreases when you cough?" "Is this pain more like gas, or burning or squeezing?" "Can you point, with one finger, to the spot that hurts the most?"

-"Can you point, with one finger, to the spot that hurts the most?" All of these are useful assessment answers, but you're dealing with a young boy who will best follow your simple instructions. The best option is to have him point to the spot that causes him the most pain. The change of pain with cough works better for adults to determine peritonitis. Picking the type of pain also works better for adults. And palpation of suspected peritonitis is really not recommended in a patient who has the symptoms he presents with. Peritonitis-Inflammation of the membrane lining the abdominal wall and covering the abdominal organs.

65 year old man complains of chest pain. You should next ask him "Are you taking any cardiac medication such as nitroglycerin?" "How many minutes have you been experiencing this pain?" "Is this the first time you've had this type of pain?" "What do you think caused this pain?"

-"How many minutes have you been experiencing this pain?" Most of these are questions should be asked, but the stem says "next." You'll gain better diagnostic information by asking "how many minutes have you been experiencing this pain?" That's because to reduce loss of cardiac tissue in the face of cardiac ischemia, catheterization needs to occur within the first hours of onset of symptoms. The other options are helpful but are less likely to change patient outcome. A patient history should be conducted using open-ended questions and converge upon evidence that gives you a field diagnosis.

Which of the statements below made by a patient would cause you to think they have acute coronary syndrome? -"I'm having dull, pressure type pain and my Dad died of a heart attack at age 51" -"I woke suddenly from sleep unable to breathe and my CPAP isn't working anymore" -"I'm having shortness of breath and it began after I began after I did some work in the garden" -"I'm feeling dizzy; I was unable to eat and I've had diabetes for 25 years"

-"I'm having dull, pressure type pain and my Dad died of a heart attack at age 51" The reason is because of a pertinent medical history cause an index of suspicion of a medical related incident.

What is the proper rate and depth of chest compressions on an adult patient needing CPR? 100 compressions per minute; 3 inches in depth 60 compressions per minute; 3 inches in depth. 100 compressions per minute; 2 inches in depth. 120 compressions per minute; 3 inches in depth.

-100 compressions per minute; 3 inches in depth The 2015 standards say 100-120 compressions per minute at 2 - 2.4 inches in depth. Note that three options are 3 inches in depth; a wrong choice. If you don't know an answer, don't think that because an option is used only once, it must be wrong. That can trick you. This is a fact that you either know or you don't. The CPR guidelines are important and are tested on the exam.

To what event do most attribute the beginning of the development of modern EMS? 1966 establishment of the National Highway Traffic Safety Administration 1966 release of the white paper "Accidental Death and Disability" 1975 conclusion of the Vietnam War 1973 passage of the DHEW's Emergency Medical Services Act

-1966 release of the white paper "Accidental Death and Disability" All of these were important to the development of modern EMS but experts most often point to the 1966 release of the white paper on accidental death and disability in the U.S. This paper helped Congress establish the National Highway Traffic Safety Administration (NHTSA) Its complement, the 1973 EMS Act, funded development of EMS systems. Many EMS systems were generated by surgeons who experienced enhanced patient outcomes due to medical efforts provided to soldiers during the Vietnam War.

A 6 year old is unresponsive and not breathing. You are unable to locate a pulse. You should begin with 2 ventilations followed by 30 chest compressions. 15 chest compressions depressing 1 1/2 inches. 30 chest compressions depressing the chest 2 inches. 2 ventilations followed by 15 chest compressions.

-30 chest compressions depressing the chest 2 inches. In this question only one choice begins with the correct number of compressions, 30 compressions. Providing ventilations first is incorrect. Providing 15 compressions is incorrect. In this question simply knowing that 30 compressions occur before ventilations leads you to the correct answer even if you don't know the depth of the chest compressions on a 6 year old.

During adult CPR, as a second rescuer you should prepare to administer 2 ventilations after unlimited chest compressions. 5 chest compressions. 30 chest compressions. 15 chest compressions.

-3o chest compressions The answer to this question remains the same in the 2015 guidelines as in the previous guidelines - after 30 chest compressions. The 15 chest compressions apply to children and infants when two rescuers are present. Five to one compressions are from older guidelines. Unlimited isn't a realistic choice.

What is the average minute volume of a person at rest? 500 mL 9,000 mL 3,000 mL 6,000 mL

-6,000ml The average minute volume is 6,000 mL. It is calculated by multiplying volume per breath times number of breaths per minute. Once again, if you don't know the answer, the best guess is to remove the highest and lowest numbers and pick one in the middle.

What sign or symptom would lead you to a high index of suspicion that your patient is suffering from a dissection of his aorta? Weak carotid pulses Distended neck veins A ripping pain in his chest Weakness of the left arm

-A ripping pain in his chest A ripping pain is a classic (but not guaranteed) presentation of a dissecting aorta. Weak carotid pulses could be hypotension. Distended neck veins are present with circulatory obstruction (e.g. cardiac tamponade or tension pneumothorax), not potential bleeding into the chest. Weakness of the left arm is a poor distractor.

You are a volunteer at a local health fair. What type of information would be most important for you to know about a patient before you recommended he seek immediate medical attention due to his blood pressure? A series of pressure checks over weeks indicated high blood pressure. The patient has a diastolic pressure of greater than 100 mmHg after walking from the parking lot. The patient has a systolic pressure of greater than 140 mmHg on a hot day. The patient has a systolic pressure of greater than 150 mmHg and presence of a headache.

-A series of pressure checks over weeks indicated high blood pressure. Essential hypertension (that which is elevated due to unknown causes but is chronic), requires a series of diagnostic checks. It is true that a systolic pressure of over 140 or a diastolic of over 100 is hypertension but it might be episodic, so you should advise this person to monitor his/her B/P over time. It's unlikely a B/P of greater than 150 with a headache represents an acute emergency; the B/P would need to be much greater than 150 mmHg.

Which of the diseases below is least likely to present with altered mental status? Acute coronary syndrome Bacterial meningitis Liver failure Drug overdose

-Acute coronary syndrome Acute coronary syndrome is least likely to be present with an altered mental status. Many of these patients are fully conscious and reliable historians. Drug overdose likely alters LOC, liver failure leads to toxins in the blood which alter LOC, and inflammation of the meninges that cover the brain also leads to an altered level of consciousness.

Which of the following patients has signs that are most consistent with hypovolemic shock? B/P 116/76, P 72, R 12 and SpO2 96% B/P 104/84, P 118, R 16 and SpO2 96% B/P 104/74, P 76, R 14 and SpO2 91% B/P 118/78, P 142, R 14 and SpO2 96%

-B/P 104/84, P 118, R 16 and SpO2 96%

A drowsy 19 year old was stabbed in the 4th intercostal space of the left side of his chest. On arrival he is struggling to breathe. You see jugular vein distention. His vital signs are B/P 98/78, P 132, R 24 and SpO2 is 88% on room air. What type of shock should you suspect? Distributive Hypovolemic Cardiogenic Metabolic

-Cardiogenic This patient likely has pericardial tamponade, a condition in which blood is found in the sac that surrounds the heart. Note the narrowed pulse pressure. The amount of blood is small and does not cause hypovolemic shock. Distributive and metabolic shock don't fit this stem.

What is the reason a victim of cardiac arrest is also apneic? Cerebral hypoxia Sympathetic nervous system dysfunction Pulmonary perfusion ventilation mismatch Cardiac arrthymia

-Cerebral hypoxia No oxygen to the brain shuts down the respiratory center and thus begins a cascade of events, one of which is apnea. Neither a cardiac arrthymia, nor a sympathetic nervous system dysfunction will lead to cerebral hypoxia unless the rhythm is ventricular fibrillation that stops all circulation. A pulmonary perfusion ventilation mismatch occurs in the alveoli and is a poor choice.

What signs would be present in a patient who had hyperglycemic hyperosmolar non-ketotic syndrome? Kussmaul's respiration, clammy skin and acetone breath Polyuria, sweating and hot dry skin Tachycardia, fruity breath and excessive sweating Dehydration, orthostatic hypotension and dry warm skin

-Dehydration, orthostatic hypotension and dry warm skin This is a difficult question. If you get this question on the test, you're either passing or it's a pilot item. To answer it, just think about what goes with hyperglycemia; forget the hyperosmolar non-ketotic words. Clammy skin and excessive sweating don't fit. Hyperglycemic patients have dry skin. And if a patient has dry skin he/she won't be urinating frequently (polyuria). So, using the process of elimination on what you should know will help you find the answer. Forget about your frustration in seeing the question, just pick the best answer you can find and move on when confronted with this type of question.

What disease affecting pediatric patients has been dramatically reduced by the administration of a haemophilus influenza type B vaccine? Otitis media Laryngotracheobronchitis Epiglottitis Meningitis

-Epiglottitis The above vaccine reduces the likelihood of acquiring epiglottitis. Laryngotracheobronchitis is the medical term for croup. Meningitis involves swelling of the meninges around the brain or spinal cord, and otitis media is an ear infection that is commonly bacterial. This is a moderately difficult question which may not have been covered in lecture but is likely in your book.

What is the reason an undiagnosed diabetic becomes so hungry? Obesity has caused the patient to have chronic hunger needs. The elevated blood glucose levels suppress secretions of glucagon. Even with an elevated glucose level none is able to enter the cells. The elevation of glucose in the blood triggers the hunger zone of the brain.

-Even with an elevated glucose level none is able to enter the cells. Only one choice makes physiological sense. Insulin helps the cells absorb glucose. Hyperglycemia doesn't trigger hunger, in normal people it prevents hunger. The obesity option is wrong and elevated blood glucose has nothing to do with the actions of normally secreted glucagon.

A 26 year old was farming during a storm and was possibly struck by lightning. You find him confused and unable to remember what happened to him. Which of the following findings best confirms he was struck by lightning? Neurogenic claudication Feathering print burns Cardiac arrthymia Anterograde amnesia

-Feathering print burns Burns that appear in a feathering pattern are unique to those found after a lightning strike. Amnesia is common after a lightning strike but it would be retrograde amnesia. Sure, cardiac arrest can occur, but the stem talks about him being confused, not in arrest or unconscious. Claudication is pain induced by a lack of circulation most likely due to atherosclerosis and the word neurogenic doesn't even fit with claudication.

According to the National EMS Scope of Practice Model, which of the following skills are part of the practice of an Advanced EMT? IV therapy, CO2 monitoring and administration of D50W E.T. tube placement, splinting and defibrillation E.T. tube placement, morphine administration and SpO2 monitoring IV therapy, administration of NTG, ASA and Beta2 drugs

-IV therapy, administration of NTG, ASA and Beta2 drugs IV therapy, administration of nitroglycerin, aspirin and beta 2 drugs are recommended minimums of care delivered by AEMTs within the Scope of Practice Model. ET tube placement is recommended for Paramedics. D50W is also a Paramedic intervention and providing morphine was recommended to be limited to Paramedics.

At the scene of a sarin gas attack it will be essential that you carry a Mark 1 kit. LPRD kit. gas mask. HEPA mask.

-Mark 1 kit The use of a Mark 1 kit is to combat the symptoms found in a sarin gas attack. Sarin gas requires a level A protective suit, not just a gas mask. A HEPA mask is a particulate mask used when in contact with patients with respiratory diseases. And there is no such thing as an LPRD kit. Never pick an answer that you have not heard or read about.

Question 41 You and your partner arrive on scene of a patient who is apneic and pulseless. What should you both do? One starts chest compressions while the other prepares the AED. One sets up the AED while the other orders others to "stand back!" One secures the airway while the other provides two rescue breaths. One starts rescue breathing while the other starts chest compressions.

-One starts chest compressions while the other prepares the AED. The team approach to patient care is becoming the educational standard. The correct answer is one starts chest compressions while the other prepares the AED. Rescue breathing and chest compressions leaves off the important step of defibrillation. Using the AED without first doing CPR in out-of-hospital un-witnessed cardiac arrest is not recommended when two rescuers are present. Managing the airway delays compressions.

Which group of signs should cause you to suspect a gunshot victim is in irreversible shock? Hypotension, unconsciousness, narrow pulse pressure Hypotension, clammy skin, anxiety Thready pulse, no bleeding, edema Oozing wounds, thready pulse, irregular respirations

-Oozing wounds, thready pulse, irregular respirations Which group of signs and symptoms indicate a patient in the worst condition? The oozing wounds, thready pulse and irregular respirations is the correct answer. Hypotension with anxiety is wrong because if hypotension is present, anxiety is unlikely; the patient will likely be apathetic and/or calm as s/he has no blood volume to produce muscle power or anxiety type symptoms (anxiety is seen in early shock). Edema is not present in irreversible shock as edema takes a lot of localized volume in a wound and takes time to develop. Hypotension and a narrow pulse pressure are unlikely to happen together, unless you have Doppler type hearing and can detect a BP of approximately 72/64. Very low blood pressures are nearly impossible to detect via sphygmomanometer and stethoscope.

You are speaking to online medical direction over the phone and providing the doctor the patient's medications. He interrupts your speaking and tells you to immediately give one of the drugs "PO". You should administer the drug: -as a topical ointment -sublingually -orally -as an eye drop

-Orally PO is a medical abbreviation meaning "administer orally." Eyes drops can be administered OS(left eye) and OD(right eye). Topical ointments are not administered orally, Sublingual is an incorrect choice.

Which group of affective behaviors are expected of EMTs? Honesty, trustworthy, on time and clean looking. Knowledge of protocols, equipment and hazards. Patient advocate, effective time management and careful delivery of service. Helpful attitude, believable, attention to detail.

-Patient advocate, effective time management and careful delivery of service. Patient advocacy, time management and careful delivery of service are measured affective behaviors within the national standards. The other behaviors are good to follow but are not national standards.

Which of the statements below is true regarding drowning? Salt water resuscitations are more successful because of the pH of the water. Resuscitation remains the same regardless of the type of water in which a victim drowns. Fresh water resuscitations are simplified because water in the lungs is absorbed by the blood. Dirty water resuscitations are the most complicated because of the solubility of the particles in the water.

-Resuscitation remains the same regardless of the type of water in which a victim drowns. This is a multiple true-false type question. So 3 are false. The true answer is resuscitation remains the same regardless of the type of water. The other distractors are just that--distractors. When someone is in cardiac arrest following a near drowning, resuscitate them.

You were called because a homeless man fell outside a coffee shop. As you assess him he tells you the FBI will be coming to interview him. You should say "When do you think they'll be hiring you?" "I see, should we transport you to the FBI?" "The FBI is not coming here right now." "That is untrue, they are not interviewing you."

-The FBI isn't coming here right now Always be factual to patients with mental disorders. It's correct to tell him the FBI is not coming. Telling him he is not telling the truth is accusatory language; refrain from using accusatory language. Agreeing with mental patients who are having hallucinations or delusions is not proper. And providing "joking" comments to mental patients is improper.

Which of the below is the best location to find the presence of pitting edema on a patient who has been lying supine? The antecubital fossa of the left arm. The sacral notch in the lower back. The suprascapular region of the posterior thorax. The fingernail beds of the right hand.

-The sacral notch in the lower back. Pitting edema is dependent edema, thus assessing the sacrum of the back is the best place to check on supine patients. Fingernail beds assess microcirculation and are used in kids to check the speed for return of color and for adults the level of "pinkness." Above the scapula (shoulder), assessment is not beneficial. The area where advanced providers likely choose to start IVs (antecubital fossa) can be used to assess for a pulse but not for edema

Which of the following is the primary reason you complete a pre-hospital care report form? So that administration can use the report for CQI Many prospective research articles are based on PCRs To serve as a "reminder" document in a legal proceeding To provide documentation for the continuity of care

-To provide documentation for the continuity of care PCRs are used for a number of reasons but the primary reason is to provide documentation of care delivery to promote the continuity of care. CQI, legal documentation and research are important secondary reasons to complete a PCR.

A one year old has had a runny nose and nasal congestion over the past 3 days. His Mom called you because he is now coughing, anxious and has skin pallor. He has a hoarse cry. You should suspect a viral upper airway infection. laryngitis. tonsillitis. a bacterial upper airway infection.

-a viral upper airway infection This child has a viral upper airway infection, most likely croup. The coughing, anxiousness and skin color are the clues. A bacterial infection like epiglottitis (now rarely seen due to vaccines) presents with a sore throat. Laryngitis is not a common childhood disease and causes a loss of voice. Tonsillitis is not seen with skin pallor and anxiousness, more likely a sore throat.

The major complication the body experiences during widespread anaerobic metabolism is the failure to produce ADP. accumulation of acid. development of hypoxia. decrease in blood sugar.

-accumulation of acid The answer is accumulation of acid. Anaerobic (metabolism with inadequate oxygenation) means cells are not able to release the acid buildup that occurs during metabolism. Blood sugar is not affected. Anaerobic metabolism occurs with hypoxia but hypoperfusion is the most likely cause of anaerobic metabolism in injury and disease. ADP is a precursor to ATP,but ATP is the energy source produced via metabolism within the cells.

You are off duty eating dinner when someone calls for help. As you approach the victim you see a middle aged man with an ashen face. You see no chest rise. You should give two rescue breaths. determine if a public access AED is present. start chest compressions. activate the EMS system.

-activate the EMS system Activate the EMS system when you are off-duty (a key word in the stem). This action must be accomplished first to yield the best patient outcome and it can be done rapidly by yelling, "Someone call 9-1-1!" You should, after activating the EMS system, check a pulse, begin chest compressions and have someone search for a nearby AED. CPR does not start by providing two rescue breaths except in near drowning cases.

A 36 year old high altitude climber complains of shortness of breath after descending from altitude. You auscultate bilateral rales below the scapula. His vitals are B/P 124/82, P 94, R16. His SpO2 is 93% on room air. You should suspect Guillain-Barre syndrome. rapid descent complex. acute mountain sickness. Kawasaki syndrome.

-acute mountain sickness. Never pick something you've never heard of in class or read in your EMT book. The answer is acute mountain sickness. There is no such thing as rapid descent complex and Gullain-Barre syndrome and Kawasaki syndrome are most likely not taught in EMT courses.

You have removed an unconscious 46 year old male from a basement where he collapsed from unknown reasons. He does not appear to have suffered any trauma. His vital signs are B/P 118/82 P 116, R 16 and his SpO2 is 99% on room air. You should first attach an AED and push the analyze button. open his airway and ventilate him with a BVM. determine the carbon dioxide levels in the basement. administer 100% oxygen by non-rebreather mask.

-administer 100% oxygen by non-rebreather mask This scenario presents so that you should suspect carbon monoxide poisoning. This patient needs 100% O2. The oxygen saturation reading is likely high because of the carbon monoxide binding with the hemoglobin molecules. Cardiac arrest isn't present. Determining carbon dioxide levels requires blood gas analysis (note it is not carbon monoxide). He is breathing so there is no need to ventilate him.

Question 50 You have removed an unconscious 46 year old male from a basement where he collapsed from unknown reasons. He does not appear to have suffered any trauma. His vital signs are B/P 118/82 P 116, R 16 and his SpO2 is 99% on room air. You should first attach an AED and push the analyze button. open his airway and ventilate him with a BVM. administer 100% oxygen by non-rebreather mask. determine the carbon dioxide levels in the basement

A 46 year old male complains of dull chest pain. You should first administer aspirin. attach the AED. administer oxygen 100% by non-rebreather mask. obtain vital signs.

-administer aspirin Administer aspirin. Providing oxygen may happen but 100% is not necessary. There is no SpO2 reading in this stem, which should be acquired before a decision is made regarding the delivery of oxygen. Never attach an AED to a conscious patient. Obtaining vital signs should occur but the stem says "first," so the best answer among these choices is to provide the aspirin.

A 46 year old male complains of dull chest pain. You should first administer aspirin. attach the AED. administer oxygen 100% by non-rebreather mask. obtain vital signs.

-administer aspirin. Administer aspirin. Providing oxygen may happen but 100% is not necessary. There is no SpO2 reading in this stem, which should be acquired before a decision is made regarding the delivery of oxygen. Never attach an AED to a conscious patient. Obtaining vital signs should occur but the stem says "first," so the best answer among these choices is to provide the aspirin.

An 8 year old male ate peanuts at school by mistake. The school principal tells you he is allergic and wants you to administer the medication. The child is cool and clammy, having wheezing and a swollen tongue. You should instruct the principal on how to give the drug. assess him for hypotension. administer epinephrine. contact parents for consent to treat.

-administer epinephrine

A 36 year old diabetic female has a history of schizophrenia. Law enforcement has her handcuffed at the roadside. She ahs removed her clothes. She tells you President Obama, "wants her." You should: -find her clothing to wear -restrain her with soft restraints -administer oral glucose

-administer oral glucose The schizophrenia in the stem can distract you from the real problem. people have co-morbid diseases. So in this case you don't know if her symptoms are due to non-compliance of her schizophrenia medications or if she is diabetic. It might help to ask her. But giving her oral glucose will "do no harm," so administering it here is not wrong. Finding her clothing to wear is outside of you responsibilities when a bed sheet can cover her. Just transporting a nude patient shows no compassion. Restraining her might be necessary but there is nothin in the stem that shows she is a danger to you or a team member.

A 32 year old male has been treated for pneumonia for the past week. His family has urged him to go to the hospital but he has refused. He is now hot to touch. His vital signs are B/P 96/78, P 104, R 24. His SpO2 is 88% on room air. You should lay him flat, warm him and treat for shock. assist his ventilations until his SpO2 improves. administer oxygen and transport rapidly. administer aspirin for fever and oxygen for hypoxia.

-administer oxygen and transport rapidly Note only one choice includes rapid transport - the correct answer. He's hypotensive (likely septic shock), and doesn't need assisted ventilations. Keeping him warm when he is hot to touch is not good therapy. Using aspirin for fever in this case is improper, not recommended and fails to recognize the severity of his condition.

On arrival a 4 year old with a sore throat is leaning forward with hands on his knees experiencing difficulty breathing. He is hot to touch. When he speaks his voice sounds hoarse. His pulse oximeter reading is 94% on room air. You should administer high flow oxygen, insert an oral airway and transport. inspect his upper airway, monitor tracheal breath sounds and transport rapidly. lay him flat, monitor his ABCs, and transport. administer oxygen, keep the child calm and transport rapidly.

-administer oxygen, keep the child calm and transport rapidly This child presents with symptoms of epiglottitis. He needs rapid transport, oxygen and to remain calm. Laying a patient flat inhibits inhalation and withholding oxygen when these symptoms are present is not advised. Inserting an oral airway is strictly contraindicated when epiglottitis is a possibility. Even looking in his airway with something like a tongue blade is contraindicated.

A 51 year old female has hot dry skin and fruity breath. Her vital signs are B/P 106/78, P 108, R 26 and SpO2 is 96%. She says she's sick and has diabetes. You should provide fluids by mouth. administer oxygen. provide rapid transport. administer oral glucose.

-administer oxygen. This patient has hyperglycemia. She doesn't need glucose, you can't give her fluids by mouth and rapid transport might help a little. Rapid transport is for true emergencies. This patient has an adequate mental status and rapid transportation isn't necessary. Providing oxygen is the best choice—although not what you might consider the ideal choice

A 2 year old female who had a "cold" for the past two days now has frequent barking coughing. Her skin is warm to touch. She has inspiratory stridor and her pulse oximeter reads 98%. When transporting her you should prepare for emesis. respiratory arrest. sepsis. airway obstruction.

-airway obstruction You should know that whenever you hear stridor, partial airway obstruction is present and soon could lead to complete airway obstruction. Airway obstruction would then lead to respiratory arrest. Emesis and sepsis are poor choices in this situation.

A patient has an allergic reaction, is hypotensive, and self-administers an Epi-pen auto injector. The therapeutic reason for this is its alpha effects. beta effects. adrenergic effects. sympathetic effects.

-alpha effects. Epinephrine has both alpha and beta effects, but the vasoconstriction of epinephrine raises the blood pressure via its alpha effects. The beta effects will dilate the bronchioles which is also helpful but this question relates to hypotension. Adrenergic effects and sympathetic effects are correct but too broad an answer; the alpha effect is more specific. Know your medication's mechanisms of action.

A 32 year old male is found sitting in a chair. As you approach him he says his cystic fibrosis is "acting up." He is coughing and unable to speak in full sentences. His vitals are B/P 126/82, P 94, R 24. His SpO2 is 88% on room air. After administering oxygen you should monitor him to assure adequate tracheal secretions. airway maintenance. pulse oximeter readings. alveolar ventilation.

-alveolar ventilation Alveolar ventilation is essential for life; it occurs at the end of the respiratory tree. This stem is about a patient who can talk; so he has an airway. Pulse ox monitoring is appropriate but not as essential as alveolar ventilation. Tracheal secretions are present with cystic fibrosis but using the amount of secretions as a "gauge" toward health status compared to the importance of alveolar ventilation is a poor choice. When monitoring patients always monitor life support signs, not just equipment.

A 62 year old male is having chest pain. He tells you it began one hour ago. You auscultate crackles in his lungs. His vital signs are B/P 142/82, P 94, R 16 and SpO2 is 94%. You administer aspirin and begin transport. En route he begins to sweat and wheeze. His B/P changes to 106/82. You suspect pneumonia. anaphylactic reaction. cardiac asthma. right sided heart failure.

-ana

A 62 year old male is having chest pain. He tells you it began one hour ago. You auscultate crackles in his lungs. His vital signs are B/P 142/82, P 94, R 16 and SpO2 is 94%. You administer aspirin and begin transport. En route he begins to sweat and wheeze. His B/P changes to 106/82. You suspect pneumonia. cardiac asthma. right sided heart failure. anaphylactic reaction.

-anaphylactic reaction This could be a difficult question if you don't notice the onset of hypotension, wheezing and diaphoresis and suspect what caused it. You just administered aspirin which could have caused the allergic condition. So suspecting an allergic reaction to the aspirin is the best choice given his symptoms. Right sided heart failure causes dependent edema (not moist lung sounds). Pneumonia doesn't have a sudden onset. Cardiac asthma is unlikely the cause of the hypotension onset.

A 68 year old female is short of breath. You are gathering a medical history but she is only able to answer in two word sentences. As you talk with her she becomes drowsy and it is harder to arouse her. When her head slumps forward you should then check for a pulse for 10 seconds and begin CPR. lay her flat and elevate her legs. assist her ventilations at 10 bpm. apply 100% oxygen by non-rebreather mask.

-assist her ventilations at 10 bpm. This patient is rapidly deteriorating in front of you and needs ventilation assistance. It is too late to administer oxygen. Laying her flat makes breathing more difficult. CPR is not necessary (at least not yet) because the patient can be aroused—albeit difficult to do so.

A 64 year old male has cold, clammy, cyanotic skin. You hear audible gurgling when he breathes. His vital signs are B/P 110/82 P 118, R 24 and SpO2 is 88% on 2 Lpm nasal cannula. En route his level of consciousness decreases. You should first attach an AED and analyze his rhythm. assist his ventilations. move him to the recovery position. increase his oxygen to 100%.

-assist his ventilations This patient is sick, has cyanosis, is on O2 and still has an SpO2 of 88%. When a patient with these types of signs and symptoms becomes unconscious they most likely need assisted ventilations. Moving the patient to the recovery position doesn't treat the cause of decreasing LOC, which is hypoxia. Increasing the oxygen level to 100% won't be helpful if the patient isn't ventilating adequately. And there is nothing in the stem that indicates any sign of cardiac arrest.

What is the primary cause of acute coronary syndrome? Atherosclerosis Cor pulmonale Sympathetic stimulation Cardiac arrhythmias

-atherosclerosis Atherosclerosis is the primary cause of coronary artery blockage (which leads to coronary artery syndrome). Arrhythmias begin when the heart suffers ischemia due to atherosclerosis. The sympathetic system speeds the heart rate (flight or fight mechanism). Cor pulmonale is right heart failure.

You are transporting a 56 year old man with chest pain. En route he slumps forward and loses consciousness. You cannot palpate a pulse. You immediately lay him flat and tell your driver to pull over. begin chest compressions. attach an AED. ventilate him.

-attach and AED The 2015 AHA guidelines recommend using an AED immediately in cases of witnessed cardiac arrest; thus the correct answer is attach the AED. In non-witnessed cases of cardiac arrest begin CPR (chest compressions) and use the AED as soon as it becomes available. Telling the driver to pull over is smart but as an individual in the patient compartment with a patient who just went into cardiac arrest you should concentrate on attaching the AED. Ventilating him will come with time but it doesn't supersede attaching the AED.

A 24 year old female who has a history of seizures may sense the onset of a seizure by experiencing a/an headache. flash. flush. aura.

-aura You must know the phases of a seizure and many seizure patients have an aura before seizure onset. An aura can be a flash, a feeling of being flushed or a headache but auras are unique to the individual and not all seizure patients have the same sense regarding what will warn them of seizure onset.

A 26 year old male complains of increased breathing difficulty over the past two days. He tells you he has been coughing frequently. His vital signs are B/P 124/88, P 108, R 18. His SpO2 is 91% on room air. You suspect his SpO2 reading is low because he has inadequate tidal volume. many collapsed alveoli in his lungs. lower airway constriction. bacteria in his lungs.

-bacteria in his lungs This patient most likely has bacteria in his lungs causing pneumonia. He has coughing and a gradual onset. Lower airway constriction causes wheezing, which is not present. Inadequate tidal volume is unlikely because he does not have shallow breathing with a change in level of consciousness. Collapse of alveoli is atelectasis; that occurs in pneumothorax and COPD but he's too young and there is no information regarding abnormal breath sounds.

A drug-influenced patient spits in an EMT's face. The EMT is angry and hits the patient in the face. Law enforcement was on the scene and arrests the EMT for assault. negligence. defamation. battery.

-battery Battery is the answer in most states. An assault legally doesn't imply physical force and could be verbal assault. Defamation relates to tort cases where one person damages the reputation of another. Negligence requires four acts to be proven: duty to act, a breach of that duty, a harmful outcome, and that the outcome was connected to your care. A violation of any one of the components can constitute negligence.

A 2 year old was eating grapes and began to choke. When you arrive he is unconscious and not breathing. You should first inspect the airway, if object is seen perform finger sweeps. begin chest compressions. perform a series of abdominal thrusts. lift the child by the feet and perform back slaps.

-begin chest compressions

As you approach a 10 month old infant you do not see any chest wall movement. You lay the infant on a hard surface and are unable to find a pulse. You should next insert an oral airway. give two breaths. apply an AED. begin chest compressions.

-begin chest compressions In order to reduce public confusion regarding CPR in kids compared to adults, the recommendation currently is to follow the same sequence of CAB, thus chest compressions is the best answer. Although giving two breaths in an infant "does no harm" the recommendation (thus the right answer) is chest compressions first. Inserting an airway is not correct because this is a sequence question. The stem's last word is "next" so pick the choice you would first accomplish. Use of an AED is important in a pulseless patient but CPR should not be delayed.

Which of the chronic diseases below leads to increased levels of carbon dioxide in the blood? Bronchitis Tuberculosis Pneumonitis Cystic Fibrosis

-bronchitis Bronchitis is one of the three diseases commonly found in patients who have COPD. They cause chronic increases in carbon dioxide. Pneumonitis occurs following aspiration of stomach juices, tuberculosis is a bacterial disease, and cystic fibrosis is a congenital disease found in children.

Which of the chronic diseases below leads to increased levels of carbon dioxide in the blood? Pneumonitis Tuberculosis Cystic Fibrosis Bronchitis

Which of the following is the least likely to cause death in a patient who is having an anaphylactic reaction? Vasodilation Hypoxemia Bronchoconstriction Airway obstruction

-bronchoconstriction Vasodilation, airway obstruction and hypoxemia will lead to death more rapidly than bronchoconstriction. Bronchoconstriction is problematic but not as much as the other choices.

A 2 year old male was submerged in a backyard swimming pool. When you arrive he is out of the water on the pool deck where bystanders are performing mouth-to-mouth ventilations. You should first perform abdominal thrusts. begin compressions. check for a pulse. ventilate him.

-check for a pulse This is a near drowning question so the best choice answer is to check for a pulse. No need in ventilating him, it's already being done by the bystanders. But do they know if he's in cardiac arrest? It is best to confirm that. Chest compressions will be necessary if the child has no pulse, but you won't know that without checking that first. Performing abdominal thrusts is a poor choice. Note the stem says "first" so this is a sequence type item.

You are unable to find a pulse on a patient who is not breathing. You should begin chest compressions and recheck for the pulse after 30 compressions. check for a radial pulse and if you're not able to find one start compressions. check for no more than 10 seconds and then start compressions. give two rescue breaths and recheck for the pulse.

-check for no more than 10 seconds and then start compressions. Checking for a pulse on a patient who is in cardiac arrest is difficult, they don't have a pulse and a weak pulse is often hard to find. So spend no more than 10 seconds assessing for a pulse and then you need to begin chest compressions. Secondarily checking for a radial pulse is not recommended. Checking for a pulse after 30 chest compressions is not recommended and neither is rechecking after rescue breaths.

The level of carbon dioxide in the blood is monitored by the medulla. chemoreceptors. lung parenchyma. respiratory rhythm center.

-chemoreceptors. "Chemo" relates to chemistry and refers to a receptor that monitors chemistry (this is how CO2 is monitored). "Baro" relates to monitoring stretch, mostly in vessels where baroreceptors monitor blood pressure. If you see this question on a CAT test, feel comfortable knowing you are getting higher level questions and likely passing at this point.

You are standing by at a public pool as lifeguards emerge with a 10 year old boy. When you pull him from the water you should first check for a pulse. insert an oral airway. begin compressions. clear his airway.

-clear his airway ABC

A 28 year old male reports he has a very severe headache that began 30 minutes ago. The pain is on one side of his head and you observe excessive tear production on the side of the pain. His vital signs are B/P 130/96, P 84, R 14. What type of headache do you suspect? Ischemic Hypoglycemic Cluster Syncopal

-cluster A cluster headache is the type of headache that has the above symptoms. Ischemia can cause a headache but most likely presents with a change in level of consciousness. A syncopal headache doesn't exist but can be confused with a syncopal episode (fainting). And hypoglycema, (if blood sugar is low enough) causes altered mental status.

An 18 year old male has a gunshot in the right side of his chest. His vitals are B/P 108/82, P 104, R 24. You should suspect pneumonitis. obstructive shock. pericarditis. compensatory shock.

-compensatory shock Because he has a narrow pulse pressure, he is still compensating for his blood loss. Note hypovolemic shock is not a choice. Pericarditis is due to an infectious process of the pericardial sac. Obstructive shock most often occurs via a large pulmonary embolism. Pneumonitis is inflammation of the lung usually caused by an infection.

You are called to the home of a 56 year old female who fell. As you examine her she does not make eye contact with you and seems disinterested in your care. You are unable to find any injury that requires immediate care. You suspect her low affect to be connected to depression. delusions. paranoia. schizophrenia.

-depression Low affect (meaning attitude, muscle movement, engaging with others, etc.) is seen in depression. Schizophrenic patients are often excited, having hallucinations, etc., but could appear depressed if they are on high doses of medications.

The primary danger for a patient with abdominal peritonitis, obtained without trauma, is development of septic shock. failure to detect the disease. loss of organ function. rupture of an organ.

-development of septic shock Peritonitis can be due to abdominal organ inflammation (appendicitis), and/or infections. These create fluid shifts and possible organ rupture leading to septic shock. It is true an organ can rupture but there are other causes of peritonitis so that is too specific to be the best answer. And if an organ ruptures it could result in loss of organ function; another distractor that is too specific. Failure to detect peritonitis is unlikely as it is very painful when fully developed. When choices are specific and a more broad answer is available, pick the more broad answer if you are unsure.

Question 62 A vasovagal syncope episode mimics a transitory and reversible shock condition most like cardiogenic shock. hypovolemic shock. distributive shock. metabolic shock.

-distributive shock The blood is not lost (hypovolemic shock) or not moving (cardiogenic shock) nor is it full of metabolic toxins (metabolic shock). The blood is resting in the dilated vascular system in distributive shock. This is often called fainting and resolves itself relatively quickly.

A vasovagal syncope episode mimics a transitory and reversible shock condition most like distributive shock. metabolic shock. hypovolemic shock. cardiogenic shock.

-distributive shock. The blood is not lost (hypovolemic shock) or not moving (cardiogenic shock) nor is it full of metabolic toxins (metabolic shock). The blood is resting in the dilated vascular system in distributive shock. This is often called fainting and resolves itself relatively quickly.

In order for a person to be allergic to a food, that person must have eaten that food before. had symptoms such as hives before. a genetic predisposition to that food. a parent who was also allergic to that food.

-eaten that food before. In order to be allergic a person must have a "sensitizing dose" that forms the antibodies that react improperly when the patient is exposed by ingesting the allergic food a second time. This might be genetic but that's not confirmed in all patients and they still must consume a sensitizing dose. The patient's parents have nothing to do with it. Not all allergies present with hives, some go straight to an anaphylactic reaction.

What phase of cardiac arrest is a patient in immediately after collapsing? Metabolic Circulatory Reversible Electrical

-electrical The most likely answer is electrical. Perfusion problems begin immediately also but electricity via successful defibrillation can reverse a perfusion problem dramatically. Continued arrest certainly produces metabolic problems. If all cardiac arrests were reversible, heart disease would not be a leading cause of death. Splitting the difference between electrical and circulatory is very close, but keeping in mind electrical helps you understand that use of an AED immediately after collapse is critically important as you attempt resuscitation. An important use of EMT Pass is to learn.

Many communications breakdowns are due to patient understanding of diseases. non-compliance regarding medical advice. encoder and decoder interpretations. hierarchical EMS systems.

-encoder and decoder interpretations Communication breakdowns most often happen because of an encoder/decoder error. When you speak, your goal is to be understood by others. This is the purpose of repeating an order given to you back to the person who gave the verbal order. The other option regarding hierarchical EMS systems might be correct in some EMS systems. Patients understanding disease processes and non-compliance of medical advice do not improve health status but are not communication breakdowns.

When assessing the respiratory functions of a patient in respiratory distress you should determine the respiratory rate. be sure breath sounds are clear. assess for a pleural friction rub. estimate the alveolar ventilation.

-estimate the alveolar ventilation. Alveolar ventilation is critical, it's where gas exchange occurs. Assessing for a friction rub, assuring breath sounds are clear, and knowing the respiratory rate are important but if the patient does not have adequate alveolar ventilation, oxygenation of the blood will not occur.

The Mom of a 2 year old male calls you because her son is not able to be aroused during the night. She said yesterday the child's pediatrician said he had an ear infection. You suspect anaphylactic reaction. influenza type symptoms. febrile seizure. meningitis.

-febrile seizure Rationale Ear infections (otitis media) are a leading cause of febrile seizures in children. There is nothing in the stem to suspect an anaphylactic reaction. Meningitis could cause unconsciousness but the child's doctor said he had an ear infection, so meningitis could be correct but not the best choice. This child doesn't have the flu and the flu doesn't often lead to unconsciousness.

The most effective method to remove a poison that is absorbed is to brush it off without touching the skin. flush it off with copious amounts of water. neutralize the solution. brush it off with gloved hands.

-flush it off with copious amounts of water. Absorbed means it's on the skin so flushing it with copious amounts of water is the correct answer. You do need to brush off lime and powder type agents that are toxic to the skin. These are more rare and specific. Brushing it off without touching it is vague and incorrect. Neutralizing an absorbed poison should only be accomplished if advised by the poison center.

A 36 year old male was playing basketball and now complains of a dull pain in the center of his chest. His breath sounds are clear bilaterally. His vital signs are B/P 138/82, P 106 and irregular and R 16. You should monitor his breath sounds for pneumothorax. ask if he takes nitroglycerin. administer oxygen by non-rebreather mask. frequently monitor his irregular pulse.

-frequently monitor his irregular pulse. The correct answer is to monitor his irregular pulse. It isn't likely that a man this young would take nitroglycerin. There is no pulse ox reading in the stem and the patient isn't in distress so administering 100% O2 is not a good choice. It would be OK to monitor his breath sounds, but clearly the best choice is to watch his irregular pulse since it might deteriorate into fibrillation.

Question 24 A 14 year old male was rescued from a pond by Good Samaritans. When you arrive he is on the shore and no CPR is in progress. As you approach him you see no chest wall movement. You cannot palpate a pulse. You should next begin compressions. give two rescue breaths. attach an AED. remove wet clothing.

-give two rescue breaths this is a special circumstances type question. A CAB approach calls for chest compressions first. But in near drowning, you should ventilate first. Beginning chest compressions should follow. Removing wet clothing doesn't treat cardiac arrest. And attaching an AED may be necessary but should not delay the beginning of resuscitation. Note the stem says "next" so this is a sequence type question.

When days are long and hot, you become most concerned if you assess someone who has dry skin and is unable to sweat. speaks slowly and is confused. lost their appetite and has weakness. has poor skin turgor and tachycardia.

-has dry skin and is unable to sweat. Hot, dry skin and inability to sweat indicate a high likelihood of heat stroke. Poor skin turgor is not a healthy sign but that option is not as good of a choice as the one that includes dry skin. Speaking slowly and being confused is more likely in heat exhaustion. A loss of appetite and weakness are more likely present with flu-like symptoms.

You approach a victim at a scene who is 15 feet away. You recognize he is likely in hypovolemic shock because he -is cyanotic -has pale skin -has blood on his face -is not looking straight at you

-has pale skin

25 year old male fell from his motorcycle. When you arrive he is walking around yelling and mad at the driver who forced him off the road. You assess him and find multiple abrasions and contusions but no fractures. His vital signs are B/P 146/82, P 104, R 16 and SpO2 is 97% on room air. As you prepare to transport he refuses care. You should ask law enforcement to require him to be transported. have him sign a refusal form in front of a witness. encourage him to seek emergency medical care. call his next of kin with instructions on having him obtain care.

-have him sing a refusal form in front of a witness Having him sign a refusal of care form in front of a witness is essential. We'd recommend you advise him to seek medical care but you cannot force someone to do this. It is important that in this stem we are providing evidence this patient is stable. And your run report should show this just in case an occult problem develops later. Law enforcement won't arrest this guy because you ask them to. Calling next of kin is advisable but you are not legally required to do this in order to protect yourself. Any actions you provide can lead to legal complications but having a witness when the patient signs a refusal of care form is important for your protection.

The origin of a thrombus that causes a stroke is most likely in the heart. brachial plexus. lower leg. lungs.

-heart It is important to know your anatomy. Two distractors, lower leg and brachial plexus are in the extremities and therefore if they caused a clot, it would lodge in the lungs. The lungs are not a location where clots originate. Blood clots to the brain come from either in the heart, or more likely from closure of an artery due to atherosclerosis.

Failure to allow recoil of the chest during chest compressions results in higher intrathoracic pressure which decreases hemodynamics. inadequate coronary artery flow which sustains ventricular fibrillation. increased incidence of rib fractures and subsequent hemothorax. reduced venous return which increases cerebral edema.

-higher intrathoracic pressure which decreases hemodynamics Changes in intrathoracic pressure help blood circulate through the chest and fill the right side of the heart. Failure to allow sufficient recoil reduces the effectiveness of CPR. Rib fractures have nothing to do with recoil. Recoil has no effect on increasing cerebral edema and neither does coronary artery flow during V-fib (it's already inadequate which is why the patient is in V-fib).

During a quality improvement meeting your medical director tells you a 59 year old man you transported last week with abdominal pain had a perforated large bowel. You remember he did not have severe abdominal pain during your care. The reason his abdominal discomfort was moderate is because of the peritoneum not becoming inflamed by fecal matter. type of bacteria in the bowel. higher pH of the fluids in the large bowel. delay between organ rupture and peritonitis being greater than 24 hours.

-higher pH of the fluids in the large bowel. The correct answer is higher pH (lower acidity) of the fluids in the large bowel. Just remember, the stomach and small intestines digest food so they contain acids and enzymes that could digest your abdominal wall and thus cause intense pain if a bowel is perforated (busted open). Bacteria released into the peritoneal cavity cause massive infection but that takes hours to develop so it's unlikely seen in EMS unless your patient is one tough dude who can take a lot of pain. The peritoneum does become inflamed by fecal matter as it contains a large amount of bacteria that start an infection if they exit the bowel into the peritoneal cavity. The time between organ rupture and peritonitis can be very quick if the fluids have acid in them (most likely from the small intestines) or delayed with a large intestine rupture but it will happen faster than in 24 hours.

A 52 year old obese female tells you she has diabetes and has been sick for four days. Which of the below symptom groups would make you think she is in diabetic ketoacidosis? Hyperventilation, sweet smelling breath, dry skin. Kussmaul's respirations, left side arm droop, diaphoresis. Orthostatic hypertension, thirst, tachypnea. Nausea, vomiting, fever, rapid respirations, dry skin.

-hyperventilation, sweet smelling breath, dry skin In this type of question use the process of elimination to find the answer. You should know hyperventilation is present in hyperglycemia. Thus the options that start with orthostatic hypertension (which is less likely) and the option that includes fever should be eliminated quickly. That leaves only the correct answer and the one that includes Kussmaul respiration left as choices. Hyperglycemia doesn't present with arm droop, so that leaves that option out. The correct answer is hyperventilation, sweet smelling breath and dry skin.

A 52 year old obese female has facial droop, arm drift and weak grips of her right hand. These symptoms began 15 minutes ago after she vomited. You should suspect influenza. electrolyte imbalance. hypoglycemia. conversion reaction

-hypoglycemia. Upon first reading the stem you would think "stroke" but that option isn't present. So, which of the answers mimics stoke? The answer is hypoglycemia. The flu, a conversion reaction (a psychological reaction) and an electrolyte imbalance won't mimic a stroke to the degree that hypoglycemia can. If stroke were present the test question would be too easy.

Body temperature is controlled by the brain's cerebellum. medulla. hypothalamus. cerebrum.

-hypothalamus The answer is hypothalamus (in the brain stem). The medulla is also in the brain stem so that is a really good distractor. The cerebellum is a separate part of the brain and it helps maintain balance when we are standing. The cerebrum is forward or higher up in the brain and it's where we do our thinking.

A 26 year old male is found unconscious in an alley outside a bar. He has pale and clammy skin. His vital signs are B/P 104/82, P 118, R 16 and his SpO2 is 95% on room air. You should suspect distributive shock. intra-thoracic bleeding. head trauma. hypovolemic shock.

-hypovolemic shock. Make sure you pick your answers related to the words in the stem and don't be distracted by thoughts not in the stem (hence reading into the question). The answer to this question is hypovolemic shock. He has cold, clammy skin and a narrow pulse pressure, hence the best (and correct) answer. There is no information in the stem related to chest or head trauma. And distributive shock is a weaker distractor since there are no indications of conditions that cause distributive shock.

As a child transitions from normal health to becoming unstable and eventually to cardiac arrest, the primary cause of these events is hypoxia. sympathetic tone. bradycardia. dysrhythmia.

-hypoxia Children are most likely deteriorate due to hypoxia. Bradycardia is a sign of hypoxia but not the cause. Bradycardia is a dysrhythmia in many cases. Sympathetic tone is not the cause and it's a poor choice.

A 26 year old was struck by lightning while playing golf. When you arrive he has amnesia, pale, cool clammy skin and an irregular pulse. As you prepare to transport him you should ventilate him with 100% oxygen hooked up to a BVM. apply an AED to monitor him for v-fib. elevate the head of the cot for comfort. immobilize him to a long backboard.

-immobilize him to a long backboard With today's therapy surrounding clearing C-spines, one might not choose the correct answer to immobilize this patient. Because it is present it could cause you to pick a wrong answer. Never apply an AED to a conscious patient and this stem does not say he is unconscious. Elevation of the head won't help this guy. There is no indication he needs oxygen as there is no SpO2 reading in the stem. Spinal fractures are a possible complication of lightning strikes.

When a patient is in cardiac arrest you can treat him under the doctrine of nolo contendere. implied consent. involuntary consent. expressed consent.

-implied consent It is implied that when a patient is unconscious he/she will want you to provide care. Expressed consent is spoken to you, or expressed when the patient calls 9-1-1 but it can be withdrawn if the patient tells you to not treat him/her. Involuntary consent is not a legal term. Nolo contendere is a plea in a legal case. Implied consent is an important term to remember.

The best position in which to place an unconscious patient who is without injury is in the recovery position on their right side. supine with their legs slightly elevated. in the recovery position on their left side. supine with the head slightly elevated.

-in the recovery position on their right side The recovery position helps drain fluids from the upper airway and is the best position to place a patient who is unconscious and without injury. Which side of body to place the patient on has no specific recommendation, but if they are on their left side they will be facing you in the ambulance. Supine works best for conscious patients.

In pediatric patients, excessive ventilations may cause collapse of immature lung tissues. reflexive regurgitation of stomach contents. increases in intrathoracic pressures. frequent bag-valve-mask pop-off malfunctions.

-increase in intrathoracic pressures Excessive ventilations may cause an increase in intrathoracic pressure in both adults and children. This decreases blood return to the heart and reduces cardiac output. All ventilation may cause regurgitation if done too forcefully but this is not "reflexive." Malfunctions with ventilation devices are rare and collapse of immature lungs is incorrect.

You find an unkempt 48 year old man outside at 4:00 a.m. on a night the temperature is 40 degrees F. He is shivering and cold to touch. To determine if he has hypothermia you should ask him how long he's been outside. ask him to walk a straight line to test his coordination. insert your hand below his clothing and feel his abdomen. take his oral temperature.

-insert your hand below his clothing and feel his abdomen. Detecting hypothermia can be complicated but if the patient has a cold abdominal wall below his/her clothing, you are dealing with hypothermia. Asking how long someone has been outside is not reliable because a hypothermic patient has an altered LOC and will be an unreliable historian (someone whose answers are not believable). An oral temperature is not reliable when a patient has been breathing in cold air. Walking a straight line is poor assessment technique for someone suspected of being hypothermic.

A 72 year old female with a history of mental illness complains of a headache. Within 5 minutes she becomes unconscious. Her vitals are B/P 128/90, P 90, R 16. You should suspect conversion reaction. intracerebral bleeding. drug overdose. vasovagal syncope.

-intracerebral bleeding Intracerebal bleeding is the best choice. Vasovagal syncope (a simple faint), is present with hypotension. Conversion reaction is a psychological reaction and typically does not present with unconsciousness. A drug overdose is unlikely to present with a headache. Patients who complain of severe head pain who lose consciousness should be suspected of most likely suffering a stroke.

A 75 year old male is hot to touch and only able to mumble when you speak to him. His wife says he's been experiencing diverticulitis for the past week. His vitals are B/P 96/78, P 126, R 16 and his SpO2 is 90% on room air. You should place him in the recovery position, provide oxygen and transport. elevate his head, titrate his oxygen, and transport. elevate his head, provide 100% oxygen and rapidly transport. lay him flat, provide 100% oxygen, and rapidly transport.

-lay him flat, provide 100% oxygen, and rapidly transport. The correct answer is to treat for shock. Elevation of the head is not recommended for patients in shock. Patients in shock that demonstrate the type of evidence found in this scenario (decreased BP, narrowing pulse pressure, altered mental status and low SpO2) need rapid transport.

A 19 year old is threatening to "kill you," if you approach him. He's already told his mother that he wants to die. You should first ask him his plan. determine his lethality. leave the scene. determine if he is serious.

-leave scene There is no lethal weapon in the stem, so this is a judgment call. The safest answer is to leave the scene; this is a law enforcement matter. Determining his lethality sounds good and you may do it, but it could result in your personal injury. Having a conversation with this young man may be OK, but it's best to wait until law enforcement tells you the scene is safe. His mother knows him best so determining if he is serious is also a judgment call that should wait until law enforcement says the scene is safe. Regardless, patients who express homicide or suicide need transport either by you or law enforcement.

Your team is performing CPR on an obese man who was found on the 2nd floor of his home. During your resuscitation attempts and transportation, outcome will most likely improve if you switch CPR partners frequently. ventilate at a rate of 10 bpm. use a mechanical CPR device. limit interruptions of chest compressions.

-limit interruptions of chest compressions Limiting interruptions of chest compressions is always recommended. In this scenario you should understand the CPR treatment dilemma. Ventilating at a rate of 10 bpm is OK, but if your team only pays attention to the ventilation rate during resuscitation and transportation, you'll be missing the biggest patient outcome opportunity of continuous CPR. Mechanical CPR devices have not been proven to provide better patient outcomes. They can be used, but scientifically they do not supersede good CPR without interruptions. Switching CPR partners is fine, but that too should be accomplished with limited interruptions.

The major complication for a patient with Type I diabetes is the long term implications. risk of death from hyperglycemia. cessation of pancreatic function. requirement to take insulin.

-long term implications It is important to know the difference between type I and type II diabetes. Type I used to be called juvenile onset, so the long term implications of the disease can be severe. Taking insulin is complicated but therapeutic. Patients with hyperglycemia know it is likely present and seek care. The loss of vision or an extremity infection are long term implications of diabetes but are not the only ones, thus a weaker choice.

Failure to maintain circulation and aerobic metabolism results in loss of the sodium/potassium pump and cell death. ineffective CPR and irreversible cardiogenic shock. escape of potassium and cardiac arrthymias. accumulation of hydrogen ions and hypoventilation.

-loss of the sodium/potassium pump and cell death. This is the final stage of life, when the sodium/potassium pump stops working for long periods of time. Cell death results in organ failure and then finally death of the patient. The accumulation of hydrogen ions (acid) is problematic but can be reversed. The escape of potassium from dying cells can cause arrthymias, but this is not the cause of death as the potassium comes from inside dead cells. Ineffective CPR contributes to serious reduction in circulation but in the end, it's the loss of the potassium/sodium pump and cell rupture that causes death.

A 53 year old female with a history of depression took 20 pills about 1 hour ago. She answers your questions but her speaking is slow. When you speak to her you should ask questions slowly to be understood. maintain good eye contact. tell her that suicide is not the answer. hold her hand to make a physical connection.

-maintain good eye contact Maintaining good eye contact shows compassion on your behalf. Asking questions slowly to a patient who speaks slowly is uncalled for. She is awake and discussing suicide with her is not called for; you can assume that based upon her history. She'll need transportation and the hospital will question her about suicide. Holding hands may make a patient comfortable but touch is not always accepted well.

A 19 year old male college student is acting oddly and you question his roommates in regards to his drinking alcohol. They say he's not been drinking. When you examine him you find "spots" which look purple over his upper thorax. He feels hot to touch and then seizes. You suspect meningitis. encephalitis. hypoxia. drug ingestion.

-meningitis People who live in congested places are susceptible to meningitis. And he has purpura, or purple spots on his thorax which is indicative of bacterial meningitis. Encephalitis is swelling of the brain that can occur from multiple causes/infections. Hypoxia doesn't fit the stem or the patient history. Drug ingestion may be a suspicion but the altered mental status with purple spots on his upper thorax make meningitis most likely.

Respiratory shock is also known as distributive shock. obstructive shock. adult respiratory distress syndrome. metabolic shock.

-metabolic shock. The answer is metabolic shock. Likely titled that because inadequate breathing for long periods causes abnormal cellular metabolism, resulting in the buildup of metabolic products. ARDS (adult respiratory distress syndrome) is found in patients who are in intensive care and have serious complications due to chest trauma or diseases.

You enter the home of an elderly couple and find the husband lying in bed. He is apneic and pulseless. His wife says he asked her to call 9-1-1. You should immediately open his airway. begin chest compressions. move him to a hard surface. apply an AED.

-move him to a hard surface This is due to chest compressions being extremely hard to do and a hard floor is more effective

Which of the following signs should most likely be present in a patient in the compensatory stage of shock? Apathy(anxiousness) Cold, clammy, pale skin Hypotension Narrow pulse pressure

-narrow pulse pressure Narrow pulse pressure is the answer. Narrow pulse pressure is found in compensatory stages of shock and is detected by noting a gap of less than 30 mmHg between the systolic blood pressure and the diastolic pressure (normally the gap is 40 mmHg such as 120/80). Hypotension is a later sign of shock. Cold, clammy, pale skin indicates serious blood loss, particularly when the vessels are empty. Apathy is a very late sign; anxiousness is more common when a patient is compensating.

You respond and find a 2 year old boy with a 1 inch scalp laceration. His parents insist you take him to the hospital. You should provide emergency transport. assure he's comfortable on the cot. buckle the child in the jump seat. transport him without lights and sirens.

-nonemergent so transport him without lights and sirens se of lights and sirens has statistically proven to be more dangerous, and the time of hospital arrival only varies slightly. So in this type of case transport without lights and sirens. Your agency should have a lights and sirens policy. The policy should allow you to transport as many patients as possible without lights and sirens.

The best sign or symptom that differentiates angina from myocardial infarction is the presence of fluid in the lungs. the intensity of the pain the patient experiences. not available within EMS practice. location of the patient's chest pain.

-not available within EMS practice. The best way to differentiate angina from an MI is to obtain serial cardiac enzymes after hospital admission. Chest pain is present in both MI and angina. Fluids in the lungs, most commonly due to cardiac disease, are present due to congestive heart failure. Pain intensity varies with all patients so angina and MI pain intensity is not specific enough. At times you will have to "eliminate" all choices and choose the one left because you know three of the four choices are wrong or less appealing choices.

Which of the below is a causal agent in development of Type II diabetes? Polyuria Pancreatitis Liver failure Obesity

-obesity Of the choices, obesity is the best answer. By the way, causal agent means that all obese patients will develop diabetes; not true but it has a high correlation value. Pancreatitis is a good distractor as insulin is made in the pancreas. Liver failure and frequent urination are poor choices.

What is the best out-of-hospital method to detect the need for cardiac catheterization? Obtaining a 12 Lead ECG Nature and type of chest pain Evaluating effectiveness of nitroglycerin care Duration of time since the onset of pain

-obtaining a 12 lead ECG Subjective information provided by a patient is less specific in regards to obtaining confirmation of cardiac ischemia than a patient history. Even a 12-lead is less specific than taking the patient to a cath lab where the interventional cardiologist can see what is occurring within the cardiac circulation.

A 62 year old male took three doses of his nitroglycerin spray prior to your arrival. You provide care and begin transport. He asks for another spray. His vitals are B/P 134/84, P 76, R 15 and SpO2 is 93% on 4 Lpm nasal cannula. You should wait until his SpO2 improves. offer him another spray. withhold further nitroglycerin. wait until hospital arrival.

-offer him another spray. The restriction to three doses of nitroglycerin treatment is a myth. Patients who "fit" within the guidelines of non-hypotension (systolic B/P above 100 mmHg) and are not bradycardic (pulse below 60 bpm) or tachycardic (pulse above 100 bpm) should be provided nitro if prescribed by a physician and they continue to have chest pain. This patient asks for another spray and you should offer it. Waiting until arrival is not advised. Improvement of his SpO2 has no physiological impact on determining whether or not to provide nitroglycerin. Withholding a therapeutic medication is not correct.

Question 58 You are off duty swimming at a lake when someone rescues a swimmer who was submerged. When the rescuer brings the swimmer to shore you determine he is pulseless and apneic. You should first perform five cycles of CPR. perform a finger sweep of his airway. assess for a cervical stepdown. activate the EMS system.

-perform five cycles of CPR Perform five cycles of CPR. Activating the EMS system is a good choice but ventilations and CPR can change the outcome rapidly in this type of emergency. Note it says five cycles. If breathing doesn't return spontaneously you will need help, so activate the EMS system. Performing a finger sweep is incorrect. Assessing for a spinal injury should not be your first choice.

A 24 year old female is having a grand mal seizure. After seizing for 5 minutes she stops. You should immediately protect her airway with an oropharyngeal airway. attach a pulse oximeter to determine hypoxia. suction her airway to remove secretions. place her in the recovery position.

-place her in the recovery position. Vomiting may follow a seizure so protecting the airway is vital. The recovery position does that and helps drainage of secretions. An oropharyngeal airway opens the airway and only protects it from collapse of the tongue in an unconscious patient. Determining blood oxygenation is nice but aspiration of stomach contents can be lethal. Suctioning is also nice but if her stomach is full prior to the seizure moving her to a lateral position helps eliminate the stomach contents if she vomits and then you should suction any remaining contents. Note the stem says "immediately."

A 61 year old male was unable to stand while in church. When you arrive he looks pale and complains of weakness. During your exam you notice a pulsating mass in his abdomen. His femoral pulses are weak when compared to his carotid pulses. His vital signs are B/P 114/86, P 88, R 16. You should administer oxygen. prepare for rapid transport. treat for shock. apply a pelvic splint.

-prepare for rapid transport. Different pulse amplitudes between the upper body and lower body indicate aorta problems and surgery is the only method to treat a dissecting aorta. He doesn't need oxygen, he's not in shock and there is nothing to suggest he has a fractured pelvis. Sometimes the best treatment is rapid transportation; however because it is a risk to you and your crew, you should know when to initiate it.

You arrive on scene and see a wife providing hands only CPR on her husband. You should wait for completion of 30 compressions and ventilate. prepare to assist with CPR and set up the AED. tell her to give rescue breaths. demonstrate how to give rescue breaths.

-prepare to assist with CPR and set up the AED. Hands only CPR is often used by lay public but you are an EMS professional. So, you should be prepared to assist in CPR but should first setup the AED on this patient. Providing rescue breaths is helpful but choosing that answer indicates you might avoid setting up the AED. Demonstrating how to provide rescue breaths is for CPR class and not to be done when you have an AED as part of your equipment. Ventilations are also part of CPR but again in this stem it is not the best choice when another answer includes setting up an AED as part of your care.

Which of the following is most likely to result in a patient developing cardiogenic shock? Prior myocardial infarctions History of COPD Pulmonary embolism Cardiac dysrhythmias

-prior myocardial infractions Cardiogenic shock is pump failure. Cardiac dysrhythmias can be present without pump failure, such as in atrial fibrillation. A pulmonary embolism produces obstructive shock. COPD produces a ventilation problem.

When caring for a school aged boy you should know that he will resist any exposure of his body parts. may want to use your equipment. probably likes EMS workers in uniform. will ask frequent questions regarding your care.

-probably likes EMS workers in uniform School aged children are more likely to admire uniforms than other aged children. Use of your equipment, resisting exposing body parts and asking frequent questions are seen during other phases of life span development.

You are providing support at a local 5K race when someone falls halfway through the race. When you arrive a 52 year old woman is in pain holding her lower leg. You should provide a sports drink. administer ASA 81 mg. rapidly cool the leg. massage her lower leg.

-provide a sports drink This person has a heat cramp and a sports drink will provide electrolytes that are necessary to prevent cramps. You won't be able to stop the cramp until the muscle relaxes and normal physiology returns. Cooling the leg is improper care as is providing an aspirin. Massaging the leg helps relieve the pain but it won't prevent a return of cramps. It takes rest and time to let the muscle return to normal physiological functioning.

A 16 year old was stabbed in his LUQ. He is comfortable but upset about the incident. His vitals are B/P 128/82, P 94, R 14 and SpO2 is 96% on room air. You should: -administer oxygen by non-rebreather mask -provide support and transport -cover the wound with a non-porous dressing -place him in recovery position

-provide support and transport Provide supportive care. This patients needs monitoring but currently is not sick. There is no evidence in the stem that that he needs O2, to be placed in the recovery position or that he needs a non-porous dressing over his abdominal wound.

You help rescue a 38 year old male hiker who was lost in the forest in the winter. His feet are waxy, white and hard to touch. You are 1 hour from a medical center. You should place his feet in tepid water. provide supportive care. apply heat packs to his feet. wrap the feet in warm towels.

-provide supportive care You should not rewarm frost bite (a frozen extremity) unless you are prepared to assure it will not refreeze and you have the ability to relieve a lot of pain that will accompany rewarming; so supportive care is recommended if you are close to a medical center. Tepid water, warm towels and heat packs suggest rewarming. Rewarming is not recommended based upon the information in this stem.

You are transporting a 46 year old male with chest pain. He say he's "never had this type of pain before." His vitals are B/P 126/82, P 94, R 16 and his SpO2 is 94% on room air. You should administer oxygen by nasal cannula, 3 Lpm. administer oxygen by non-rebreather mask. provide supportive care. determine if he has been prescribed nitroglycerin.

-provide supportive care. Provide supportive care. There is no need to provide oxygen as his SpO2 is adequate and it's highly unlikely he has been prescribed nitroglycerin before based on his age and what he says. While you will still ask him if has been prescribed nitro, this is not a "best" choice.

Rapid ascent to high altitude without proper acclimatization will produce pericarditis. pulmonary edema. anaerobic metabolism. thrombophlebitis.

-pulmonary edema The only realistic choice is pulmonary edema. Anaerobic metabolism happens most often when healthy people exercise beyond their aerobic range and it is present in low perfusion states. Pericarditis is wrong as it's an inflammation of the heart. Thrombophlebitis happens when venous blood is not moving or there is damage to the lining of a vein. Acclimatization means getting "used to" a rise in elevation over time.

When moving objects it is always best to complete a lift within 10 seconds. complete a lift within 30 seconds. push rather than pull. pull rather than push.

-push rather than pull Pushing objects leads to less injuries than pulling objects. There is no time limit on lifting or moving objects or patients.

A victim who has a low body temperature must be re-warmed from the center outward. ventilated with super heated air. placed in a hyperbaric chamber. re-warmed before defibrillation.

-re-warmed from the center outward. The general answer of rewarmed from the center outward is the correct answer. Not all hypothermic patients are in fibrillation and some can be shocked depending upon how low the body temperature is. Ventilation with warm moist air is a technique for rewarming from the core outward but not with super-heated air such as that seen during a fire where flames are inhaled. A hyperbaric chamber is used to decompress patients with the bends who surface too fast when SCUBA diving as well as for other therapies.

When lifting and moving a patient you should have as many assistants as possible help you. seek the aid of mechanical devices when possible. reduce the height or distance an object must be moved. protect your back by flexing it forward.

-reduce the height or distance an object must be moved. When lifting and moving it is a goal to reduce the height or distance an object must be moved. Having other assistants to help you move an object is helpful but not always available. Using mechanical devices is correct (just not as specific) because often these assist in reducing height or distance. Flexing the back forward is wrong.

When a person goes into cardiac arrest the oxygen level in the non-circulating arterial blood remains the same. decreases dramatically. becomes diffused into tissues. decreases slightly.

-remains the same Deoxygenation of blood takes time. Right when someone goes into cardiac arrest the blood oxygen remains the same. After 1 minute without breathing it decreases and the longer apnea is present the more it decreases. Note the stem says, "goes into cardiac arrest." Read each question carefully and its lettered answers. Oxygen diffuses into cells but that is not as strong an answer as it remains the same. Because blood oxygen remains the same initially, the AHA guidelines continue to recommend not delaying chest compressions while the AED is being prepared in cases of non-witnessed cardiac arrest.

A 65 year old, 3 pack a day smoker, is short of breath. He tells you he has been coughing up phlegm for four months. You auscultate his chest and hear rales. crackles. rhonchi. wheezes.

-rhonchi Rhonchi is the correct answer. Rhonchi are rattling noises often heard in patients with chronic lung problems as you might expect from this heavy smoker. Crackles is another word for rales that sounds like popping heard upon inhalation. Wheezing is high-pitched, usually heard on exhalation and heard throughout the lungs.

A 63 year old male with a history of alcoholism is vomiting up bright red blood. You should suspect esophageal tear. ruptured esophageal varices. peptic ulcer disease. stomach cancer.

-ruptured esophageal varices Esophageal varices is the answer. Alcoholism causes liver disease that then causes increased portal blood pressure that then causes the varices (swollen veins at the end of the esophagus). When they rupture the patient vomits bright red blood. Peptic ulcer disease is most often caused by an infectious process. Stomach cancer is not strongly associated with alcoholism. An esophageal tear (rupture) can occur in alcoholics as well as for many other reasons.

A 26 year old male was stung by a bee and collapsed. When you arrive his vitals are B/P 92/84, P 116, R 12 and his SpO2 is 94% on room air. You should immediately open his airway and ventilate him. seek epinephrine for his care. locate the stinger and remove it. provide oxygen by nasal cannula.

-seek epinephrine he has a analyphlatic reaction

A 62 year old male tells you he has been experiencing headaches when he wakes up in the morning. He called you because he woke up today with left arm weakness. He says he bit his tongue while sleeping. You suspect a stroke due to ischemia. seizure due to a stroke. seizure due to a brain tumor. stroke due to an intracerebral bleed.

-seizure due to a brain tumor. This patient had a seizure. The fact that he bit his tongue should lead you there. The second clue is that the patient has had "headaches" (plural) over days. It is unlikely that a stroke (or TIA) would happen at the same time on multiple days. If you rule out stroke there is really only one choice. The gradual onset should lead you to think of chronic conditions like a brain tumor. Intracerebral bleeds usually keep hemorrhaging. It is important to read questions carefully and pick up subtleties such as gradual onset.

You are called to an unkempt home of a 32 year old female, whose father called because she had an acute onset of shortness of breath. During your assessment she says she is afraid to go outside and to the hospital. Her vital signs are B/P 128/84, P 90, R 16 and her SpO2 is 90%. You hear diffuse wheezing throughout her lung fields. You suspect hyperventilation syndrome. hypoglycemia. she has a phobia. drug interaction.

-she has a phobia. Except for the wheezing, this person is doing pretty well. Being afraid to go outdoors to the hospital would represent a phobia called agorophobia. Respiratory rates of 16 are unlikely to yield hyperventilation unless the inspiratory volume is very high. She's not diabetic so hypoglycemia is unlikely. There is no mention of her taking prescription drugs so a drug interaction is unlikely. Drug interactions occur with prescription and over-the-counter drugs. Don't confuse drug interaction with a drug overdose.

Most ingested poisons are absorbed in the colon. small bowel. large bowel. stomach.

-small bowel Toxins are absorbed in the small bowel. The stomach starts the digestive process but doesn't absorb many products. The large bowel continues the digestive process and the colon absorbs water and stores fecal matter.

A 25 year old male complains of shortness of breath over the past four hours after playing soccer. His chest expansion is normal and he has no chest wall pain. You hear diminished breath sounds over his right upper thorax. Vital signs are B/P 126/84, P 106, R 18. His SpO2 is 92% on room air. You should suspect pulmonary embolism. spontaneous pneumothorax. costochondritis. pleuritis.

-spontaneous pneumothorax This man most likely suffered a spontaneous pneumothorax. Exertion during exercise of a young man, (likely thin in body structure), that causes diminished breath sounds on one side are the clues. A pulmonary embolism is unlikely in a young person who was exercising. Costrochondritis presents with chest wall pain. Pleuritis presents with chest pain that dissipates when the patient holds their breath

A 6 month old boy is cyanotic and has a pulse rate of 46 bpm. You should attach an AED that possesses a pediatric attenuator device. start chest compressions using the two finger chest compression technique. start chest compressions using the two thumb encircling hand technique. attach an AED that is capable of adjusting the shock delivered in joules.

-start chest compressions using the two thumb encircling hand technique. Rationale This infant is hypoperfusing and needs to improve circulation. Start chest compressions first. It is recommended to perform the two thumb encircling hand technique on a 6 month old rather than the two finger chest compression technique. Attaching an AED is incorrect as most infants who have hypoperfusion without trauma develop arrest due to a lack of oxygen. The patient has a pulse.

Which two entities establish the Scope of Practice (SOP) and the Standard of Care (SOC)? Statewide protocols establish the SOP and the local protocol establishes the SOC. Local medical director establishes the SOP and the local protocol establishes the SOC. State EMS Office establishes the SOP and the EMS department establishes the SOC. State legislature establishes the SOP and the local community establishes the SOC.

-state legislature establishes the SOP and the local community establishes the SOC State legislatures determine the scope of practice and in tort cases the local community establishes the standard of care. State EMS Offices administrate the laws of the state and an EMS department might participate in establishing the standard of care if they're involved in EMS protocols. The local medical director likely will be called into a tort case to interpret if you practiced to the standard of care, but in most states does not establish the scope of practice. Statewide protocols must be based upon the scope of practice outlined in state law.

A 58 year old female is unconscious and in respiratory failure. As you begin managing her she vomits. You should first suction her airway for a minute then ventilate her. ventilate her twice and then clear her airway. rapidly turn her to clear her airway then turn her supine to ventilate. suction her for 15 seconds then ventilate her.

-suction her for 15 seconds then ventilate her. Suction quickly and efficiently for as long as it takes to clear the airway. 15 seconds isn't a definite rule, but is the best answer here. Suctioning is part of opening an airway, which precedes any ventilations. If you ventilate gastric juices into the lung you can help cause a lethal aspiration pneumonitis. Suctioning is more effective than moving the patient onto their side. Suction first, then ventilate.

A 52 year old male complains of sudden onset of shortness of breath. He has some right sided chest pain. His vitals are B/P 102/84, P 108, R 18 and SpO2 is 86% on room air. He tells you he thinks he has some odd type of flu because 2 days ago he flew home from Asia. You suspect Asian encephalitis. pulmonary embolism. pneumonia. cor pulmonale.

-sugar drink This is because the two different type of sugars in soda and a "sugar drink"

Inhalation of a toxic gas can lead to hypoxia when the substance in the gas produces irritation of the larynx and esophagus causing spasm. damage to the epithelial cells of the airway. breakdown of cilia in the airway causing pain. swelling which narrows the bore of the airway.

-swelling which narrows the bore of the airway. Swelling in airways causes airway obstruction (in upper airways, lower airways or both). A breakdown of the cilia lining in the lower airways occurs due to cigarette smoking or chronic exposure to toxins. Irritation of the larynx is a poor choice. A toxic gas will damage the epithelial cells of the airway after they swell up and close the airway causing additional long term complications from the inhalation.

A 60 year old male tells you he has taken 5 nitroglycerin tablets in the past hour without relief. He wants to take another tablet. You should allow him to take another tablet. ask him if the dose typically relieves pain. tell him 5 tablets in one hour is the maximum dose. take his vital signs.

-take his vital signs Before you administer nitroglycerin be sure you have current vital signs. Allowing him to take another nitro without knowledge of vital signs is improper; he might be hypotensive or have bradycardia/tachycardia. There is no maximum dose for nitroglycerin; in the hospital a patient may be give nitroglycerin via continuous IV drip. Asking him if that dose typically relieves his pain is nice to develop rapport but it doesn't show him you're taking any action to help relieve his pain.

A 13 year old with a history of asthma self administered her metered dose inhaler prior to your arrival. She remains short of breath and has wheezes throughout her lung fields. After administration of oxygen you should tell her to self administer a second dose of medication. ask her to demonstrate how she used the inhaler. transport her routinely to the hospital. titrate her oxygen delivery to pulse oximeter reading.

-tell her to self administer a second dose of medication Telling this person to repeat the dose of her inhaler will inform you if she is oriented enough to understand your instructions and if she can self-administer the medication properly. Another dose won't cause any harm as there is no toxic dose for beta2 inhalation drugs. Titrating her O2 to pulse oximeter readings is not recommended. It could be OK to transport routinely but in light of the other choices, this would not be optimal care or the best answer (this answer assumes you are not going to provide any care). Having her demonstrate how she used the inhaler doesn't mean she is receiving a second dose.

Which of the below is the best location to find the presence of pitting edema on a patient who has been lying supine? The antecubital fossa of the left arm. The sacral notch in the lower back. The fingernail beds of the right hand. The suprascapular region of the posterior thorax.

-the sacral notch in the lower back Pitting edema is dependent edema, thus assessing the sacrum of the back is the best place to check on supine patients. Fingernail beds assess microcirculation and are used in kids to check the speed for return of color and for adults the level of "pinkness." Above the scapula (shoulder), assessment is not beneficial. The area where advanced providers likely choose to start IVs (antecubital fossa) can be used to assess for a pulse but not for edema

Heat stroke patients have hot dry skin because during the prodromal phase all their fluids are shifted. their ability to sweat becomes disrupted. they were unable to ingest adequate fluids. during transition from exhaustion to stroke they did not absorb water.

-their ability to sweat becomes disrupted. This is a process of elimination question because all but the right answer are definitely wrong. Hot dry skin is a key sign in heat stroke, which affects the thermoregulating system in the brain. A prodromal phase relates to infectious diseases. Fluid input helps prevent heat stroke but once it's present, it's too late to drink fluids. Not absorbing water is a very weak distractor.

Which of the following hormones, when in an imbalanced state, may facilitate hypothermia? Thymus Pituitary Thyroid Adrenaline

-thyroid The thyroid gland deals with metabolism and if imbalanced may cause hypothermia. The adrenal glands produce epinephrine and other hormones that are part of the fight or flight mechanism. The pituitary gland is located within the skull and although a gland it is almost like part of the brain as it is the "master" gland of the body having influence over most other glands in the endocrine system. The thymus is found under the skin of the sternum and doesn't do much but help with infection particularly in young children.

An elementary school nurse calls you to transport a child she says had a petit mal seizure. During transport you should monitor the child to assure an open airway. to provide support and comfort. for signs of impending brain attack. for periods of apnea.

-to provide support and comfort. A petit mal seizure is a simple seizure and this child will likely become fully conscious without any care. Petit mal seizures don't cause apnea. The child will have an open airway. And a stoke (or brain attack) is very unlikely in this child.

You transported a 78 year old male from a nursing home who had facial droop, slurred speech and arm drift. One hour later you are back in the emergency department with another patient and you see the 78 year old is now comfortable without any symptoms. He most likely suffered a epidural bleed. basal cell stroke. transient ischemic attack. migraine headache.

-transient ischemic attack. A transient ischemic attack (TIA) can have all of the signs and symptoms of a stroke. However, since it is transient (not permanent), full recovery can occur. There is no such thing as a basal cell stroke. An epidural bleed is unlikely to stop bleeding without surgery. A migraine headache can have some stroke-like symptoms but not as severe as those in this stem.

The cause of primary hypertension is specifically atherosclerosis. unknown. hardening of the arteries. smoking.

-unknown Many conditions contribute to hypertension but the specific cause is unknown. Hardening of the arteries is a lay term for atherosclerosis. When two answers are the same they can be ruled out, as only one answer is correct or the best choice. Smoking contributes to ill health but not specifically to hypertension

The cause of schizophrenia is malnutrition. unknown. poor child development. genetic.

-unknown This is one that you either know or don't know. The cause of schizophrenia is unknown. Your studies would have mentioned if it was a genetic disease, or due to poor child development or malnutrition. So, if you didn't read or hear the best answer to a test item in class or from the book, and unknown is an option, pick that option.

The cause of epilepsy is abnormal delivery. unknown. poor nutrition. non-compliance of drugs.

-unknown the cause is unknown. Poor nutrition and abnormal delivery (childbirth) are poor choices. Non-compliance of medications for those who have epilepsy may make seizures more frequent but it is not the pathophysiological cause.

Question 72 A 60 year old male is pale and short of breath on your arrival. He asks to go to the hospital because he is "sick and weak." His vitals are B/P 104/82, P 96, R 14. He tells you his stools have been dark colored for the past week. You should suspect lower gastrointestinal bleeding. the onset of colon cancer. upper gastrointestinal bleeding. diverticulitis.

-upper gastrointestinal bleeding The best assessment would most likely be an upper GI bleed. An upper GI bleed leads to "digested" blood being dark in color compared to a lower GI bleed where the blood is more red in color. The diverticula appear in the lower bowel and cause pain, and perhaps bleeding. Since the colon is also in the lower bowel an understanding of anatomy helps lead to the answer.

When speaking to a child under the age of 4 it is best to -hold their hand to reduce fear -use a calm voice and smile at them -let them hold a toy or blanket -change your voice to a higher tone

-use a calm voice and smile at them Rationale: using a calm voice and smiling are effective with a child of this age. Giving them a toy or blanket might be helpful but younger children will likely benefit more than this age child. Change your voice doesn't help. Since the child doesn't know you, touch or holding the hand might cause anxiety.

The mechanism that causes migraine headaches is vasospasm followed by vasodilation. vasodilation followed by nerve cell inflammation. vasoconstriction followed by vasospasm. nerve cell inflammation followed by vasoconstriction.

-vasospasm followed by vasodilation. This one is a moderate to difficult question for an aspiring EMT. Vasospasm of cerebral arteries leading to vasodilation of those arteries causes migraine headaches. Vasoconstriction is not part of the mechanism. Nerve cell inflammation (encephalitis) is likely from a cerebral infection.

A 14 year old female collapsed at a drug store after receiving a flu shot. When you arrive she is conscious and alert. Her vital signs are B/P 108/78, P 64, R 12. Her SpO2 is 97% on room air. You suspect anaphylactoid reaction. vasovagal syncope. allergic reaction. psychosomatic symptoms.

-vasovagal syncope. She fainted. Vasovagal syncope is the cause. There are no other signs of an anaphylactoid reaction or an allergic reaction. Psychosomatic symptoms is not the answer, but for a teenager getting a shot can cause psychological stress.

The primary origin of an irregular pulse is located in the left mainstem artery. ventricles. atrium. SA node.

-ventricles. A heart beat is detected peripherally by amplitude of the stroke output detected along an artery that passes over a bony area, such as the radial pulse. When it is irregular, the primary cause is a premature ventricular beat that disrupts stroke volume (thus a loss of pulse amplitude). The SA node can misfire but it will cause a loss of atrial kick. While affecting stroke volume, it is less likely to cause a loss of pulse. The mainstem artery and atrium are poor anatomic choices.

A 56 year old male desires to take another nitroglycerin for his chest pain. His vitals are B/P 106/86, P 118, R 16 and his SpO2 is 94% on room air. You should withhold his nitroglycerin at this time. administer oxygen by nasal cannula. administer oxygen by non-rebreather mask. assist him in taking his nitroglycerin.

-withhold his nitroglycerin at this time. The recommendation is to withhold nitro on patients whose B/P is below 100 mmHg systolic or those whose heart rate is greater than 100 beats per min. With a pulse ox of 94% he doesn't need 100% oxygen and if oxygen is indicated in a patient with this presentation, it is usually administered by nasal cannula.

During a 9-1-1 call you should communicate with dispatch when you arrive at the patient's side. your unit is back in service. you will need to speak to medical direction. your unit needs to be re-supplied.

-your unit is back in service Let dispatch know when you are back in service. Other reasons to inform dispatch may be true but they would be company policies that could differ nationally. Remember the test will not be about a company policy.

An 18 year old male was hit by a car while walking. He responds to verbal commands with inappropriate words. During your physical examination you noted he had a lower left arm fracture because he withdrew and had facial grimace when you assessed the arm. What should you record as his Glasgow Coma Scale score? -10 -14 -8 -12

10 is the answer. He responds (inappropriately) so record a 3 for eye opening. He uses inappropriate words so that's a 3, and he withdraws from pain which is a 4. GCS questions are difficult to determine the answer. You likely will not memorize the scale and we think you should be using a visible chart when recording a GCS in the field. Have enough familiarity with a GCS to make a good guess on a test. Remember when four numbers are given as choices on any test, it's likely the highest and lowest numbers are wrong choices.

How effective is the best possible CPR technique compared to a normal heart beat? 5% 10% 50% 25%

25%

Which of the below should be recorded on a PCR to illustrate a response to painful stimuli? The patient grabbed me by the wrist when I applied supraorbital pressure. When I squeezed the patient's ear lobe he did not make a facial grimace. The patient showed a facial grimace when we splinted his fractured leg. The patient tried to push my hand away when I applied a trapezius pinch.

The patient tried to push my hand away when I applied a trapezius pinch. earlobe and providing supraorbital pressure are not appropriate stimuli. And reporting facial grimace after splinting a leg fracture is appropriate but might make those who read the report wonder if you know how to asses and treat a suspected fracture.

What is the primary cause of esophageal varices? Alcoholism Portal hypertension Liver failure Gastric reflux

The primary cause is portal hypertension. If you don't know what portal hypertension is, the term "portal" frequently refers to a type of circulation around the liver. Liver failure is commonly seen in patients with esophageal varices as a co-morbid disease but it is not the cause. Gastric reflux causes indigestion and a burning sensation. Alcoholism is also co-morbid with esophageal varices but not all alcoholics have the varices. These are like hemorrhoids of the lower esophagus and when they rupture there is massive upper GI bleeding and vomiting of blood.

Atherosclerosis

condition in which fatty deposits called plaque build up on the inner walls of the arteries

As you approach a patient who is sitting upright in a chair at home you should have open arms, open hands and relaxed shoulders. begin to gather a history of the current illness. look at surroundings to see medications or any home treatments. observe if the patient is alone and ask for others.

have open arms, open hands and relaxed shoulders. Your nonverbal communications are important when interacting with patients. The best example of using nonverbal therapeutic communication from these examples is to use open arms, open hands and relaxed shoulders. Gathering the history of the current illness happens rapidly on arrival but first try to determine if you are speaking to a reliable historian. Getting some sense of LOC and ability to answer your questions is an important part of your verbal communications, but this item was designed to teach you the importance of nonverbal communication as you approach a patient. Information regarding who is present should be included in your PCR. Looking around a house might be important but not until you've established rapport with the patient, completed a history, performed a physical exam and provided any immediate care.

acute coronary syndrome

sudden symptoms of insufficient blood supply to the heart indicating unstable angina or acute myocardial infarction

An 81 year old female has increasing shortness of breath. She tells you she smoked cigarettes "all my life and I loved them!" She has swollen lower extremities. Her vitals are B/P 112/86, P 86, R 16 and her SpO2 is 93% on 3 Lpm. You should ask her if she is being treated for emphysema. transport her on 3 Lpm by nasal cannula. administer oxygen by non-rebreather mask. increase her oxygen to 6 Lpm by nasal cannula.

transport her on 3 Lpm by nasal cannula. Transport her and maintain her O2 flow rate. Her assessment findings indicate she is oxygenating well for someone with COPD. She doesn't need ventilation. Increasing her oxygen flow rate is not necessary at this point—and 6 liters is a lot, which makes this choice less valid. Another dose of medication may help but is not necessary. She needs transport more than any other choice listed.

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