Week 7
The EMT shows that he understands the seriousness of a prolapsed umbilical cord when he states:
"The priority when treating a patient with a prolapsed umbilical cord is keeping the cord moist." Correct! "A prolapsed cord that is pinched can stop the flow of oxygen to the baby and must be addressed immediately." "If the cord is observed protruding from the vagina, it should be clamped and cut immediately." "A baby can bleed to death inside the uterus if the cord is compressed for more than 10 minutes."
The EMT would recognize which neonate as premature?
A baby weighing 8 pounds 6 ounces born at 39 weeks Correct! A baby weighing 7 pounds 4 ounces born at 36 weeks A baby weighing 6 pounds 2 ounces born at 38 weeks A baby weighing 8 pounds 6 ounces born at 41 weeks
pneumonia results from inhaled food or vomitus.
Aspiration
trauma exceed cases of ________ trauma in infants and children.
Blunt; Penetrating
Slow heart rate
Bradycardia
The neck of the uterus.
Cervix
Vision disturbances caused by glaucoma occur secondary to:
Clouding of the lens Lack of tear production Persistent hypotension Correct! Damage to the optic nerve
The second stage of labor begins with ___________ cervical _________ and ends with delivery of the baby.
Complete; Dilation
The only major cause of infant and child death to have increased in the past 30 years is
Correct Answer child abuse. burns. vehicular trauma. poisoning.
When cutting the umbilical cord, it should be cut __________ inches from the infant.
Correct! 6 2 4 10
The EMT is correctly assessing a child's BRUE when he:
Correct! Obtains a thorough history Immediately starts the child on blow-by oxygen Expedites transport to the ED Allows the caretaker to hold the child during transport
Which one of the following should be performed for an elderly trauma patient regardless of the severity of the mechanism of injury or level of responsiveness?
Correct! Rapid trauma assessment Focused medical exam Focused trauma exam Historical exam
With an elderly patient who has aching in her shoulders, fatigue, and trouble breathing, an EMT should suspect
Correct! a heart attack. kyphosis. arteriosclerosis. degenerative spinal changes.
Grating Sensation
Crepitation
Patients with abdominal injuries are not allowed to ______ or __________ in case they need to have emergency surgery.
Eat; Drink
Air in the chest cavity is called a hemothorax.
False
Jugular venous distention is an early sign of a tension pneumothorax.
False
The term "toddler" refers to a child between 3 and 5 years of age.
False
is an injury created by adjacent rib segments that are unattached to the rest of the rib cage.
Flail Chest
Condition created by the fracture of two or more ribs in two or more places
Flail Segment
A greenish or brownish-yellow staining of the amniotic fluid.
Meconium
Typically a patient is considered to have ______________ when more than one major system is involved.
Multisystem Trauma
You would apply a(n) __________ to seal an open chest wound.
Occlusive Dressing
are the female gonads or sex glands.
Ovaries
A decrease in the size of the liver with aging means that many elderly patients who take prescription medications may suffer from an accidental drug
Overdose
Blood in the sac surrounding the heart
Pericardial Tamponade
is the area of skin between the vagina and the anus.
Perineum
Collapsed lung
Pneumothorax
If a patient with COPD becomes fatigued from the effort of breathing, be prepared to provide ___________ ventilations.
Positive Pressure
You are transporting a critically ill 4-year-old patient. Regarding the panicked and upset mother, you would:
Secure the mother to the stretcher and allow her to hold the patient Ask the mother to get to the hospital by way of private vehicle Correct Answer Secure the mother in the "captain's chair" of the ambulance, behind the patient, during transport to the hospital Allow the mother to kneel next to the stretcher so her son can see her
An impaled object in the chest must be _________before moving the patient.
Stabilized
Rapid respiratory rate
Tachypnea
The space within the chest
Thoracic Cavity
Determining the cause of respiratory distress in a pediatric patient is an important part of an EMT's assessment.
True
During the assessment and treatment of a young child, you will, if possible, want the child to sit in the caregiver's lap.
True
Modesty and body image are very important issues for school-age children.
True
The EMT should never ask a suspected victim of child abuse to explain the circumstances of an incident while the possible abuser is present.
True
The Pediatric Advanced Life Support (PALS) assessment format can be used to establish a general impression of the patient from the "doorway" when presented with a pediatric emergency.
True
The mediastinum houses the trachea.
True
The mucus and blood that are expelled from the vagina as labor begins is known as the bloody show.
True
With pediatric patients, slow delivery of ventilations and cricoid pressure can help reduce gastric distention.
True
With submersion patients in whom normal breathing is restored, deterioration can still take place from minutes to hours after the event.
True
If a patient develops respiratory distress after an occlusive dressing has been applied to a chest wound, the EMT should
cover the wound with more dressings. continue monitoring, as this reaction is to be expected. begin assisting breathing with positive pressure ventilation. Correct! lift a corner of the dressing to allow pressure to escape.
All of the following are signs and symptoms of major chest trauma except
cyanosis. hemoptysis. paradoxical movement. Correct! bradycardia.
Use __________________ alternating with ______________________ to clear a complete airway obstruction in an infant age 1 year or younger.
finger sweeps, chest compressions Correct! back blows, chest thrusts back blows, finger sweeps finger sweeps, deep breaths
The net effect of changes in the respiratory systems of elderly people is that _____air enters the system, _______ gas exchange takes place, and there is a(n) _____ likelihood of an infection.
greater, greater, less less, greater, greater Correct! less, less, greater less, less, less
When a patient presents with jugular venous distention, respiratory distress, and hypotension following a closed chest injury, the EMT should suspect
subcutaneous emphysema. rib fractures. a sucking chest wound. Correct! a tension pneumothorax.
The EMT shows that he understands the difference between a pneumothorax and a tension pneumothorax when he makes which statement?
"A pneumothorax is caused by a closed chest injury; a tension pneumothorax is caused by an open chest injury." "A pneumothorax describes a collapsed lung; a tension pneumothorax involves both a collapsed lung and blood loss." Correct! "A tension pneumothorax causes cardiac output to decrease; a simple pneumothorax does not affect cardiac output." "A tension pneumothorax causes blood to accumulate around the lung; a pneumothorax involves the accumulation of only air around the lung."
Which statement indicates an accurate understanding of administering positive pressure ventilation (PPV) to a geriatric patient?
"An increase in the force of ventilation is needed to get air into the stiff lungs." "If the patient is breathing between 10 and 20 breaths per minute, PPV is not needed." "If the geriatric patient has a history of COPD, a pediatric bag-valve mask may be needed." Correct! "Gentle ventilations that make the chest rise are adequate to provide proper airflow to the lungs."
Which statement made by an EMT demonstrates an understanding of chest trauma?
"Closed chest injuries are caused by penetrating trauma and cause more life-threatening injuries than do open chest injuries." Correct! "Closed chest injuries are caused by blunt trauma, and can be just as serious as open chest injuries." "Open chest injuries are more serious than closed chest injuries, because air and bacteria can enter the chest through the open wound." "In general, an open chest injury caused by blunt trauma is more life threatening than a closed one due to increased potential for blood loss."
When asked, a young female with abdominal pain replies that she is not sure if she is pregnant. Given this response, which question would provide the best information to determine if the patient may be pregnant?
"Do you feel pressure in your belly area?" Correct! "When was your last normal menstrual period?" "Have you been vomiting in the morning?" "Does it feel like the last time you were pregnant?"
The EMT has fundamental understanding of abdominal trauma when he states:
"Evisceration injuries can be recognized by dark-colored bruising over the top of the injury site." Correct! "Blunt trauma is especially lethal because of the large number of organs that can be affected." "Injuries to solid organs like the bladder tend to be more lethal than injuries to hollow organs." "Injuries to hollow organs tend to be worse than injuries to solid organs because of the increased potential for blood loss."
A new EMT who just started working with your EMS system asks you to quickly describe a flail segment. Which statement best describes this injury?
"Fractured ribs have collapsed the underlying lung." "Multiple fractures to the rib cage are caused by blunt trauma." Correct! "Two or more adjacent ribs are broken in two or more places." "Multiple rib fractures have bruised the underlying lung."
You suspect a very sick child to be in shock. His skin is dry, radial pulse weak, and blood pressure low. Which statement made by the parents would reinforce this suspicion?
"He has had a headache since last night." "I gave him an aspirin this morning." Correct! "He has had diarrhea for three days." "His stepfather has really bad diabetes."
You have been called for a 16-year-old female with vaginal bleeding. On scene, you determine the patient to be pregnant and bleeding for 3 hours. Which statement would indicate proper care of the patient?
"I am going to place this piece of sterile gauze into your vagina to try to stop the bleeding." "I know that it is uncomfortable, but try to keep your legs apart so the blood can flow out of your body." Correct! "I am going to put this sanitary napkin between your legs to collect the blood." "I am going to insert my gloved hand into your vagina and apply pressure to try to stop the bleeding from the inside."
You are assessing a young male patient who was assaulted with a baseball bat and struck once on the left upper quadrant of the abdomen. You would recognize that this patient has Kehr's sign when he makes which statement?
"I am having a hard time breathing!" "My belly hurts really bad." Correct! "My left shoulder is killing me!" "It really hurts for me to breathe."
When assessing a 27-year-old patient who is eight months pregnant, which statement made by the patient should the EMT be most concerned about?
"I had some belly cramps two weeks ago." "I was a drug addict when I was a teenager." Correct! "I have not been able to see the doctor this pregnancy at all." "My last baby came two weeks late."
You are transporting a young female who just had a miscarriage at home. During the transport the woman weeps continually. Which statement is most appropriate given the situation?
"If you want another child, wait a few months and then get pregnant again." "It is best to stay strong; your other child needs your support." "I think in the long run you will be okay and things will work out." Correct! "Is there anything that I can do to help you right now?"
You are caring for an emotionally distraught female who just suffered a miscarriage. During transport, which statement would be the most appropriate one for the EMT to make to the patient?
"It is better to have this happen at five weeks instead of 25 weeks." "Let's just think of the two beautiful children whom you have at home." "Maybe at some time in the future, you can get pregnant again and things will turn out okay." Correct Answer "I really do not know what to say, but let me know how I can help you."
Family has called you for a 78-year-old female with a history of dementia, because she appears more confused than normal. The primary assessment reveals no life-threatening conditions. Her vital signs are pulse, 88 beats/min; respirations, 22 breaths/min; blood pressure, 134/66 mmHg; and SpO2, 95% on room air. Aside from the dementia, the patient has a history of hypertension, COPD, and breast cancer, which resulted in the removal of her right breast 11 years ago. Lately, she has had an upper respiratory infection and is telling family that she has a headache. Your first question to family should be:
"It sounds like the dementia is getting worse, do you agree?" Correct! "Do you know if she fell recently and hit her head?" "Is there any possibility of diabetes and a low blood sugar level?" "Does she take any medications for the high blood pressure?"
Which statement regarding the placenta, made by your EMT partner while reviewing the OB/GYN protocols, is most accurate?
"The EMT must deliver the placenta by applying gentle pressure to the abdomen after the baby has been born." "The placenta is full of bacteria and should not be transported in the ambulance near the baby." "It is essential that the mother not be moved until the placenta has been delivered." Correct Answer "The placenta typically delivers itself within 20 minutes of the birth of the baby."
The EMT would recognize potential geriatric neglect when the patient makes which statement?
"They are rough with me when I wet myself and need my bedding changed." Correct! "They do not give me my high blood pressure medications daily as I think they are supposed to." "They are spending all my money on illegal drugs." "They wake me up every 6 hours at night to see if I am incontinent."
While performing the reassessment of a 2-year-old male who is severely dyspneic, you note that he is now unresponsive and not breathing. He has a heart rate of 32 beats per minute and his skin is cool and diaphoretic. Which instruction would you provide to another EMT who is helping you transport the patient?
"We need to get a blood pressure and then I will call medical direction." "Please increase the oxygen in the nonrebreather face mask to 15 liters per minute." Correct! "Let's start chest compressions and positive pressure ventilations." "We need to try humidified oxygen to see if he will improve with that."
A woman informs you that she is eight months pregnant and fatigues easily. She is apprehensive because when she lies down, she gets dizzy and feels as though she is going to vomit. What is the EMT's best response?
"We really need to get to the hospital right away to make sure that your baby is okay. This does not sound good." "As long as the baby is still moving, you are okay. Just try to get through one more month." Correct Answer "Check with your obstetrician, but you may want to rest and sleep on your left or right side." "You should really call your doctor. During the eighth month of pregnancy, energy levels usually increase."
You are assessing an 86-year-old male who fell down a flight of stairs after getting out of bed to use the bathroom. He complains of severe head, neck, and back pain. Which question is most appropriate to ask this patient?
"Were you holding onto the railing?" "Were you confused when you fell?" Correct! "Do you know what caused you to fall?" "Do you seem to fall a lot?"
It takes _____ liter(s) of blood to expand the girth of the abdomen by 1 inch.
0.5-1.0 Correct! 1.0-2.0 1.5-2.5 2.0-3.0
Pediatric patients are patients who range in age from:
1 year to 8 years birth to 12 years Correct! birth to 18 years 1 year to 15 years
By the time a fetus reaches full term, the tidal volume of the female has increased by:
15 percent Correct! 40 percent The tidal volume remains the same but the rate increases by 30 percent 25 percent
For infants and children in respiratory distress or respiratory failure, the EMT should provide artificial ventilations at a minimum rate of _______breaths per minute.
20
In the unstable multisystem trauma patient, vital signs should be assessed every _________ minutes.
5
What would the expected preductal SpO2 reading be at 5 minutes after birth?
70% to 75% Over 94% Correct! At least 80% 85% to 90%
During spine motion restriction, the EMT must pad from the shoulders to the hip in patients younger than _______ years old to assure proper spinal alignment.
8
What would the minimum expected preductal SpO2 reading be at one minute after birth?
94% 85% 80% Correct! 60%
When assessing a geriatric patient for pneumonia, the EMT must remember that:
A cough with bloody sputum is typically observed with pneumonia Hypotension is commonly associated with the pulmonary infection Correct! A normal body temperature may still be observed in this patient Chest pain and chills are almost always present in geriatric patients with pneumonia
A patient was stabbed in the right anterior chest and is in obvious respiratory distress. As you perform the secondary assessment, which signs and/or symptoms would suggest that she is developing a tension pneumothorax?
Absent breath sounds on the left, hypotension, SpO2 of 98%, bradycardia Absent breath sounds on the right, tracheal deviation to the right, cyanosis Respiratory distress, absent breath sounds on the left, flat neck veins, tachycardia Correct Answer Absent breath sounds on the right, distended neck veins, tracheal deviation to the left
Assessment indicates that a term newborn's respiratory rate is 38 breaths per minute and his heart rate is 80 beats per minute after administration of supplemental blow-by oxygen. The EMT should:
Administer high-concentration oxygen via a pediatric nonrebreather mask Correct! Start positive pressure ventilation with supplemental oxygen Continue to monitor the baby for another 30 seconds Start chest compressions at a rate of 120 compressions per minute
An 83-year-old female fell down the basement stairs. Once at her side, she tells you that her left hip hurts and rates it as 10/10. Since the patient is downstairs, you recognize the need for assistance in extricating her from the residence. As you start the primary assessment, you note a dog at the top of the stairs starts growling at you. At this time, what is your primary concern?
Airway Pain Need for additional help Correct! Dog
An 82-year-old female with nausea and vomiting has called 911. When obtaining her past medical history, she informs you that she suffered a transient ischemic attack (TIA) two months ago. Based on this information, what should the EMT expect to find?
Altered motor and sensory to one side of the body Unequal pupils Difficulty in speaking and/or swallowing Correct! The absence of any neurologic deficits
A mother asks you what causes her son to get bronchiolitis. You would inform her that this infection is caused by:
An unknown bacterium The same bacterium that causes strep throat A pneumonia-type virus Correct! Respiratory syncytial virus
A 62-year-old female with severe kyphosis fell and hit the back of her head, which is now oozing blood from a small laceration. Family members state that she suddenly complained of a "very bad headache" before collapsing to the kitchen floor. She has snoring respirations and cyanosis in the extremities. Which intervention should you perform first?
Apply a cervical collar Correct! Use a jaw-thrust maneuver Start positive pressure ventilation Cover the laceration
A frantic mother has contacted EMS because she believes that her 4-year-old daughter got into her blood pressure medications and ate three or four pills. The patient presents as awake and oriented, with pale skin that is cool and diaphoretic. Her pulse is rapid and respirations adequate. Vital signs are pulse, 116 beats/min; respirations, 22 breaths/min; blood pressure, 82/44 mmHg; and SpO2, 99%. After completing the primary assessment, what would your immediate action be?
Apply high-concentration oxygen Educate the mother on safe storage of medications Contact poison control and induce vomiting Correct! Obtain the name and dosage of the medication, and then call the poison control center
A 74-year-old female complains of abdominal pain after falling down five stairs off her front porch and striking her abdomen and left hand on a mailbox at the bottom. The patient also reports pain in her left wrist and right ankle, both of which show obvious deformity. She is alert and oriented, and her abdomen is free of bruising but tender in the left upper and lower quadrants. Her vital signs are pulse, 132 beats/min; respirations, 22 breaths/min; blood pressure, 106/86 mmHg; and initial SpO2, 93% on room air. Oxygen has been applied, and the patient has full spine motion restriction precautions in place. Advanced life support has been requested and is 12 minutes away from your current location. What is your next action?
Apply ice to the wrist and ankle while awaiting arrival of the ALS unit Correct! Initiate immediate transport and intercept with the ALS unit Monitor the patient and wait for ALS assistance Secure the wrist and ankle to board splints, initiate transport, and cancel the ALS unit
You have arrived at a residence to find a 6-month-old girl in her crib in cardiac arrest. Quick assessment reveals no rigor mortis or lividity. The mother states that she put the baby to bed at 9 p.m. last night and awoke at 3 a.m. to find her in her present state. What would your first action be?
Ask if the baby has any medical conditions Correct! Open the airway and provide 2 ventilations Inquire whether the mother wants resuscitation started Apply oxygen and move the baby to the ambulance
You have been called for a 7-year-old girl who has vomited once and complains of abdominal pain. When you are performing the secondary assessment and obtaining a medical history, which action by you would be considered most appropriate?
Asking mostly questions that can be answered with a "yes" or "no" Standing above the child and smiling while asking questions Correct! Allowing the child to play with the stethoscope before listening to her lungs Using "baby talk" when asking the child questions about her pain
Describe the emergency assessment and treatment for abdominal trauma.
Assess the ABCs Provide oxygen therapy as needed Treat for hemorrhagic shock Control any external bleeding Position the patient Stabilize the impaled object Consider the need for spine motion restriction precautions Transport as quickly as possible
You are assessing a 2½-year-old female who was involved in a minor car accident. She is currently alert and oriented. While you are assessing her for possible injuries, which assessment procedure would be considered appropriate?
Assess the child starting at her head and moving to her feet Correct! If possible, allow the child to hold a favorite toy during the assessment Be firm with the child and provide concrete instructions on what you expect Touch and hold the child as much as possible
birth is one in which the buttocks or lower extremities are the presenting part of the baby.
Breech
List at least six signs that may indicate geriatric abuse.
Bruises Bite marks Bleeding beneath the scalp (indicates hair-pulling) Lacerations on the face Trauma to the ears Broken bones Deformities of the chestCigarette burns Rope marks Inconsistencies in patient history
While delivering a baby, you note that the umbilical cord is wrapped around the baby's neck. You would:
Clamp and cut the cord to prevent strangulation of the newborn Stop the delivery and transport Correct! Attempt to slip the cord over the baby's shoulders or head Contact medical direction for directions
____ heart __________ is caused by a heart that has become weakened over time.
Congestive, Failure
An 89-year-old female with dementia, who is being cared for by her daughter, fell and now exhibits deformity to her left upper arm. As you attempt to splint her arm, she continually screams and pulls away from you. After several attempts, your best course of action should be to:
Contact advanced life support for assistance Correct Answer Coach the daughter on how to help apply the splint Transport the patient without a splint and document that splinting was attempted Gently restrain the patient and apply the splint
You have been called by the caregiver of a 91-year-old female with dementia. The patient complains of pain and deformity to her upper left arm. As you assess the patient, you note various bruises to the patient's body, and become suspicious of elder abuse. Which action is most appropriate at this time?
Contact the police to report your suspicion Confront the caregiver regarding the bruises to the patient's arm Ask the patient if she is being abused Correct! Treat the patient for a possible broken arm and initiate transport
The EMT shows that he understands care of the post-delivery mother when he states:
Correct Answer "Allowing the baby to nurse immediately after delivery can help to control uterine bleeding." "We should be concerned if there is any bleeding from the vagina following delivery." "If blood is observed coming from the vagina after the baby has been delivered, the mother should be placed in the shock position." "Post-delivery hemorrhage can best be controlled by inserting a bulky dressing into the vagina."
On scene at a school cafeteria, you are presented with a 11-year-old boy who attempted to eat a small plum whole. He is conscious with stridorous respirations and unable to cough when instructed to do so. His skin color is gray and cyanotic. What would your immediate action be?
Correct Answer Deliver five abdominal thrusts Provide positive pressure ventilation Place an oral pharyngeal airway Check for radial and carotid pulses
The family of an 87-year-old female has called 911. The patient is confused and exhibiting improper and out-of-character behavior. The family informs you that the patient has diabetes, but takes pills and not insulin. They also state that she has been complaining of dizziness and has been drinking water nonstop as well as urinating. Assessment reveals adequate breathing, skin that is cool, and a radial pulse that is rapid and weak. The glucometer is malfunctioning and not providing a glucose reading. Based on her history, you should be suspicious of and treat the patient for:
Correct Answer Elevated blood sugar Urinary tract infection Stroke or transient ischemic attack Hypoglycemia
During the secondary assessment, the EMT notes instability and a flail segment to a patient's lower left lateral chest. The EMT would immediately:
Correct Answer Stabilize the segment with his hand Apply bulky dressings to the area Auscultate breath sounds Start positive pressure ventilation
The mother of a 3-year-old boy has called 911 because her son has a low-grade fever and difficulty breathing. On scene, the mother tells you that she is a licensed practical nurse (LPN), and that she suspects her son is suffering from croup. Which statement made by the mother would reinforce this suspicion?
Correct! "At night, he seems to get a barking-like cough." "When he is short of breath, his heart rate increases." "There are times when he continually drools." "When I turn the air conditioner on, he becomes more short of breath."
An elderly female fell down three steps and now complains of back pain. After performing the primary assessment, which question would be most important to ask first?
Correct! "Did you become dizzy and fall or slip and then fall?" "Why did you not use the ramp on the other side?" "Do you have a history of high blood pressure?" "Which medications are you taking?"
Which statement made by the EMT is most appropriate regarding dealing with caregivers and children during a medical emergency?
Correct! "I try to include the caregiver in all that I do with his or her child so that the child and caregiver are more comfortable." "It is best to separate the caregiver from the child so that a proper assessment and care can be given." "I include the caregiver in the care until I get the information that I need, then I remove the child to continue the assessment in the ambulance." "I tell the caregiver that everything will be okay so the caregiver remains calm and is better able to help the child."
Another EMT tells you that he had a call the previous shift in which he thought a 5-year-old boy might be the victim of abuse, since he had bruises on both upper legs and chest. However, the EMT did not communicate this suspicion to anyone or transport the patient. What would your best response be?
Correct! "If you do not take steps to report this suspicion, you can be punished in a court of law." "Let's see if we can go back to the house to make a better assessment of the situation." "This sounds more like neglect, rather than physical abuse, so there is not much to do at this point." "Bruises in these areas are very typical for an active 5-year-old, making abuse unlikely."
A 5-year-old boy who is drooling has suspected epiglottitis. His pulse rate is 144 beats/min, respirations are 46 breaths/min, and blood pressure is 110/52 mmHg. The patient is noncompliant with the pulse oximeter, but his skin is normal colored. Which statement made by the EMT indicates proper care of this patient?
Correct! "Let's give him some supplemental oxygen." "I need to depress his tongue with the tongue blade to see the swelling." "Let's suction his airway to remove the secretions." "We need to place him on his side to drain secretions and transport immediately!"
You have determined that you will need to perform a field delivery. Which instructions to the patient show that the EMT is properly positioning her?
Correct! "Please lie on your back, draw your knees upward, and spread your legs apart." "I am going to place you on your left side with your legs up until the baby's head is visible." "Please lie back, and then elevate both legs into the air. Your husband will help you hold them up." "I'd like you to lie flat on the bed and bend your right leg while keeping your left leg straight."
Which statement made by the EMT indicates an understanding of the relationship between seizures and pregnancy?
Correct! "Prolonged seizures can easily cause the mother and baby to become hypoxic." "A short seizure in the pregnant female with a seizure history generally does not require transport." "Seizure activity in the pregnant female is typically not life threatening unless the patient has had seizures in the past." "If the pregnant patient is seizing, the EMT must quickly make a decision to administer or withhold her antiseizure medications."
When faced with a limb presentation during delivery, the EMT should
Correct! . place the patient on oxygen and transport immediately. try to reinsert the limb remain on scene and complete delivery. begin transport and try to turn the infant
What percentage of minor trauma involving pregnant patients results in fetal loss?
Correct! 1-3 percent Less than 1 percent 6-12 percent 10-20 percent
Ongoing assessment of a stable and alert elderly patient who has an injured arm should take place every
Correct! 15 minutes. 20 minutes. 10 minutes. 5 minutes.
The EMT is performing CPR on a neonate. What is the correct compression-to-ventilation ratio?
Correct! 3 compressions to every 1 ventilation 5 compressions to every 2 ventilations 15 compressions to every 5 ventilations 30 compressions to every 2 ventilations
Infants born before __________ weeks' gestation are considered premature.
Correct! 37 40 20 28
During pregnancy, maternal blood volume increases by __________ percent.
Correct! 45 35 10 25
When asked by a concerned newborn parent, the EMT should indicate that an acceptable respiratory rate for the newborn is:
Correct! 52 breaths per minute 24 breaths per minute 70 breaths per minute 12 breaths per minute
The initial Apgar score should be completed at _______ seconds after birth.
Correct! 60 30 10 20
The EMT should recognize a full-term pregnancy has occurred in which patient?
Correct! A 21-year-old woman who is 39 weeks pregnant and feeling dizzy A 40-year-old woman beginning her third trimester but whose water just broke A 25-year-old woman who is 220 days into pregnancy and complaining of back pain A 33-year-old woman who is pregnant with twins and in the eighth month of pregnancy
When an elderly individual is injured, deterioration of compensatory mechanisms in the patient can result in:
Correct! A rapid onset of shock Resistant hypertension Agitation Chronic depression
When providing care to the pediatric patient who has been injured or ill, the most important aspect of care normally revolves around:
Correct! Airway and respiratory support Assessment and support of circulation Ability to provide rapid transport Knowledge of illnesses that affect children
Management of an injury caused by blunt trauma to the scrotum may include
Correct! All of the above bleeding control. direct pressure. cold compresses.
A patient has been assaulted and sustained blunt trauma to the abdomen. As you start the primary assessment, you note that he is vomiting blood and you begin to suction him immediately. After the airway has been suctioned, you should:
Correct! Check the adequacy of the patient's breathing Examine the abdomen for specific injuries Obtain a full set of vital signs Administer oxygen with a nonrebreather face mask
In an unstable multitrauma patient, when should minor musculoskeletal injuries be splinted?
Correct! En route to the hospital if time perm Prior to leaving the scene They do not need to be splinted due to the severity of the patient's condition. Only at the request of the advanced life support provider if on scene or met en route
Which single assessment finding is most consistent with a stable newborn?
Correct! Heart rate of 140 beats per minute Respirations of 28 breaths per minute Facial grimace when irritated Heart rate of 100 beats per minute
A newborn's first Apgar score was 6. His second Apgar score is 9. What does this information mean to the EMT?
Correct! Improvement Need for extensive resuscitation Total score of 15 Poor heart and lung function
When evaluating capillary refill time in a pediatric patient, the EMT must remember that:
Correct! It is considered more reliable than in an adult It should be less than 5 seconds It is not a good test of perfusion It is not affected by environmental conditions
Shoulder pain caused by blood irritating the diaphragm is called
Correct! Kehr sign Babinski sign McRobert's sign. Kelly's sign.
How can an EMT help prevent the stress and anxiety associated with treating critically injured children?
Correct! Learn and practice the skills and equipment used when treating children Engage in discussions with friends about stressful trips Utilize available mental health services to help diffuse the stress Control your emotions while rendering care
You are transporting a 19-year-old male with a gunshot wound to the chest. On scene, you covered the wound with an appropriate dressing. Now, as you reassess the patient, you note that the patient is tachypneic and complains of increased difficulty breathing. Breath sounds on the side of the injury are diminished. Your immediate action would be to:
Correct! Lift the dressing from the wound briefly during exhalation Cover the wound with another dressing Tape the dressing on the fourth side Provide positive pressure ventilation with high-concentration oxygen
A patient has been stabbed in the right upper quadrant of the abdomen. Which solid organ should the EMT be most concerned with being injured?
Correct! Liver Stomach Small intestine Kidney
What is the most common cause of blunt abdominal trauma?
Correct! Motor vehicle crashes Falls Gunshot wounds Assaults
Why are premature uterine contractions of concern in the pregnant trauma victim?
Correct! Premature contractions can cause the release of oxytocin, which can start labo Contractions can cause an artificially high blood pressure reading. Premature contractions may result in supine hypotensive syndrome. Adequate pain medication is not available in the prehospital setting.
A patient with evisceration becomes tachycardic, cool, and hypotensive during transport. What would your next action be?
Correct! Reevaluate the patient's priority status and expedite transport. Replace the dressing. Support the injury with the patient's arm Loosen one corner of the dressing.
The mother of a 2-year-old has called EMS because her son has an axillary temperature of 103.2°F. On scene, your assessment reveals the boy to be confused and lethargic, with a rectal temperature of 104.1°F. When caring for this child, you would:
Correct! Remove the child's clothes and sponge his body with tepid water Apply washcloths soaked in cold water until the child begins to shiver Administer oxygen and cool the child by sponging his body with alcohol Have the mother administer rectal Tylenol and cool the child by sponging his body with cold water
Pathologic narrowing of the valves within the heart is referred to as:
Correct! Stenosis Cardiac hypertrophy Dysrhythmia Pulmonary edema
A 42-year-old male was involved in a fight and was stabbed in the right lateral chest. The knife is still impaled, and the patient now complains of shortness of breath. When he speaks, he gurgles and blood drains from his mouth. His respirations are labored and his radial pulse is weak. Which intervention should you perform first?
Correct! Suction the blood from the airway Remove the knife and seal the injury with an occlusive dressing Provide positive pressure ventilation Stabilize the knife with bulky dressings
On scene, a 6-year-old male who is short of breath will not allow EMRs to place a nonrebreather face mask on his face. Assessment indicates moderate respiratory distress with the following vital signs: pulse, 124 beats/min; respirations, 24 breaths/min; blood pressure, 98/56 mmHg; and SpO2, 92%. At this time, you try:
Correct! Using a nasal cannula with 2 lpm oxygen Holding the nonrebreather mask firmly to the patient's face Start positive pressure ventilation Placing a nasal airway and nasal cannula with 6 lpm oxygen
How would you tell a pregnant woman to restrain herself when traveling in a car?
Correct! Wear all seat belts normally, as you would if not pregnant Use the shoulder restraint but not the lap belt to prevent abdominal injury Avoid the belt system as long as your car has front and side air bags in place The lap belt by itself should be adequate, as long as the car is equipped with air bags
When a child for whom an EMT has provided care dies and it results in a stress response in the EMT, it can be a good idea for the EMT to turn for assistance to
Correct! a trusted friend. the ALS crew. the QI manual. the ICS plan.
Your patient is the driver of a car that was hit head on. You find her lying on the sidewalk with her knees drawn toward her chest. She has no specific complaints. You suspect
Correct! abdominal trauma due to the mechanism of injury and patient positioning. little or no injury because the patient has gotten out of the car cavitational injuries due to the mechanism of injury. paradoxical motion due to the patient positioning.
A 36-year-old pregnant woman was the driver of a car that struck a tree while traveling at a slow speed. The patient is complaining of severe tearing abdominal pain and vaginal bleeding. The most likely injury to this patient is
Correct! abruptio placentae. lacerated liver. placenta previa. lacerated placenta.
When obtaining a history from an elderly patient, the EMT should
Correct! address the patient as "Mr." or "Mrs." unless asked to do otherwise speak first to family members, as they are most likely to have accurate information. use terms of endearment like "honey" to break the ice shout loudly, as the patient is probably deaf.
In caring for a sick child, the EMT should have the parent or caregiver
Correct! assist in the care of the child when appropriate. step out of the room follow the ambulance to the hospital. speak only with the doctor about the child.
Abdominal aortic injury may cause the pulses of the lower extremity
Correct! be weaker than the upper extremities. be stronger and bounding. be different on each foot. be easier to detect.
The damage that results from ruptured hollow abdominal organs is
Correct! caused by acids and bacteria. not life threatening. treatable in the field. caused by profuse bleeding.
All of the following are signs of child abuse except
Correct! children with scrapes to the elbows and knees. bruises or burns in unusual shapes and locations. more injuries than usual for a child that same age. an injury that does not correlate with the cause provided.
The third stage of labor begins following
Correct! delivery of the baby. delivery of the placenta. onset of contractions. arrival of the physician.
The abdominal cavity is separated from the chest cavity by the
Correct! diaphragm. stomach. lower ribs. pelvis.
A normal developmental characteristic of toddlers is that they
Correct! do not like to be touched. are very accepting of an oxygen mask are eager to show independence from caregivers. need detailed explanations.
When assessing an elderly patient in a nursing home or extended-care facility who shows signs and symptoms of a respiratory disorder, the EMT should
Correct! don a HEPA or N-95 respirator. immediately begin positive pressure ventilations. make the patient a high priority for transport. put a surgical mask on the patient
Inconsistencies in a patient's history as supplied by the patient versus caregivers should increase suspicions of the possibility of
Correct! elder abuse. TIA. COPD. "silent heart attack."
Geriatric patients are most commonly injured by
Correct! falls. snow removal. auto accidents. abuse.
In a breech birth, the presenting part of the baby is typically the
Correct! feet/buttocks. head. arm. umbilical cord.
Signs of early respiratory distress in an infant include all the following except
Correct! fontanelle retractions. nostril flaring. intercostal retractions. "seesaw" respirations.
The injuries most commonly sustained by children who, while riding a bike, are struck by a car, involve the
Correct! head, spine, and abdomen. leg, hand, and back. head, spine, and lower extremity. upper extremity, lower extremity, and abdomen
When elderly people living on fixed incomes try to save money by keeping their furnace set very low, it may lead to cases of
Correct! hypothermia hypertension. pulmonary embolus. stroke.
If an elderly patient has altered mental status and is unable to swallow, the EMT should position him
Correct! in the left lateral recumbent position on a backboard, using pillows to support the head. in Fowler's position. supine.
Definitive care for the victim of multisystem trauma
Correct! is most often provided in the surgery suite. requires administration of whole blood. is not available to 95 percent of the U.S. population. is the goal of prehospital care.
Blood pressure readings in children ______ are unreliable due to their ability to compensate
Correct! less than 3 years old less than 10 years old less than 6 months old less than 1 year old
All of the following are hollow organs except the
Correct! liver. urinary bladder. stomach. gallbladder.
In assessing a toddler, the EMT knows that the rib cage is
Correct! much more pliable than the rib cage in adults. more susceptible to fracture than the rib cage in adults a likely spot for fractures. composed of incomplete skeletal plates.
The best place to check for signs of dehydration in the elderly patient is the
Correct! mucous membranes of the eyes and mouth. palms of the hands or soles of the feet. skin of the forearms. scalp.
Patients are considered to have multisystem trauma when more than ______ major system(s) is (are) involved
Correct! one two three four
The organ that interfaces between the mother's and fetus' blood flow, providing needed nutrients to the fetus, is the
Correct! placenta. fallopian tube. cervix. uterus.
The leading medical cause of cardiac arrest in infants and children is
Correct! respiratory failure. seizure. anaphylactic shock. fever.
When dealing with multisystem trauma, spine motion restriction
Correct! should be initiated as soon as possible if warranted. should be initiated only after all injuries have been identified should be initiated only after you determine the patient has an altered level of consciousness does not need to be initiated with critical patients.
After a pediatric submersion patient has been removed from the water, the EMT should provide
Correct! spine motion restriction while establishing an airway. back blows while establishing an airway. chest thrusts while establishing an airway. suctioning while establishing an airway.
A screwdriver impaled in the chest should be managed by
Correct! stabilizing it with a bulky dressing. removing it and covering the wound with a pressure dress applying Vaseline around the screwdriver to seal the edge. removing it and covering the wound with an occlusive dressing.
Emergency care for an elderly patient experiencing a seizure includes
Correct! suctioning the airway as necessary. restraining the patient to prevent injury. placing the patient in the prone position. administering oxygen at 15 liters per minute via nasal cannula.
The most common cause of hypoxia in the unconscious pediatric patient with a head injury
Correct! the tongue. intracranial pressure. increased blood pressure. Kussmaul respirations.
Women have _________ ovaries.
Correct! two one four every woman is different
Pregnancy-induced hypertension is defined as a blood pressure greater than 140/90 mmHg on at least ________ occasions that are 6 hours a
Correct! two three four six
Management of a female patient who has suffered a laceration to the genital area will include all of the following except
Correct! vaginal packing. assessment for hypoperfusion. direct pressure. use of a sanitary pad.
A flail segment occurs
Correct! with fracture of two or more ribs in two or more places. when initiated by paradoxical motion. after a pneumothorax.
You have been called for a male patient who was shot with a rifle. Assessment reveals an entrance wound to the left lower quadrant of the abdomen. A hemorrhaging exit wound to the left lower back is also located. What should you do immediately?
Cover the abdominal wounds with dry sterile gauze dressings Auscultate the patient's breath sounds Correct! Cover the entrance wound with a gloved hand Place a cervical collar on the patient
Fractured ribs may produce _______, a grating sound or sensation.
Crepitation
Which behavior would the EMT recognize as uncharacteristic of a conscious and stable 2-year-old boy who fell and hurt his hand?
Cries any time you or your female partner touch him Correct! Does not cry or protest when taken from his mother Becomes upset when you lift his shirt to assess his abdomen Apologizes several times for falling and hurting his hand
You are delivering a baby in the patient's house. As the baby's head appears at the opening of the vagina, you notice that the amniotic membrane is still intact. You would:
Cut the sac with the sterile scissors in the OB kit Transfer the patient to the stretcher for immediate transport Continue with the delivery of the baby Correct! Rip open the amniotic sac with your fingers
You have just arrived by the side of an elderly patient who accidentally overdosed with his daily medications after becoming confused about what to take and when. Given this scenario, what would be a priority in caring for this patient?
Determine which medications were taken and how much Determine the patient's past medical history Gather up all medications for transport with the patient Correct! Evaluate and support the patient's airway and breathing
List eight of the golden principles for prehospital multisystem trauma care.
Ensure the safety of the rescue personnel and the patient Determine additional resources needed Understand kinematics Identify and manage any life threats Manage the airway while maintaining spine motion restriction Support ventilation and oxygenation Control external hemorrhage and treat for shock Perform a secondary assessment and obtain a medical history Splint musculoskeletal injuries and maintain spine motion restriction when required Make transport decisions
The ________is the tube-like structure that connects the stomach with the mouth.
Esophagus
List the emergency care steps for a child with seizures caused by a high fever.
Establish and maintain an airway Protect the patient from injury Suction secretions for no longer than 5-10 seconds at a time Provide positive pressure ventilations with supplemental oxygen at 20 breaths/min if breathing is inadequate Administer oxygen as appropriate if breathing is adequate (consider blow-by oxygen in very young children) Remove clothing and cool by fanning or sponging with tepid water as protocol permits Consider advanced life support transport Perform ongoing assessment every 5 minutes
List the basic emergency care steps for the pediatric multisystem trauma patient.
Establish and maintain spine motion restriction and open the airway using the jaw-thrust maneuver Suction as necessary, no more than 5-10 seconds at a time Provide oxygen by nonrebreather mask at 15 liters per minute or provide positive pressure ventilation with supplemental oxygen for inadequate breathing Provide occlusive dressings for any open wound to the chest Cover any eviscerations with moist, sterile gauze dressing and secure Consider a request for ALS support Transport Splint fractures and dress open wounds Perform ongoing assessment every 5 minutes
You have been called to the side of a confused geriatric female who complains of abdominal pain. Before palpating the patient's abdomen, you would first:
Explain to family members why you are feeling the patient's abdomen Find out if the patient has a Do Not Resuscitate (DNR) order Correct! Inform the patient that you will be pressing on her abdomen Determine whether the patient has a history of respiratory disease
Trauma is the leading cause of death for pregnant women. They are especially susceptible to abuse and
Falls
are considered the most common cause of injury in the elderly.
Falls
A pneumothorax occurs only if there is a break in the skin over the chest cavity.
False
An occlusive dressing must be taped on all four sides to protect the chest wound.
False
Any patient with any type of chest injury is automatically considered a high priority.
False
Because children have a smaller blood volume than adults, issues of blood loss are less serious in those patients.
False
Crepitation with rib fractures is generally felt over the abdomen following blunt trauma.
False
During exhalation, the diaphragm contracts and moves downward.
False
Explaining to parents that SIDS is a relatively common occurrence is one way the EMT can help them cope with the loss of a child.
False
For any infant or child patient suffering a partial airway obstruction, the EMT should provide an initial series of six blows to the back.
False
If you suspect abuse as the cause of injury with a child trauma patient, you should question the caregivers about abuse or question them.
False
In a pediatric patient with a foreign body airway obstruction, the EMT should perform a "blind" finger sweep of the oral cavity if back blows do not dislodge the obstruction.
False
Infants and children need a respiratory tidal volume of approximately 10 mL/kg.
False
When a sucking chest wound is detected, immediate care is to dress and bandage the wound.
False
With any infant or child poisoning patient, you should administer activated charcoal once you determine that the airway is open.
False
An infant weighing less than 5 pounds, or an infant born prior to 37 weeks' gestation is known as full term.
False (Premature)
A female patient has acute onset of right-sided abdominal pain, describes it as sharp, and rates it as 9/10. The primary survey reveals no life threats, but her skin is cool and diaphoretic. She states that she has been going to the bathroom more and is worried because her father has diabetes. Her last period was nine weeks ago, and she has a history of irregular periods. Her heart rate is 122 beats/min, respirations are 20 breaths/min, blood pressure is 138/68 mmHg, and SaO2 is 97%. In this scenario, which bit of information is of most concern to the EMT?
Family history of diabetes Increased urination Correct Answer Last period nine weeks ago Periods irregular in nature
tubes are placed into the stomach to assist with feeding.
Gastronomy
injuries cause excruciating pain and can be quite embarrassing for the patient.
Genital
You are assessing a 29-year-old pregnant female who has signs of imminent delivery. Her past medical history includes HIV infection. Compared to a patient with no infectious disease, how will standard precautions differ for this patient?
Gloves, a gown, and goggles will be used for this patient; only gloves and a gown are required for a healthy patient in labor Gloves are needed for a noninfectious patient in labor; goggles and gloves must be worn for the patient with HIV A HEPA filter mask should be used for the patient with HIV, but not for the noninfectious patient Correct! Gloves, a gown, and eye protection should be worn for both the patient with HIV and the noninfectious patient
refers to the number of times a woman has been pregnant.
Gravida
An unrestrained female patient, who was involved in a minor motor vehicle collision, refuses EMS care or transport. She is seven months pregnant and is alert and oriented. When asked, she denies any complaint. Your best action would be to:
Have her follow up with her obstetrician Correct! Contact medical direction for instructions Make contact with her obstetrician Have the police witness her signing the refusal-of-care form
You suspect that your patient-a lethargic 6-month-old baby-is the victim of child abuse. When performing the primary assessment, which assessment parameter should you use to quickly establish his perfusion?
Heart rate Correct! Capillary refill Presence of a radial pulse Blood pressure
an spill their contents into the abdominal cavity if they are injured from trauma.
Hollow Organs
When opening a child's airway, it is important not _______ to the child's neck.
Hyperextend
Diarrhea and/or vomiting, dehydration, infection, abdominal injuries, and blood loss are common causes of _________ in infants and children.
Hypoperfusion
Because children have a large surface area in proportion to their body mass, they are especially prone to
Hypothermia
You have been called to a local daycare facility for a sick child. At the scene, panicked daycare workers inform you that the 4-year-old child was lethargic all morning and wanted to sleep. After resting for several minutes, she began to "shake all over." This lasted for approximately 30 seconds. Your assessment reveals the patient to be responsive to painful stimuli and breathing adequately. Her airway is open and her radial pulse is strong and bounding. Her skin is hot and moist to the touch, with no signs of cyanosis. You are told that the patient has no medical history. En route to the hospital, the patient's mental status improves. Based on this presentation and information, you assume that the seizure occurred secondary to:
Hypoxia Correct! Fever Hypoglycemia Altered mental status
You arrive at the residence of a physician who informs you that his pregnant wife requires immediate transport to the hospital because she is bleeding and has a history of abruptio placentae. As a knowledgeable EMT, you should recognize that the greatest threat to the baby is:
Infection Maternal shock Correct! Hypoxia Fluid loss
You have arrived on the scene to help a child who is short of breath. The mother is screaming hysterically that her 3-year-old boy cannot breathe, making assessment of the patient very difficult. Your initial action in the management of this situation would be to:
Inform the mother that you will call the police if she does not calm down Quickly remove the child to the ambulance and assess while transporting Summon the police to the residence to subdue the mother Correct! Have your partner talk to the mother while you assess the child
A middle-aged male patient has been stabbed once in the right anterior chest. His airway is patent, respirations tachypneic, pulse weak and rapid, and skin cool and diaphoretic. Breath sounds are clear on the left and severely diminished on the right. JVD and tracheal deviation are present. His SpO2 is 93% on supplemental oxygen via BVM. The vital signs are pulse, 140 beats/min; respirations, 28 breaths/min; and blood pressure, 100/78 mmHg. Your next action should be to:
Initiate positive pressure ventilation utilizing FROPVD Await the arrival of ALS to "burp" the dressing between ventilations Attempt to relieve the tension while awaiting ALS arrival at the scene Correct! Call for an ALS intercept en route to the ED and lift the dressing to see if air escapes during exhalation
A 23-year-old female has been involved in a serious motor vehicle collision. Which assessment finding best indicates that she has a flail segment?
Intense pain with deep inspiration Shortness of breath upon exertion Decreasing SpO2 reading despite high-flow oxygen Correct! Uneven chest wall movement during breathing
Muscles between the ribs
Intercostal Muscles
emergency is one that occurs during the period from the onset of labor to the actual delivery of the neonate.
Intrapartum
Engorgement of the neck veins
Jugular Venous Distension
When dealing with a prolapsed cord, you should position the patient in the _________-________ position.
Knee-Chest
is the term used to describe the process of birth.
Labor
What would be a primary concern for an 11-year-old female with a prolonged asthmatic episode lasting several days and a low-grade temperature?
Laryngeal edema Croup Febrile seizure Correct! Dehydration
Preeclampsia occurs frequently in the ________ trimester.
Last
A patient who experienced blunt trauma to the abdomen has a lacerated liver. Given this information, what would represent the most immediate threat to life?
Liver infection Significant pain Development of acute peritonitis Correct Answer Internal hemorrhage
The aorta, vena cava, esophagus, and trachea are located in the _________, a hollow area in the center of the thoracic cavity.
Mediastinum
List four signs of possible child abuse.
Multiple abrasions, lacerations, incisions, bruises, broken bones; multiple injuries or bruises in various stages of healing; injuries on both sides or both front and back of the child's body; unusual wounds; a fearful child; injuries to the genitalia; injuries to the spinal cord and brain when the child is violently shaken; situations in which the injuries are not consistent with the story; lack of adult supervision; untreated chronic illness; malnourishment; delay in reporting injuries.
Which statement accurately describes multisystem trauma?
Multisystem trauma is the leading cause of death for persons older than 65 years The multisystem trauma patient is less likely to develop shock if otherwise healthy Correct! Multisystem trauma has a noted higher incidence of morbidity and mortality The definitive care for multisystem trauma is cardiopulmonary resuscitation
List at least five signs of respiratory distress in pediatric patients.
Nasal flaring Retractions Neck muscle use "Seesaw" respirations Breathing noises such as stridor, wheezing, or grunting Breathing rate above normal for child's age Cyanosis Decreased muscle tone Poor peripheral perfusion Altered mental status Head bobbing
Contrary chest motion during respiration
Paradoxical Movement
With _______________________- , the rib segment moves inward during inhalation and outward during exhalation, opposite the rest of the chest.
Paradoxical Movement
An injury to the ______ and/or ___________ should be treated as a soft tissue injury to the male genitalia.
Penis; Scrotum
You have been summoned to a grocery store for a 6-year-old girl who has collapsed. On scene, you find the girl lying unresponsive on the floor. You quickly open the patient's airway and determine that she is not breathing. When you try to ventilate her with the bag-valve mask, you are unable to do so. Repositioning the head and reattempting ventilation is not successful in passing air into the lungs. What would your next action be?
Perform a blind finger sweep Correct Answer Administer 30 chest compressions Ventilate the patient with greater force Place an oral airway
Blood is not irritating to the _________ lining and may not cause acute severe abdominal pain suddenly.
Peritoneal
You have been called to a residence for a 21-year-old female in labor. On arrival, you immediately see that the head of the baby is out of the vagina. While delivering the head, the mother tells you that she is having twins. The EMT should immediately:
Place the patient on her left side Provide blow-by oxygen to the baby Correct! Call for another EMS crew Place the patient on the stretcher for transport
A young female complains of sharp pain to the left lower quadrant of her abdomen. She states that her last period was seven weeks ago. With this information, the EMT should be suspicious of:
Placenta previa Appendicitis Abruptio placentae Correct Answer Ectopic pregnancy
Prior to delivery, the EMT prepares to create a sterile field around the patient's vaginal opening. This is best accomplished by:
Placing sheets from the OB kit over both the patient's legs and her abdomen Using towels from the patient's residence to wrap each leg and cover her abdomen Using a sheet from the patient's bed to cover her abdomen and groin Correct! Placing a sheet from the OB kit under the patient's hips and another over her abdomen and legs
Describe the comprehensive emergency medical care treatments for patients in active labor with normal childbirth.
Position the pregnant patient Create a sterile field around the vaginal opening if time permits Monitor the patient for vomiting; continually assess for crowning Place your gloved fingers on the bony part of the infant's skull when it crowns Tear the amniotic sac if it is not already ruptured Determine the position of the umbilical cord As the torso and full body are expelled, support the newborn with both hands Grasp the feet as they are born Dry, wrap, warm, and position the infant Assign your partner to monitor and complete initial care of the newborn Clamp, tie, and cut the umbilical cord as pulsations cease Observe for delivery of the placenta Transport the delivered placenta Place one or two sanitary pads over the vaginal opening Record the time of delivery Transport the mother, infant, and placenta to the hospital
The diagnosis of SIDS is made
Postmortem
The first 14 days after conception are called the __________ stage.
Pre-Embryonic
Exercise extreme caution when _______ the geriatric patient for transport due to degenerative changes to the spinal column.
Preparing
List three of the predisposing factors for an ectopic pregnancy.
Previous ectopic pregnancies Pelvic inflammatory disease Adhesions from surgery Tubal surgery (including elective tubal ligation)
During a motor vehicle collision, a confused unrestrained male struck the steering wheel with his abdomen. Currently, he is confused and complains of generalized abdominal pain, which he rates as 6/10. Assessment indicates red marks across his lower abdomen caused by the steering wheel. His pulse is 140 beats/min, respirations are 24 breaths/min, blood pressure is 108/88 mmHg, and SpO2 is 86%. The patient looks pale and has moist skin. What is most appropriate when providing oxygen to this patient?
Provide 2 lpm through a nasal cannula Provide 8 lpm through a simple face mask Correct! Provide 15 lpm through a nonrebreather mask Oxygen can be withheld due to the SpO2 reading
You have been called for a 35-year-old female who is experiencing vaginal spotting. The patient states that she has noted the discharge of blood from her vagina and is concerned because she is 36 weeks pregnant. She has also experienced some abdominal pain, which she describes as "sharp." Your assessment reveals bleeding as noted and tenderness on palpation just right to the midline of her abdomen. Her pulse is 122 beats/min, respirations are 22 breaths/min, blood pressure is 118/82 mmHg, SpO2 is 96%, and oral temperature is 97.3°F. Based on this presentation, you would:
Provide low-concentration oxygen and nonemergently transport the patient Place the patient in a supine position and immediately transport her Correct! Administer high-concentration oxygen and immediately transport the patient Massage the abdomen, provide high-concentration oxygen, and nonemergently transport the patient
Fluid that has leaked into the space between the capillaries and alveoli of the lung may cause
Pulmonary Edema
With age, degenerative changes decrease the ability of the heart to ________ blood as efficiently as it did in younger years.
Pump
After being assaulted by her boyfriend, an 18-year-old female who is 33 weeks pregnant is found unresponsive in her bedroom. She appears to have been beaten in the head and abdomen, as evidenced by multiple hematomas and lacerations to these areas. Which assessment finding should concern the EMT most and should be addressed first?
Rapid heart rate Bright red vaginal bleeding Abdominal contusions Correct! SpO2 of 93% on room air
In infants and children, a disturbance in the ________ system typically occurs first, even if the infant has other medical problems.
Respiratory
You are assessing a 6-year-old girl with possible pneumonia. She has labored breathing and a fever of 102°F. When you are assessing and classifying her respiratory status, which finding would provide the strongest evidence that she is in respiratory failure?
Respiratory rate of 36 breaths/min Correct! Altered mental status Fever of 102°F Nasal flaring
While en route for a call involving a pregnant patient, an Emergency Medical Responder (EMR) on scene contacts you and reports that the patient is actively seizing. The EMR reports that she is seven months pregnant and has not been feeling well for the past three days (per family). Which instruction is critical for you to relay to the EMR?
Restrain the patient on her back or left side Place a tongue blade in the patient's mouth Correct! Provide oxygen at 15 liters per minute Determine if the patient has a seizure history
Fever, epilepsy, meningitis, drug overdose, hypoglycemia, head trauma, and decreased levels of oxygen can bring on in _________ children.
Seizures
You have completed the assessment of a 32-year-old patient who is starting her seventh month of pregnancy. During your assessment, which finding should you be most concerned about?
Several painless contractions Increased desire to eat Increased weight over the past month Correct! Intermittent vaginal bleeding
Which finding is of greatest concern when assessing a 33-year-old female who is eight months pregnant?
Shortness of breath when lying flat Recent onset of a fever of 99.3°F Daily contractions that are irregular and painful Correct! Vaginal bleeding not associated with pain
Due to changes in pain perception, elderly persons may experience a(n) ___________ heart attack.
Silent
Aging decreases the effectiveness of the [ANSWER1] as a protective barrier that keeps microorganisms out of the body.
Skin
At the scene of a motor vehicle accident, a car has extensive front-end damage and a deformed steering wheel. The restrained driver, who was self-extricated, is in the care of EMRs, who have applied a cervical collar and continue to maintain spine motion restriction precautions. The patient's airway is patent and respirations adequate. His radial pulse is rapid and weak, and his skin is cool and diaphoretic. The EMRs report the following vital signs: pulse, 136 beats/min; respirations, 20 breaths/min; blood pressure, 100/68 mmHg; and SpO2, 95% with supplemental O2 being administered. The right forearm is deformed, and the head, chest, and upper back are uninjured according to your assessment. Your next action would be to:
Start positive pressure ventilation Repeat the vital signs Change the nonrebreather mask to a nasal cannula Correct! Check the abdomen for injury
You have been called for a 77-year-old female with altered mental status. On scene, you note the patient's inability to speak and vomitus in her airway. Her breathing is labored and inadequate, and radial pulse rapid and weak. She is not moving her right arm or right leg. What should be your first priority?
Start positive pressure ventilation with supplemental oxygen Administer glucose and immediately transport the patient to a stroke center Correct! Suction the airway and determine adequacy of the breathing Establish the time of stroke onset and start high-concentration oxygen
You are transporting a child with a small laceration to his leg, sustained after cutting himself of a piece of broken glass. During transport, you observe a pulse oximeter reading of 87% on the frantic, crying, and actively moving child. The child is alert and oriented with a normal pulse and respiratory rate with pink skin that is warm to touch. You should consider:
Starting positive pressure ventilation with supplemental oxygen Correct! Attempting to calm the child and obtain another SpO2 reading Applying high-concentration oxygen via a nonrebreather mask Checking the laceration for uncontrolled bleeding
List six of the hollow organs contained in the abdominal cavity.
Stomach Gallbladder Urinary bladder Ureters Internal urethra Fallopian tubes Small intestine Large intestine.
If a patient has severe retroperitoneal bleeding from an organ located within this cavity, she has most likely injured her:
Stomach Liver Large intestine Correct! Kidney
List at least five conditions commonly responsible for an assessment finding of altered mental status in geriatric patients.
Stroke Transient ischemic attack Seizure Syncope Drug toxicity Dementia Hypotension Alzheimer's disease
An open chest wound can pull air into the thoracic cavity, sometimes with a noticeable sound. This injury is referred to as a(n)
Sucking Chest Wound
An open chest wound that permits air entry
Sucking Chest Wound
You are preparing to transport an 86-year-old female with an altered mental status who complains of nausea and vomiting. During transport, the occurrence of aspiration pneumonia would be best prevented by:
Suctioning the patient's airway as soon as she vomits Providing supplemental oxygen Giving the patient aspirin prior to transport Correct Answer Transporting the patient in a semi-Fowler's position
When placing a patient in her third trimester in the supine position, the EMT must elevate the right hip 4 to 6 inches to prevent
Supine Hypotensive Syndrome
Is a temporary loss of responsiveness that is caused by a reduced flow of blood to the brain.
Syncope
List the emergency medical treatments for trauma patients.
Take Standard Precautions Establish and maintain spine motion restriction Maintain a patent airway Adequate breathing, and oxygenation Monitor the airway, breathing, pulse, and mental status for deterioration Control bleeding Treat for shock Identify any other injuries and treat them appropriately Transport immediately
A 6-year-old male has a decreased level of consciousness. His mother states that the family does not have health insurance, so they did not take him to the hospital last week when he started vomiting and had copious amounts of diarrhea. She reports that he has not had anything to eat or drink since then. The patient has snoring respirations that are rapid and inadequate. His radial pulse cannot be located, and his carotid pulse is rapid and weak. His capillary refill is 5 seconds and his skin is cool to the touch. What would your first intervention in caring for this child be?
Take manual spine motion restriction of the head and neck Correct! Open the airway using the head-tilt, chin-lift maneuver Provide positive pressure ventilation Attach the automated external defibrillator
If a(n) _________ pneumothorax exists, it may become increasingly difficult for the patient to breathe.
Tension
A(n) ____________- occurs when air trapped in the thoracic cavity expands under pressure.
Tension Pneumothorax
Air trapped in the thoracic cavity under pressure
Tension Pneumothorax
When assessing a 3-year-old child for possible injuries after the child fell down a flight of stairs, which finding would raise the EMT's suspicion that the child may be a victim of physical abuse?
The child cries when you palpate his arm Several bruises are located on his knees and shins The child is fearful and appears thinner than other children this age Correct Answer Bruises are found on his chest and abdomen
List six factors that put geriatric patients at higher risk for medical/trauma emergency.
The patient lives alone Incontinence Is immobile Has recently been hospitalized Has recently been bereaved Has an altered mental status
List the three types of placenta previa.
Total Partial Marginal
Movement of the primary breathing tube from its usual position
Tracheal Deviation
For children with special airway needs, the most common problems that EMS will encounter are with _________ tubes, __________ ventilators, ___________ lines, and feeding tubes.
Tracheostomy, Mechanical, Central
Rapid extrication and immediate _______ of the multisystem trauma patient is essential.
Transport
Sudden compression of the thoracic cavity
Traumatic Asphyxia
An unrestrained female driver hit a utility pole with her vehicle at a moderate rate of speed. During the impact, she struck the steering wheel with her chest. The patient's airway is open, and she states that it is painful to breathe. Her pulse is moderate in strength, irregular, and tachycardic. Breath sounds are equal bilaterally, and no jugular venous distention is noted. Assessment of her chest reveals bruising and instability to the sternum. When asked, she denies any past medical history. Based on this mechanism and the assessment findings, the EMT should be suspicious of which condition?
Traumatic asphyxia Pneumothorax Correct Answer Cardiac contusion Tension pneumothorax
A drop in blood pressure is a late sign of shock in children.
True
A sunken fontanelle is a sign of dehydration in an infant.
True
An umbilical cord that is wrapped around the infant's neck is known as a nuchal cord.
True
Blunt trauma to the chest may cause ineffective heart pumping from heart damage.
True
Capillary refill can be a useful tool in assessing circulation in pediatric patients.
True
For infants and young children who are frightened by the oxygen mask, the EMT could provide oxygen using the "blow-by" technique.
True
Gloves and eye protection are considered minimal body substance isolation precautions for an open chest injury.
True
Penetrating chest trauma occurs more often with violence than with blunt trauma.
True
Prolonged seizures—those that last longer than five minutes or recur without a return to consciousness—represent a true medical emergency.
True
Talking to a trusted friend is one way EMTs can initially defuse the stress created by dealing with pediatric emergencies.
True
A 22-year-old female, who is eight months pregnant, calls 911 for vaginal bleeding. Your primary assessment reveals no acute life threats, but the patient does have some evidence of blood in her underwear. The patient denies abdominal pain. Her vital signs are normal. Given these findings, the EMT should be suspicious of:
Uterine rupture Ectopic pregnancy Pelvic inflammatory disease Correct Answer Placenta previa
What are the stages of labor in the order in which they occur?
Uterine, delivery, and recovery Correct! Dilation, expulsion, and placental delivery Uterine, expulsion, placental, and recovery Dilation, delivery, placental, and afterbirth
The aorta and ________ will bleed massively and quickly lead to hemorrhagic shock.
Vena Cava
The most common cause of cardiac tamponade is
an explosion. Correct! a stab wound to the heart. a shotgun wound to the chest. a fall from a ladder.
You have been called to an assisted living facility to transport a patient who has been vomiting continuously for 6 hours. She is responsive to verbal stimuli. The patient has both arthritis and severe kyphosis. How should you transport this patient on the stretcher?
emi-Fowler's position Correct Answer Left lateral recumbent position Secured to a long spine board Prone with her head turned to the side
In a cardiac contusion the area of the heart most likely to be injured is the
left ventricle. left atrium. right atrium. Correct! right ventricle.
The respiratory and circulatory organs are protected primarily by the
mediastinum. venae cavae. Correct! ribs. clavicles.
A pulmonary contusion can be life threatening because it can
penetrate the lung. cause a hemorrhage into the trachea take up space needed by the heart to contract. Correct! reduce oxygen exchange via the alveoli.
A 1-year-old male is in respiratory distress and wheezing. His pulse is 156 beats/min, respirations are 32 breaths/min, and SpO2 is 95% on 4 lpm of blow-by oxygen provided by on-scene EMRs. His mother denies a medical history for the patient, but states that she has asthma and uses an albuterol inhaler. Given this information, what would be appropriate in the care of this child?
ransport the patient in low Fowler's position Contact medical direction for authorization to administer albuterol MDI Correct Answer Add humidification to the oxygen Increase the oxygen to a high concentration through a mask
During traumatic asphyxia there is
slow increase in pressure in the chest. rapid decrease in pressure in the chest. slow decrease in pressure in the chest. Correct! rapid increase in pressure in the chest.
